Pictorial Cigarette Warning Labels: Effects of Severity and Likelihood of Risk Messages.

INTRODUCTION Pictorial cigarette warning labels often contain text-messages about severity of health risks and less often about the likelihood of health risks. We aimed to examine the influence of severity of risk versus likelihood of risk text-messages on information-seeking behavior. METHODS Study 1: An experimental study with a 2 (severity) × 2 (likelihood) between-subjects design (n = 260); Study 2: An experimental study with a 2 (severity) × 2 (likelihood) × 2 (picture) between-subjects design (n = 537). Main outcome measures were information-seeking intention and information-seeking behavior (accepting a brochure about smoking cessation in Study 1; clicking on a link to a smoking cessation webpage in Study 2). RESULTS In Study 1, exposure to likelihood text-messages was associated with more information-seeking behavior but not with attitudes and intention to quit. In Study 2, exposure to likelihood text-messages was not associated with information-seeking behavior, but was associated with higher warning label ratings and with more positive attitudes towards quitting when it was a pictorial cigarette warning label; exposure to severity text-messages was associated with higher warning label ratings and higher risk perceptions. Presence of a picture with smokers' diseased lungs in Study 2 was associated with higher warning label ratings and with higher risk perceptions, but did not influence attitudes and intention to quit. CONCLUSIONS We found preliminary indications that pictorial cigarette labels with likelihood of risk text-messages may be effective in influencing behavior. However, results from our two studies were not consistent. Therefore, future studies should examine this further. IMPLICATIONS Although we can only draw preliminary conclusions from our study that should be replicated in future studies, our findings suggest that it is worthwhile to further explore the addition of likelihood of risk text-messages to pictorial cigarette warning labels, which is not the current practice in most countries.