A few years ago, federal health officials proposed replacing the familiar warning labels on cigarette packs with vivid photos showing tobacco damage, such as rotted teeth and diseased lungs.



Tobacco companies cried foul with a 2012 lawsuit, and a federal court agreed the graphic labels did "not convey any warning information at all" and were "unabashed attempts to evoke emotion (and perhaps embarrassment) and browbeat consumers into quitting."



But new research from the University of Pennsylvania and Ohio State University shows those emotional images do indeed turn more people away from smoking.



The study analyzed data from 244 adults who smoked between five and 40 cigarettes per day. Smokers received their brand of cigarettes to smoke for a month with either the photo labels proposed by the U.S. Food and Drug Administration on the front and back of the packs, or text mandated by the government in the Family Tobacco Act of 2009 on the side of the pack where current warnings appear.



"Graphic images changed smokers' views about smoking, made them feel more negative about smoking, and made them believe the messages were more credible," said study codirector Daniel Romer of the Annenberg Public Policy Center at Penn. "All of this cascaded toward an intention to quit.



"If you follow through the cascade of these effects, it means that if we had images on packages in the market, it would lead to people trying to quit at a higher rate than if they just had text," Romer said.



The study also showed that smokers learned more from the graphic images, and that pictures held more information than text.



"It's one thing to tell people that cigarettes cause cancer; it's another to show them a picture of a cancer lesion on a lip," Romer said. "This illustrates in a very clear way what the words mean."



An earlier study Romer coauthored used functional magnetic resonance imaging to show that graphic images produced greater activation in the part of the brain that registered emotional memory and fear. In that research, the vivid labels proved more memorable and were associated with greater reduction in the urge to smoke than print-only labels.



"The court ruling is ironic since it implied that you can't have a warning that has an emotional impact," Romer said. "Meanwhile, you have a product that can kill you - which has a great emotional impact."



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