After analyzing more than 300 pictorial warning messages for 40 individual features, researchers found that images of diseased body parts and testimonials from real people were most effective at getting smokers to quit

At least 120 countries around the world require pictorial warning labels on cigarette packages--for example, gangrene feet or a dead body--but the United States is notably missing from the list. Despite a 2009 Congressional act instructing the Food and Drug Administration (FDA) to implement pictorial warning labels, American cigarette packs still contain text-only warnings. A new court order issued in September 2018 says the FDA must speed up its timeline for the implementation of pictorial warning labels.

A new study from the Annenberg School for Communication at the University of Pennsylvania aims to contribute valuable research toward this end. Researchers analyzed more than 300 pictorial warning labels to determine which features most effectively get smokers to quit. They found that testimonial frameworks and images of diseased body parts were the most effective individual features.

"Humans act in response to our emotions," says Doctoral Candidate Jazmyne Sutton, lead study author. "When we feel a negative emotion--fear, disgust, etc.--we want to avoid the source of that emotion."

It makes sense, then, that images of diseased body parts and smoking horror stories told by real people would be most influential in getting smokers to stop smoking. No one wants to end up as the testimonial on a cigarette pack.

To analyze the various features used in pictorial warning labels, the researchers collected more than 300 warning labels from various sources. They used pictorial warning messages on cigarette packs in Australia, Canada, New Zealand, and the United Kingdom; pictorial warning messages proposed by the FDA that have not been implemented; a set of anti-smoking messages produced by tobacco companies; testimonial pictorial warning messages developed for an experimental study; and pictorial ads used in various local and national campaigns.

The researchers identified 48 objective features that could be present in the ads, including factors like image color, photo type, presence of male or female characters, presence of medical equipment, and argument type. They then recruited nearly 1,400 current smokers to view the ads and answer questions about how the ads affected them.

"A wide variety of studies from different countries show that pictorial warning labels are effective in curtailing smoking behavior," says senior author Joseph N. Cappella. "Our work seeks to isolate some of the specific elements that enhance and retard effectiveness to help guide future message designs."

The researchers say they hope that this study can offer generalizable guidelines for label designers to create more effective pictorial warning messages, which will eventually impact smoking-related attitudes and promote behavior change. In upcoming studies, they will focus on the relationship between text that appears on the labels and the pictorial elements.

The study, "Perceived Effectiveness of Objective Features of Pictorial Warning Messages," was published in Tobacco Control. Authors include: Doctoral Candidate Jazmyne Sutton, Doctoral Candidate Sijia Yang, and Professor Joseph N. Cappella.

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