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) x 2 (likelihood) between-subjects design (n=260); Study 2: An experimental study with a 2 (severity) x 2 (likelihood) x 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.