Emotional IS factual: Emotional reactions to cigarette graphic warnings increase smoker choices

 

By Abigail Evans and Ellen Peters

The US Food and Drug Administration (FDA) was sued by the tobacco industry after requiring graphic warning labels for cigarette packaging. Federal district and appeals courts concluded that FDA’s warnings were unconstitutional, calling them “unabashed attempts to evoke emotion… and browbeat consumers into quitting.” Our research, however, shows that the emotions evoked by graphic warnings are critical for informing smokers about the risks of smoking and encouraging them to quit.

Smoking is the leading cause of preventable death worldwide. At least 100 countries currently require that cigarette packaging feature warnings with images depicting the health consequences of smoking (e.g. blackened lungs and diseased teeth). Because the images evoke negative emotions, the DC Circuit Court concluded that graphic warnings did not convey factual information and blocked their implementation. However, the court’s reasoning is based on the out-of-date view that emotion conflicts with rational decision making. We know instead that feelings can enable good decisions. In a recent randomized clinical trial, we found that one way emotional reactions to graphic cigarette warnings helped smokers is by encourating them to pay attention to the warning, increasing their understand of the risks of their habit.

To understand and use information, people process it through two interacting modes of thought. One mode is more thoughtful and deliberative whereas the other is more experiential and emotional. The experiential mode is what we rely on to make good choices quickly. It produces feelings that are based on our past experiences. We then use these feelings as a motivator of behavior, as information, and as a spotlight to guide where we focus our attention.

In our recent clinical trial, we randomly assigned 293 smokers to receive their cigarettes in packaging which featured either text-only warnings or graphic warnings for four weeks. After the first week, we measured smokers’ emotional reactions to the warnings and how often they had looked at the warnings. At the end of the trial, we measured their smoking risk perceptions and quit intentions. The graphic warning labels made smokers feel worse about smoking compared to text-only labels. Emotional reactions to the warnings influenced smokers through both experiential and deliberative processes.

First, emotion acted as a direct motivator of behavior. A key function of emotion is to prepare us for action. For example, anger readies us to fight whereas fear readies us to flee. Emotions often motivate health-related behaviors. Smoking is no exception. The negative emotion from graphic warnings in our clinical trial directly motivated quit desires, independent of smokers’ increased risk perceptions.

Emotion did not only motivate behavior directly though. Smokers who felt worse as a result of viewing the warnings perceived tobacco as more dangerous. When faced with a difficult decision, like whether or not to quit smoking, we simplify our task by relying on feelings that tell us whether something is good or bad for us. Using emotions to simplify complicated decisions allows people to act in order to avoid dangers quickly and efficiently. In our clinical trial, emotions acted as information about risk. Smokers who felt worse after viewing the graphic warnings reported increased smoking risk perceptions. These increased risk perceptions led to increased quit intentions.

Finally, emotion acted as a spotlight, attracting a person’s attention and focusing it on specific parts of the information. In our clinical trial, the negative feelings smokers experienced when viewing graphic warnings caused them to think more about the risk information on the warnings. This means that the graphic warning did not simply cause smokers to feel bad; it also caused them to pay more attention to important information.When smokers perceived the warning information as trustworthy after thinking about it, risk perceptions and quit intentions increased.

One limitation of this work is that our participants were established smokers who did not intend to quit at pre-screening. The importance of graphic warnings may be different for new smokers and/or established smokers already thinking about quitting. Increased thought may be especially critical for early smokers, many of whom give little to no thought to the dangers of smoking. Our sample size was also relatively small. A more recent clinical trial with a much larger sample of 2,149 smokers demonstrated that the use of graphic labels increased quit attempts by 6%. Our study reveals why these effects likely emerged.

Overall, the results of our research suggest that graphic warnings are not merely “unabashed attempts to evoke emotion.” Instead, the ability to evoke emotions is a crucial component of getting people to scrutinize, understand, and react to warnings. Although the courts in the R. J. Reynolds vs. FDA case attempted to tease apart warnings that are “factual” from warnings that are “emotional,” behavioral sciences research suggests that this is counterproductive. Emotions enhance our ability to understand and use factual information through multiple processes. In the context of cigarette graphic warning labels, the ability of emotions to communicate, in ways words cannot, may be a matter of life and death for millions of smokers worldwide.

Further reading: Evans, A. T., Peters, E., Strasser, A. A., Emery, L. F., Sheerin, K. M., & Romer, D. (2015). Graphic Warning Labels Elicit Affective and Thoughtful Responses from Smokers: Results of a Randomized Clinical Trial. PLOS ONE, 10(12), e0142879. https://doi.org/10.1371/journal.pone.0142879

Funding Acknowledgement: Research reported in this publication was supported by grants number P50CA180908 and R01CA157824 from the National Cancer Institute and FDA Center for Tobacco Products(CTP).The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration.

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