Effects of Fear and Perceived Message Sensation Value of Visual Warnings on Cigarette Packages on Smoking

Theoretical Background and research questions/hypothesis:Cigarette smoking is the leading cause of preventable morbidity and premature mortality. Studies documented the significant increase in the smoking rate in the United States. One effective strategy to reduce the smoking rate, which has been used in countries such as Canada and Australia, is the use of graphic visual warnings on cigarette packages. Both fear and the perceived message sensation value (PMSV) are message features that closely relate with the effectiveness of such graphic warnings. To understand the impacts of PMSV and fear appeal of visual warning on cigarette pack, the current study uses the prospect theory and the extended parallel processing model as the guiding frameworks. The current study proposed the following two sets of hypothesis and research question: H1/2: There is a significant correlation between PMSV/ fear communicated through the visual warnings on cigarette packages and (a) attitudes toward smoking and (b) intentions to quit smoking. RQ1/2: What are the relationships between PMSV/ fear communicated through the visual warnings on cigarette packages and (a) perceived susceptibility, (b) perceived threats, (c) self-efficacy, and (d) response efficacy?  

Methods: The current study created 8 visual warnings for cigarette packages, which included images presenting serious smoking-related health consequences including lung cancer, oral cancer, facial destruction, tongue destruction, lip destruction, teeth loss, and brain damage. These 8 images were then incorporated onto an image of a cigarette package using Photoshop. These warnings varied in their levels of fear arousal and PMSV.  The pilot test assessed the level of fear each image aroused. The main study asked each participant to review and assess one of the eight randomly assigned visual warnings. Participants were 195 college students (48 for pilot study and 147 for the main study; 101 males and 94 females; 72 smokers) from a Midwestern university.

Results: The results showed that the PMSV of graphic warnings was highly correlated with attitudes toward smoking (r =.26, p<.01), perceived threat (r =.56, p<.01), perceived susceptibility (r =.45, p<.01), self-efficacy (r =.38, p<.01), and response efficacy (r =.20, p<.05), after controlling for the smoking statuses. However, the level of fear was not significantly associated with the dependent variables besides perceived threat (r =.30, p< .01). In addition, the intentions to quit smoking, after reviewing the graphic warnings were jointly predicted by self-efficacy and perceived threat ( F(2, 37)= 12.23, p<.001), with an R²of .40.

Conclusions: Overall, the visual warnings on cigarette packages are effective in promoting smoking cessation. Specifically, the PMSV of visual warnings on cigarette packages had strong impacts on smoking-related behaviors, especially compared with fear appeal.

Implications for research and/or practice: The current paper highlighted the importance of exploring and comparing different message features. PMSV of graphic warnings on cigarette packages is important to consider, and fear appeal might not be as effective as predicted. The current study offered healthcare professionals and policymakers theoretical and practical guidance for implementations of such graphic warnings. Limitations and directions for future research were discussed.