Worth a thousand words: The neural impact of graphic warning labels on young adult smokers

Warning labels on cigarette packaging featuring graphic images have a significant impact on the brains of young adult smokers, particularly in neural regions responsible for emotion, memory and decision-making, according to results of study published on in the journal Addictive Behavior Reports.

Now implemented in 65 countries around the world, the inclusion of graphic warning labels on cigarette boxes has been shown to significantly impact smoking cessation rates among adolescent and middle-aged smokers as compared to traditional text-only warnings. However, the effect of this imagery on one particularly vulnerable segment of the smoking population—young adults—has yet to be researched, said lead author Adam Green, MD, of Georgetown University in Washington, D.C., and colleagues.

“Young adults are a priority for tobacco control due to high rates of smoking experimentation, frequent transitions to regular smoking, and the high prevalence of smoking in this group,” the authors wrote. “Examining young adult smokers' neural response to [graphic warning labels] on branded and plain packaging can extend the evidence surrounding potential mechanisms of [graphic warning label] action and inform future research and policy.”

With this in mind, Green and his team set out to assess the effects of graphic anti-smoking imagery as part of cigarette package warning labels on the minds of young adult smokers. They performed fMRI scans on 19 smokers with a median age of 23 years, all of whom self-reported demographics, smoking behavior and nicotine dependence prior to the examinations. The subjects were shown 64 different images of cigarette packs and warning labels for a total of four seconds each, then ranked each image in real time based on its effect on the participants’ smoking cessation motivation.

Their results showed that graphic warning labels produced significantly greater self-reported motivation to quit than standard text-based warnings, along with increased neural activation in subjects’ medial prefrontal cortex, amygdala, medial temporal lobe and occipital cortex. No significant variation was found among participants in response to warnings presented on branded versus plain cigarette packaging.

“[Graphic warning labels] promoted neural activation in brain regions involved in cognitive and affective decision-making and memory formation and the effects … did not differ on branded or plain cigarette packaging,” the researchers concluded. “These findings complement other recent neuroimaging [graphic warning label] studies conducted with older adult smokers and with adolescents.”