Testing competing explanations for graphic warning label effects among adult smokers and non-smoking youth

Chris Skurka, Sahara Byrne, Julie Davydova, Deena Kemp, Amelia Greiner Safi, Rosemary J. Avery, Michael C. Dorf, Alan D. Mathios, Jeff Niederdeppe

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Rationale: The United States courts have blocked the implementation of graphic warning labels on cigarette packages (GWLs). This decision was based, in part, on the premise that GWLs are unnecessarily emotional and are meant to scare rather than inform consumers about smoking's health effects. However, research in judgment and decision-making suggests these relationships are more complex. Objective: In this article, we draw on several theoretical frameworks that lead to competing hypotheses about the relationships between negative affect, health risk beliefs, and quit intentions (among adult smokers) or susceptibility to start smoking (among non-smoking youth). Method: We tested these competing mediation models using data from two experiments with two populations each—adult smokers (Ns = 313 and 238) and primarily non-smoking middle-school youth (Ns = 340 and 237). Using mobile recruitment methods, we focused specifically on individuals from socioeconomically disadvantaged communities in rural and urban areas of the Northeastern United States. Results: The best fitting model across all four datasets was one in which label-induced negative affect (a) directly predicted intentions/susceptibility but also (b) indirectly predicted intentions/susceptibility via risk beliefs. Although mediation analyses did not demonstrate significant serial mediation effects of label exposure on intentions/susceptibility through negative affect then risk beliefs, there was some evidence that label exposure indirectly promoted adults' quit intentions through negative affect. Additionally, negative affect consistently mediated the indirect effect of label exposure on strengthened risk beliefs among adults and youth. Conclusions: These results speak to the importance of negative affect in directly motivating adult smokers' quit intentions but also serving an informational function, directing adult smokers and non-smoking youth to accept the health risks of smoking.

Original languageEnglish (US)
Pages (from-to)294-303
Number of pages10
JournalSocial Science and Medicine
StatePublished - Aug 2018

All Science Journal Classification (ASJC) codes

  • Health(social science)
  • History and Philosophy of Science


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