Neural biomarkers for assessing different types of imagery in pictorial health warning labels for cigarette packaging: a cross-sectional study

Abstract

ObjectiveCountries around the world have increasingly adopted pictorial health warning labels (HWLs) for tobacco packages to warn consumers about smoking-related risks. Research on how pictorial HWLs work has primarily analysed self-reported responses to HWLs; studies at the neural level comparing the brain's response to different types of HWLs may provide an important complement to prior studies, especially if self-reported responses are systematically biased. In this study we characterise the brain's response to three types of pictorial HWLs for which prior self-report studies indicated different levels of efficacy.MethodsCurrent smokers rated pictorial HWLs and then observed the same HWLs during functional MRI (fMRI) scanning. Fifty 18–50-year-old current adult smokers who were free from neurological disorders were recruited from the general population and participated in the study. Demographics, smoking-related behaviours and self-reported ratings of pictorial HWL stimuli were obtained prior to scanning. Brain responses to HWLs were assessed using fMRI, focusing on a priori regions of interest.ResultsPictorial HWL stimuli elicited activation in a broad network of brain areas associated with visual processing and emotion. Participants who rated the stimuli as more emotionally arousing also showed greater neural responses at these sites.ConclusionsSelf-reported ratings of pictorial HWLs are correlated with neural responses in brain areas associated with visual and emotional processing. Study results cross-validate self-reported ratings of pictorial HWLs and provide insights into how pictorial HWLs are processed.

Neural response to pictorial health warning labels can predict smoking behavioral change

“…Smoking causes cancer), with three different types of image for each set: (i) graphic—vivid depiction of the physical effects of smoking; (ii) suffering—vivid depiction of personal experience that included faces and showed physical, social, or emotional impact of smoking-related morbidity & mortality; 3. symbolic—representation of health risks using abstract imagery or symbols (e.g. ticking time-bomb to represent impending heart attack) (Hammond et al , 2012; Thrasher et al , 2012a; Hammond et al , 2013; Newman-Norlund et al , 2014). …”

“…Morris et al (1998) showed that amygdala activation occurred when subjects were exposed to human faces with emotions such as fear or suffering. Several recent studies found that the amygdala responds robustly to the presentation of pictorial HWLs (Jasinska et al , 2012; Newman-Norlund et al , 2014; Wang et al, 2015). Other research suggests that the amygdala’s response to emotional stimuli is predictive of a wide variety of behavioral outcomes including post-exposure memory (Canli et al , 2005).…”

Depressive symptoms and responses to cigarette pack warning labels among Mexican smokers.

“…The influence of pictorial HWLs, that include prominent graphic imagery, on cessation-related beliefs and behaviors involves both affective and cognitive pathways (Emery, Romer, Sheerin, Jamieson, & Peters, 2013; Thrasher et al, 2013; Newman-Norlund et al, 2014). Prior research on the effectiveness of pictorial HWLs on cigarette packages has shown that cognitive and behavioral responses to HWLs predict cessation behavior (Borland et al, 2009; Fathelrahman et al, 2009; Yong et al, 2014).…”

Scanning the brain for answers about effectiveness of graphic warning labels

“…Studies have documented strong relationships between self-reported arousal and neural responses as measured by functional MRI (fMRI),16 and strongly emotional stimuli have been linked to memory encoding and retrieval (likely through an interaction between the amygdala and hippocampus) 17–19. These findings have particular relevance for GWLs since emotional antismoking visual stimuli have been shown to produce activation in similar regions of the brain (eg, the amygdala),20–22 and this activation is associated with quitting smoking 23…”