Designing Effective Testimonial Pictorial Warning Labels for Tobacco Products

ABSTRACT

Warning labels on tobacco products sometimes feature images and stories of real people whose health has been affected by smoking. We examined effects of some of the design elements that may contribute to the effectiveness of these testimonial pictorial warning labels (PWLs). Beginning with a testimonial PWL that contained an image of a person and a basic warning statement (e.g., “Smoking can kill you”), we examined the impact of adding: (a) text detailing the person’s name, age and health status (identifiers); and (b) explanatory statements that elaborated on the basic warning using a testimonial or non-testimonial message. In an online experiment, 1255 adult smokers in the United States were randomly assigned to one of six experimental conditions (2 [identifier: none/identifier] × 3 [explanatory statement: none/non-testimonial/testimonial]), or a control condition (text only warning labels that currently appear on packs in the United States). In each condition, participants were exposed to multiple labels each focused on a different health effect. Effectiveness was assessed using emotional responses, engagement and behavioral intentions measured immediately post-exposure, and quit attempts measured at five-week follow up. Testimonial PWLs were more effective than the text only labels. However, there was little evidence that adding identifiers or the explanatory statements enhanced effectiveness; rather, there was some evidence that testimonial explanatory statements reduced effectiveness. These findings suggest that the most effective design for testimonial PWLs may be to combine a basic warning statement with an image of a real person, without any additional textual components.

Supplementary material

Supplementary material data for this article can be accessed on the publisher’s website.

Acknowledgments

We acknowledge the contribution of Mr Kyle Cassidy at the Annenberg School for Communication, University of Pennsylvania, who created the stimuli used in this study. We thank Sijia Yang at the Annenberg School for Communication, University of Pennsylvania for his advice on statistical analyses. We also thank Professor Robert Hornik, Dr Laura Gibson, Professor Caryn Lerman, Dr Andrew Strasser, and Professor Emily Falk at the University of Pennsylvania, Professor Melanie Wakefield at Cancer Council Victoria, Associate Professor David Hammond at University of Waterloo, and Professor Ellen Goodman at Rutgers, who all provided feedback on the original study design. Thank you also to staff at Health Canada and at the Office on Smoking and Health at the Centers for Disease Control and Prevention, who arranged access to the images and stories used in the testimonial pictorial warning labels.

Additional information

Funding

This work was supported by the National Cancer Institute of the National Institutes of Health and the Food and Drug Administration’s Center for Tobacco Products (P50CA179546). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration