ArticleTobacco control2018
Negative affect, message reactance and perceived risk: how do pictorial cigarette pack warnings change quit intentions?
Article in Tobacco control, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 70 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
70 citing papers in PubMed, 1 synthesis or guideline pooled it, 110 citations in OpenAlex.
- The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions.BMC public health · 2021Pooled it
- Perceived Effectiveness of Cigar Warnings Among Young People in the U.S.American journal of preventive medicine · 2026Trial
- The role of sympathy in motivating behaviour change: a discrete emotions approach to examining responses to cancer warning labels for alcohol.Health education research · 2025Trial
- Campaign messages to support pictorial health warning labels for little cigars and cigarillos: an online survey-based experiment.BMJ open · 2025Trial
- Harnessing Hope and Bolstering Knowledge of How to Quit: A Qualitative Investigation of Including Efficacy Content in Tobacco Risk Communication via Daily SMS.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Trial
- Relative Efficacy of Cigarillo Warning Statements in Text and Pictorial Formats: An Experimental Study Among a Sample of US Young Adults.Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco · 2025Trial
- Understanding Potential Mechanisms of Vaping Prevention Messages: A Mediation Analysis of the Real Cost Campaign Advertisements.Health education & behavior : the official publication of the Society for Public Health Education · 2025Trial
- Countermarketing Versus Health Education Messages About Sugar-Sweetened Beverages: An Online Randomized Controlled Trial of US Adults.American journal of public health · 2024Trial
- Combining Inserts With Warning Labels on Cigarette Packs to Promote Smoking Cessation: A 2-Week Randomized Trial.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2024Trial
- How pictorial warnings change parents' purchases of sugar-sweetened beverage for their children: mechanisms of impact.The international journal of behavioral nutrition and physical activity · 2023Trial
- Effects of Sugary Beverage Text and Pictorial Warnings: A Randomized Trial.American journal of preventive medicine · 2023Trial
- Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults.Tobacco control · 2023Trial
- Should messages discourage sugary drinks, encourage water, or both? A randomized experiment with U.S. parents.Preventive medicine · 2023Trial
- Consumer Reactions to Positive and Negative Front-of-Package Food Labels.American journal of preventive medicine · 2023Trial
- Reactions to Pictorial and Text Cigarette Pack Warning Labels among Chinese Smokers.International journal of environmental research and public health · 2022Trial
- Mediational Effects on Motivation to Quit Smoking After Exposure to a Cigarette Pictorial Warning Label Among Young Adults.Annals of behavioral medicine : a publication of the Society of Behavioral Medicine · 2022Trial
- Longitudinal effects of cigarette pictorial warning labels among young adults.Journal of behavioral medicine · 2022Trial
- Developing health and environmental warning messages about red meat: An online experiment.PloS one · 2022Trial
- Cognitive and emotional responses to pictorial warning labels and their association with quitting measures after continued exposure.Addictive behaviors · 2022Trial
- A Walk in the Park? Examining the Impact of App-Based Weather Warnings on Affective Reactions and the Search for Information in a Virtual City.International journal of environmental research and public health · 2021Trial
10 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
objectivePictorial warnings on cigarette packs increase motivation to quit smoking. We sought to examine the potential mediating role of negative affect, message reactance (ie, an oppositional reaction to a message) and perceived risk in shaping quit intentions.
methodsIn 2014 and 2015, we randomly assigned 2149 adult US smokers to receive either pictorial warnings or text-only warnings applied to their cigarette packs for 4 weeks. Analyses used structural equation modelling with bootstrapped SEs to test our theorised mediational model.
findingsPictorial warnings increased negative affect, message reactance and quit intentions (all P<0.001), but not perceived risk (ie, perceived likelihood and severity of harms of smoking). Negative affect mediated the impact of pictorial warnings on quit intentions (mediated effect=0.16, P<0.001). Message reactance weakened the impact of pictorial warnings on quit intentions, although the effect was small (mediated effect=-0.04, P<0.001). Although pictorial warnings did not directly influence perceived risk, the model showed additional small mediation effects on quit intentions through negative affect and its
conclusionsPictorial cigarette pack warnings increased quit intentions by increasing negative affect. Message reactance partially attenuated this increase in intentions. The opposing associations of negative affect and reactance on perceived risk may explain why pictorial warnings did not lead to observable changes in perceived risk.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.