Trial reportAnnals of behavioral medicine : a publication of the Society of Behavioral Medicine2019
Understanding Why Pictorial Cigarette Pack Warnings Increase Quit Attempts.
Trial report in Annals of behavioral medicine : a publication of the Society of Behavioral Medicine, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT02247908 (A Randomized Controlled Trial Evaluating the Impact of Graphic Cigarette Warnings on Smoking Behavior), which is not on this map. Cited by 108 papers, 5 of them syntheses 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.
A Randomized Controlled Trial Evaluating the Impact of Graphic Cigarette Warnings on Smoking Behavior
Who cites it
108 citing papers in PubMed, 5 syntheses or guidelines pooled it.
- Do Vaping Prevention Messages Impact Adolescents and Young Adults? A Meta-Analysis of Experimental Studies.Health communication · 2023Pooled it
- Can Extant Vaping Prevention Message Experiments Tell Us Something About What Works? A Response to O'Keefe.Health communication · 2023Pooled it
- Impact of health warning labels on selection and consumption of food and alcohol products: systematic review with meta-analysis.Health psychology review · 2021Pooled it
- The effectiveness of graphic health warnings on tobacco products: a systematic review on perceived harm and quit intentions.BMC public health · 2021Pooled it
- Sugary drink warnings: A meta-analysis of experimental studies.PLoS medicine · 2020Pooled it
- Effect of food swap recommendations on the healthfulness and carbon footprint of grocery purchases in a naturalistic online store: A randomized parallel trial.PLoS medicine · 2026Trial
- 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
- Ecolabels and the Healthfulness and Carbon Footprint of Restaurant Meal Selections: A Randomized Clinical Trial.JAMA network open · 2025Trial
- Sharing Antivaping Social Media Messages.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2025Trial
- Campaign messages to support pictorial health warning labels for little cigars and cigarillos: an online survey-based experiment.BMJ open · 2025Trial
- Identifying Promising Message Themes for Youth Who Use Multiple Tobacco Products.The Journal of adolescent health : official publication of the Society for Adolescent Medicine · 2025Trial
- Tobacco package health warnings about product manipulations: an experimental study among Australian adults who smoke.Health promotion international · 2025Trial
- Developing and testing health warnings about alcohol and risk for breast cancer: Results from a national experiment with young adult women in the United States.Alcohol, clinical & experimental research · 2025Trial
- Effects of narrative versus non-narrative pictorial warning labels on visual attention and alcohol-related cancer risk perceptions: An eye-tracking study.Addictive behaviors · 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
- Trial
- Optimising messages and images for e-cigarette warnings.Tobacco control · 2025Trial
- Perceived effectiveness of messages to address cervical cancer screening barriers: An online experiment.PloS one · 2025Trial
48 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
6 authors.
Funding
Abstract
backgroundOur randomized trial found that pictorial cigarette pack warnings elicited more quit attempts than text-only warnings. PURPOSE: In the current study, we sought to identify psychological mechanisms that explain why pictorial cigarette pack warnings change behavior.
methodsIn 2014 and 2015, we recruited 2,149 adult smokers in NC and CA, USA. We randomly assigned smokers to receive on their cigarette packs for 4 weeks either a text-only warning (one of the USA's current warnings on the side of cigarette packs) or a pictorial warning (one of the USA's proposed text warnings with pictures on the top half of the front and back of cigarette packs).
resultsPictorial warnings increased attention to, reactions to, and social interactions about cigarette pack warnings (all p < .05). However, pictorial warnings changed almost no belief or attitude measures. Mediators of the impact of pictorial warnings included increased attention, negative affect, social interactions, thinking about the warning and harms of smoking, and intentions to quit (all p < .05). Analyses also found that pictorial warnings led to greater avoidance of the warnings, which was associated with more quit attempts (p < .05).
conclusionsPictorial warnings increased quit attempts by eliciting aversive reactions and by keeping the message vividly in smokers' minds. Contrary to predictions from several theories of health behavior, the warnings exerted little of their influence through changes in beliefs and attitudes and none of their influence through changes in risk perception. We propose the Tobacco Warnings Model based on these findings. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov identifier: NCT02247908; https://clinicaltrials.gov/ct2/show/NCT02247908.
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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.