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Cigarette Warning Labels: Research Synthesis and Impact on Smoking Behavior

Principal Investigator:  Norman Sharpless (previous P.I.: H. Shelton Earp)

Funding Mechanism:  Intra-Departmental Delegation of Authority

ID Number: 3P30CA016086-38S2

Award Date:  5/1/2014

Institution:  University of North Carolina-Chapel Hill 


The FDA has a legislative mandate to require new warnings on cigarette packs that communicate the health risks of smoking. In this supplement to an existing research grant, researchers will synthesize the published literature on the impact of warnings on smoking-related outcomes and then will conduct an experiment in which they label smokers’ own cigarette packs with text or graphic warnings to examine real-world impact on smoking behavior.  Specific aims are: (1) to assess the impact of cigarette pack warnings by conducting a systematic review and meta-analysis of the existing literature; and (2) to test the impact of cigarette pack warnings on smoking behavior. To accomplish Aim 1, researchers will search research databases and examine references in review and primary articles, code relevant articles for important study characteristics, and conduct a separate analysis for each key outcome (i.e., cognitive and emotional reactions, risk perception, intention to quit, and the moderating effects of income, race/ethnicity, age, smoking status, sampling method, and study design). To accomplish Aim 2, researchers will randomly assign 2,250 smokers aged 18-65 to one of seven experimental conditions in which smokers’ cigarette packs are labeled with a warning (i.e., three text-only warnings, three graphic warnings, and the current Surgeon General’s warning as a control condition). Researchers will then assess the relationship between warning type (i.e., text or graphic) and cessation behaviors (i.e., quitting, attempting to quit, smoking fewer cigarettes); evaluate the impact of graphic warnings on emotional and cognitive reactions, perceived risk of smoking-related harm, discouragement from smoking, and quit intentions; and examine whether the impact of warnings varies by income level. This research may inform future regulatory activities related to cigarette pack warning labels.