Graphic Cigarette Warnings Seen to Trigger Decision-Making Brain Areas

Graphic Cigarette Warnings Seen to Trigger Decision-Making Brain Areas

Researchers with Georgetown University Medical Center and Truth Initiative recently reported that graphic anti-smoking images on cigarette packs produced brain activity in areas involved in memory, emotion, and decision-making, and may motivate people looking at them to consider the health consequences of cigarettes.

The study, “Young adult smokers’ neural response to graphic cigarette warning labels”, published in the journal Addictive Behaviors Reports, is the first conducted in young adult smokers using brain scanning to capture reactions to negative images of smoking’s potential effects.

“What we found in this study reinforces findings from previous research where scientists have asked participants to report how they think and feel in response to graphic warnings on cigarettes,” Darren Mays, PhD, MPH, assistant professor of Oncology at Georgetown Lombardi Comprehensive Cancer Center in Washington, D.C. and a co-lead author of the study, said in a news release. “This study offers us new insights on the biological underpinnings for those responses, bolstering evidence for how these warnings can work to motivate a change in behavior.”

In total, the research team analyzed 19 young adult smokers using self-reported measures of demographics, cigarette smoking behavior, nicotine dependence, and through an fMRI scanning session. During the scanning session,  participants viewed cigarette pack images based on the warning label, and branded or plain pack branding.

Participants reported motivation to quit in response to each image using a push-button control. During the task, the team gathered whole-brain blood oxygenation level-dependent (BOLD) functional images.

When the participants were exposed to images including an open mouth, showing a rotted teeth and a tumor on the lower lip, with the text: “WARNING: Cigarettes cause cancer,” key brain areas showed notable responses, said Dr. Adam Green, a cognitive neuroscientist, assistant professor in the department of psychology at Georgetown and the study’s other co-lead researcher. The amygdala and the medial prefrontal region were the areas where responses were more evident.

“The amygdala responds to emotionally powerful stimuli, especially fear and disgust. And experiences that have a strong emotional impact tend to impact our decision-making,” Dr. Green said. “The medial prefrontal region that responded to graphic warning labels in this study has been previously associated with self-relevant processing. When we find information to be self-relevant, that may increase how impactful it is for our life decisions.”

Previous studies have shown that activation in the amygdala and in the medial prefrontal cortex might influence health-related attitudes and decisions.

“Regulators can and should use this research to craft more effective warning labels and messages to smokers that both deliver facts about the negative effects of smoking, and trigger thoughts and actions that move smokers toward quitting,” said Dr. Raymond S. Niaura, senior study author, and director of Science at the Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative. “Tobacco is still the leading preventable cause of death in the U.S. and the growing body of research showing the effectiveness of warning labels should energize policymaking.”

The research team found that the self-reported motivation to quit smoking was superior for graphic warning images compared with control warnings, with results confirmed by the brain images. Researchers also found that plain packaging did not change participants’ responses.

According to the authors, the findings complement other recent neuroimaging studies conducted with older adult smokers and adolescents by demonstrating similar patterns of neural activation in response to graphic warning labels.

“As more evidence like this is published, the case grows stronger that graphic warnings are important and can make a difference in terms of motivating smokers to take steps to quit,” concluded Dr. Mays.

Cigarette smoking is a well-known cause of several lung diseases, especially lung cancer and chronic obstructive pulmonary disease (COPD). In fact, smoking is thought to be directly responsible for almost 90 percent of lung cancer and COPD deaths.

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