Emotional graphic cigarette warning labels reduce the electrophysiological brain response to smoking cues

An Li Wang, Dan Romer, Igor Elman, Andrew A. Strasser, Bruce I. Turetsky, Ruben C. Gur, Daniel D. Langleben

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


There is an ongoing public debate about the new graphic warning labels (GWLs) that the Food and Drug Administration (FDA) proposes to place on cigarette packs. Tobacco companies argued that the strongly emotional images FDA proposed to include in the GWLs encroached on their constitutional rights. The court ruled that FDA did not provide sufficient scientific evidence of compelling public interest in such encroachment. This study's objectives were to examine the effects of the GWLs on the electrophysiological and behavioral correlates of smoking addiction and to determine whether labels rated higher on the emotional reaction (ER) scale are associated with greater effects. We studied 25 non-treatment-seeking smokers. Event-related potentials (ERPs) were recorded while participants viewed a random sequence of paired images, in which visual smoking (Cues) or non-smoking (non-Cues) images were preceded by GWLs or neutral images. Participants reported their cigarette craving after viewing each pair. Dependent variables were magnitude of P300 ERPs and self-reported cigarette craving in response to Cues. We found that subjective craving response to Cues was significantly reduced by preceding GWLs, whereas the P300 amplitude response to Cues was reduced only by preceding GWLs rated high on the ER scale. In conclusion, our study provides experimental neuroscience evidence that weighs in on the ongoing public and legal debate about how to balance the constitutional and public health aspects of the FDA-proposed GWLs. The high toll of smoking-related illness and death adds urgency to the debate and prompts consideration of our findings while longitudinal studies of GWLs are underway. There is a debate in the US about constitutionality of the graphic cigarette warning labels that evoke a strong emotional reaction. Using event-related potentials and cue-induced craving, we found that warning labels rated high on an emotional reaction scale, attenuated the brain and behavioral response to visual smoking cues more than those rated low. These effects on surrogate measures of smoking addiction suggest that the emotional impact of graphic warning labels contributes to their public health effectiveness.

Original languageEnglish (US)
Pages (from-to)368-376
Number of pages9
JournalAddiction Biology
Issue number2
StatePublished - Mar 1 2015
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Medicine (miscellaneous)
  • Pharmacology
  • Psychiatry and Mental health


  • Attentional bias
  • P300
  • cigarette craving
  • event-related potentials
  • graphic cigarette warning labels
  • tobacco control policy


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