When a federal appeals court ruled in 2012 that graphic cigarette warning labels were unconstitutional, it said that the selected images “did not convey any warning information at all” and were “unabashed attempts to evoke emotion (and perhaps embarrassment) and browbeat consumers into quitting.” But a new study suggests that using emotionally evocative images such as rotting teeth and a diseased lung is important in making the warning labels more memorable and effective in conveying the risks of smoking. The study, led by researchers at the Annenberg Public Policy Center (APPC) and the Perelman School of Medicine, both at the University of Pennsylvania, is the first to report the use of functional magnetic resonance imaging (fMRI) to study smokers’ brain response to graphic warning labels. The researchers found that warnings with more powerful images produced greater activation in parts of the brain that register emotional memory and fear. The more emotional labels also proved more memorable and were associated with greater reduction in the urge to smoke than the less emotional labels. The findings suggest “that emotional imagery in graphic warning labels is an integral factor in the labels’ memorability” and “contributes to their public health impact,” according to the authors of the study, which was published online in Tobacco Control. A sample high “emotional reaction” label. Emotional images prove more memorable The fMRI study reported results from 19 smokers who were shown 24 pictorial warning labels. In previous testing by the FDA, 12 of those labels were judged to produce a high “emotional reaction” while 12 were at the low end of the scale. The more emotional labels show images such as a corpse and a man blowing smoke through a tracheotomy hole; the less emotional labels show images such as tombstones and an oxygen mask. Another 12 scrambled images were used as controls. Daniel D. Langleben, M.D., an associate professor of psychiatry at the Perelman School of Medicine’s Center for the Study of Addiction, a distinguished research fellow at APPC, and the principal investigator on the project, said, “This study shows that the more scary pictures reduce craving, which means you can’t separate scary from effective. The emotional effects and behavioral effects may be inseparable.” A sample low “emotional reaction” label. The study found that the pictorial warning labels with more emotional content produced a greater response in the limbic system, brain structures associated with emotions, such as fear. These structures also encode experiences into longer-term memory, an effect that was apparent in the greater ability of smokers to recognize the more emotional warnings after a delay. Smokers were tested on their recognition of the labels 20 minutes after being shown them. An-Li Wang, Ph.D., a senior researcher at APPC and lead author of the study, said that the findings reported in Tobacco Control are preliminary, and a study to determine the longer-term effects of the labels is underway. “Memory is a gateway to a long-term behavioral change,” she said, “and we look forward to testing that prediction in our ongoing research.” “You want warning messages to be memorable,” said APPC associate director Daniel Romer, Ph.D., a co-author of the study. “This study shows that the emotional impact of the more graphic labels has an educational benefit that supports public health.” Dan Romer writes an op-ed in The Hill about the study here. For the complete news release, click here. For the study in Tobacco Control, click here.