Impact of images and text designs on the effectiveness and reactance to graphic health warnings on cigarette packages in Colombia

In some countries (e.g. Colombia), graphic health warnings (GHWs) for cigarette packages include both implicit and explicit images and certain keywords bolded in the text. The purpose of this study was to evaluate how these factors impact both perceived message effectiveness and message reactance in a group of non-smokers. We conducted an on-line experiment with a sample of 221 non-smoking young adults (ages 18-22 years). Participants were randomly divided into three groups (i.e. GHWs with regular font, GHWs with keywords in bold font and GHWs with keywords in bolder font). Each group was presented with four GHWs (two with implicit pictures and two with explicit pictures). The participants were asked a series of questions as a pre- and post-measure of attitudes toward smoking, smoking intentions, confidence in their ability not to smoke and crave. After viewing each image, participants were asked to answer questions pertaining to perceived message effectiveness, attention, message reactance and motivation not to smoke. A main effect of the picture was found for perceived message effectiveness, attention, reactance, and motivation not to smoke, pointing out that explicit pictures lead to significantly greater scores in all these measures. No significant effect was found for the alterations in font weight. GHWs containing explicit images proved to be more effective in preventing cigarette smoking in young adults. The results suggest that the change in the text design does not have an effect on the motivation not to smoke.