Emotional Impact of Graphic Health Warnings on Tobacco Packages in Colombia

Around the world, approximately 168 countries have used graphic health warnings (GHWs). Colombia has used such GHWs since 2009. The present study evaluated the emotional impact of GHWs that were used in Colombia from 2009 to 2017; additionally, we also assessed craving toward GHWs, since previous studies have found that some GHWs may induce positive affective states. The study included 703 participants (47.9% female; mean age = 25.43 years), classified into three age groups (adolescents, young adults, and adults) and into three smoking status groups (nonsmokers, smokers, and former smokers) and with two different educational levels (medium and high). We recorded valence, arousal, and craving responses to 33 GHWs with sizes that were similar to those that appear on cigarette packages and analyzed the effect of sex, smoking status, education level, and age. The results showed that all of the GHWs that were used in Colombia generated aversive affective states, and none of them produced craving. Nonsmoker adult women may be a population that can benefit the most by this public policy. GHWs are useful for communicating health messages to people with different levels of education. However, these GHWs produced low levels of arousal, which decreases their emotional impact. The main reason why GHWs may not increase arousal is their relatively small size, suggesting that the size of GHWs should be increased to generate a higher arousal response, especially in adolescents.