Many studies have shown cigarette packs with graphic warning labels—with images such as bleeding, cancerous gums and lips—can deter smokers from lighting up.

New Cornell research suggests graphic warning labels have the same anti-smoking effect when they’re placed on cigarette ads. Just as important, they also cancel out the effect of ads that prompt children to think of smoking as cool, rebellious, and fun.

“This study suggests the value of graphic warning labels extends beyond just getting people to have more negative feelings about smoking. It also seems to have the added benefit of reducing the influence of ‘social cue’ ads that entice young people to want to smoke in the first place,” said lead author Jeff Niederdeppe, associate professor of communication, who wrote the paper with a team of Cornell-affiliated researchers. “Cigarette ads often try to convey that smoking cigarettes is way for young people to communicate their identity and sociality, and the graphic warning labels undermine that.”

Graphic warning labels, conveying the dangers of smoking, were integrated into cigarette ads in a recent Cornell study. It found the graphic warnings are more effective than text-only warnings at deterring people from smoking. The paper, “Using Graphic Warning Labels to Counter Effects of Social Cues and Brand Imagery in Cigarette Advertising,” was published Oct. 24, 2018 in Health Education Research.

The Food and Drug Administration, which funded the study through its Center for Tobacco Products, will consult this research as it considers revising the current surgeon general warnings. Those small, text-only warnings haven’t changed in nearly 40 years.

The study assessed the graphic warning labels’ effect on 451 adult smokers and 474 middle schoolers in rural and urban low-income communities in the Northeast. Each participant was randomly assigned a set of six ads. Some saw ads with social cues, such as a group of smiling people taking a selfie, and a graphic warning label covering 20% of the ad. Other groups saw ads with various combinations of text-only warnings, graphic warnings, the current surgeon general warning, brand imagery, and social cues. “The idea was to identify which variable mattered, whether in isolation or in combination,” Niederdeppe said.

Using Cornell’s mobile media lab, the researchers tracked study participants’ eyes to measure what parts of the ad they looked at and for how long. After viewing the ads, participants reported the degree to which they felt negative emotions including anger, fear, and sadness.

The graphic warning labels drew viewers’ attention away from ads and toward the warning—regardless of whether the warning was graphic or text only—more than the current surgeon general warning. The graphic warning labels also aroused more negative feelings than the text-only labels. “That’s important, because there’s pretty good evidence that the visceral reactions to these warnings are a main driver of their effectiveness,” Niederdeppe said.

And graphic warning labels reduced the children’s perceptions that cigarette brands are attractive and exciting. “These ads are trying to create a positive brand image, and the graphic warning labels suppress that,” he said.

The study also found participants felt the same levels of negative emotion whether they looked at a graphic warning label covering 20% of a full page ad or 50% of a much smaller cigarette pack. “We were pleasantly surprised that the levels of negative emotion were equivalent between those two conditions,” Niederdeppe said. “It suggests that 20% coverage on an advertisement is a high enough threshold to create the negative emotion.”