College student reactions to health warning labels: Sociodemographic and psychosocial factors related to perceived effectiveness of different approaches

Objective: To examine factors associated with perceiving different types of pictorial cigarette health warning labels as most effective in motivating smokers to quit or preventing smoking initiation among college students. Method: We administered an online survey to 24,055 students attending six Southeast colleges in Fall, 2010. We obtained complete data for the current analyses from 2600. Results: Current smoking prevalence was 23.5%. The largest majority (78.6%) consistently rated gruesome images as most effective, 19.5% rated testimonial images as most effective, and only a small proportion rated either standard (1.6%) or human suffering images (0.3%) as most effective. Subsequent analyses focused on differences between those endorsing gruesome images or testimonials as most effective. Factors related to ranking testimonials versus gruesome images as most effective included being female (p < 0.01), White (p < 0.01), and nonsmokers (p = 0.04), lower perceived smoking prevalence (p < 0.01), and greater receptivity to laws/restrictions around smoking (p < 0.01) and tobacco marketing (p = 0.01). Among smokers, factors related to ranking testimonials as most effective versus gruesome images included being female (p = 0.03), being White (p = 0.03), higher autonomous motivation (p = 0.03), and greater extrinsic self-efficacy (p = 0.02). Conclusions: Understanding factors related to perceived effectiveness of different pictorial warnings among subpopulations should inform health warning labels released by the FDA.