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Effect of Graphic Images in Cigarette Health Warning: A Call for Stricter Packaging Regulation in Japan

ABSTRACT This study examined the impact of unexpectedness, novelty, and relevance when including a shocking picture on cigarette packages in Japan. An experimental design compared reactions of Japanese smokers exposed to a health warning including a picture versus the current text-based health warning message. A health warning with a graphic image was confirmed as more effective in attracting attention and easier to understand, with some limited impact in persuading smokers to act on the information. Overall, the findings provide support for regulations in Japan to require health warnings featuring novel imagery, such as those found in Europe, Canada, and Australia.