Do Cigarette Warning Labels Matter for Cancer Risk Perception? Results From the 2020 Health Information National Trends Survey

Background: Smoking is a risk factor for several types of cancer (e.g., lung, bladder), given the carcinogenic effects of tobacco. Public health efforts for tobacco cessation and prevention have led to the inclusion of warning labels on cigarette packs to inform consumers of tobacco’s health risks. These labels are designed to provide information about the health risks of smoking. However, there are mixed findings on whether reading cigarette warning labels is associated with higher cancer risk perception, with some experimental studies demonstrating that warning labels can elicit perceptions of threat, defensiveness, and—in some cases—more positive attitudes about smoking. As such, it is important to test whether noticing warning labels is associated with higher cancer risk perception in an ecologically valid context and using a large, nationally representative sample.

Purpose: Using cross-sectional data from the 2020 Health Information National Trends Survey (HINTS), we evaluated the pre-registered hypothesis that a higher frequency of noticing cigarette warning labels would be associated significantly with higher cancer risk perception among individuals who smoke.
Method: The current study analyzed data from n=546 participants who reported current smoking and no prior diagnosis of cancer (out of N=6,252 total respondents from HINTS). A multivariable linear regression model was conducted, in which the perceived lifetime likelihood of getting cancer was entered as the outcome, and the frequency of noticing cigarette warning labels was entered as the predictor. Analyses were adjusted for age, race, education, income, and insurance coverage.

Results: On average, cancer risk perceptions were moderate (M = 3.04 out of 5, SD = 0.16). Findings demonstrated no significant association between the frequency of noticing cigarette warning labels and cancer risk perception (b = 0.09 p = .343 95% CI [-0.93, 0.26]). There were also no significant associations between covariates and cancer risk perception (all p > .05).

Conclusions: Contrary to our hypothesis, a higher frequency of noticing cigarette warning labels was not associated with higher cancer risk perception. Additional research is needed to clarify whether the characteristics of the labels (e.g., size, message) are important for communicating information about cancer risk. Future studies should also assess potential changes in cancer risk perception following the planned inclusion of images on cigarette warning labels in the U.S