Identifying and selecting effective graphic health warnings to prevent perceptual wearout on tobacco packaging and in advertising

Graphic visual health warnings (GHWs) on cigarette packaging are used in more than 120 countries globally. Because there are concerns about the effectiveness of using the same visual warnings over many years due to wearout, a primary issue is how to identify the most effective visual stimuli. Adolescent smokers and nonsmokers provided more than 2000 ratings of different visual warnings. Cluster analysis and follow‐up analyses are used to identify a high‐performing visual stimuli group from the larger group of GHWs. Subsequent analyses also show that compared to other pictorial stimuli, the high‐performing group is perceived as effective in preventing adolescent smoking initiation and adolescent smokers' motivation to quit. These findings addressing the selection and evaluation of high‐performing visual warnings have implications for global health and public policy communities through identification of pictorial warnings that can be most effective in impacting smoking‐related outcomes for adolescents.