Date of Award


Document Type

Open Access Thesis


Health Promotion, Education and Behavior

First Advisor

James Francis Thrasher


Tobacco use is the leading cause of preventable death in the United States. The Family Smoking Prevention and Tobacco Control Act was signed into law in 2009 and gave the U.S. Food and Drug Administration (FDA) the authority to implement pictorial health warning labels (HWLs) on cigarette packages. Multiple studies investigating self-reported affective, cognitive and behavioral impacts of HWLs suggest that the most effective warnings include imagery that depicts physical damage to the body due to smoking. However, self-report methods of assessment used in these studies may be biased. Far less is known about how HWLs directly modulate brain activity. To address this issue, we used functional magnetic resonance imaging (fMRI) to examine cortical activity in smokers while they viewed pictorial HWLs (including both HWLs proposed by the FDA as well as more graphic HWLs implemented in other countries) and a set of scrambled images, using an event related design. Each participant underwent fMRI while viewing stimuli and performing a simple visual discrimination task. The results revealed greater activity bilaterally in the lateral occipital cortex in response to foreign images compared to the FDA images, and there was no evidence that this effect was reduced with repeated exposure. These findings suggest that more graphic HWL imagery elicits more salient cortical response, perhaps due to their more explicit emphasis on the negative consequences of smoking on human health. These findings bring us a step closer to understanding ways to evaluate effective HWLs and may strengthen the case for implementing even more graphic HWLs in the U.S. compared to what the FDA had proposed.