Skip to main content
SpringerLink
Log in

Brain Responses to Anti-smoking Health Warnings in Youth

  • Adolescent/Young Adult Addiction (T Chung, Section Editor)
  • Published:
Current Addiction Reports Aims and scope Submit manuscript

Abstract

Purpose of the Review

Adolescents and young adults are a critical target for smoking prevention efforts. Health education is a key approach to these efforts, yet little is known about how adolescents and young adults process health information. One novel approach to understanding the neurobiological mechanisms of cognitive processing of public health communications is to use neuroimaging techniques to map the brain regions involved and make inferences about the neural systems engaged in the processing of health information. We reviewed recent studies that employed functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) to examine the brain responses of adolescents and young adults to anti-smoking health messages and videos.

Findings

This narrative literature review found that the medial prefrontal cortex, amygdala, and hippocampus were the brain regions most commonly engaged in response to health warnings. Developmental factors modulate the relationship between brain regions, regulated emotional reaction, and frontal regions that are responsible for decision making.

Summary

Research that integrates neurophysiology and behavior to study adolescent and young adult neurocognitive responses to health messaging is an important tool for identifying optimal methods to communicate the health hazards of smoking with this vulnerable population.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. CDC. Smoking-attributable mortality, years of potential life lost, and productivity losses—United States, 2000–2004. MMWR Morb Mortal Wkly Rep. 2008;57(45):1226–8.

    Google Scholar 

  2. USDHHS. Preventing tobacco use among youth and young adults: a report of Surgeon General. Atlanta (GA): National Center for Chronic Disease Prevention and Health Promotion, Health UOoSa; 2012.

  3. • Do KT, Galvan A. FDA cigarette warning labels lower craving and elicit frontoinsular activation in adolescent smokers. Soc Cogn Affect Neurosci. 2015;10(11):1484–96. This study characterized brain response to the FDA-proposed graphic warning labels in adolescent and adult smokers and nonsmokers.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Koechlin E, Ody C, Kouneiher F. The architecture of cognitive control in the human prefrontal cortex. Science. 2003;302(5648):1181–5.

    Article  CAS  PubMed  Google Scholar 

  5. Donoso M, Collins AG, Koechlin E. Human cognition. Foundations of human reasoning in the prefrontal cortex. Science. 2014;344(6191):1481–6.

    Article  CAS  PubMed  Google Scholar 

  6. Lau JY, Britton JC, Nelson EE, Angold A, Ernst M, Goldwin M, et al. Distinct neural signatures of threat learning in adolescents and adults. Proc Natl Acad Sci U S A. 2011;108(11):4500–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Mueller SC, Cromheeke S, Siugzdaite R, Nicolas Boehler C. Evidence for the triadic model of adolescent brain development: cognitive load and task-relevance of emotion differentially affect adolescents and adults. Dev Cogn Neurosci. 2017;26:91–100.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Gabard-Durnam LJ, Flannery J, Goff B, Gee DG, Humphreys KL, Telzer E, et al. The development of human amygdala functional connectivity at rest from 4 to 23 years: a cross-sectional study. NeuroImage. 2014;95:193–207.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Satterthwaite TD, Wolf DH, Erus G, Ruparel K, Elliott MA, Gennatas ED, et al. Functional maturation of the executive system during adolescence. J Neurosci. 2013;33(41):16249–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Gogtay N, Giedd JN, Lusk L, Hayashi KM, Greenstein D, Vaituzis AC, et al. Dynamic mapping of human cortical development during childhood through early adulthood. Proc Natl Acad Sci U S A. 2004;101(21):8174–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Romer D. Adolescent risk taking, impulsivity, and brain development: implications for prevention. Dev Psychobiol. 2010;52(3):263–76.

    PubMed  PubMed Central  Google Scholar 

  12. Pruitt DB. Your adolescent: emotional, behavioral, and cognitive development from early adolescence through the teen years. New York: HarperCollins; 2000.

    Google Scholar 

  13. Chang FC, Miao NF, Lee CM, Chen PH, Chiu CH, Lee SC. The association of media exposure and media literacy with adolescent alcohol and tobacco use. J Health Psychol. 2016;21(4):513–25.

    Article  PubMed  Google Scholar 

  14. FTC. Federal Trade Commission Cigarette Report for 2014. 2016.

  15. Kids CfT-F. Broken promises to our children. 2015.

  16. Hitchman SC, Driezen P, Logel C, Hammond D, Fong GT. Changes in effectiveness of cigarette health warnings over time in Canada and the United States, 2002-2011. Nicotine Tob Res: Off J Soc Res Nicotine Tob. 2014;16(5):536–43.

    Article  Google Scholar 

  17. Peebles K, Hall MG, Pepper JK, Byron MJ, Noar SM, Brewer NT. Adolescents’ responses to pictorial warnings on their parents’ cigarette packs. J Adolesc Health. 2016;59(6):635–41.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Family Smoking Prevention and Tobacco Control Act Pub. L. No. 111-31 Stat. 1776 (2009).

  19. R.J. Reynolds Tobacco Co. et al v. FDA et al. USDist Affirmed ed: United States District Court For The District Of Columbia; 2011.

  20. R.J. Reynolds Tobacco Co. v. United States FDA. 845 Fd Supp 2d 266: U.S. Dist. LEXIS 26257 (D.D.C., 2012); 2012.

  21. R.J. Reynolds Tobacco Company v. Food and Drug Administration. F3d: US Court of Appeals for the DC Circuit; 2012. p. 1205.

  22. Robinson TN, Killen JD. Do cigarette warning labels reduce smoking? Paradoxical effects among adolescents. Arch Pediatr Adolesc Med. 1997;151(3):267–72.

    Article  CAS  PubMed  Google Scholar 

  23. Hitchman SC, Mons U, Nagelhout GE, Guignard R, McNeill A, Willemsen MC, et al. Effectiveness of the European Union text-only cigarette health warnings: findings from four countries. Eur J Pub Health. 2011;

  24. • Wang AL, Lowen SB, Romer D, Giorno M, Langleben DD. Emotional reaction facilitates the brain and behavioural impact of graphic cigarette warning labels in smokers. Tob Control. 2015;24(3):225–32. This is the first neuroimaging study that demonstrated the emotional salience of graphic warning labels engaging brain regions that mediate emotional memory and influence recall and cigarette craving.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Wang AL, Romer D, Elman I, Strasser AA, Turetsky BI, Gur RC, et al. Emotional graphic cigarette warning labels reduce the electrophysiological brain response to smoking cues. Addict Biol. 2015;20(2):368–76.

    Article  PubMed  Google Scholar 

  26. Green AE, Mays D, Falk EB, Vallone D, Gallagher N, Richardson A, et al. Young adult smokers’ neural response to graphic cigarette warning labels. Addict Behav Rep. 2016;3:28–32.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Falk EB, Berkman ET, Whalen D, Lieberman MD. Neural activity during health messaging predicts reductions in smoking above and beyond self-report. Health Psychol. 2011;30(2):177–85.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Phelps EA. Human emotion and memory: interactions of the amygdala and hippocampal complex. Curr Opin Neurobiol. 2004;14(2):198–202.

    Article  CAS  PubMed  Google Scholar 

  29. Hamann S. Cognitive and neural mechanisms of emotional memory. Trends Cogn Sci. 2001;5(9):394–400.

    Article  CAS  PubMed  Google Scholar 

  30. Zald DH. The human amygdala and the emotional evaluation of sensory stimuli. Brain Res Rev. 2003;41(1):88–123.

    Article  PubMed  Google Scholar 

  31. Hesse E, Mikulan E, Decety J, Sigman M, Garcia Mdel C, Silva W, et al. Early detection of intentional harm in the human amygdala. Brain :J Neurol. 2016;139(Pt 1):54–61.

    Article  Google Scholar 

  32. LaBar KS, Cabeza R. Cognitive neuroscience of emotional memory. Nat Rev Neurosci. 2006;7(1):54–64.

    Article  CAS  PubMed  Google Scholar 

  33. Newman-Norlund RD, Thrasher JF, Fridriksson J, Brixius W, Froeliger B, Hammond D, et al. Neural biomarkers for assessing different types of imagery in pictorial health warning labels for cigarette packaging: a cross-sectional study. BMJ Open. 2014;4(12):e006411.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Wang AL, Lowen SB, Romer D, Giorno M, Langleben DD. Emotional reaction facilitates the brain and behavioural impact of graphic cigarette warning labels in smokers. Tob Control. 2015;24(3):225–32.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Do KT, Galvan A. FDA cigarette warning labels lower craving and elicit frontoinsular activation in adolescent smokers. Soc Cogn Affect Neurosci. 2015;10(11):1484–96.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Jasinska AJ, Chua HF, Ho SS, Polk TA, Rozek LS, Strecher VJ. Amygdala response to smoking-cessation messages mediates the effects of serotonin transporter gene variation on quitting. NeuroImage. 2012;60(1):766–73.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Maynard OM, Brooks JCW, Munafo MR, Leonards U. Neural mechanisms underlying visual attention to health warnings on branded and plain cigarette packs. Addiction. 2017;112(4):662–72.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Blakemore SJ, Choudhury S. Development of the adolescent brain: implications for executive function and social cognition. J Child Psychol Psychiatry. 2006;47(3–4):296–312.

    Article  PubMed  Google Scholar 

  39. Wang AL, Ruparel K, Loughead JW, Strasser AA, Blady SJ, Lynch KG, et al. Content matters: neuroimaging investigation of brain and behavioral impact of televised anti-tobacco public service announcements. J Neurosci. 2013;33(17):7420–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Chua HF, Ho SS, Jasinska AJ, Polk TA, Welsh RC, Liberzon I, et al. Self-related neural response to tailored smoking-cessation messages predicts quitting. Nat Neurosci. 2011;14(4):426–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Denny BT, Kober H, Wager TD, Ochsner KNA. Meta-analysis of functional neuroimaging studies of self- and other judgments reveals a spatial gradient for mentalizing in medial prefrontal cortex. J Cogn Neurosci. 2012;24(8):1742–52.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Falk EB, O’Donnell MB, Tompson S, Gonzalez R, Dal Cin S, Strecher V, et al. Functional brain imaging predicts public health campaign success. Soc Cogn Affect Neurosci. 2016;11(2):204–14.

    Article  PubMed  Google Scholar 

  43. Ramsay IS, Yzer MC, Luciana M, Vohs KD, AW MD. Affective and executive network processing associated with persuasive antidrug messages. J Cogn Neurosci. 2013;25(7):1136–47.

    Article  PubMed  Google Scholar 

  44. Cartocci G, Modica E, Rossi D, Maglione AG, Venuti I, Rossi G, et al. A pilot study on the neurometric evaluation of “effective” and “ineffective” antismoking public service announcements. Conf Proc IEEE Eng Med Biol Soc. 2016;2016:4597–600.

    PubMed  Google Scholar 

  45. Stothart G, Maynard O, Lavis R, Munafo M. Neural correlates of cigarette health warning avoidance among smokers. Drug Alcohol Depend. 2016;161:155–62.

    Article  PubMed  PubMed Central  Google Scholar 

  46. Chiosi JJ, Andes L, Asma S, Palipudi K, McAfee T. Warning about the harms of tobacco use in 22 countries: findings from a cross-sectional household survey. Tob Control. 2016;25(4):393–401.

    Article  PubMed  Google Scholar 

  47. Pierce JP, Sargent JD, White MM, Borek N, Portnoy DB, Green VR, et al. Receptivity to tobacco advertising and susceptibility to tobacco products. Pediatrics. 2017;139(6):e20163353.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Rahman MA, Hann N, Wilson A, Mnatzaganian G, Worrall-Carter L. E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PLoS One. 2015;10(3):e0122544.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Victoria P. Fairchild & Daniel D. Langleben

  2. Annenberg Public Policy Center, University of Pennsylvania, Philadelphia, PA, 19104, USA

    Catherine A. Aronowitz & Daniel D. Langleben

  3. Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    An-Li Wang

Authors
  1. Victoria P. Fairchild
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Catherine A. Aronowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Daniel D. Langleben
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. An-Li Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to An-Li Wang.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Adolescent/Young Adult Addiction

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fairchild, V.P., Aronowitz, C.A., Langleben, D.D. et al. Brain Responses to Anti-smoking Health Warnings in Youth. Curr Addict Rep 5, 372–378 (2018). https://doi.org/10.1007/s40429-018-0221-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40429-018-0221-z

Keywords

Search

Navigation