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Abstract

Introduction: People who smoke nondaily represent nearly one third of U.S. adults who smoke and experience significant smoking-related morbidity and mortality, yet they are rarely considered when evaluating the efficacy of graphic cigarette warnings.

Method: In October 2019, U.S. adults who smoked nondaily ( n =59) and daily ( n =183) evaluated 13 Food and Drug Administration–proposed graphic warnings and 13 equivalent text-only warnings on the extent to which they elicited understanding, perceived new knowledge, worry about smoking, and discouragement to smoke and were believable. Repeated-measures ANOVA and planned comparisons tested for between-subjects (smoking status) and within-subjects (warning type) effects. The strength of within-subjects effects were characterized using Cohen’s d p and Common Language Effect Size. Finally, repeated-measures ANCOVAs evaluated whether demographic characteristics (e.g., race/ethnicity) that differed between adults smoking nondaily and daily were associated with within-subject evaluations of graphic versus text-only warnings.

Results: Adults who smoked nondaily (versus daily) were younger ( p < 0.001); more educated ( p < 0.001); and less likely to be non-Hispanic White ( p =0.04), to be female ( p =0.04), or to intend to quit within 6 months ( p < 0.001). Adults smoking nondaily (versus daily) rated graphic warnings as eliciting more discouragement to smoke ( p =0.045). Graphic (versus text) warning evaluations were stronger for all outcomes in both groups ( p < 0.001). The effect sizes for graphic warnings were substantially larger among adults smoking nondaily for discouragement and believability ( d p difference >0.10). Race/ethnicity moderated evaluations of discouragement ( p =0.03) and believability ( p =0.01) among adults smoking nondaily and daily.

Conclusions: The capacity of graphic warnings to elicit responses associated with motivation to quit smoking may be particularly robust for adults smoking nondaily. That graphic warnings discourage smoking is promising for this underserved group of people who smoke.

Document Type

Article

Publication Date

2026

Notes/Citation Information

© 2025 The Authors. Published by Elsevier Inc.

Digital Object Identifier (DOI)

https://doi.org/10.1016/j.focus.2025.100474

Funding Information

This work was supported by a grant from the UC Tobacco-Related Disease Research Program (A19-0017-001). This study was also supported by the Cancer Center Support Grants at H. Lee Moffitt Cancer Center and Research Institute (P30CA76292) and the University of Kentucky Lucille P. Markey Cancer Center (P30CA177558), National Cancer Institute Designated Comprehensive Cancer Centers. During manuscript preparation, BSF was supported by the National Institutes of Health Training Grant in Behavioral Oncology (T32CA090314-18) and the Appalachian Tobacco Regulatory Science Team (AppalTRUST, NIH/National Institute on Drug Abuse/Food and Drug Administration, U54DA058256).

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