Graphic warning labels affect hypothetical cigarette purchasing behavior among smokers living with HIV

Lauren R. Pacek, Meredith S. Berry, Olga Rass, Melissa Mercincavage, F. Joseph McClernon, Matthew W. Johnson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing behavior among HIV-positive smokers. Participants (n = 222) completed a cigarette valuation task by making hypothetical choices between GWL cigarette packs at a fixed price ($7.00) and text-only warning label cigarette packs at increasing prices ($3.50 to $14.00; $0.25 increments). More than one-quarter (28.8%) of participants paid more to avoid GWLs. The remaining participants’ purchasing decisions appear to have been driven by price: 69.8% of participants chose the cheaper pack. Across all participants, overall monetary choice value observed for GWL cigarette packs (mean = $7.75) was greater than if choice was driven exclusively by price ($7.00). Most (87.4%) preferred the text-only warning label when GWL and text-only cigarette packs were equally priced. Correlation analysis indicated GWL pack preference was associated with agreement with statements that GWLs would stop individuals from having a cigarette or facilitate thoughts about quitting. These data suggest that GWLs may influence some HIV-positive smokers in such a way that they are willing to pay more to void seeing GWLs.

Original languageEnglish (US)
Article number3380
JournalInternational journal of environmental research and public health
Issue number18
StatePublished - Sep 2 2019


  • Behavioral economics
  • Comorbidity
  • Graphic warning labels
  • HIV
  • Pictorial warning labels
  • Smoking
  • Tobacco
  • Tobacco control

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Pollution
  • Health, Toxicology and Mutagenesis


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