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 journalArticle


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
  • Health, Toxicology and Mutagenesis

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