흡연자의 정서조절이 담뱃갑 경고그림 효과에 미치는 영향

Abstract

The current study examined how emotion regulation strategies moderate the impacts of graphic health warning (GHWs) on intention to quit smoking. Existing literature have shown that cigarette pictorial warnings are effective in reducing smoking behavior. Some studies, however, have revealed insignificant impact of GHWs or boomerang effect such that pictorial warnings even increased smoking behavior. The present study attempted to identify a boundary condition that moderates the impact of pictorial warnings on smokers’ desire to quit smoking. We hypothesized that the impact of GHWs will depend on the type of emotion regulation strategies that the smokers often use to regulate their negative emotions. Two different types of emotion regulation strategies are widely known. First, reappraisal occurs before emotional arousal is fully experienced and encourage people to think of the situation that induce such emotional reaction in a more positive way. For example, a person who feels very nervous waiting for a job interview may reduce such nervousness by thinking the situation as an opportunity to receive a useful feedback on his or her aptitude and skills. Individuals with greater reappraisal tendency attempt to reduce a detrimental impact of negative emotion through interpreting a specific situation that induce the emotion in a more positive manner. In contrast, suppression strategy does not contain such a cognitive process. Individuals with greater suppression tendency try not to reveal one’s emotional feelings in order to regulate their emotions. Literature on emotion regulation consistently have shown that reappraisal is more adaptive than suppression strategy in reducing negative emotional feelings. Suppression strategy was shown to reduce emotional expressions but not to reduce emotional experiences. Also, individuals with greater suppression tendency showed increased activities in sympathetic nervous system as well as heart rate. Suppression, compared to reappraisal strategy thus appear not to solve underlying emotional experiences. Based on the literature we predicted moderated mediation effect of the type of emotion regulation strategy such that mediating role of negative emotion will be significant for smokers with high reappraisal tendency but not for those with high suppression tendency. Smokers with high reappraisal tendency were predicted to regulate their negative emotion induced from GHWs more effectively since they will regard the pictorial warnings as useful information, which results in enhanced desire to quit. Smokers with high suppression tendency were predicted to be relatively ineffective in reducing their negative emotion and their desire to quit thus would not be affected by GHWs. We conducted experiments with 205 Korean smokers and presented them with either a pictorial warning or a text-only warning. Pictorial warning depicts a cancerous lung in full color along with corresponding texts. A text warning was included at the front and side of the cigarette package. The front warning was “Smoking causes various diseases such as lung cancer! Would you still smoke?” and the side warning was “The tar intake may vary depending on the smoker's smoking habits.” After participants were presented with stimuli they indicated the extent to which they felt negative emotions including fear and answered to an emotional regulation scale. The data revealed that participants showed greater level of negative emotion as well as increased desire to quit after exposed to a pictorial warning than to a text-only warning message. The pictorial warning was effective in enhancing desire to quit smoking only for the smokers whose reappraisal tendency was high. Suppression tendency did not significantly moderate the relationship between cigarette pictorial warning (vs. text-only warning) and desire to quit. Also, negative emotion mediated the relationship between cigarette pictorial warning (vs. text-only warning) and desire to quit, and this mediation effect was moderated by reappraisal but not by suppression tendency. The current findings seem to suggest that detrimental impacts of negative emotion that is induced by exposure to cigarette pictorial warnings can be reduced through emotion regulation, especially reappraisal tendency. Also, this study suggested that lack of emotion regulation could have explained previous findings that failed to show effectiveness of cigarette pictorial warnings in reducing smoking behavior. Specifically, reappraisal but not suppression tendency is shown to be more adaptive strategy in smoking cessation. Such finding may in part be due to the fact that suppression strategy requires more amount of cognitive resources than reappraisal strategy. Smoker with high suppression tendency could not have sufficient cognitive resources that is enough to process pictorial warning messages and thus might not have accepted it. Previous studies have demonstrated that the impacts of GHWs are mediated by cognitive processes such as perceived risk of smoking, believability of warning messages, and perceived information effectiveness. Suppression compared to reappraisal strategy appears to interfere with such a role of cognitive factors. The present finding has practical implication. Smoking cessation program for smokers should adopt some form of emotion regulation training. For example, the program can provide a meditation session with smokers that is helpful in reappraise their negative emotion. The current study shows beneficial role of emotion regulation tendency in enhancing GHWs’ effects. Our findings seem to reconcile recent controversy on the effectiveness of cigarette pictorial warning in Korea. This study demonstrated that GHWs are effective communication tool for smokers in helping their smoking cessation attempts. There are some situations, however, in which pictorial warning messages are ineffective due to negative emotional responses towards such messages and GHWs seem to be ineffective communication tool for smokers with low emotion regulation tendency.