ABSTRACT
Introduction: The addition of graphic health warnings on cigarette packets can facilitate smoking cessation, primarily through their ability to elicit a negative affective response. Smoking is linked to COVID-19 mortality, thus making it likely to elicit a strong affective response in smokers. COVID-19-related health warnings (C19HW) may therefore enhance graphic health warnings, when compared to traditional health warnings (THW). Further, because impulsivity influences smoking behaviours, we also examined whether these affective responses were associated with delay discounting. Methods: In a between-subjects design, 240 smokers rated the valence and arousal elicited by tobacco packaging that contained either a C19HW or THW (both referring to death). Participants also completed questionnaires to quantify delay discounting and attitudes towards COVID-19 and smoking (eg, health risks, motivation to quit). Results: There were no differences between the two health warning types on either valence or arousal, nor any secondary outcome variables. There was, however, a significant interaction between health warning type and delay discounting on arousal ratings. Specifically, in smokers who exhibit low delay discounting, C19HWs elicited significantly greater subjective arousal rating than did THWs, whereas there was no significant effect of health warning type on arousal in smokers who exhibited high delay discounting. Conclusion: The results suggest that in smokers who exhibit low impulsivity (but not high impulsivity), C19HWs may be more arousing than THWs. Future work is required to explore the long-term utility of C19HWs, and to identify the specific mechanism by which delay discounting moderates the impact of tobacco health warnings.