Is disgust the driver behind the selection of images for UK tobacco packets?

The use of pictorial warning labels on tobacco packets has gained almost universal international acceptance. In a public consultation exercise in 2006, the Department of Health in England, through a web-based answering system, asked people's preferences of 42 images, asking which images might be effective to encourage tobacco cessation in smokers. On cursory inspection of the rank order of preference, a pattern appeared to suggest that effectiveness was associated with the level of disgust emotion generated; that is, the images rated the most likely to persuade smokers to quit tobacco consumption appeared revolting. The objective of this study was to confirm that disgust emotion generated by United Kingdom (UK) tobacco packet images was associated with the public's selection of possible effective images. Three cross-sectional opinion surveys were conducted including students from medicine and psychology disciplines and a section of the public. In addition, a web opinion consultation database was made available for secondary analysis. A total of 291 participants were involved in the three convenience surveys and 19,812 participants gave complete replies to the public consultation website. Each individual rated every image on a five-category rating scale ranging from ‘extremely disgusting’ to ‘not disgusting’. Significant correlations (ranging from 0.91 to 0.94) existed between the image rank order aggregated preference ratings from the original public consultation and the average final score of the disgust ratings for specific items for the three groups. The emotion of disgust may be a possible intervening variable to explain the initial reactions to health promotion materials and smoking cessation.