본 연구는 정서조절이 담뱃갑 경고그림 효과에 어떤 영향을 미치는 지 알아보고자 했다. 많은 선행연구가 경고그림이 금연의도에 기여함을 보였지만 일부 연구는 경고그림의 효과를 부정하거나 오히려 그것이 흡연 행동을 증가시킴을 보여주었다. 본 연구는 흡연자의 정서조절 성향을 경고그림의 효과를 조절하는 경계 조건으로 설정하였다. 정서조절은 재평가와 정서억제 전략으로 나눌 수 있다. 재평가는 부정적 정서를 일으킨 상황을 긍정적인 방향으로 해석하여 정서를 조절하는 전략이며 정서억제는 느끼는 감정을 겉으로 표현하지 않는 전략이다. 선행 연구는 재평가가 정서억제보다 적응적인 전략임을 보고한다. 본 연구는 재평가 성향이 높은 흡연자는 경고그림이 유발한 부정적 정서를 적절히 조절해 높아진 금연의도를 보일 것으로 예상했다. 반면 정서억제 성향이 높은 흡연자에게서는 부정적 정서의 매개효과가 나타나지 않을 것이라고 예상했다. 가설을 검증하기 위해 흡연자 205명을 대상으로 실험을 실시하였다. 참가자는 경고그림 또는 경고메시지에 노출된 후 부정적 정서를 느낀 정도, 금연의도 및 정서조절 성향을 측정하는 문항에 응답했다. 실험 결과, 참가자들은 경고문구보다 경고그림에 노출되었을 때 더 높은 부정적 정서와 금연의도를 보였다. 정서조절 성향을 재평가와 정서억제로 나누어 분석해 보니, 재평가의 조절효과는 통계적으로 유의하였지만 정서억제의 조절효과는 유의하지 않은 것으로 나타났다. 즉, 재평가 성향이 높은 흡연자들에게서만 담뱃갑 경고그림이 금연의도를 높이는 효과가 관찰되었으며, 정서억제 성향은 경고그림의 효과에 영향을 미치지 않았다. 또한, 담뱃갑 경고와 금연의도 간의 관계를 흡연자가 인식한 부정적 정서가 매개하는 효과도 재평가 성향에 의해 조절되었다. 반면 정서억제의 조절된 매개효과는 통계적으로 유의하지 않았다. 이 결과는 경고그림에 수반되는 부정적 정서의 순기능이 재평가 전략을 사용하는 흡연자에게서 더 증폭될 수 있음을 보여준다. 따라서 흡연자들이 재평가 전략을 사용하도록 돕는 금연 프로그램을 적극적으로 도입해볼 만하다.

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.