Study: Gruesome Cigarette Warnings Likely to Work

Graphic pictorial warnings on cigarette packaging may be effective in getting smokers to quit, HealthDay reported Nov. 22.

The web-based study, led by Villanova University marketing professor Jeremy Kees, was performed on 511 smokers between the ages of 19 and 79, 80 percent of whom had smoked every day of the previous month. Half lived in Canada, and half lived in the United States.

Participants were surveyed after reviewing one of four sample cigarette packages. One showed only a text warning and no image; another a mouth with clean white teeth; still another a smoker's mouth with moderate damage; and the last showed a mouth disfigured by cancer. The more gruesome the image that participants were shown, the more likely they were to say they intended to quit.

The study did not measure whether smokers actually quit, but deciding to quit is a key step in kicking the habit. “The more graphic, the more gruesome the image, the more fear-evoking those pictures were,” said Kees. “As you increase the level of fear, intentions to quit for smokers increase.”

The milder, less graphic pictures had no impact on increasing smokers' desire to quit when compared with the text-only image. Kees and his colleagues concluded that warning images, to be effective, had to be gruesome. Simply including a “pictorial warning on a package is not necessarily beneficial,” they wrote.

The study coincides with an initiative by the Food and Drug Administration (FDA) to decide on graphic warning labels for cigarette packages sold in the U.S., as required by the Smoking Prevention and Tobacco Control Act, passed in 2009. The new images will be finalized in July 2011 and required on all cigarette packaging in the United States after October 22, 2012.

Kees stated that the images the FDA is considering are not as graphic as those used in other countries and therefore may not be effective at encouraging smokers to quit. “Other countries have had success in using graphic visual warnings on cigarette packages,” he said. “It's important that we don't get it wrong. If we have even one warning that is cartoonish, that leaves the door open to smokers discounting all warnings as not realistic.”

View the FDA images 

Not everyone may be swayed by appeals to fear, said Michael Mackert, who teaches advertising at University of Texas at Austin. He reported that students in his college classroom found the images being considered by the FDA amusing.

“Teens and younger people, if they have this air of invincibility, are they going to react to the fear appeal?” Mackert asked. “A 15-year-old might think, 'Oh, that's so far away.' A lot of college students consider themselves social smokers, who smoke a few cigarettes when they're at a bar. They think, 'I don't smoke enough for that to happen to me,' or 'I'll quit before that happens to me.'”

In the new study, Kees and his colleagues acknowledged that the effects of gruesome warnings may differ among subgroups of smokers.

“Understanding How Graphic Pictorial Warnings Work on Cigarette Packaging,” was published in the Journal of Public Policy and Marketing on Nov. 1, 2010. An executive summary is available on the American Marketing Association website.

Editor's note: The FDA seeks public comments on the graphic images being considered for U.S. cigarettes, through Jan. 11, 2011. View the proposed images and follow instructions to comment.