Are Cigarette Warnings That Show Actual Harm More Effective At Getting People To Quit?

Image courtesy of US Centers for Disease Control and Prevention

Imagine you’re holding a package of cigarettes you’re thinking about buying. Which would encourage you to quit: a label with a written warning, or a label with a photo of a throat cancer patient and former smoker who’s had a larygnectomy? According to a new study, labels with photos that show the harm done by smoking are more effective at dissuading people from lighting up.

Researchers at the Penn Tobacco Center of Regulatory Science (TCORS) at the University of Pennsylvania’s Annenberg School for Communication found that warning labels featuring photos of real smokers who were harmed by their habit are more effective in getting smokers to quit than the text-only labels currently required in the U.S.

The U.S. Food and Drug Administration did propose series of such warning labels as mandated by the Family Smoking Prevention and Tobacco Control Act in 2011, but that effort was shut down by a legal challenge from Big Tobacco in 2012. This, because the labels — which showed fictional images of smokers and simulations of diseased body parts — were emotional instead of factual.

The matter of the labels was remanded back to the FDA to effectively start over, a process that some anti-smoking advocates say has been too slow.

In the study, which will be published in Nicotine & Tobacco Research, researchers tested graphic images of real people who had been harmed by smoking, an appeal that the group calls “both factual and emotional.”

“Our aim in this study was to find out how smokers respond to cigarette pack warning labels that use photographs of real people whose health has been affected by their own, or by someone else’s, smoking,” says lead author Emily Brennan, Ph.D., David Hill Research Fellow at the Cancer Council Victoria in Australia.

Participants in the study viewed several labels from one of three categories: labels with a photo of a real person who had been harmed by smoking, some of which included a short caption describing the person; the FDA’s earlier attempt at image-based labels; or the current text-only version.

US Centers for Disease Control and Prevention

US Centers for Disease Control and Prevention

They were then asked to report their initial responses to the labels, and their intentions to quit smoking. Researchers checked in with them five weeks later to see if they’d tried to quit, and if so, how successful they were.

Overall, researchers found that warning labels with images “consistently outperformed text-only labels”: in the text-only group, 7.4% of smokers tried to quit, while those who viewed the photos of real smokers had a quit attempt rate of 15.4%, and were four times as likely to have been successful.

“There’s a stickiness to the testimonial photos – the suffering of real people in real contexts – and they increased the likelihood that people would attempt to quit and stay quit,” says senior author Joseph N. Cappella, Ph.D., Gerard R. Miller Professor of Communication at the Annenberg School.

Researchers now hope that the data from this study, in conjunction with findings from other studies, will help bring about more effective warning labels.

“The use of testimonial images may help to minimize how vulnerable the next iteration of warning labels in the United States are to legal challenges based on the factual nature of the messages.”

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