I went shopping at a supermarket recently with a couple of friends. I came upon the cigarette counter which had two prominent brands in stock, Dunhill and Benson & Hedges.
On both brands were a pretty unusual and dare I say stark warning. Alongside the well-known caveat from the federal ministry of health that smokers are liable to die young were pictures of two lungs placed side by side, a healthy one and a smoker’s lung.
Also conspicuously stated on the packets were that they contained 70 substances known to cause cancer. In all my life I had never seen such negative advertising sponsored by the owners themselves. Everything about those packs was literally screaming at you, almost forcing you not to indulge in them.
Warnings for rotation on cigarette packages. Credit: U.S. Food and Drug Administration
I stood transfixed for a while at the counter trying to make sense of it. To be clear I am passing no judgment on lifestyle choices. My wonderment merely derived from the reason for the depressing advertisement which drove me to read up on it.
Usually, warnings on cigarette packs were small up until 2019 when a law was passed mandating tobacco companies to make it as conspicuous as possible. A statement from the FDA to that effect read: The new required warnings must appear prominently on cigarette packages and in cigarette advertisements, occupying the top 50 percent of the front and rear panels of cigarette packages and at least 20 percent of the area at the top of advertisements.
That said, do these warnings work? Are more people deterred from taking a puff? The answer is not so straightforward.
A 2019 research paper by the Oxford University Press set out to answer the question on whether graphic health warning labels on cigarette packages deter purchases at point-of-sale.
The study was conducted in the RAND StoreLab (RSL), a life-sized replica of a convenience store that was developed to evaluate how changing POS tobacco advertising influences tobacco use outcomes during simulated shopping experiences.
Adult smokers (n = 294; 65% female; 59% African-American; 35% White) were assigned randomly to shop in the RSL under one of two experimental conditions: graphic health warning labels present on cigarette packages versus absent on cigarette packages.
Cigarette packages in both conditions were displayed on a tobacco power wall, which was located behind the RSL cashier counter. Results revealed that the presence of graphic health warning labels did not influence participants’ purchase of cigarettes as a main effect.
Graphic health warning labels reduced the chances of cigarette purchases for smokers lower in nicotine dependence but had no effect on smokers higher in dependence.
In other words, negative advertising had no effect on people who were serial smokers. However, that was just one study. A 2021 study on the effectiveness of warning graphic labels on cigarette packs in Bangkok arrived at a somewhat similar conclusion.
The results showed that warning graphic images exhibiting patients suffering from cancers (e.g., lung cancer or laryngeal cancer) and images of damaged body parts were perceived as the scariest warning images.
In contrast, images that did not illustrate serious disease suffered by smokers were perceived as the least scary images. The scariest images generated a significant higher level of fear of smoking-related harms than the least scary images.
In addition, non-smoking participants were more sensitive to scary warning images than smoking participants. It was also found that the level of fear of smoking-related harms was significantly based on individual cognitive judgment, and it was not affected by the influence of social groups such as friends and family members.
Here, the findings of the study also suggest that regular smokers were less likely to change their behaviour as a consequence of negative advertising which presents some salient points.
First, it is clear that the scary warnings on cigarette packs are likely directed at passive or non-smokers as opposed to regular smokers which seems counter-intuitive. If you’re trying to raise awareness on the ill effects of tobacco shouldn’t the target audience be the smokers themselves?
Second, one of the studies noted that the reaction to the images was significantly based on the individual as against the prompting of external agents like family or friends. This tells us something about behaviour which we already know: people tend to make changes only when they come to the realization by themselves, not through coercion which is more or less what these graphic warnings are.
It reminds me of the ‘Do not urinate’ or ‘Post no bill’ signs we see in public spaces. Ever notice that places that have these signs tend to be the dirtiest or the most defaced as the situation applies? What does that tell you?
Behavioural scientists have come up with a concept known as nudge theory which attempts to alter behaviour by shaping the environment—known as the choice architecture—with the effect that one option is chosen over another.
First introduced by Richard Thaler and Cass Sunstein in the book: ‘Nudge: Improving Decisions about Health, Wealth, and Happiness’ written in 2008, the theory seeks to reinforce positive behaviour by nudging people towards a desirable course of action without any coercion. An example may suffice here.
Suppose there is a public male restroom where signs are in place asking men to pee properly without splattering all over the place. However that has not had much success. So instead, one tries a nudge.
The toilet bowl is redesigned such that there is an illustration of a fly at its centre. You’ll observe that the average guy who goes to use the toilet subconsciously aims at the centre trying to use their urine to ‘catch’ the fly. Without being forced they are altering their behaviour and shooting straight—which is the desired outcome.
Similarly, to encourage people to stop smoking in the Philippines, an experiment was conducted which saw a select group of smokers provided with a bank account where they saved money they would ordinarily have used to buy cigarettes. If they stayed away from smoking for six months—which was checked by conducting urine tests—they would get the money. Otherwise, the funds would go to charity.
The success of initiatives like these provides evidence that positive reinforcement works much better than scare tactics. It’s not that people are not aware of the dangers of smoking, sometimes what they really need is a nudge.
As far as negative advertising goes, I don’t think it does the trick. But that’s just me. What do you think?
P.S
Hi!
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Insightful as ever Stepho 👏 👏