Will new, graphic tobacco health warnings affect kids?

The following was written by Lauren Rubenzahl, EdM, program coordinator at Children’s Center on Media and Child Health (CMCH) and David Bickham, PhD, CMCH staff scientist.

Last week, the FDA released new requirements for labels on cigarette packaging, which will take effect next September. The nine new health warning labels portray the health effects of smoking through text and full-color graphics, like one that compares a healthy set of lungs with a diseased set of lungs and reads, “Cigarettes cause fatal lung disease.” According to the FDA, these labels are intended to “increase awareness of the specific health risks associated with smoking”, “encourage smokers to quit”, and “empower youth to say no to tobacco.”

These warnings could have positive results. By placing graphic health warnings so prominently in cigarette advertisements (they must take up 20% of the ad) and packaging (they must take up 50% of the front and back), the changes will reduce kids’ exposure to actual cigarette advertising, which influences their decision to use tobacco.

The images were selected based on research into what would be most effective for youth, young adults, and adults. This research focused on how well the images conveyed the intended message and on whether they encouraged viewers to stop smoking. The hope is that they will do both of those things. But will these grisly pictures affect kids in the way they are intended to?

It’s hard to say for sure because fear can be a double-edged sword.

Campaigns like this, which rely largely on fear to encourage personal behavior change, can certainly be effective, and the FDA seems to have done substantial research in an attempt to ensure that this campaign will fall into that camp. Shocking images are a fairly direct and memorable way to stimulate intense emotional response. And in the case of smoking, such a portrayal is easy because the outcomes are already scary.

But when not handled carefully, these types of campaigns can backfire: If smoking is already seen as rebellious and cool, then warnings and scary pictures may only serve to reinforce that image. Likewise, training teens to say no doesn’t address the reasons they say yes, which is likely part of why the DARE program wasn’t found to be effective.

If fear campaigns are to leverage the power of the visceral response in the ways they intend to, then they need to do the following.

  1. Stay relevant to the target audience. The teen brain has not yet developed the ability to really understand long-term consequences. Thus, arguing that they shouldn’t smoke because it could give them lung cancer years from now is less effective than pointing out immediate side effects—like saying that it stains your teeth yellow or causes acne. For most teenagers, their current social image is MUCH more important than what might happen to them when they’re older.
  2. Empower the target audience. Once they’ve grabbed your attention, fear campaigns must follow through by telling you what to do and provide a tool with which to do it. The new FDA warning labels succeed in this regard because they provide a hotline to call if you’re a smoker who would like to quit. Operators can connect callers with a list of resources in your area and free nicotine patches if you don’t have health insurance.

But inspiring fear isn’t the only way to grab a viewer’s attention. Campaigns that target social norms, like the Truth campaign, can be effective in a different way and may have a broader impact. Public health campaigns like the FDA’s new cigarette ads target individuals; while others, like the Truth campaign, target social norms, which can may a broader impact.

Instead of arguing that smoking is dangerous, Truth empowers young people with information and new ways of understanding tobacco. They show teens the ways in which they’re being manipulated by tobacco companies—and offer ways of fighting back. In addition, this campaign appeals to teens’ general mistrust of corporations that market heavily to them and heightens their awareness in a way that may make them less vulnerable to the messages in advertising.

An approach that attempts to shift social norms in this way can lead to huge successes in reducing smoking. Today, you can’t smoke in bars, restaurants, or, in some cities, even in public parks. And that’s a broader scale shift that work alongside an approach that targets individuals.

These changes will likely inspire tobacco companies to change their approach to marketing tobacco products and as a result we may see less advertising and more product placement in other media. This could potentially be the first of an effective two-prong approach: getting smokers to quit and preventing non-smokers from becoming smokers. In the meantime, however, when working to ensure that youth and young adults don’t start smoking at all, the arguments will be most effective if they focus on what’s important to teens. Even though some of the new warnings don’t seem to do that, parents, teachers and (most importantly) other youth can. For ideas on explaining the dangers of tobacco use to young people, take a look at the Truth campaign, or send a question to the Mediatrician at www.askthemediatrician.org.