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Stanford Research into the Impact of Tobacco Advertising

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Other Bodily Disease – img12539

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One of the most common anti-smoking advertisement approaches is featuring smoking-related diseases as the consequence of smoking. Ads in this “disease” category stress the long-term and short-term consequences of smoking. They are meant to inform people about the risks of smoking and counter the tobacco industry’s portrayal of smoking as glamorous and healthy.

These advertisements range from gruesome pictures of pain and suffering to images that would seem completely unrelated to smoking if it were not for the captions. Many show what smoking-related diseases look like and what they do to specific parts of the human body. The most graphic ads are meant to evoke feelings of disgust and fear that will discourage people from continuing to smoke or will prevent people from beginning to smoke in the first place.

According to the current literature, the effectiveness of these ads is ambiguous and varies among target groups. Several studies have found that ads that show long-term health consequences of smoking, such as cancers and heart disease, are less effective among youth than adults. One study suggests that adolescents are not responsive to these ads because they are already aware of the potential dangers of smoking, and these consequences seem so far in the future that they feel immune to them, believing they can quit before they contract the diseases in question (1). Adults, however, seem to be much more receptive to fear and threat, and rises in calls to quitlines and public health departments demonstrate increases in quit attempts as a result of exposure to antismoking campaigns (1).

Another reason these ads may be ineffective is because threatening information can induce defensive biases that cause the audience to stop processing the information (2). Fear, specifically, activates psychological reactance, which is a response that may lead to rejection of the message because a person’s freedom is threatened (3).

However, another study shows contrasting results and suggests that ads with higher emotional intensity, such as those that feature graphic disease or suffering, lead to reduced intention to smoke (3). These ads are more likely to be recalled, which means that they are cost-effective because they don’t have to be distributed as often to be effective.

An explanation for these conflicting results may come from another study, which examines the closely tied feelings of fear and empathy, sentiments that can both arise from seeing images of people suffering from diseases (4). The findings of this study suggest that the feeling of empathy that often comes from seeing people suffer from these diseases can increase the persuasiveness of the message, while, fear may decrease the persuasiveness of the ads by activating psychological reactance, leading to rejection of a message when freedom is threatened (4).

The effectiveness of disease-related ads may also vary between smokers and nonsmokers. Anit-tobacco advertisements are often processed in an attitude-consistent fashion. This means non-smokers tend to agree with the ads and retain the messages better, while smokers tend to avoid negative-self implications, disagree with the messages, and become less responsive to them. Repeatedly showing these advertisements to people who look upon these messages unfavorably may even strengthen these initially defensive responses(5). Similarly, fatigue by repetition may desensitize any audience to these messages.

Some methods of using disease to discourage smoking behaviors may be more effective than others. For youth audiences, highlighting their vulnerability to these diseases may be much more important than stressing the severity of the potential problems(6). In the context of low perceived vulnerability, emphasizing health risks could increase the symbolic value of smoking as a risk-seeking, rebellious, and thus attractive behavior(6). These ads appear to work better if youth know how to refuse cigarettes from peers. Thus, to enhance the effectiveness of these ads, they should be supplemented with in-school programs that teach youth these skills.

As mentioned above, ads that evoke empathy, instead of fear, can increase the persuasiveness of disease ads for youth(4). The youth audience has to be able to personally relate to the ads in order to respond to the messages. Ads that feature the long-term effects of smoking are more influential on adolescents who have personal experience with the disease represented in the ads, such as a friend or family member who has suffered or is suffering from the condition(1).

However, for youth who do not have personal experience with smoking-related diseases, the presence of a peer or someone slightly older in age that can act as a role model in the ad can increase responsiveness and help the young audience relate to the message. Anti-smoking ads that feature attractive models also lower smoking intent more than ads with unattractive models (7). Many studies have stressed the importance of testing the effectiveness of ads on focus groups to ensure that they work on their target audience before distributing them.

REFERENCES:

1. Goldman LK, Glantz SA. Evaluation of Antismoking Advertising Campaigns. JAMA 1998; 279: 772-777.

2. Agostinelli G, Grube JW. Tobacco Counter-Advertising: A Review of the Literature and a Conceptual Model for Understanding Effects. Journal of Health and Communication 2003; 8: 107-127.

3. Biener L, Wakefield M, Shiner CM, Siegel M. How Broadcast Volume and Emotional Content Affect Youth Recall of Anti-Tobacco Advertising. Am J Prev Med 2008; 35 (1).

4. Shen L. The Effectiveness of Empathy- Versus Fear-Arousing Antismoking PSAs. Health Communication 2011; 26: 404-415.

5. Leshner G, Bolls P, Wise K. Motivated Processing of Fear Appeal and Disgust Images in Televised Anti-Tobacco Ads.

6. Pechmann C, Zhao G, Goldberg ME, Reibling ET. What to Convey in Antismoking Advertisements for Adolescents: The Use of Protection Motivation Theory to Identify Effective Message Themes. Journal of Marketing 2003; 67: 1-18.

7. Shadel WG, Fryer CS, Tharp-Taylor S. Uncovering the most effective active ingredients of antismoking public service announcements: The role of actor and message characteristics. Nicotine & Tobacco Research; 11 (5); 547-552

Bad Influence – img12726

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Many anti-smoking advertisements use children as a motivation for adults to quit smoking. The two most common themes in this category are 1) your children are suffering from your secondhand smoke, and 2) that you are being a poor role model for your children.

These ads remind smokers that their “choice” to smoke not only negatively affects themselves as individuals, but also harms innocent bystanders and those whom the smokers love most.

Children are particularly vulnerable because they have no say in the smoking habits of the adults in close proximity to them. Children exposed to secondhand smoke wheeze and cough more often, get sick more often, and experience more frequent and more intense life-threatening asthma attacks than children not exposed to secondhand smoke. (1)

Other ads in this category concentrate on the example smokers set for their children. Multiple studies have shown that children whose parents smoke are much more likely to start smoking themselves than are their peers. These ads thus force smokers to think about the consequences of smoking not just for themselves, but for others as well.

While the primary goal of these ads is to increase the number of adult quitters, the ads may also have cascading effects on adolescents. Unfortunately, literature on the effectiveness of these children-themed ads on adult quitting rates is lacking, and there has not been extensive research on whether the ads persuade adults to talk to their children about smoking.

However, there is research on how parental smoking and parental behaviors affect smoking behaviors in children. Smoking socialization, which can include both directly transmitted knowledge of smoking through parental conversations with children and indirectly transmitted knowledge through parental smoking habits, has been shown to influence children’s future smoking habits. Exposure to second-hand smoke and a lack of anti-smoking expectations and smoking-specific rules are parenting behaviors associated with current smoking in adolescents and the likelihood of children to pick up smoking later in life.

Interestingly, one study noted that while parenting behaviors had a significant impact on smoking patterns in adolescents, actual parental smoking did not (2). The results of this study suggest that perhaps ads that focus on the health of children should be supplemented with parenting advice for adult smokers. A second study also supports the claim that “higher quality” parenting, which in this case was defined as “positive in affect and tone, responsive, directive, and empathetic,” was associated with a lower likelihood of smoking initiation in adolescents, further indicating the importance of smoking socialization between parent and child (3).

Though the primary purpose of these children-themed ads may not be to prevent smoking in adolescents, the ads may raise awareness in families about the influence parents can have on their children’s smoking behaviors. If these ads are supplemented with support and advice on parenting and how to talk to children about smoking, they may have the potential to reduce smoking not just in adults, but also in adolescents as well.

REFERENCES:

1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General: Secondhand Smoke: What It Means To You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2011 Mar 11].

2. Waa A, Edwards R, Newcombe R, Zhang J, Weerasekera D, Peace J, McDuff I. Parental behaviors, but not parental smoking, influence current smoking and smoking susceptibility among 15 and 15 year-old children. Aust NZ J Public Health 2011; 35: 530-536.

3. Richmond MJ, Mermelstein RJ, Wakschlag LS. Direction Observations of Parenting and Real-Time Negative Affect Among Adolescent Smokers and Nonsmokers. Journal of Clinical Child & Adolescent Psychology 2012; 0:1-12.

 

Brazil – img12827

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It is known that smoking cigarettes has numerous harmful effects on people’s health, and one tactic used to dissuade people from smoking is explicitly stating these effects on cigarette boxes via warning labels. People are more likely to see an anti-smoking message if it is present in the form of a label right on the outside of the cigarette box they are holding, which is why these pack warning labels can be an effective form of advertising.1

They can be text-only, like the ones on Winston cigarettes boxes in the UK that say “Smoking seriously harms you and others around you,” or also include graphic images, such as the ones in Brazil that include images ranging from a stillborn baby to a dismembered and blackened foot. One study “found that 50 percent of subjects remembered the text-only warning label, while 83 percent correctly recalled the label that contained a graphic image,” so it is a more effective advertising strategy to incorporate pictures on labels because the message will then be more memorable. In fact, “research on pictorial warnings show that they are: (i) more likely to be noticed than text-only warning labels; (ii) more effective for educating smokers about the health risks of smoking and for increasing smokers’ thoughts about the health risks; and (iii) associated with increased motivation to quit smoking.”2 Pictorial labels are also more effective at raising awareness of the health effects of smoking in areas with low literacy rates.2

However, a study on the effectiveness of Canadian warning labels shines light on the big issue of whether or not people stop to read and think about the warning labels, as people who do so are the ones who are “significantly more likely to either quit, attempt to quit, or reduce their smoking.”3 Another issue that is often brought up is the defensive and avoidant behavior that pictorial images may elicit, but in reality, “such reactions are actually indicators of positive impact” caused by the presence of graphic images.2

Resources:

1. http://www.cbsnews.com/news/study-graphic-tobacco-warning-labels-more-effective-at-delivering-anti-smoking-message/

2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2733253/

3. http://tobaccocontrol.bmj.com/content/12/4/391.full.html

Growing Up In Smoke – img12741

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Many anti-smoking advertisements use children as a motivation for adults to quit smoking. The two most common themes in this category are 1) your children are suffering from your secondhand smoke, and 2) that you are being a poor role model for your children.

These ads remind smokers that their “choice” to smoke not only negatively affects themselves as individuals, but also harms innocent bystanders and those whom the smokers love most.

Children are particularly vulnerable because they have no say in the smoking habits of the adults in close proximity to them. Children exposed to secondhand smoke wheeze and cough more often, get sick more often, and experience more frequent and more intense life-threatening asthma attacks than children not exposed to secondhand smoke. (1)

Other ads in this category concentrate on the example smokers set for their children. Multiple studies have shown that children whose parents smoke are much more likely to start smoking themselves than are their peers. These ads thus force smokers to think about the consequences of smoking not just for themselves, but for others as well.

While the primary goal of these ads is to increase the number of adult quitters, the ads may also have cascading effects on adolescents. Unfortunately, literature on the effectiveness of these children-themed ads on adult quitting rates is lacking, and there has not been extensive research on whether the ads persuade adults to talk to their children about smoking.

However, there is research on how parental smoking and parental behaviors affect smoking behaviors in children. Smoking socialization, which can include both directly transmitted knowledge of smoking through parental conversations with children and indirectly transmitted knowledge through parental smoking habits, has been shown to influence children’s future smoking habits. Exposure to second-hand smoke and a lack of anti-smoking expectations and smoking-specific rules are parenting behaviors associated with current smoking in adolescents and the likelihood of children to pick up smoking later in life.

Interestingly, one study noted that while parenting behaviors had a significant impact on smoking patterns in adolescents, actual parental smoking did not (2). The results of this study suggest that perhaps ads that focus on the health of children should be supplemented with parenting advice for adult smokers. A second study also supports the claim that “higher quality” parenting, which in this case was defined as “positive in affect and tone, responsive, directive, and empathetic,” was associated with a lower likelihood of smoking initiation in adolescents, further indicating the importance of smoking socialization between parent and child (3).

Though the primary purpose of these children-themed ads may not be to prevent smoking in adolescents, the ads may raise awareness in families about the influence parents can have on their children’s smoking behaviors. If these ads are supplemented with support and advice on parenting and how to talk to children about smoking, they may have the potential to reduce smoking not just in adults, but also in adolescents as well.

REFERENCES:

1. U.S. Department of Health and Human Services. The Health Consequences of Involuntary Exposure to Tobacco Smoke: A Report of the Surgeon General: Secondhand Smoke: What It Means To You. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2006 [accessed 2011 Mar 11].

2. Waa A, Edwards R, Newcombe R, Zhang J, Weerasekera D, Peace J, McDuff I. Parental behaviors, but not parental smoking, influence current smoking and smoking susceptibility among 15 and 15 year-old children. Aust NZ J Public Health 2011; 35: 530-536.

3. Richmond MJ, Mermelstein RJ, Wakschlag LS. Direction Observations of Parenting and Real-Time Negative Affect Among Adolescent Smokers and Nonsmokers. Journal of Clinical Child & Adolescent Psychology 2012; 0:1-12.