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.
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