Will New Cigarette Warnings Work?

Can graphic displays of tobacco's ravages provoke veteran smokers to quit and reduce youth smoking? The FDA explains, according to the Washington Post,

Although smoking rates have dropped in the United States, about 20 percent of adults and high school students smoke, and tobacco remains the leading cause of premature and preventable death in the country, causing 443,000 deaths each year and one-third of all cancer deaths. An estimated 4,000 youths try a cigarette for the first time each day, and 1,000 become regular smokers.

The proposed warnings include one containing an image of man smoking with a hole in his throat from a tracheotomy; another depicts a body with a large scar running down the chest, and another shows a man who appears to be suffering a heart attack. Others have images of diseased lungs and stained teeth and mothers blowing smoke into a baby's face.

The logic is that if glamorous images hook smokers, especially teenagers, then the ugly truth will deter them. But will it work? There's evidence it may backfire.

Last year in Miller-McCune magazine, Tom Jacobs summarized behavioral research on warning labels based on an ominous-sounding but increasingly popular concept in social psychology, Terror Management Theory:

The threat to one's life would presumably result in an urge to pump up one's self-esteem -- which, for those individuals, could easily mean a renewed commitment to smoking.

To test this concept, the researchers conducted a study of 39 smokers, ranging in age from 17 to 41. Participants filled out a questionnaire designed to measure the degree to which they base their self-esteem on smoking. They then were presented illustrations of a cigarette pack containing a warning message.

Half of them read warnings that spoke of the life-threatening consequences of smoking, such as "Smoking leads to deadly lung cancer." The other half read warnings that did not involve mortality, such as "Smoking makes you unattractive."

Following a 15-minute delay in which participants answered questions unrelated to smoking (so that the warning messages would leave their conscious minds), they answered a final set of questions including "Do you enjoy smoking?" "How important is smoking to you?" and "Are you going to smoke a cigarette directly after this study?"

The researchers found that, among those who associated smoking with self-esteem, the death-related warnings actually led to more positive attitudes toward cigarette use. They concluded the smokers clung more tightly to their habit as "a strategy to buffer against existential fears provoked by death-related warning messages."

On the other hand, for these same people, the non-death-related warnings had a dampening effect on attitudes toward smoking. Warnings that smoking makes one less attractive "may be particularly threatening to people who believe the opposite," [Dr. Joachim Hansen and his collaborators] report.

Actually Death Cigarettes were a popular novelty brand in England in the 1990s. Wouldn't it be better to have, say, quit-smoking toll-free numbers in ultra-bold print, and other links to anti-smoking resources? We need not blows to the solar plexus, but the same sophistication and ingenuity that promoted the cigarette habit to begin with.