Study: Graphic images deter smokers

Nov 15, 2010

Highly graphic images of the health consequences of smoking have the greatest impact on smokers' intentions to quit, according to a study by researchers from the University of Arkansas, Villanova University, and Marquette University.

The study will appear in the fall issue of the Journal of Public Policy & Marketing.

The findings support the U.S. FDA's recent announcement that starting in 2011 it will require larger warnings and graphic images of the negative effects of tobacco consumption on all cigarette packages and in all cigarette advertising. Canada, Australia, and many European countries already use strong written messages and graphic images on cigarette packages.

Scot Burton, MBA, PhD, a marketing professor at the University of Arkansas; Jeremy Kees, PhD, and John Kozup, PhD, marketing professors at the Villanova University; and Craig Andrews, MBA, PhD, a marketing professor at Marquette University, developed the study to help officials at the FDA and the U.S. Department of Health and Human Services better understand what types of pictorial warnings are most effective and why they are effective.

In the study, 511 adult smokers, all members of a Web-based research panel, were shown one of four different types of warning information on cigarette packages. These included one of three photographs along with this written message: "WARNING: Smoking Causes Mouth Diseases." The fourth package included the written message with no picture. The warning information covered approximately 40% of the entire package. Participants were asked questions concerning their opinions about the cigarette package and intentions to quit smoking.

The researchers chose images illustrating tobacco's effect on oral diseases, which yield the most externally visible health consequence. They started by using images that ranged from highly graphic -- vivid and powerful images of advanced mouth cancer -- to less graphic -- photographs of stained teeth caused by nicotine.

Participant responses indicated that pictorial warnings had a significantly positive effect on smokers' intentions to quit. The researchers found that the graphic images evoked fear, which in turn served as the primary underlying mechanism explaining the effects of the pictorial warnings. As depictions of the consequences of smoking were presented more graphically, smokers reported higher levels of fear, Burton said.

The most graphic images, such as those showing severe mouth diseases, including disfigured, blackened, and cancerous tissue, evoked fear about the consequences of smoking and thus influenced consumer intentions to quit.

"These results suggest that there appears to be little downside on intentions to quit from using extremely graphic pictorial depictions of the negative health outcomes due to smoking," Burton said in a press release. "Our research shows that strong, negative graphic imagery -- and fear evoked from such imagery -- influences smokers' intentions to quit. We also found this to be the case even though recall of the written messages on package labels was reduced by the more graphic images. In other words, smokers were influenced primarily by the images and not by the written message."