A new study suggests that graphic warning labels on cigarettes — cadavers, diseased lungs and gums, and smoke drifting around an infant — strike some people as manipulative, a reaction that could backfire on the attempt to steer individuals away from smoking.
The study on the effectiveness of graphic warnings being recommended by the Food and Drug Administration was published online Feb. 22 by University of Illinois researchers at the journal Communication Research.
Lead researchers Nicole LaVoie and Brian Quick said their goal was measuring whether individuals felt their behavioral freedom — also known as psychological reactance — was being threatened by a requirement for graphic warnings on cigarette packaging.
“The perception that the message or source is trying to manipulate you — in this case ‘scare’ you into cessation or maintaining prevention — is heavily tied to reactance and is part of the broader theory of reactance,” said LaVoie, a doctoral student in communications.
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“The more reactant someone is, the more likely they are to attempt to restore their freedom, which they feel has been threatened by a manipulative message,” LaVoie said.
Researchers cited other studies addressing consumer warnings and perceived threats to freedom that cover gun control, legalizing marijuana, condom use, binge drinking, exercise, recycling and sunscreen use.
In the graphic warnings label study, the researchers said “participants did not like the images — reactance was high for all participants exposed to them.”
“The good intentions of this tobacco control measure may be for naught.
“In light of this study’s findings, using graphic warning images on tobacco packaging should be carefully considered before its implementation,” she said.
Lengthy process
It’s been more than three years since there’s been movement on graphic warnings, particularly on what they will look like and when they will appear.
The legal question about the labels seems settled after the U.S. Supreme Court declined in April 2013 to hear an appeal on the images from a group of tobacco manufacturers that include R.J. Reynolds Tobacco Co. and Lorillard Inc.
Nine labels were chosen by the FDA in June 2011. The labels had been scheduled to debut in September 2012.
However, two parallel legal cases with differing judicial opinions have put the initiative on hold.
The Sixth Circuit judges ruled in 2012 that “ample evidence establishes that current warnings do not effectively inform consumers of the health risks.”
The U.S. Court of Appeals in Washington reaffirmed in December 2011 its ruling that the labels violate tobacco companies’ free-speech rights under the First Amendment.
FDA spokesman Michael Felberbaum said last week that “I don’t have any updates to share.”
In December 2010, an FDA study found that putting more graphic-warning labels on cigarette packs may stir the emotions of smokers, but it might not spur them to quit.
Smokers surveyed by the Journal on the subject have said most Americans are too desensitized by images in videos and other media to be fazed by graphic cigarette warnings. Others said they would just buy a slip cover so they don’t have to view the warnings.
Unintended effects
Researchers in the new study on cigarette labeling said 435 young adults between ages 18 and 25 participated in the study, with 17.5 percent of them being smokers during the month in which the research occurred.
About 15.2 percent of adults were considered as smokers during the first quarter of 2015, according to Centers for Disease Control and Prevention.
All participants were given a cigarette package of Marlboro Gold — because of Marlboro’s overall dominant U.S. market share — and a questionnaire to determined their reaction to the package.
Half of smokers and non-smokers were given a package with one of seven FDA-proposed graphic warnings that would cover the top half of packs. The others were given packs with the current text warnings.
“The intention of the pending federal law requiring graphic images on warning labels on cigarette packaging is clearly designed to deter citizens from the dangers of smoking,” the researchers said.
“Cigarette packages containing a graphic image resulted in stronger freedom threat perceptions than cigarette packages without an image.”
LaVoie said that sometimes researchers “don’t remember to look at what else these messages are doing that we’re not thinking about, like causing reactance.”
LaVoie said researchers were surprised that most participants didn’t like the warning labels, “whether they are smokers or nonsmokers.”
“It makes them angry, it makes them express negative thoughts about the packaging, that they’re being manipulated,” LaVoie said.
“Ultimately, it also makes them think that the source — the government in this case, mandating these labels — is being overly domineering, is being too much in their business.”
Other studies
LaVoie said researchers were aware of numerous studies in other countries, such as Australia, where the use of graphic warning labels led to a decrease in adult smoking.
But she said in many instances, the decrease may have been influenced more by excise tax increases on tobacco products and public smoking bans.
Pro-smokeless tobacco advocates say the increasing popularity of electronic cigarettes and vaporizers has contributed significantly to the smoking decrease. Some analysts believe e-cigs and vaporizers will outsell traditional cigarettes in the next five-10 years.
Stephen Pope, managing partner of research firm Spotlight Ideas of London, said most adults are aware of the risks and consequences of smoking.
“So if people chose to smoke, ghastly graphic images will be mentally ignored,” Pope said.
“The idea is to scare people off the product, but I suppose we have to bow to the issue of sensitivity.”
Quick, a professor of communication and a co-author of the paper, said that some individuals not only will react negatively to potential threats to their freedom, “they are going to be more attracted to perform the threatened behavior.”
“We might actually be doing harm to a group that might need the most help if they’re battling an addiction to smoking.”
LaVoie said that by using “fear appeals, graphic imagery and scary warnings, we also risk ‘compassion fatigue.’
“That is when societal patience and desire to help people with addiction (competes with) marginalizing or stigmatizing them, which is highly counterproductive.”