Freakonomics Poll: Will New Cigarette Warning Labels Reduce Smoking?

Photo: kadavy

Soon, new warning labels on cigarette packs will have even scarier messages, and photos too. Canada has been doing this for years. Will it reduce smoking?

Here are three quick thoughts.

1)    I strongly doubt it will increase the quantity of information about smoking. Folks know it is bad for you already.

2)    This does not mean it won’t work. Maybe people try to forget the health risks in that moment of passion (folks know birth control helps prevent pregnancy, but similarly, when faced with impending temptations, magically forget such trivial details). Will these photos remind them at that moment of temptation? Maybe. Or maybe it will increase how often their kids or friends give them grief for it, thus creating some social pressure to stop. Naturally there is a counter-argument, that this may enhance teenage smoking, if “being bad” makes it cooler.

3)    We do have some related evidence on this. It doesn’t bode well for the messages and photos. A few years ago Levitt blogged here about a commitment contract randomized trial I did in the Philippines. The commitment contracts worked great to reduce smoking for those who would sign a contract (disclosure: these contracts are designed similarly to stickK.com, a corporate wellness program and personal behavior modification website I co-founded with Ian Ayres, except minus the internet). And 11% signed a contract, which is really high for any consumer products or services firm, but low if your goal is to eliminate smoking entirely.

The commitment contracts treatment arm was the main point, but there was a placebo group which didn’t get much attention. Messages and photos!

A group also received a card to keep in their wallet or home. The card had nasty photos of black lungs and throat cancer. Spot checks conducted during the study found that folks knew where their card was, they didn’t just throw it away.

 

After one year, we found that the cue card barely made a dent in smoking, a reduction of 0.9 percentage points (at 95% confidence, +/- 3.1 percentage points). At six months the point estimate was slightly higher (1.5 – 2.2 percentage points), but still not statistically significant. Hardly a resounding success, and a decently small confidence interval, so the null effect we believe was truly a sign of an ineffective treatment.

In fairness to the CDC’s new messages and photos, this was not the same as putting the messages and photos on the cigarette packages themselves. There is a constancy in putting it on the packages themselves that maybe is essential to make this work? (Although I also suspect this policy will now create a new line of products for cigarette package covers, to cover up the nasty photos. This could be like a new fashion statement, changing every week with your ringtone.)

There is hope though: another study, here, found that sending frequent text messages to encourage individuals to stop smoking had a big effect. The timing here is different, and in a potentially important way. These messages came throughout the day, not at the moment of passion. Imagine sending someone frequent messages throughout the week to practice safe sex, compared to just tapping someone on the shoulder immediately before the act to remind them. I strongly suspect the former would be more effective than the latter.

So what will the net effect be, fewer smokers or more smokers?

Will more graphic warning labels and pictures on cigarette packs

View Results

Loading ... Loading ...

Leave A Comment

Comments are moderated and generally will be posted if they are on-topic and not abusive.

 

COMMENTS: 36


  1. jim says:

    people know by now what they’re doing to their bodies. they either don’t care or are addicted. this is pointless stuff to change(the new warning lables), but it can’t hurt either.

    Thumb up 1 Thumb down 4
    • Nikki says:

      Or addiction is not really an addiction but part of identity and attention now is more important than health damage in the future (which may not happen at all if you die from other causes before that future arrives). People love being addicted. They don’t just like coffee: it’s their brain in the cup! They don’t just like Apple products: they’ll not use a Blackberry even if it’s all they’ve got on a desert island and their life depends on it! Both are actual statements, I’m not making this up. I knew a grown-up person who assured everyone she was literally unable to drink tea from a cup, so she drank it from a saucer. Nobody gave a darn. She magically learned to use cups. So I suspect shrug-and-move-on may be a better policy for curing some other addictions as well.

      Thumb up 0 Thumb down 2
      • ThatMattGuy says:

        “People love being addicted.” That may be the stupidest thing ever said or written. Refusing to use anything but an iPhone and being addicted to a drug aren’t even in the same sport, let alone ballpark. (Hint: the iPhone thing isn’t an addiction. It’s a preference. A preference over everything else but a preference nonetheless.)

        Thumb up 1 Thumb down 3
    • Nazumi says:

      Okay first off you can’t make anyone quit or try to cinconve anyone to quit. The only way to quit is because that person WANTS to quit. I was a smoker for years and it took alot of self disaplin to actually quit. I have quit for a long time and I still think about smoking and every few months I will have a drag or two. Once your addicted to cigarettes you are addicted for life. Especially when your stressed out they calm you down and help you relax. But you can go from smoking to the E cigarette. It’s electrical and not as bad. It’s still nicotine but it doesn’t have the nasty smoke or nasty smell and doesn’t have carbon monoxide and all that other gross stuff. It would be at least a start

      Thumb up 0 Thumb down 0
  2. Mike B says:

    Why are we trying to reduce smoking again? Declines in smoking have been associated with obesity, increased Medicare costs and pension fund insolvency. The only reason government and industry were able to promise such lavish retirement benefits in the first place was because smoking tended to kill people at or before the retirement age.

    Hot debate. What do you think? Thumb up 12 Thumb down 13
    • Nanno says:

      Here in Europe the U S of MackeyD, BK and KFC is associated with obesity and smoking with increased healthcare costs.

      Thumb up 4 Thumb down 1
      • Nanno says:

        I might actually be wrong…

        herewith healthcare costs (in the Netherlands) attributed to risk factors by gender in millions of Euros (in 1999).

        Man Woman Total
        Smoking 334,1 174,6 508,7
        Obesity 257,9 247,4 505,4

        http://www.kostenvanziekten.nl/object_binary/o3366_kvz_folder.pdf (table 3 and 4)

        Damn obese women screwing up my (point of) view. (not going to bother finding out whether there were more smoking or obese people in 1999)

        Thumb up 1 Thumb down 1
  3. BL1Y says:

    Why are we putting forward explanations for why it would or would not reduce smoking, when we can just look at 43 countries that already do this and ask has it actually reduced smoking?

    It looks like there’s pretty wide spread evidence that these campaigns cause smokers to either reduce how much they smoke, or increase the chance they will try to quit. http://www.tobaccofreekids.org/research/factsheets/pdf/0325.pdf

    The argument against the labels isn’t that they might be ineffective, but that they go too far in interfering with free enterprise. It’s pretty hard to brand and market your product, when that much of the packaging is taken up by a warning (and I suspect that’s a large part of the motivation to have this type of warning, since branding it very important to cigarette companies).

    Well-loved. Like or Dislike: Thumb up 9 Thumb down 1
  4. Tedy Acosta says:

    what about the non-smokers youth? dont you think this photos and messages frightened enough to even try??

    Thumb up 4 Thumb down 0
    • Mark_H says:

      My thought exactly. The end of the linked CNN article says:

      “Every day of the year approximately 2,200 adults — who presumably have heard about the health hazards their entire lives — begin, for the first time, to smoke cigarettes on a daily basis.”

      It’d be hard to believe that these types of ads wouldn’t have any effect on them.

      Thumb up 2 Thumb down 0
  5. Daniel says:

    Here in Chile we’ve had this campaign since a couple of years, 50% of the package must come with the nasty warnings. Now the cigarettes come with a sheet (with 50% nasty photos) that you fold in half, insert outside the box but inside the plastic to cover the warnings.

    Well-loved. Like or Dislike: Thumb up 5 Thumb down 0
  6. Nabeel says:

    I think the main affect will be in cigarette boxes sales.

    Thumb up 1 Thumb down 0
  7. Nanno says:

    The Dutch government subsidizes tools to help you quit smoking since January 1, 2011 and research has show that we had a 25% drop in smokers to reach an all time low. However, since it is too costly they will reduce it in 2012 and fully stop subsidizing in 2013.
    stats are found here: http://www.depers.nl/binnenland/588469/Aantal-rokers-lager-dan-ooit.html
    more on topic: Studies in France, Scotland and Belgium have shown that generic packs will make smoking less attractive for non-regular smokers and especially for adolescents. Secondly they have shown that the health-warnings become more noticeable. And third they supposedly look more ‘unreliable, cheap and of lesser quality’. Therefore the Association of European Cancer Leagues wants the European Committee to make generic packaging (no logo’s, brand colors, brand name in a ‘neutral font’) mandatory.
    http://www.ad.nl/ad/nl/1015/Gezondheid-wetenschap/article/detail/1886377/2011/01/12/Oersaaie-pakjes-maken-roken-onaantrekkelijk.dhtml?redirected

    I personally think this will work much better, especially for adolescents (which should be the primary target), in discouraging people to start smoking and “making it less cool”

    Well-loved. Like or Dislike: Thumb up 6 Thumb down 0
  8. Brad says:

    Dennis Leary was right – you could name your cigarettes “Tumors” and put a skull and crossbones on the pack and people would still smoke. There are too many “other” reasons for people to smoke to have this change human behavior. Noble effort, however.

    Thumb up 3 Thumb down 3
  9. rationalrevolution says:

    Well I take issue with the wording of the poll. Since the size of the population is growing, the NUMBER of smokers could increase while the rate of smoking still goes down.

    In addition to that, the rate of consumption could go down even if the percentage of people who smoke stays the same if they change their habit from a pack a day to 3 or 4 a day.

    So I think that the poll is too simplistic.

    Do I think that the images will reduce the rate of cigarette consumption? Yes.

    That may or may not translate into fewer actual smokers though.

    Having said that, I do take issue with these images because I think they could be counter productive even if they work a little bit, because they are lies and people figure that out and then the message becomes less trustworthy. They are lies in the sense that the images are of people whose conditions are caused simply by smoking. A picture of the mouth of a homeless crack addict who smokes implying that anyone who smokes will end up like that is a lie.

    As an example, in high school were were repeatedly told that pot was some horrible drug that would cause you to go crazy, would lead to brain damage, would destroy your life, would cause you to do horrible things, etc. all in attempts to scare kids away from it.

    Now maybe it did scare some kids away, but for the ones to tried it anyway they quickly learned that that was all BS and that pot didn’t do any of those things. The next logical conclusion what that everything you had been told about recreational drugs was all lies. Which leads to then believing that cocaine and heroin and pcp, etc. were all perfectly safe too.

    So this is the problem I have, and we see this a lot in religious messaging too, where prohibitions against something are made using exaggerated claims, which may work for some people, but then drives many other people in the opposite direction as they correctly conclude that they are being lied to.

    So, while I support the principle of this anti-smoking campaign, I think that the distortions made by the campaign will have a back-firing effect, even if, on net it causes some modest reduction in behavior (and I think it will) it will end up with conflicting effects and have some reinforcement effect, which I suspect will spill over into other areas leading to further distrust of government and what are many other reasonable claims. For example if could lead some people to then take warnings about alcohol, food, and other drugs less seriously as well.

    This would be a thing to study. For the people who continue smoking after these warnings are put on, do they then adopt more harmful consumption patterns, out of a belief that “its all bullsh*t”.

    BTW, I have never smoked in my life and think its disgusting. The reason I never smoked as a teen was because I was (and remain) massively anti-corporate and saw smoking as simply form of corporate slavery and thought it was idiotic to give money to a bunch of lying rich bastards. Now I still feel that way, but am even more repulsed by the health effects and just because they are nasty.

    Thumb up 4 Thumb down 2
  10. Dave says:

    Unlikely.

    In short, the fMRI results showed that cigarette warning labels not only failed to deter smoking, but by activating the nucleus accumbens, it appeared they actually encouraged smokers to light up.

    See the rest here: http://www.farnamstreetblog.com/will-new-tobacco-labelling-with-gross-images-decrease-consumption/

    Thumb up 1 Thumb down 0
    • Nanno says:

      Interesting article, however, I’m surprised they didn’t consider (or at least state in this article) whether the association with smoking (whether it is the sight of a package or a warning label or being told the consequences of smoking) might already be enough to activate the nucleus accumbens. To be honest I just went for a smoke after reading (and commenting on) this blog.

      Don’t you think that talking about smoking to a smoker makes him want to smoke (e.g. activate his craving/nucleus accumbens)?

      Thumb up 1 Thumb down 0
  11. Dan says:

    Australia has been using these images for several years now. From my personal experience the images in combination with tougher laws (we couldn’t smoke in pubs anymore) helped me and several of my friends quit. Every time I went to smoke I had a horrible visual association with the results of contining to smoke. At first we joked about the images, but eventually they had the desired effect of making me feel ill when reaching for a pack. The thought of looking like that or going through that pain in the future made me feel sick. And the thoughts were very hard to escape because of the graphic images on every pack. Personally I feel the images played a large part in helping me quit. And subsequently I have enjoyed a much higher standard of living for the last 5 years. I truely believe they are worth while and if it has a positive impact on just a handful of people then that’s bloody great!

    Well-loved. Like or Dislike: Thumb up 17 Thumb down 0
  12. Agustina says:

    I live in Singapore and cigarette packs are really expensive here and show the picture of a tumour or something that could happen to you as a result of being a smoker, and it didnt have any influence in my smoker friends customs…they were willing to pay for the cigarettes even if a pack was worth 14 sg dollars and also didnt care about the pictures even though they are very disgusting….

    Thumb up 0 Thumb down 0
  13. Ambata says:

    For some reason, this plan reminds of collectible baseball cards included in packs of gum. If enough young people see it as such, buying a pack of cigarettes will become a novelty and, potentially, increase the number of young people smoking. Smoking may not be cool, but disturbing images definitely are in a society where more and more children (young adults) are desensitized to gruesome images.

    Thumb up 4 Thumb down 3
  14. Pablo Benítez says:

    Here in Brazil we are doing it for more than 6 years now and it showed little impact in sales.

    However, about 4 years ago, some cities like Rio de Janeiro and Sao Paulo approved a law where you cannot smoke inside ANY closed public place.

    So, no smoking in restaurants, malls and dance clubs. Since people still want to party, most of us forgot about cigarettes. A few people just go outside to smoke. In most places now you can go dance and come back home without tobacco smell in your clothes.

    Thumb up 1 Thumb down 0
  15. Steve says:

    In the book Buyology by Martin Lindstrom, he does an fmri scan on people’s brains to look at tobacco warning labels, and sometimes these warning labels heighten the craving to smoke.

    Thumb up 0 Thumb down 0
  16. Brett says:

    I read a study 4 or 5 years ago that the best way to keep people. especially young people from doing a harmful activity is not to focus on the harm but to focus on the fact that most people don’t do it.

    Most kids don’t smoke because they like it. They don’t smoke because they want to be “Bad”. They smoke because they think “all the cool kids do it”. Pointing out that the vast majority of the cool kids don’t smoke has a very significant impact.

    Thumb up 2 Thumb down 0
  17. truzo says:

    i couldn’t even read the rest of the article after point 3) because the images are horrendous to look at. And i would often reach for a smoke when I am partying on the weekends. somebody guess the effect on my future partying..

    Thumb up 1 Thumb down 0
  18. laura says:

    Yes, people “know” that it is bad for them, but have no clue *how* bad or addictive it is. Not all risks are of the same magnitude, but we’ve not done a good job of teasing out the distinctions.

    Thumb up 0 Thumb down 0
  19. Ted says:

    I’d suggest these types of warnings would achieve optimal efficacy if accompanied by appropriate price signalling (excise) and education (health ed at school).

    Check out the new labels coming to Australia (assuming the bill, currently before parliament, passes)

    http://www.health.gov.au/internet/ministers/publishing.nsf/Content/mr-yr11-nr-nr064.htm

    Thumb up 1 Thumb down 0
  20. Yefan C. says:

    Many people are skeptical about new policies on smoking, such as the new cigarette package labels mentioned above. It’s true that those who are already addicted may not be too effected since they’ve known the facts all their lives (and still resist them), but for adolescents and emerging young adults who, for the first time, wanted to try a cigarette – it may have a resounding impact. These messages may just curb some potential smokers from ever starting, and every effort should be made to do so.

    Thumb up 0 Thumb down 0
  21. VWVagabonds says:

    Regardless of whether the warnings reduce, increase or have no effect on how many people smoke, they will certainly CAUSE MORE CASES OF CANCER.

    Researchers at the University of California strapped electrodes to the heads of volunteers and told them a mild electric current would be administered to measure the effects of electricity on cognition. The volunteers were warned that they may experience a headache.

    Two thirds of the participants did indeed experience headaches despite the fact that the electricity was never turned on. Such is the power of expectation. The power of the nocebo.

    People will see those grotesque cancerous growth every day and will manifest them in the same way that people receiving a sugar pill manifest the placebo cure for an aliment.

    Thumb up 1 Thumb down 0
  22. Jay says:

    As a young Canadian I can not remember seeing a pack of cigarettes without a warning label (introduced in 1994, updated in 2000). As far as I know, that’s what cigarette packaging looks like. If I took up smoking it would be with a prior understanding of the risks so I can’t imagine those images being effective for young people in my situation. I think the US would see some initial results but nothing longterm.

    Thumb up 0 Thumb down 0
  23. Rajat says:

    Sometimes I wonder if these types of warnings are counter productive. By constantly shoving it in your face, people may choose to ignore them altogether. A person may stop believing any warning, especially if they don’t encounter actual people who got the extreme results.

    Thumb up 0 Thumb down 0
  24. SteveWBCanada says:

    As a long-time Canadian smoker, I believe graphic packages have no effect. I remember the earliest large-print warnings (no photos). There was one that read “Tobacco smoke causes fatal lung disease in non-smokers”. We all joked that that label was our favourite, and we’d ask for it specifically. I remember writing Health Canada and asking how many non-smokers I had actually killed by smoking myself — they didn’t reply. The whole thing showed that somewhere in the Health Canada bureaucracy there was a warning label writer with a great sense of humour (who probably smoked), and a boss who was paying no attention.

    Thumb up 0 Thumb down 0
  25. Carolyn Thomas says:

    An Institute of Medicine study found that 85% of Canadian respondents, who first started seeing graphic warnings in late 2000, used tobacco packages as a source of health information, compared to 47% of American smokers. And there have been actual results in decreased smoking rates (although this could also be credited to a number of anti-smoking campaigns and the general disdain directed at smokers these days!) For example, a 2009 Health Canada study found:

    - 7% decrease in the overall smoking rates from 25% in 1999 to 18% in 2009.
    - 15% decrease in the 15 to 19 year olds who smoke, from 28% in 1999 to 13% in 2009.
    - 7% greater proportion of the population that were never smokers — 49% in 1999 and 56% in 2009

    So contrary to your readers’ poll results here, graphic illustrations do seem to work. Except for diseased body parts – pictures of diseased organs did not have as great an impact as images depicting poor life quality, according to another Health Canada survey in 2009.

    Thumb up 0 Thumb down 0
  26. Jed says:

    I’m from Malaysia and honestly when I was smoking normal ciggies I have never paid attention to those graphic warnings since our Govt launched such packaging back in year 2008. Coupled with the 500% increase of price within 10 years (It was only RM 2.00 for a pack of 20s back in year 1998 when I picked up this habit during my 9th grade) due to revision on taxes also did not deter me from continuing smoking then.

    My fellow smoking cliques then were joking about going to shops to purchase and collect different ciggie brands with different graphic warnings as a form of “collection” and some even requested their favorite brands with specific graphics request when they shop their packs and they parade them when we gather to smoke as if they have gotten their “trophy fix” of the day.

    The conclusion? Nah, it didn’t help at all to deter/reduce smoking. Maybe because of my working environment then, I saw an increase of smokers within my company too.

    Thumb up 0 Thumb down 0
  27. Jon Thomas (@Story_Jon) says:

    I saw these a few months ago in an airport in Mexico for the first time. I’m no fan of smoking and if something could be done to rid the world of them, I’d be all for it. But I’m just a little weary that this approach is enough, or if it’s even fair. I mean, are people really not aware of the negative effects?

    Why stop at cigarettes? Why not warn people about the adverse effects of alcohol? Or Keeping Up with the Kardashians? Or Ke$ha’s music? We mocked up a few of those at our blog here: http://bit.ly/qAloJP

    Thumb up 0 Thumb down 0
  28. Shaun Wilde says:

    In Australia these images have been used for some time and now the government have introduced laws such that the packets are stored out of sight and soon it looks like they will also have to have be sold in plain packaging. These latter rules are supposed to prevent people, especially children, from taking up smoking.

    However I personally don’t know of any smoker that started by buying a packet of cigarettes from a shop, most start when they are given one to try by a friend or relative. If you want young people to not start perhaps we need to stop people from drawing people into their own hhabit; perhaps we should make giving away a ‘ciggy’ a drug dealing offence.

    Thumb up 0 Thumb down 0
  29. Makia says:

    The warning labels apply to only those who can read, understand basic human anatomy and trust the motives the regulators have. Why are there no homocide caused by knife wounds images displayed next to a kitchen knife on display in a mall? Or next to guns for that matter? Will putting pictures of gun shot wounds from sucide victims reduce sucide rates?

    Thumb up 0 Thumb down 0