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?

[poll id=”15″]


jim

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.

Mike B

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.

Nanno

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

Nanno

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)

BL1Y

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).

Tedy Acosta

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

Daniel

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.

Nabeel

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

Nanno

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"

Read more...

Brad

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.

rationalrevolution

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.

Read more...

Dave

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/

Nanno

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)?

Dan

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!

Read more...

Agustina

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....

Ambata

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.

Pablo Benítez

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.

Steve

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.

Brett

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.

truzo

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..