Which is more likely to convince a smoker to quit? The words, "Warning: cigarettes cause cancer" beneath the image of an open mouth with a cancerous lesion and rotten teeth, or the same image with the words, "Warning: Quitting smoking reduces the risk of cancer"?
The answer depends on how confident you are in your ability to quit, according to a study led by researchers at Georgetown Lombardi Comprehensive Cancer Center and published in the journal Nicotine & Tobacco Research.
The research, which involved 740 participants and three D.C. area institutions, suggests that a mix of messages might work best to help convince some of the 45 million smokers in the U.S. to give up the habit, says the study's lead investigator, Darren Mays, PhD, MPH, a Georgetown Lombardi population scientist who specializes in behavioral cancer prevention.
The study found that "gain-framed" messages - those that stressed the benefits in quitting, such as "quitting smoking reduces the risk of death due to tobacco" - were more effective for smokers who believed quitting would be hard.
On the other hand "loss-framed" messages - the ones that emphasized the negative outcomes from smoking, such as "smoking can kill you" - were more effective for smokers who thought they could quit when they wanted.
Most of the warnings used now on tobacco packages in the U.S., and worldwide, are loss-framed messages, which may not be sufficiently convincing to many smokers, says Mays. "This study shows us that leveraging both gain- and loss-framed messaging may prompt more smokers to quit," he says.
Mays and his colleagues undertook the study to build the evidence base for the new graphic warnings proposed for U.S. cigarette packages. The 2009 Family Smoking Prevention and Tobacco Control Act authorized the U.S. Food and Drug Administration (FDA) to regulate tobacco products, and required new pictorial labels for cigarette packs.
Tobacco industry lawsuits, however, have delayed implementing the new pictorial warning labels, and in 2012, the U.S. Court of Appeals struck down the nine pictorial warnings proposed by the agency. The FDA is currently pursuing additional research to support implementation of the warning label requirements.
Mays and colleagues chose to study the impact of four pictorial pictures - a man using a breathing apparatus; two sets of lungs, one healthy and one diseased; a prone man with stitches on his chest lying on a white sheet; and the cancerous mouth- with loss-frame or gain-framed messages. Each was effective.
"Leveraging policies such as graphic warnings for cigarette packs to help smokers quit is critical to improve public health outcomes. Our study shows that that framing messages to address smokers' pre-existing attitudes and beliefs may help achieve this goal," says Mays.
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