Joanna Athina Lau

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“Why graphic warnings on cigarette packs may not be effective in reducing smoking behavior?”

“Why graphic warnings on cigarette packs may not be effective in reducing smoking behavior?”

Smoking behavior is one of the main public health concerns because it is one of the leading causes of preventable death in the world (World health Organization, 2013). By 2016, it has been reported that the diseases associated with smoking are listed in the top 10 causes of global deaths, with ischemic heart disease accounting for almost 10 million deaths and lung cancer 1.7 million deaths (Who, 2018). Furthermore, chronic diseases associated with smoking may not only affect smokers themselves but even non-smokers can be at risk of lung cancer due to second-hand smoke (Asomaning et al., 2008; Besaratinia and Pfeifer, 2009Hori et al., 2016).

Why do we use graphic warnings on cigarette packs?

Numerous studies suggest that graphic warnings were more effective than text warnings in promoting fear and increasing one’s intention to quit smoking (Brewer et al., 2016; Noar et al., 2015). Based on 32 studies from 20 countries with over 800,000 participants, it has been suggested that strengthening cigarette pack warnings (with the majority using graphic warnings) can promote awareness about the risks of smoking, provide quitline knowledge, increase the use of quitlines, reduce smoking behavior, promote attempts to quit, increase short-term smoking cessation, and reduce prevalence of smoking (Noar et al., 2016).

Why don’t they have any effect on some smokers?

Although the majority of studies support that graphic warnings are effective in increasing the intention to quit smoking, they often fail to measure the actual change in behavior. Having the intention does not necessarily mean actually doing it. There can be several reasons to why the gruesome images may not have any impact to some people..

●  Reviews of fear appeal research suggests that graphic warnings can be counterproductive and promote a defensive reaction because they elicit fear but provide no information on how to deal with it or change their smoking behavior (Peters, Ruiter, & Kok, 2013; Ruiter, Kessels, Peters, & Kok, 2014).

●  Smokers are more likely to disengage as a defensive reaction to high-threat information (Kessels, Ruiter, & Jansma, 2010).

●  Too much fear due to very intense graphic imagery is not always the best. It can be too overwhelming and the ‘shock’ can lead people to not want to process the information they just read or seen (Kees et al., 2010). When eliciting fear it has been suggested that it should be done in a way that readers are still comfortable enough to think through it.

  Being exposed to graphic warnings over time can lead to desensitization; the effects of warnings may partially wear out over time which leads to the need of constant change on the image and type of information (Li et al., 2015; Borland et al., 2009).


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