Monday, October 3, 2011

When cigarette warnings backfire

Cigarettes are a clear public health problem.  A significant number of people who smoke regularly throughout their lives will develop serious health problems including lung cancer, heart disease and emphysema.  And for 30 years now, governments around the world have worked to change people’s attitudes toward smoking.  Indeed, the US government wants to institute a number of graphic new warning labels on cigarette packages to deter smokers.

There are two classes of measures that have been taken to fight smoking (and related public health problems like alcohol and unhealthy eating).  One is to make smoking less attractive in the short-term to counteract the positives of smoking.  The other is to provide warnings about the dangers of smoking.

As I have written before in previous entries, one reason why smoking is so difficult to quit is that it provides some pleasure in the short term (and for the addicted smoker also the absence of painful cravings).  The health risks are in the long-term and so they have a weaker pull over current behavior.  Thus, measures like making it illegal to smoke indoors in public places and raising the price of cigarettes through taxes are aimed at decreasing the pleasure of smoking in the short term.

The other major public health initiative is to influence the information that is available about smoking.  For example, in the US, there are very few venues in which cigarette manufacturers are allowed to advertise, and so there are few positive messages about smoking in mainstream media.  In addition, by law, cigarette packs have to come with a warning about the dangers of smoking.

A paper by Jochim Hansen, Susanne Winzeler, and Sascha Topolinski in the January 2010 issue of the Journal of Experimental Social Psychology examined the effectiveness of these warnings on the attitudes of smokers toward smoking. 

The authors reasoned that there are two kinds of smokers.  Some smokers find that smoking is an important part of their self concept.  They are truly smokers.  Other people smoke cigarettes, but that is not an important part of their self-concept.  They do not identify strongly as smokers. 

There are also two kinds of warnings that are often given about smoking.  Some of those messages are about the negative social consequences of smoking.  For example, a warning might point out that “Smoking makes you unattractive.”  Most of the warnings that actually appear on cigarette packs tend to focus on the danger of death associated with cigarettes, issuing warnings like “Cigarettes are dangerous for your health” or “Cigarettes cause lung cancer.”   

In other posts, I have discussed the idea of mortality salience:  that being reminded of your own mortality can affect your self-esteem.  Hansen and colleagues reasoned that a cigarette warning that highlights that cigarettes may cause death could actually backfire.  When someone identifies strongly as a smoker, then a warning that focuses on mortality can threaten that person’s self-esteem.  Because they identify strongly as a smoker, the easiest way to boost their self-esteem is to increase their favorable attitude toward cigarettes.

To test this hypothesis, a number of cigarette smokers were tested.  Some of these people were ones for whom smoking was an important part of their self-concept, while others were ones for whom smoking was not that important to their self-concept.  The smokers read either a warning that talked about how smoking decreases a person’s attractiveness or a warning that talked about how smoking causes death.  Later, these people rated their attitude toward smoking. 

As these researchers predicted, if people thought smoking was an important part of their self-concept, they rated smoking as much more attractive if they read a warning that focused on death than if they read a warning focused on attractiveness.  That is, for the group of smokers whose identity is bound up with smoking, the kinds of warnings that are typically shown on cigarette packs actually backfire.

This research suggests the importance of gathering evidence about programs that relate to the behavioral aspects of public health problems.  On the surface, nobody could oppose big warnings on cigarettes that trumpet their health risks.  However, we must be careful, because these warnings could actually do more harm than good.