Two-thirds of adolescent and young adult smokers become lifetime smokers, and one-half of those lifetime smokers will die from this habit. The authors examine alternative persuasive pathways to thoughts of quitting taken by adolescent and young adult smokers when exposed to graphic visual health warnings on cigarette packages. For adolescent smokers, the authors find that graphic warnings and smoking frequency affect fear, and fear influences negative health beliefs about smoking, ultimately increasing thoughts of quitting. They also find that the graphic warning and a graphic warning × smoking frequency interaction have incremental effects on quit thoughts beyond the effects of fear and negative health beliefs. Using a longitudinal design with a sample of young adult smokers, the authors find support for many of the adolescent smoker findings, particularly the incremental effects of graphicness and its interaction with smoking frequency. These similar results from diverse samples support the use of graphic visual warnings but suggest that effects are attenuated for those who smoke the most. The authors offer implications for countermarketing programs and public health policy.
AndrewsJ. Craig (2011), “Warnings and Disclosures,” in Communicating Risks and Benefits: An Evidenced-Based Users Guide, Baruch FischhoffNoel, BrewerT., and DownsJulie S., eds. Silver Spring, MD: U.S. Food & Drug Administration, 149–61.
2.
AndrewsJ. Craig, NetemeyerRichard G., BurtonScot, Paul MobergD., and ChristiansenAnn (2004), “Understanding Adolescent Intentions to Smoke: An Examination of the Relationships Among Social Influence, Prior Trial Behavior, and Antitobacco Campaign Advertising,”Journal of Marketing, 68(July), 110–23.
3.
ArnettJeffrey Jensen (2000), “Optimistic Bias in Adolescent and Adult Smokers and Nonsmokers,”Addictive Behaviors, 25(4), 625–32.
4.
BettmanJames R., PayneJohn W., and StaelinRichard (1986), “Cognitive Considerations in Designing Effective Labels for Presenting Risk Information,”Journal of Public Policy & Marketing, 5(Spring), 1–28.
5.
BienerLois, JiMing, GilpinElizabeth A., and AlbersAlison B. (2004), “The Impact of Emotional Tone, Message and Broadcast Parameters in Youth Anti-Smoking Advertisements,”Journal of Health Communication, 9(3), 259–74.
6.
BlockLauren G., MorwitzVicki G., PutsisWilliam P.Jr., and SenSubrata K. (2002), “Assessing the Impact of Anti-Drug Advertising on Adolescent Drug Consumption: Results from a Behavioral Economic Model,”American Journal of Public Health, 92(8), 1346–51.
7.
BosterFranklin J., and MongeauPaul (1984), “Fear-Arousing Persuasive Messages,” in Communication Yearbook, Vol. 8, RobertN. Bostrom, and WestleyBruce H., eds. Beverly Hills, CA: Sage Publications, 330–75.
8.
BotvinElizabeth M., BotvinB.J., and BakerEli (1983), “Developmental Changes in Attitudes Toward Cigarette Smokers During Early Adolescence,”Psychological Reports, 53(2), 547–53.
9.
BrownAmy E., CarpenterMatthew J., and SutfinErin L. (2011), “Occasional Smoking in College: Who, What, When and Why?”Addictive Behaviors, 36(12), 1199–1204.
10.
BurkeMarian Chapman, and EdellJulie A. (1989), “The Impact of Feelings on Ad-Based Affect and Cognition,”Journal of Marketing Research, 26(February), 69–83.
ChassinLaurie, PressonClark C., PittsSteven C., and ShermanSteven (2001), “The Natural History of Cigarette Smoking from Adolescence to Adulthood in a Midwestern Community Sample: Multiple Trajectories and Their Psychosocial Correlates,”Health Psychology, 19(3), 223–31.
14.
CostelloDarce M., DierkerLisa C., JonesBob L., and RoseJennifer S. (2008), “Trajectories of Smoking from Adolescence to Early Adulthood and Their Psychosocial Risk Factors,”Health Psychology, 27(6), 811–18.
DumasBethany K. (1990), “An Analysis of the Adequacy of Federally Mandated Cigarette Package Warnings,” in Language in the Judicial Process, JudithN. Levi, and WalkerAnne G., eds. New York: Plenum Press, 309–352.
17.
EaglyAlice H., and ChaikenShelly (1993), The Psychology of Attitudes.Fort Worth, TX: Harcourt Brace Jovanovich.
18.
EmerySherry, WhiteMartha M., and PierceJohn P. (2001), “Does Cigarette Price Influence Adolescent Experimentation?”Journal of Health Economics, 20(2), 261–70.
19.
Family Smoking Prevention and Tobacco Control Act (2009), Pub. Law No. 625 110 U.S.C. § 900-302, June 22.
20.
FarrellyMatthew C., DavisKevin C., HavilandLyndon, MesseriPeter, and HealtonCheryl G. (2005), “Evidence of a Dose-Response Relationship Between ‘Truth’ Antismoking Ads and Youth Smoking Prevalence,”American Journal of Public Health, 95(3), 425–31.
FlynnBrian S., WordenJohn K., Secker-WalkerRoger, PiriePhyllis L., BadgerGary J., CarpenterJoseph H. (2004), “Mass Media and School Interventions for Cigarette Smoking Prevention: Effects 2 Years After Completion,”American Journal of Public Health, 84(7), 1148–50.
24.
HammondDavid, FongGeoffrey T., McDonaldPaul W., CameronRoy, and BrownStephen K. (2003), “The Impact of the Graphic Canadian Warning Labels on Adult Smoking Behavior,”Tobacco Control, 12(4), 391–95.
25.
HarkenLaurel S. (1987), “The Prevention of Adolescent Smoking: A Public Health Policy,”Evaluation and the Health Professions, 10(4), 373–93.
26.
HigginsE. Tory, and BarghJohn A. (1987), “Social Perception and Social Cognition,”Annual Review of Psychology, 38, 369–425.
27.
JamiesonPatrick, and RomerDaniel (2001), “What Do Young People Think They Know About the Risks of Smoking?” in Smoking: Risk, Perception, & Policy, SlovicPaul, ed. Thousand Oaks, CA: Sage Publications, 51–63.
28.
JanisIrving L., and LeventhalHoward (1968), “Human Reactions to Stress,” in Handbook of Personality Theory and Research, EdgarF. Borgatta, and LambertWilliam W., eds. Chicago: Rand McNally, 1041–85.
KeesJeremy, BurtonScot, Craig AndrewsJ., and KozupJohn (2006), “Tests of Graphic Visuals and Cigarette Package Warning Combinations: Implications for the Framework Convention on Tobacco Control,”Journal of Public Policy & Marketing, 25(Fall), 212–23.
31.
KeesJeremy, BurtonScot, Craig AndrewsJ., and KozupJohn (2010), “Understanding How Graphic Pictorial Warnings Work on Cigarette Packaging,”Journal of Public Policy & Marketing, 29(Fall), 265–76.
32.
KellerPunam Anand, and BlockLauren Goldberg (1996), “Increasing the Persuasiveness of Fear Appeals: The Effect of Arousal and Elaboration,”Journal of Consumer Research, 22(4), 448–59.
33.
KellerPunam, and LehmannDonald R. (2008), “Designing Effective Health Communications: A Meta-Analysis,”Journal of Public Policy & Marketing, 27(Fall), 117–30.
KesslerDavid A., NatanblutSharon L., WilkenfeldJudith P., LorraineCatherine C., MaylSharon Lindan, BernsteinIlisa B.G. (1997), “Nicotine Addiction: A Pediatric Disease,”The Journal of Pediatrics, 130(4), 518–24.
36.
KisieliusJolita, and SternthalBrian (1984), “Detecting and Explaining Vividness Effects in Attitudinal Judgments,”Journal of Marketing Research, 21(February), 54–64.
37.
KotlerPhilip, and KellerKevin Lane (2012), Marketing Management, 14th ed.Boston: Prentice-Hall.
38.
KroppRhonda Y., and Halpern-FelsherBonnie L. (2004), “Adolescents’ Beliefs About the Risks Involved in Smoking ‘Light’ Cigarettes,”Pediatrics, 114(4), 445–51.
39.
LeventhalHoward (1970), “Findings and Theory in the Study of Fear Communications,” in Advances in Experimental Social Psychology, Vol. 5, BerkowitzLeonard, ed. New York: Academic Press, 119–86.
40.
LeventhalHoward, and ClearyPaul D. (1980), “The Smoking Problem: A Review of the Research and Theory in Behavioral Risk Modification,”Psychological Bulletin, 88(2), 370–405.
41.
MacKinnonDavid P. (2008), Introduction to Statistical Mediation Analysis.New York: Lawrence Erlbaum Associates.
42.
MayhewKathryn P., FlayBrian R., and MottJoshua A. (2000), “Stages in the Development of Adolescent Smoking,”Drug and Alcohol Dependence, 59(Supplement 1), S61–S81.
43.
McAfeeTim, DavisKevin C., AlexanderRobert L.Jr., PechacekTerry F., and BunnellRebecca (2013), “Effect of the First Federally Funded U.S. Antismoking National Media Campaign,”The Lancet, 382(9909), 2003–2011.
44.
McGuireWilliam J. (1980), “The Communication-Persuasion Model and Health Risk Labeling,” in Product Labeling and Health Risks, MorrisL.A., MazisM.B., and BarofskyI., eds. Cold Spring Harbor, NY: Cold Spring Harbor Laboratory, 99–122.
MoralesAndrea C., WuEugenia C., and FitzsimonsGavan J. (2012), “How Disgust Enhances the Effectiveness of Fear Appeals,”Journal of Marketing Research, 49(June), 383–93.
47.
MyersMatthew L. (2012), “Court Ruling Against Cigarette Warnings Is Wrong on the Science and Law and Should Be Appealed,” Campaign for Tobacco-Free Kids, (August 24), (accessed December 19, 2013), [available at http://www.tobaccofreekids.org/press_releases/post/2012_08_24_decision].
48.
OzanneJulie L., and AndersonLaurel (2006), “In Harm's Way: The Turbulence of Adolescence,” in Advances in Consumer Research, Vol. 33, PechmannCornelia, and PriceLinda L., eds. Duluth, MN: Association for Consumer Research, 12–14.
49.
PassynKirsten, and SujanMita (2006), “Self-Accountability Emotions and Fear Appeals: Motivating Behaviors,”Journal of Consumer Research, 32(4), 583–89.
50.
PechmannCornelia, and ReiblingEllen Thomas (2000), “Planning an Effective Anti-Smoking Mass Media Campaign Targeting Adolescents,”Journal of Public Health Management Practice, 6(3), 80–94.
51.
PechmannCornelia, and ReiblingEllen Thomas (2006), “Antismoking Advertisements for Youth: An Independent Evaluation of Health, Counter-Industry, and Industry Approaches,”American Journal of Public Health, 96(5), 906–913.
52.
PechmannCornelia, ZhaoG., GoldbergMarvin E., and ReiblingEllen Thomas (2003), “What to Convey in Antismoking Advertisements for Adolescents? The Use of the Protection Motivation Model to Identify Effective Message Themes,”Journal of Marketing, 67(April), 1–18.
53.
PeracchioLaura A., and LunaDavid (1998), “The Development of an Advertising Campaign to Discourage Smoking Initiation Among Children and Youth,”Journal of Advertising, 27(3), 49–56.
54.
PetersEllen, RomerDaniel, SlovicPaul, JamiesonKathleen Hall, WharfieldLeisha, MertzC.K. (2007), “The Impact and Acceptability of Canadian-Style Cigarette Warning Labels Among U.S. Smokers and Nonsmokers,”Nicotine & Tobacco Research, 9(4), 473–81.
55.
PettyRichard E., and CacioppoJohn T. (1986), Communication and Persuasion: Central and Peripheral Routes to Attitude Change.New York: Springer-Verlag.
56.
PreacherKristopher J., and HayesAndrew F. (2008), “Asymptotic and Resampling Strategies for Assessing and Comparing Indirect Effects in Multiple Mediator Models,”Behavior Research Methods, 40(3), 879–91.
57.
ProchaskaJames O., and DiClementeCarlo C. (1983), “Stages and Processes of Self-Change of Smoking: Toward an Integrative Model of Change,”Journal of Consulting and Clinical Psychology, 51(3), 390–95.
58.
ProchaskaJames O., and VelicerWayne F. (1997), “The Transtheoretical Model of Health Behavior Change,”American Journal of Health Promotion, 12(1), 38–48.
59.
RomerDaniel, PetersEllen, StrasserAndrew, and LanglebenDaniel (2013), “Desire Versus Efficacy in Smokers’ Paradoxical Reactions to Pictorial Health Warnings for Cigarettes,”PLOS One, 8(1), e54937.
60.
ShivBaba, and FedorkhinAlexander (1999), “Heart and Mind in Conflict: The Interplay of Affect and Cognition in Consumer Decision Making,”Journal of Consumer Research, 26(3), 278–92.
61.
SiegelMichael, and BienerLois (2000), “The Impact of an Anti-smoking Media Campaign on Progression to Established Smoking: Results of a Longitudinal Youth Study,”American Journal of Public Health, 90(3), 380–86.
62.
SlaterSandy J., ChaloupkaFrank J., WakefieldMelanie, JohnsonLloyd D., and O'MalleyPatrick M. (2007), “The Impact of Retail Cigarette Marketing Practices on Youth Smoking Uptake,”Archives of Pediatrics & Adolescent Medicine, 161(5), 440–45.
63.
SlovicPaul (2000), “What Does It Mean to Know a Cumulative Risk? Adolescents’ Perceptions of Short-Term and Long-Term Consequences of Smoking,”Journal of Behavioral Decision Making, 13(2), 259–66.
64.
SteenkampJan-Benedict E.M., and BaumgartnerHans (1998), “Assessing Measurement Invariance in Cross-National Consumer Research,”Journal of Consumer Research, 25(1), 78–90.
65.
AbuseSubstance, and AdministrationMental Health Services (2011), “Results from the 2011 National Survey on Drug Use and Health: Summary of National Findings,” (accessed December 19, 2013), [available at http://www.samhsa.gov/data/nsduh/2k11results/nsduhresults2011.htm].
66.
Surgeon General Report (2012), Preventing Tobacco Use Among Youth and Young Adults.Rockville, MD: U.S. Department of Health and Human Services.
67.
TannerJohn F.Jr., HuntJames B., and EpprightDavid R. (1991), “The Protection Motivation Model: A Normative Model of Fear Appeals,”Journal of Marketing, 55(July), 36–45.
TormalaZakary L., and PettyRichard E. (2004), “Resisting Persuasion and Attitude Certainty: A Meta-Cognitive Analysis,” in Resistance and Persuasion, KnowlesEric, and LinnJay A., eds. Mahwah, NJ: Lawrence Erlbaum Associates, 65–82.
70.
TramifowDavid, and SheeranPaschal (1998), “Some Tests of the Distinction Between Cognitive and Affective Beliefs,”Journal of Experimental Social Psychology, 34(4), 378–97.
71.
TurnerLindsey R., VeldhuisCindy B., and MermelsteinRobin (2005), “Adolescent Smoking: Are Infrequent and Occasional Smokers Ready to Quit?”Substance Use & Misuse, 40(8), 1127–37.
72.
WakefieldMelanie A., LokenBarbara, and HornikRobert C. (2010), “Use of Mass Media Campaigns to Change Health Behaviour,”The Lancet, 376(9748), 1261–71.
73.
WangAn-Li, RomerDan, ElmanIgor, TuretskyBruce I., GurRuben C., and LanglebenDaniel D. (2013), “Emotional Graphic Cigarette Warning Labels Reduce the Electrophysiological Brain Response to Smoking Cues,”Addiction Biology, (available electronically December 15), [DOI: 10.1111/adb.12117].
74.
WangMin Q., FitzhughEugene C., EddyJames M., and Carl WesterfieldR. (1996), “Attitudes and Beliefs of Adolescent Experimental Smokers: A Smoking Prevention Perspective,”Journal of Alcohol and Drug Education, 41(3), 1–12.
75.
WegenerDuane T., PettyRichard E., SmoakNatalie D., and FabrigarLeandre R. (2004), “Multiple Routes to Resisting Attitude Change,” in Resistance and Persuasion, KnowlesEric, and LinnJay A., eds. Mahwah, NJ: Lawrence Erlbaum Associates, 13–38.
WhiteVictoria, WebsterBernice, and WakefieldMelanie (2008), “Do Graphic Health Warnings Labels Have an Impact on Adolescents’ Smoking-Related Beliefs and Behaviours?”Addiction, 103(9), 1562–71.
78.
WitteKim (1992), “Putting the Fear Back into Fear Appeals: The Extended Parallel Process Model,”Communication Monographs, 59(4), 329–49.
79.
WitteKim, and AllenMike (2000), “A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns,”Health Education & Behavior, 27(5), 591–615.
80.
WitteKim, and MorrisonK. (1995), “The Use of Scare Tactics in AIDS Prevention: The Case of Juvenile Detention and High School Youth,”Journal of Applied Communications Research, 23, 128–42.
81.
YeagerHolly, and DennisBrady (2013), “Lobbying to Shape E-Cigarette Debate,”The Washington Post, (October 7), A3.
82.
ZajoncRobert C. (1980), “Feeling and Thinking: Preferences Need No Inferences,”American Psychologist, 35(2), 151–75.
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