Examining the Effectiveness of Proposed Cigarette Package Warning Labels with Graphic Images among U.S. College Students

ABSTRACT The smoking rate among U.S. college students is much higher than the national average. College is a time when many young adults try smoking and see smoking as having social benefits. Most of these new smokers believe that they will quit smoking once they leave campus, but many of them find it difficult to do so, and they become life-long smokers. The U.S. government, along with governments of most developed countries, is keenly interested in curbing the smoking rate for numerous reasons, including the physical and social welfare of its citizens and to reduce government expenditures subsidizing healthcare costs for smokers who become ill. One avenue for accomplishing this is the mandating of on-pack warning labels detailing the health hazards of smoking. Warning labels used in the U.S. are relatively small and repetitive, and the described health risks are pallidly stated compared to labels used in many other countries, most notably Canada. An online experiment was conducted examining the effectiveness of Canadian-style cigarette package warning labels currently proposed for adoption in the U.S. The proposed package warning labels include a full-color picture complementary to the content of the message. The major goal of the study was to assess the effectiveness of these more detailed and vivid health warning messages among a U.S. at-risk population (college students). Another goal was to determine the efficacy of the (pictorial) element specifically, while holding the text message constant. In a sample of young adults, the proposed package warning labels were shown to outperform the current U.S. warning labels in aided recall, depth of processing, and perceived argument strength. When graphic and no-graphic versions of the proposed labels were compared, the graphic version was rated as more credible. Current smokers rated the arguments in all package warning labels as weaker than nonsmokers, as expected. INTRODUCTION Cigarettes are often cited as the only legally-marketed consumer good that, when used as directed, is known to cause harm to its users. Moreover, cigarettes are successfully marketed to a group of consumers (at least in the U.S.) who are probably well aware of the negative health effects of smoking. Anti-smoking campaigns in the U.S. are routinely targeted to children as young as seven years old. Despite these education efforts, however, the Center for Disease Control and Prevention reports that 22.5% of American adults currently smoke cigarettes (Center for Disease Control 2004). A significant proportion of these smokers are young, educated adults who have been exposed to anti-smoking messages from a very young age. Casual observation on college campuses in the U.S. seems to suggest that the percentage of traditional-age college students who smoke has been increasing over the last several years. At least two recent empirical studies confirm this supposition. A comprehensive national study of college students at U.S. four-year colleges conducted by Harvard in 2001 showed that 29.8% of the respondents reporting that they were currently smokers (Moran, Wechsler, & Rigotti 2004). This percentage is much higher than the overall level of smoking in the U.S. reported above (22.5%). In fact, adult smoking in the U.S. has decreased over the period from 1993-2000 for all age groups except young adults between 18 and 24 years old (Center for Disease Control 2002). Similarly, in earlier waves of this same Harvard study, results showed that between 1993 and 1997, cigarette use by college students increased from 22.3% to 28.5% (Wechsler, Rigotti, Gledhill-Hoyt, & Lee 1998). The comparatively high prevalence of smoking among these young, educated adults is especially troublesome. These individuals would in all likelihood have been exposed to significant anti-smoking information in their formative years, yet they elect to start smoking in spite of their knowledge of smoking's negative effects and addictive properties. …