There's no question that the nine new graphic cigarette warning labels designed by the Food and Drug Administration (FDA), which will be on all cigarette packages sold in the United States starting in September 2012, are ghastly. But has rampant gruesome imagery in shows like House emasculated their effectiveness? And will these pictures really convince a jaded smoker to quit or prevent a rebellious teenager from starting?
The 2009 Family Smoking Prevention Tobacco Control Act, which gave FDA the authority to regulate tobacco, mandated that the agency issue requirements for cigarette labels large enough to make up 50% of the front and rear panels of the package, with specific wording of risk warnings, including "color graphics depicting the negative health consequences of smoking."
What exactly those graphics would be was up to FDA. So in 2010, the agency devised 36 images depicting different health consequences and held an 18,000 participant survey to determine the nine winners. The study looked at factors such as how well people could recall a certain image days later, or what kind of emotional response a subject had. What the study didn't address: whether or not people actually quit as a result of seeing the images.
FDA spokesperson Jeffrey Ventura says that isn't the point. The study, he says, is just one data point in a larger body of literature that finds warning labels effective. Gruesome warning labels aren't new; over 40 nations already require them. In countries like the United Kingdom and Canada, however, it's impossible to say whether the imagery itself contributed to a decline in smoking or other influences caused smoking to fall out of vogue.
Ventura adds that this analysis wasn't needed for the FDA decision. "This was a requirement under the law. This wasn't up for FDA to interpret or a choice to do or not to." Still, he says the labels fit in with FDA's larger mission of raising awareness of smoking risks; currently they are only in text. "These warnings haven't been updated since 1985, and anecdotal logic says that these warnings have become white noise," Ventura says. "The new generation of youth at risk are a very visually stimulated group of folks."
Behavioral psychologist Carol Tavris, author of the recent book Mistakes Were Made (But Not By Me), doubts that teenagers will be scared by images of bad things happening to older strangers. "Has anyone been to the movies lately? [HBO's] Game of Thrones, where people's heads are cut off in front of you? I think people's tolerance for the ugly and the violent is quite high. "
But the FDA wasn't aiming for scary imagery, says Ventura. "The images in other countries are extremely graphic, but I think these images weren't necessarily chosen for shock and awe." For instance, the woman holding a baby illustrates the dangers of secondhand smoke, while the man smoking through a tracheotomy hole in his neck illustrates the power of addiction.
Science Insider asked Tavris what the current research in behavioral psychology has to say about the effectiveness of fear imagery.
" 'Current' research?" she replied in an e-mail. "Social psychologists have decades of research showing that fear communications generally backfire, that people tune them out, and therefore that these tactics are generally not effective."
Tavris cites the Department of Homeland Security's post-9-11 terror alert system as an example of warning that became a joke to many Americans. While the system certainly raised awareness, it didn't couple that awareness with any action a person could take to protect himself. "To be effective, the fear message must be combined with an immediate action the person can do to alleviate the fear," she says. "So what are people going to do with these new feelings of anxiety and fear? To calm yourself, you think, 'What a stupid code.' "
The new FDA labels do suggest an action: stop smoking. But as any smoker can attest, this is far more easily said than done. Counterintuitively, Tavris says, smokers who want to quit but have failed are actually the group who are most likely to make a joke out of the new labels. The behavioral phenomenon at play is called cognitive dissonance: a clash between two conflicting beliefs. One way to resolve the tension is to override the disturbing new message.
"Dissonance is a pretty powerful phenomenon," says Tavris. It explains "why people continue to do things they know are harmful, but still see themselves as smart." And the people most likely to do this, she says, are the ones who have tried to quit and failed.