In 2009 the FDA finally acquired the authority to regulate the production and marketing of tobacco. On the marketing front, the tobacco industry fought back with a legal challenge. It claimed the new Congressional law violated the industry’s right to free speech. If cigarette packaging had to feature strong graphic images – one of the provisions of the bill — the industry would required to “stigmatize their own products through their own packaging.”
The lawsuit is still pending, but the results of new marketing requirements have begun to appear. The question remains: Will they be effective?
Scary labels may be counter-production
Martin Lindstrom, a former ad agency executive and expert on the science of marketing, has used neuroimaging to study what makes people buy. In his bestseller Buyology: Truth and Lies About Why We Buy
There’s a possible explanation for this in a concept called Terror Management Theory, which includes the idea that a threat to one’s life increases the need for self-esteem.
In a study of smokers, participants were first evaluated to determine if their self-esteem was based on smoking. Then half the participants read warnings that featured a life-threatening message about smoking: “Smoking leads to deadly lung cancer.” The other half read non-threatening warnings: “Smoking makes you unattractive.” (emphasis added)
Following a 15-minute delay in which participants answered questions unrelated to smoking (so that the warning messages would leave their conscious minds), they answered a final set of questions including “Do you enjoy smoking?” “How important is smoking to you?” and “Are you going to smoke a cigarette directly after this study?”
The researchers found that, among those who associated smoking with self-esteem, the death-related warnings actually led to more positive attitudes toward cigarette use. They concluded the smokers clung more tightly to their habit as “a strategy to buffer against existential fears provoked by death-related warning messages.”
On the other hand, for these same people, the non-death-related warnings had a dampening effect on attitudes toward smoking. Warnings that smoking makes one less attractive “may be particularly threatening to people who believe the opposite.”
Tobacco industry targets women in low-income countries
The tobacco industry understands that the growth market for its products is no longer in countries like the US, but in the developing world. While regulation of tobacco by the FDA was under debate, Phiip Morris International was test–marketing a new high-tar, high-nicotine cigarette in Southeast Asia – targeting countries like the Philippines, Indonesia, Cambodia, and Bangladesh. These countries were using highly graphic images on cigarette packs and posters long before the new US rules, but to little effect.
Forty percent of the Bangladesh population — 144 million — survives on less than a dollar a day. The annual sale of tobacco products in that country is estimated at around one billion dollars. Here are some examples of how smoking is promoted in Bangladesh, especially to women. (emphasis added)
Bangladeshi chest doctor Kazi Saifuddin Bennoor has seen many misleading cigarette advertisements, but the one that suggested smoking could make childbirth easier plumbed new depths. … “[I]f a lady smokes, her baby will be smaller and it will be easier to deliver, the labour will be less painful“.
It’s hard to imagine corporate responsibility sinking much lower than that.
Note the appeal to self-esteem in the following.
Advertisements telling smokers they are smarter, more energetic and better lovers than their non-smoking counterparts are a familiar sight across Bangladesh — something unimaginable in most other countries.
Women are a prime target.
”(Tobacco use) has become an epidemic among rural women. It’s a very serious health issue.” … This rise is largely because more Asian women are entering the workforce, have disposable income and see smoking as “modern and liberated.” … Tobacco companies are encouraging the trend, viewing women in developing countries as their “largest unexploited market“, according to the WHO. …
“We see clear marketing strategies targeting women in Asia such as lipstick-type cigarette packs in Indonesia, Malaysia and Laos.” … The pretty, small packets of ultra-thin cigarettes are designed to be something a woman would like to carry around with her at all times, just like her favourite lipstick. “These fit easily into women’s purses. Cigarette packs are coloured pink and there are even fruit flavoured cigarettes.”
In Bangladesh’s remote, rural areas, the health risks of tobacco use are not always well known, Bennoor said, making poor farmers — particularly women who are generally less well educated — an easy target. “It is a vicious cycle: people who are poor are more vulnerable to tobacco addiction, and then they are smoking, and it makes them poorer.”
Who’s smarter now?
The new graphics used in US advertising and on cigarette packs are mild compared with images used in other countries – like these warnings used in Singapore (I thought they were too gruesome to include here). And compare this Brazilian warning poster. Canada has been using more graphic warnings since 2000 — much more graphic than those proposed by the US — and has seen a drop in smoking. It’s difficult to prove direct cause and effect, of course. If it turns out really scary images are counter-productive, that may be a good thing for the US.
Past experience suggests that congressional legislation on tobacco can backfire. Warning labels on cigarette packages — “Caution: Cigarette Smoking May be Hazardous to Your Health” — were not only weak and ineffective, but were secretly advocated by the tobacco industry. The warning labels allowed cigarette manufacturers to avoid lawsuits from consumers, since smokers had been warned. Facing litigation, the tobacco industry had considerable success with the argument that “its product was preempted from liability by Congressional mandate.”
If I had to guess who, in the long run, will outsmart the other – the tobacco industry or a government trying to protect the health of its citizens – the odds so far have favored tobacco. Unfortunately, all too often, life isn’t fair when it comes to corporate interests versus the public good.
Related links:
Whatever you say, Phillip Morris
Coughing Up Blood Money: The Altria Earnings Protection Act?
Coughing Up Blood Money: “Before they quit or die”
Coughing Up Blood Money: The hit parade of cigarette ads
Coughing Up Blood Money: FDA regulation of tobacco
Coughing Up Blood Money: Taxing tobacco, taxing credibility
Resources:
Image source: Green Agenda
For a funny and thought-provoking film on the tobacco industry, check out Thank You for Smoking
Duff Wilson, New Bold Warnings on Tobacco Ads, The New York Times, May 3, 2010
Edward Tenner, Will New Cigarette Warnings Work?, The Atlantic, November 10, 2010
Tobacco firms take aim at Bangladeshi, Asian women, MySinchew.com, April 29, 2010
Allan M. Brandt, FDA Regulation of Tobacco — Pitfalls and Possibilities, The New England Journal of Medicine, July 31, 2008
Mary Elizabeth Williams, Cigarette warnings are bad for you, Salon, April 29, 2010
Over the years I have slowly come to the conclusion, and have had to learn to accept, that people are going to do what they want to do no matter how many facts are out there.
I think I may have told this story here at Health Culture before. I had a psychology professor in college who always said, “People do what they want to do. They make up their excuses afterwards.”
The more I get to know humans and the more I see, the more I agree with Dr. Wade.
Not smoking is one of the few things that’s been scientifically validated as preventing disease. Not only does it prevent lung cancer, but it makes the body unhealthy in many ways. Surgeons are reluctant to operate on long-time smokers because their odds are not good. It’s a burden to the cost of health care.
Nevertheless, I sometimes find myself leaning towards a libertarian position on issues like this. With smoking, of course, once we discovered the effects of second-hand smoke, the danger was no longer confined to just the smoker. So we had to protect other people by creating non-smoking work environments, etc.
But I’m uncomfortable with denying people the right to live their lives the way they want if they’re fully informed and choose to take the risk. We don’t tell skiers and mountain climbers and motorcyclists they can’t pursue their lifestyles, even though those things are risky and create expenses for the health care system. Who gets to decide how we should live our lives?
Same for obesity. It hasn’t even been proved that being overweight (rather than obese) is a source of poor health. It seems to depend on other factors, like exercise. An overweight person might be less inclined to exercise, but that doesn’t mean it’s the extra pounds that are the physiological source of poor health. One study found that being a little overweight was actually better for older people.
There’s a big social stigma attached to weight. And now smoking is stigmatized also. I’m very suspicious of stigmas. They’re subjective, psychological reactions that change over time, not scientific evidence.