Which is more likely to convince a smoker to quit? The words, "Warning: cigarettes cause cancer" beneath the image of an open mouth with a cancerous lesion and rotten teeth, or the same image with the words, "Warning: Quitting smoking reduces the risk of cancer"?
The answer depends on how confident you are in your ability to quit, according to a study led by researchers at Georgetown Lombardi Comprehensive Cancer Center and published in the journal Nicotine & Tobacco Research.
The research, which involved 740 participants and three D.C. area institutions, suggests that a mix of messages might work best to help convince some of the 45 million smokers in the U.S. to give up the habit, says the study's lead investigator, Darren Mays, PhD, MPH, a Georgetown Lombardi population scientist who specializes in behavioral cancer prevention.
The study found that "gain-framed" messages — those that stressed the benefits in quitting, such as "quitting smoking reduces the risk of death due to tobacco" – were more effective for smokers who thought they could quit when they wanted.
On the other hand "loss-framed" messages — the ones that emphasized the negative outcomes from smoking, such as "smoking can kill you" — were more effective for smokers who believed quitting would be hard.
Most of the warnings used now on tobacco packages in the U.S., and worldwide, are loss-framed messages, which may not be sufficiently convincing to many smokers, says Mays. "This study shows us that leveraging both gain- and loss-framed messaging may prompt more smokers to quit," he says.
Mays and his colleagues undertook the study to build the evidence base for the new graphic warnings proposed for U.S. cigarette packages. The 2009 Family Smoking Prevention and Tobacco Control Act authorized the U.S. Food and Drug Administration (FDA) to regulate tobacco products, and required new pictorial labels for cigarette packs.
Tobacco industry lawsuits, however, have delayed implementing the new pictorial warning labels, and in 2012, the U.S. Court of Appeals struck down the nine pictorial warnings proposed by the agency. The FDA is currently pursuing additional research to support implementation of the warning label requirements.
Mays and colleagues chose to study the impact of four pictorial pictures — a man using a breathing apparatus; two sets of lungs, one healthy and one diseased; a prone man with stitches on his chest lying on a white sheet; and the cancerous mouth— with loss-frame or gain-framed messages. Each was effective.
"Leveraging policies such as graphic warnings for cigarette packs to help smokers quit is critical to improve public health outcomes. Our study shows that that framing messages to address smokers' pre-existing attitudes and beliefs may help achieve this goal," says Mays.
The research was supported by the American Cancer Society and Georgetown Lombardi.
About Georgetown Lombardi Comprehensive Cancer Center
Georgetown Lombardi Comprehensive Cancer Center, part of Georgetown University Medical Center and MedStar Georgetown University Hospital, seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic and clinical research, patient care, community education and outreach, and the training of cancer specialists of the future. Georgetown Lombardi is one of only 41 comprehensive cancer centers in the nation, as designated by the National Cancer Institute (grant #P30 CA051008), and the only one in the Washington, DC area. For more information, go to http://lombardi.georgetown.edu.
About Georgetown University Medical Center
Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC's mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.
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