Health warnings are indeed a hot issue these days, and one particular theme on the use of gory images of health related diseases and disorders that stem from smoking. One can understand the basic intention of such warnings: scare smokers (or wannabes) to avoid smoking. For example, tips for quitting safely can be found here.
In a recent blog post, Roger Dooley gives his take on the reason he thinks that these warnings will not work:
I don’t think these images will actually increase the desirability of smoking, and perhaps a few non-addicts will be dissuaded from starting. As repulsive as we find the images, though, we shouldn’t expect them to have much impact on long-time smokers.
I’d love to have Dooley go a bit more in depth about his take on this. I do believe that he is indeed on the right track, and I believe that I can explain why it is so.
And let me be right up front and remind you that the explanation offered by Martin Lindström is really not tenable. Rather, it is a prime example of pseudoscientific babble stemming from a misuse and misunderstanding of neuroimaging results.
Let’s first look at the basics: The main assumption in these warning ads is that when seeing these images, smokers (and non-smokers alike) will be motivated to avoid smoking. In some way, smoking will be associated with bad health, and motivate us to stop smoking, or never start smoking. Another possible assumption is that this relies on a very overt and rational process. We have to connect the bad outcome to smoking, and consciously make the decision to avoid smoking. Alternatively, one may wish to prime smoking to bad health (and disgust).
It strikes me that several years ago, a study by one of my colleagues, Maurice Ptito, reported that these warning labels did not work at all. In fact, when studying smokers’ behaviour, they realised that smokers did not pay much attention to the warnings at all. Interestingly, instead of using the packages, smokers had their own packages where they put the cigarettes. The original package with the warnings was thrown away.
Why? Here’s the interesting story… and let me start by asking you to look at this image…please try as much as you can:
Want to look away? Did you even go beyond this image to read on? Scrolled past the image? How did you feel when you looked at it?
Sorry to put you through it. But I felt it crucial for you to understand my point – to feel it yourself.
Here’s what happens: disgusting images have a primary motivating force on us: it makes us want to look away. Indeed, several studies have now demonstrated a role of the insula in disgust (see review). Disgusting images recruit this region involved in processing and producing visceral responses. It is also involved in our ability to understand facial expressions of disgust in others.
Indeed, in the study by Ptito et al, it was found that the disgusting warnings recruited the insula. The role of the insula has also been shown to be related to motivating behaviours. One example is the study by Knutson et al. who demonstrated that increasing product prices were related to increased engagement of the insula, and a lower likelihood in purchasing that particular product.
In other words, disgusting images of all kinds makes us want to look away. We are primarily motivated to avoid that situation. We look away, walk away, close our eyes. Indeed, this primary motivation is the reason that the warnings do not work. First, they lead to reduced attention to the information. Second, the primary and direct motivation to avoid the information/picture never becomes connected to the cigarette packages themselves. Warnings of this kind could only work if they were so disgusting that people would not even touch them…
So what could work instead? Positive and direct motivation! Some opportunities would be to say that quitting smoking makes things better for you. This could include better skin, body odour and oral hygiene; improved health and so on. The more one can get at direct motivating factors, the better. The image on the right side may be in the right direction, but not quite there…