Picture-based cigarette warnings effective?

Singapore passed a legislation sometime back for all cigarette packs to display a picture showing the possible physical consequences of smoking. In 2006 , the Health Ministry commissioned a new set of pictures to replace the ones used since 2004. Compared to the first set of pics, I felt that the 2nd set was significantly more grotesque. See here for comparison.

In passing this legislation, I believe the govt is following in the footsteps of Canada, which if i recall correctly, is the first country to impose picture-based health warnings on cigarette packs. I'm pretty confident that having these picture-based warnings increase the salience of the health warnings. A study by Hammond and colleagues (2003) found such pictures to serve as an effective cessation intervention, was associated with increased cognitive processing of warnings, attempts to quit, and reduction in smoking. A 4-country study published in 2007 by the same author revealed that countries with the least prominent health warnings were associated with the lowest levels of effectiveness. With these results, you can be pretty sure that picture-based warnings do work.

But it's probably not as simple as that. A brief review of the literature on fear appeals show 3 major variables that moderate the effectiveness of such messages. They are the 1) intensity of fear appeal, 2) presence of instructions on how to overcome the fear, and 3) the level of personal relevance of the message to the intended audience.

1) Intensity of fear: Fear arousing communications are unlikely to work if they trigger so much fear that pple shut down and become unable to think rationally about the issue. In one study, a scary ad about AIDS actually led to riskier behaviour in a sample of gay men (Rosser, 1991).

2) Presence of instructions: This will teach the subject how to reduce their fear. This variable may in turn be moderated by an individual's coping appraisal. Say if the subject were to find recommended instructions to be ineffective or impossible, the fear arousal will then bring forth fear control processes, resulting in denial and avoidance (Witte, 1992).

3) Level of personal relevance: Highly relevant info can sometimes result in defensive systematic processing of the threatening message. In an experiment by Liberman and Chaiken (1992), women coffee drinkers were less persuaded of the link between caffeine and fibrocystic breast disease than women non-coffee drinkers and they seemed to process the message in a defensive, biased manner. This runs counter to the Elaboration Likelihood Model which predicts people pay more attention to messages when it is more relevant to them.

Given the variables above, i think it becomes harder to judge whether these picture-based warnings are effective in Singapore. Compared to other countries with the same legislation, I find Singapore's warnings to be bloodier, more grotesque and hence more likely to be considered high in fear intensity. You can compare the pictures across various countries here (just follow the link to the various countries).

So are our picture-based warnings effective? (Effectiveness may be measured by cessation, attitude change, reduction etc depending on your operational definition) I'm not sure but at least anecdotally, I don't see it working but we won't know until someone does a study to find out.

Just a random thought, I'm a bit sad that I won't get to light up in a French cafe when I'm on exchange. Sounds crazy, but I've always pictured myself having a good conversation in a quaint French cafe, over a cup of hot coffee and cigarettes.