Graphic images on cigarette packaging keep some adult smokers from buying them. But smokers who have their first cigarette within 30 minutes of waking up aren't influenced the by the stomach-churning photos, according to new research from the RAND Corporation in Pittsburgh.
William Shadel, a senior behavioral scientist at RAND who co-authored the study, said he was surprised by the results because he expected smokers across the board to react the same way.
"But the results of this study give us a little pause to say wait a minute, there might be some people who really respond to these, and some people who don't respond at all in the way we'd expect," Shadel said.
Study participants were asked to visit the RAND StoreLab, a replicated convenience store that stocks more than 650 products. They were given $15 in cash and asked to shop for any items they wanted. As in many convenience stores, cigarettes were located behind the cash register.
For some participants, every box of cigarettes was affixed with a graphic health warning label. These photos included diseased lungs, autopsy photos and rotting teeth. For other participants, the cigarettes had no warning labels.
Smokers who have their first cigarette more than 30 minutes after they wake up were less likely to buy cigarettes when the graphic labels were present. All study participants smoked at least five cigarettes per day in the month preceding the study, and had smoked at least 20 days in the previous month.
"[Graphic warning labels] aren't reaching the most dependent people, arguably, who might have the most difficulty quitting," Shadel explained.
Allegheny County Health Department Director Karen Hacker said she's not surprised by the findings.
"If you are super addicted, you've probably seen it all," she said.
Hacker said there are a couple interventions she thinks would be universally effective: change state law to restrict indoor smoking and increase taxes on cigarettes.
"Those seem to be very effective, particularly for populations that are highly addicted to nicotine," Hacker said.
In 2008, Pennsylvania enacted the Clean Indoor Air Act, which prohibits smoking in most indoor public places. However, the law exempts some bars and casinos, and it's estimated that more than 2,300 establishments in the commonwealth still allow indoor smoking.
A RAND study from last year found teens considering smoking were more interested in trying it after seeing graphic warnings on a poster. Based on those findings, Shadel cautioned retailers against using graphic anti-smoking posters in stores.