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Jeremy Fink, LCSWJeremy Fink, LCSW
A Blog About Counseling Children, Adolescents, Adults, and Couples

Why The New Graphic Cigarette Labels May Increase Teenage Smoking

Jeremy Fink, LCSW Updated: Jul 1st 2011

Last week I was interviewed by Michael Brownlee of Fox 11 news and contributed to a story about the graphic cigarette labels implemented under the new FDA regulation and their effectiveness for teenagers and young adults. When asked about what I thought about the FDA's new warning labels (the most significant change to cigarette packs in 25 years) my response was that I believe these new labels will have limited success deterring teenagers and young adults from smoking, and in fact may actually prove to increase smoking amongst those who have already picked up the habit. Attempts at shocking or scaring teens "straight" and towards behavioral change is nothing new; however, this strategy and use of "fear communication" is as ineffective as it has always been, as evidenced by countless social psychological research studies, and is even less effective when used with children and adolescents. Here's why:

cigarette box labeled smoking killsDuring Adolescence the prefrontal cortex (PFC), the front uppermost part of the brain, responsible for planning and decision-making is not yet fully developed and is rapidly undergoing changes. Due to this neuro-developmental growth spurt teens may experience difficulty with deductive logic, cause and effect relationships, and judgment; they often lack an understanding of consequences and experience difficulty with the relationship between the past, present, and future. The graphic images depicting rotten teeth, cancerous lungs, infants in incubators, and even a corpse will not be received by young people in the way the FDA intends; in fact very few teens and young adults will be able to personalize or effectively connect these images to their behaviors.

Is a picture really worth a thousand words? Two ways that these graphic images may impact teens and young adults is to cause fear and anxiety, or disinterest and desensitization. Either way this is counterproductive and does not convey the sentiment that the FDA is trying to impress. As most of us know, when we are anxious we are unable to think clearly. This is because in a state of anxiety our brains downshift from the thinking areas to the more primitive parts that activate the fight, flight, and freeze responses. Consequently, evoking fear and anxiety as a teaching tool is ineffective because messages are almost completely blocked out of the higher functioning areas of the brain, such as the PFC, and are not processed.

A 2010 New York University study published in the Journal of Experimental Social Psychology (46,1) found that the anxiety evoked from the graphic images on cigarette packages could actually cause an increase in smoking. Based on Terror Management Theory (Greenberg, Pyszczynski & Solomon 1986), which hypothesizes that people attempt to feel good and strengthen their sense of selves during times of anxiety, in particular the anxiety produced from fear of mortality, cigarette package images may cause people who already smoke to smoke more, as cigarette smoking is closely linked to one's sense of self. Adolescents and young adults are particularly prone to coping in this manner. When presented with the threat of mortality, teens and young adults who already smoke may become more entrenched in their smoking habits in an attempt to bolster their fragile and developing sense of self.

Initially the graphic images on cigarettes packages may cause an increase in anxiety, which as explained above, may even result in an increase in smoking; however, after prolonged exposure to these images research suggests that teens and young adults may become desensitized. Desensitization often occurs through a process in which cognitive dissonance, holding two conflicting beliefs in mind, causes anxiety and will become resolved as one modifies their belief system. According to the National Institute of Neurological Disorders and Stroke (NINDS) (2010), prolonged exposure to violent images and video results in diminished emotional response and ultimately desensitization. In her 2006 study of the effects of graphic images on teenagers, Dr. Lesley Murphy of the Robert Gordon University, UK, stated:

"It would appear that graphic or sensational imagery designed for 'shock impact' such as depictions of dead bodies, body parts, injuries, blood and violence do not have much effect. While the pupils often registered the obvious sadness or anger, it was just as likely the pictures provoked boredom and lack of interest."

Scare tactics don't work and these graphic images will have a lackluster effect if any on teenagers and young adults. It is more important for parents to open up a dialogue with their teenagers, helping them to discern healthy choices from dangerous and unhealthy ones. Parents can begin conversations with their teens by inquiring about what their teen already may know, and listening to their opinions on the subject of smoking.


Jeremy Fink, LCSWJeremy Fink, LCSW, provides psychotherapy to adults, children, adolescents, and couples and is the director of The Dynamic Counseling Center in Agoura Hills, CA. He has extensive experience working with children, adolescents, and adults who experience depression, ADHD, eating and body image disorders, anxiety, bipolar disorder, and schizophrenia, as well as drug, alcohol, and other substance abuse. He utilizes attachment based psychodynamic psychotherapy treatment, psychobiological couples and family therapy, group psychotherapy, and facilitates linkages to community resources, such as drug and alcohol rehabilitation programs, psychiatric referrals, and high school/college resources. 
 Jeremy received his B.A from the University of California, Los Angeles (UCLA) and his M.S.W. from the University of Southern California (USC).

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