Hammond countered that there has been an evolution in the ads based on the health effects of smoking. He claimed the newer ads convey the information that smoking is bad for one’s health in a more emotionally engaging way. “The key is emotional engagement. These ads strike a chord.” He pointed out that the CDC’s Tips from Former Smokers ads had many themes in addition to direct health effects, including personal loss, and the impact that smoking has on others. There also are anti-industry themes in that ad campaign. “The best ads hit on more than one level,” he said.

Cummings stressed that “we talk about reducing tobacco almost separate from reducing cancer. We have got to pair those together, because the public doesn’t really care about reducing tobacco, but they want to reduce cancer mortality. Unless those are linked, we are not going to win the war on cancer.” The complexity of the issue was noted by McAfee who stated that tobacco control efforts, including media, quit resources, comprehensive state programs and funding, are facing changing demographics.

Positive or Negative Message Framing

There was extensive discussion at the workshop about the advantages and limitations of positive and negative framing of messages in media campaigns. “There may be unintended consequences of the most shocking ads, and they may not translate into constructive behavior as opposed to more supportive media messages,” warned Abrams.

Toll noted that messages can be gain-framed, or framed in a positive way, such as “quitting smoking will make you live longer,” or they can be loss-framed, such as “if you don’t quit smoking, you will die sooner.”

One small study found teens rated the loss-framed warnings as probably working better, in terms of impeding their plans to smoke in the future (Goodall and Appiah, 2008). Another study involving tobacco control messaging in conjunction with tobacco cessation medicine found approximately a 12 percent greater sustained quitting rate in those given gain-framed messages, which was significant compared to those given loss-framed messages (Toll et al., 2007). Another study found that loss-framed messages were better received by individuals highly dependent on smoking, while individuals with lower tobacco dependence reacted more positively to the gain-framed messages (Moorman and van den Putte, 2008). But these findings contradict the results of a subsequent study (Fucito et al., 2010). Another study found that when counselors at a quitline incorporated gain-



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