framed messages, people were significantly more likely to quit smoking 2 weeks later than those given standard care messages (Toll et al., 2010).

Despite the mixed findings, Toll asserted, “We feel that people [with high nicotine dependence] exposed to gain-framed messages will quit smoking at greater rates because if you are highly dependent on nicotine, you may be scared you are going to get the health consequences of smoking and less confident about your ability to quit.” But he noted that graphic warning labels are harder to put into a gain-framed context. “We don’t want Marlboros to have smiley faces on their packages,” he said. Warren suggested that gain-framed messaging that promotes a positive outcome may be more appropriate for cancer patients, but he acknowledged that this approach is as yet untested.

Healton suggested the ideal messaging outreach for cessation therapy probably should have a mix of both gain- and loss-framed messages. She noted that when a gain-framed tobacco control ad campaign was run in Grand Rapids, there was an 11-fold increase in quitline call volume.19 She also pointed out that as an ex-smoker, she tended to shut down her responses to loss-framed messages because they aroused so much fear. “I think the jury is still out on what is the best mix for bringing about this type of population-based response to communications. It is intuitive that there are all sorts of people who smoke, with different motivations, so that an ideal model would be one that provides some kind of mix,” Healton said. Fong concurred. “It is important for us to be able to speak to multiple audiences using mass media channels, so for something like warning labels, there should be something for everybody in there.”

Ostroff added that the ads for tobacco cessation medications tend to be “feel-good” ads that are hopeful and gain-framed. She suggested more research could be conducted on framing messages about how easy or hard it is to quit to assess the best approach. Healton pointed out that the ads for tobacco cessation medicines are based on extensive consumer market research, with companies tracking consumer response to their ads through sales. Healton pointed out that few ads for tobacco cessation medicines focus on eliciting fear; instead, they usually are serious, supportive, or humorous.

Hammond added that the different findings on tobacco control message framing may be due to whether they are aimed at preventing smoking versus aimed at prompting people to quit smoking. Even people who smoke

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19 EX Pilot Evaluation, Grand Rapids, Michigan, 2007 (unpublished data).



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