seem to want different types of framing depending on whether they are already engaged in attempting to quit or not. “The warnings that actually motivate them to make the next quit attempt are different than the information that they want when they are ready to quit. Then they want positive encouraging information, as well as concrete information on how to quit,” he said. Toll added that it is very difficult to quit smoking and “an ad is not going to make you quit smoking forever. You also need counseling and medication. The ad is really a bridge to get people into treatment.”

Khuri suggested younger generations may respond better to positive messaging than older generations. “Some data suggest for this newer generation, the more positive, get-your-life back messaging works,” he said. Hammond responded that studies of the graphic warning labels show “what works well, works across groups. The ads that hit, hit your 16-year-old kid and they hit your 68-year-old smoker.”

Stevens concluded the discussion of gain- versus loss-framed messaging by noting, “We have seen it as sort of a push-pull. We do some ads that push you to quit and make it uncomfortable for you to smoke. Other ads say ‘we are here to help.’”


Several workshop participants stressed the important roles that clinicians, clinician organizations, and patients can play in advocating for antismoking policy. Herbst, an oncologist who treats lung cancer patients, stressed, “The best way I can help a patient is for them to never get lung cancer. Once a patient has lung cancer, about half of the time, it’s already metastatic, and despite everything we have, we still can’t cure most of these patients.” McGoldrick pointed out that the Illinois Medical Society was instrumental in the recent passage of a tobacco tax in Illinois. This society had been a reliable campaign supporter of the Illinois House Republicans and lobbied their support for the tax because the alternative was a cut in Medicaid payments to physicians. “That’s why we won in Illinois. It wasn’t because the tobacco tax was going to save lives, it was because the House GOP always sticks with the docs, no matter what,” said McGoldrick. “We have to be strong advocates for these policies. You can have all the science in the world, but if we each individually and organizationally don’t get involved in the policy process, then we are going to suffer the fate we have been suffering the last few years because we have very powerful forces working against us,” he stressed.

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