FRB Richmond: Do Nicotine Replacement Therapy Ads Encourage Smoking?

Vanessa Sumo of the Richmond Fed looks at research on the relationship between smoking and advertising for nicotine replacement products:

Ad Intervention, FRB Richmond, Region Focus, By Vanessa Sumo: Next Safety, a West Jefferson, N.C., company that specializes in high-tech respirators, recently introduced a handheld nicotine inhaling device that promises to help smokers kick the habit. About the size of a pack of cigarettes (but more closely resembling an iPod), the device is said to deliver nicotine into the bloodstream and to the brain more effectively than a cigarette can. So, smokers trying to quit can still get the nicotine fix that they crave, but without the dangerous effects of smoking tobacco.

Next Safety's pulmonary drug delivery device is one of many smoking cessation products available that aim to make it easier for people to quit. Most work by delivering nicotine — the addictive substance in tobacco — through a variety of methods such as inhalers, sprays, gums, and patches. A Surgeon General's report in 2000 said that there is "strong and consistent" evidence that such treatments can help people quit.

But what if the very existence of such products — publicized to the masses via advertising campaigns — actually causes some smokers to prolong the habit? A new study suggests that young smokers in particular can get the "wrong" message from ads promoting smoking cessation products because they may give the impression that quitting can be achieved easily. This is consistent with earlier research, which finds that people may become less careful about keeping a healthy lifestyle when, through advertising, they learn about a new drug treatment that can, for instance, treat high blood pressure or cholesterol. In other words, why exercise today when you can take a pill tomorrow?

A recent paper by health policy experts Henry Saffer, Melanie Wakefield, and Yvonne Terry-McElrath estimates that a 10 percent increase in advertising of nicotine replacement therapies would increase smoking among the young by about 1 percent. (Specifically, the authors looked at the effect on high school students). Average youth smoking, according to the authors, is about 5.77 cigarettes per day, so a 10 percent increase in advertising would bring the average up to 5.82 cigarettes per day.

The reason for this surprising estimate is that advertising could create a classic moral hazard problem — it "increases the expectation that cessation is relatively easy," say the authors. Knowing that an effective product is readily available to help a young person quit anytime he wants might actually delay his attempt to stop smoking.

This observation is at odds with other widely cited research. A 2006 paper by Rosemary Avery, Donald Kenkel, Dean Lillard, and Alan Mathios, a group of public policy experts at Cornell University, finds that smokers are more likely to try to kick the habit, and will probably be successful at doing so, when exposed to more advertising. Moreover, those who decide to stop smoking may be persuaded to purchase a smoke cessation product to help them quit, while others may be encouraged by the same ads to quit cold-turkey or to quit by some other method. Thus, because the wider public health objective is to get people to stop smoking, the authors argue that "the public health returns to smoking cessation product advertisements exceed the private returns to the manufacturers."

Spending on advertising for smoke cessation products rose sharply after 1995, partly because of two regulatory changes by the Food and Drug Administration (FDA). In 1996, the FDA approved the sale of nicotine gum and nicotine patches over the counter, meaning that they would no longer be subject to disclosure requirements when advertising these products. Print ads for prescription drugs might need a full page detailing in fine print a product's risk information, driving up the cost of advertising. (Sprays and inhalers remain classified as prescription drugs.) Also, the FDA significantly reduced the disclosure requirements for broadcast advertising of prescription drugs in 1997 when it recognized the limitations, for instance, of advertising on radio and television.

The Cornell group's results can be used to argue for less regulation in smoke cessation product ads, especially when one compares these disclosure requirements with the relatively small warning label that accompanies cigarette packs. "The irony is that smoking cessation product advertisements may serve some of the same public health goals as public service antismoking campaigns," say the authors in another study. They estimate that if the FDA had allowed all smoke cessation products to be immediately sold over the counter, then the number of advertisements would have risen by 80 percent.

Related Links:

Avery, Rosemary, Donald Kenkel, Dean R. Lillard, and Alan Mathios. "Private Profits and Public Health: Does Advertising Smoking Cessation Products Encourage Smokers to Quit?" NBER Working Paper No. 11938, January 2006.

Avery, Rosemary, Donald Kenkel, Dean Lillard, and Alan Mathios. "Regulating Advertisements: The Case of Smoking Cessation Products." NBER Working Paper No. 12001, January 2006.

Iizuka, Toshiaki, and Ginger Zhe Jin. "Drug Advertising and Health Habit." NBER Working Paper No. 11770, November 2005.

Saffer, Henry, Melanie Wakefield, and Yvonne Terry-McElrath. "The Effect of Nicotine Replacement Therapy Advertising on Youth Smoking." NBER Working Paper No. 12964, March 2007.

Comments

[robertdfeinman]

Where is the evidence for this?
This is consistent with earlier research, which finds that people may become less careful about keeping a healthy lifestyle when, through advertising, they learn about a new drug treatment that can, for instance, treat high blood pressure or cholesterol. In other words, why exercise today when you can take a pill tomorrow?

There is an ad running sponsored by the NYC board of health featuring a man who has had his larynx removed and now breaths through a tube in his throat. Smoking by young people dropped off noticeably when the ad started to run.

The anti-smoking ads were paid for by the tobacco industry and were designed to be ineffectual. (There is some evidence of their participation in the design of the ads.)

Changing behavior can be successful when that is the intent. Didn't Bush turn the country in to a rabid bunch of yahoos demanding the blood of rag heads?

It the government was serious about eliminating tobacco use there are any number of things that could have been put in place over the past 50 years. The political pressure and the control over key Southern politicians prevented this.

Some economists need to get out a bit more and read the papers.

[James Killus]

I'll generally agree with what robertdfeinman says, with some refinements.

It seems to be fairly difficult to design anti-drug ads generally. I doubt that the illegal drug industry has much of a say in the "Just Say No" and related campaigns, but some of the anti-drug ads definitely have the effect of reminding drug users that they haven't gotten high for a while and hey, now's as good a time as any. This is particularly true of ads that either a) show the drug itself being used or b) feature hot young women. I doubt there's anything more behind b) than the simple fact that ad agency folks like working with hot young women as much as anybody.

In the case of nicotine replacement therapy ads, there's not really that much doubt about what's going on. These are ads that are advertising for people to use a drug. I know one woman who has been using nicotine gum for over a decade now. She likes nicotine but doesn't like the health effects of smoking. What's hard to understand about that?

[Deborah]

Products that are used to "help" people to quit smoking that contain nicotine should not be view or promoted as cessation products. There is little evidence to show that they truly help people to quit.

However, a human society would view the problem of smoking and addiction and educate about harm reduction. Why must a smoker expose them self and the people around them to thousands of chemicals, many carcinogenic when we could design pure nicotine delivery systems that would reduce the health risks to that of nicotine alone, not the many carcinogens and carbon monoxide, for that matter.

Truth is 50% of people diagnosed with lung cancer continue to smoke and have to deal not only with the fear of dealing such a deadly disease, but also the despair over being powerless to quit even facing death.

[wogie1]

Deborah

There is also more than a little hysteria in the advetising about second hand smoke, a la the American Cancer Society. They blare that it increases the cancer risk of non-smokers by 20 percent. True as far as it goes, but it's overblown. Lung cancer for example. The life time risk for non-smokers is 1 percent -- so second hand smoke increases the risk to 1.2 percent. Hardly the crisis the ads would have one believe.

[wogie1]

By the way, the lifetime risk of lung cancer fro a smoker is 8 percent.

[High Blood Pressure]

Alistrol provides an absolute solution for avoiding high blood pressure symptom by giving services of natural high blood pressure supplement.

[Dan]

I really cant see how those ads would make anybody want to smoke. They do not glamourize it in anyway