Perceptions of Risk and Cigarette Package Warning Labels of

Perceptions of Risk and Cigarette Package
Warning Labels of Adults in Turkey
GIBA 2014, 05/16/2014
Destan KIRIMHAN
OUTLINE
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Research questions
Motivation
Theoretical foundations
Methods and procedures
Results
Conclusions
Limitations
RESEARCH QUESTIONS
• Are cigarette smokers more risk seeking than nonsmokers?
• Which one is more effective on adults’ attitudes?
Gain-avoidance, gain-benefit or loss framed messages
on cigarette packages.
• Is prospect theory valid for cigarette smokers?
• Which one do cigarette smokers perceive as riskier?
Continuing smoking or quitting smoking.
MOTIVATION
Cigarette consumption in Turkey, 2003-2012
MOTIVATION
Volume of tax-paid sales of tobacco products (exclusive of exports),
2003-2012
MOTIVATION
Projected number of smokers and number of tobacco deaths in Turkey
under alternative prevalence scenarios
MOTIVATION
Different properties of cigarettes:
• increased future smoking by creating addiction
• intergenerational and intragenerational effects
 negatively affected babies whose mothers smoked during
pregnancy,
 decreased future national income due to the increased health
expenditures spent on smoking related diseases
 increased negative externalities caused by passive smoking
and taking smokers as role models
• smokers delay their quitting decisions or do not plan to quit
since short-run negative effects of smoking are not as harmful as
its long-run negative effects (Press Release of Global Adult
Tobacco Survey, 2012).
MOTIVATION
• Importance of taking effective precautions
• a room for government regulation and policy.
• public spots and framed messages on cigarette
packages
• knowledge of smokers’ risk perceptions toward
continuing smoking and quitting smoking.
• a modest contribution to designing framed messages by
synthesizing different points of view in the literature
• Is it effective to have only loss-framed messages on
cigarette packages like nowadays in Turkey?
THEORETICAL FOUNDATIONS
• Some studies evaluated smokers as irrational
(Chesney & Hazari, 1998; Goodin, 1989; Slovic et
al., 2004)
• Becker and Murphy (1988) rational addiction model
• Becker, Grossman and Murphy (1994) adjacent
complementary pattern of optimal consumption
• Rachlin (2007) addicts have higher discount rates
addicts choose small-sooner gains to larger-later gains
THEORETICAL FOUNDATIONS
• Orphanides and Zervos (1995) cigarettes have
unknown addictive power.
• Blondel et al. (2007) drug-addicts are more risk
seeking than non-addicts but are not less rational
• This paper mainly utilizes from the risk measurement
methods employed in Blondel et al. (2007) in order to
investigate whether cigarette smokers are more risk
seeking than non-smokers.
THEORETICAL FOUNDATIONS
• Blondel et al. (2007) increase in the average prices of
cigarette packages.
• Orphanides and Zervos (1995) addicted individuals’
price elasticity of demand for cigarettes is low.
 a ban or any other restriction on cigarette consumption is
not Pareto efficient under some conditions.
• Krohn et al. (1983) commitment to education
• This study analyzes only the effects of framed
messages on cigarette packages as a way to prevent
and/or cease smoking behavior.
THEORETICAL FOUNDATIONS
• Kahneman and Tversky (1979) prospect theory
 people are risk averse in the gain space
 risk seekers in the loss space
• Goodall & Appiah (2008)
 quitting smoking makes a person healthier in the long run
(gain-framed benefit message)
 quitting smoking significantly decreases the risk of heart
attacks, strokes, lung cancer and other diseases in the long
run (gain-framed avoidance message)
 smoking significantly increases heart attacks, strokes, lung
cancer and other diseases in the long run (loss-framed
message)
THEORETICAL FOUNDATIONS
• Goodall and Appiah (2008) quitting smoking is related
with certain outcome of a decreased risk of illnesses.
• Prospect theory warning labels cigarette packages are
more effective when they are gain-framed rather than
loss-framed
• This paper is mainly inspired from the method of study
used in Goodall and Appiah (2008) in order to examine
the effects of gain-framed and loss-framed messages
on adults’ smoking-related attitudes and behaviors.
THEORETICAL FOUNDATIONS
• Prospect theory does not have to be always true.
• Toll et al. (2008) addicts who perceive quitting
smoking as highly risky due to weight gain, loss of
attention and/or concentration, social ostracism, loss of
enjoyment and craving for cigarettes reported fewer
days to the first cigarette when they are exposed to
gain-framed messages.
• This study integrates the approach of Toll et al. (2008)
regarding the risk perceptions of cigarette smokers
toward quitting smoking.
THEORETICAL FOUNDATIONS
• Goodall and Appiah (2008) loss-framed messages,
especially highlighting the risks associated with
adolescents’ appearance such as teeth spots, are more
effective in preventing smoking than gain-framed
messages.
• A synthesis of different points of view in the literature
on the validity of prospect theory for smokers.
• Distinguishing points of reviewed studies and bring up
an integrated approach of evaluating adults’
perceptions of risk and warning labels in Turkey.
METHODS and PROCEDURES
• An experiment with a questionnaire
• 19 cigarette smokers and 16 non-smokers
• randomize the subjects - criterion of being a visitor of
a tobacco shop in a shopping center in Ankara at the
first weekend of June in 2013
• this survey is presented as a part of a research study
about smoking decisions of individuals
• restriction of this analysis - samples of smokers and
non-smokers are seperately small samples
METHODS and PROCEDURES
• First part - individual characteristics like age, sex,
race, employment status and income.
Two sided p-value
between s and ns
0,79
0,72
0,37
Smokers (s)
Non-smokers (ns)
Age in years
Percentage of men
Percentage of whites
Rate of unemployment
43,1 (10)
30% (0)
100% (0)
10% (0)
44,1 (11)
40% (1)
100% (0)
0% (0)
Income per month (Turkish Lira)
3315,8 (2572) 2537,5 (1212)
0,28
Oldness in consumption (years)
19,2 (10)
-
-
Number of consumed cigarettes
(pieces)
12,6 (8)
-
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METHODS and PROCEDURES
• Second part - compare risk perceptions of cigarette
smokers and non-smokers
• 9 lottery choice and 5 lottery evaluation questions
METHODS and PROCEDURES
• Percentages of risky choices of smokers and non-smokers
• for each lottery choice question choice indicator of risk
(CIR)
• for each lottery evaluation question pricing indicator of risk
(PIR)
• compared with the help of two sided student’s t-test
• Blondel et al. (2007)
METHODS and PROCEDURES
• Third part - examine the effects of gain-framed
benefit, gain-framed avoidance and loss-framed
messages on adults’ smoking behaviors
• validity of prospect theory for cigarette smokers
• Three types of risks
 tolerable risks of smoking on appearance like teeth spots
 intolerable risks of smoking like heart attacks
 perceived risks of quitting smoking like weight gain
METHODS and PROCEDURES
• Goodall & Appiah, 2008
METHODS and PROCEDURES
• The most effective type of framed message among
loss-framed, gain-framed avoidance and gain-framed
benefit messages and validity of prospect theory are
investigated with the help of analysis of variance
(ANOVA) method by examining whether there are
differences among the mean values of these types of
framed messages.
RESULTS
Percentages of risky lottery choices selected by smokers and non-smokers
Question
number
1
2
3
4
5
6
7
8
9
All
Percentages of risky choices
Smokers (s)
Non-smokers (ns)
31,6
31,3
21,1
25,0
26,3
31,3
47,4
43,8
15,8
12,5
42,1
62,5
21,1
50,0
15,8
43,8
26,3
43,8
27,5
38,2
Two sided p-value
between s and ns
0,98
0,79
0,76
0,84
0,79
0,24
0,08*
0,07*
0,29
0,04
* Difference is significant at 10% significance level.
RESULTS
Average prices written by smokers and non-smokers for lottery evaluations
Question
number
10
11
12
13
14
All
Average prices
Smokers (s)
85,0
122,5
78,4
136,6
83,9
101,3
Non-smokers
(ns)
119,1
67,2
65,3
115,9
87,2
90,9
Two sided p-value between s
and ns
0,30
0,32
0,64
0,65
0,90
0,55
Average risk indicator values for smokers and non-smokers
Average values of risk indicators
Smokers (s) Non-smokers (ns)
Two sided p-value between
s and ns
Choice indicator of risk
0,3
0,4
0,40
Pricing indicator of risk
0,4
0,5
0,34
RESULTS
Adults’ mean and standart deviation responses to different types of framed messages
for the overall risks
Lossframed
(LF)
Gainframed
avoidance
(GFA)
Gainframed
benefit
(GFB)
p-value of
one-way ANOVA
among LF, GFA
and GFB
Reducing
smoking level
3,6
(1,0)
3,3 (1,3)
3,4 (1,2)
0,03
Improving
ability to quit
3,6
(1,1)
3,4 (1,2)
3,4 (1,1)
0,15
RESULTS
Smokers’ and non-smokers’ mean and standart deviation responses to
different types of framed messages for teeth spots
Smokers
Reducing
smoking level
Improving
ability to quit
Non-smokers
Reducing
smoking level
Improving
ability to quit
p-value of
two-way
ANOVA among
LF, GFA and
GFB
Lossframed
(LF)
Gain-framed
avoidance
(GFA)
Gainframed
benefit
(GFB)
3,2 (1,0)
2,5 (1,4)
3,0 (1,2)
0,21
3,3 (1,0)
2,8 (1,2)
3,1 (0,9)
0,16
3,6 (0,9)
3,4 (1,1)
3,7 (1,1)
0,81
3,2 (1,2)
3,1 (1,5)
3,6 (1,2)
0,16
RESULTS
Smokers’ and non-smokers’ mean and standart deviation responses to
different types of framed messages for heart attacks
Smokers
Reducing
smoking level
Improving
ability to quit
Non-smokers
Reducing
smoking level
Improving
ability to quit
p-value of
two-way
ANOVA among
LF, GFA and
GFB
Lossframed
(LF)
Gain-framed
avoidance
(GFA)
Gainframed
benefit
(GFB)
3,8 (1,0)
3,4 (1,3)
3,5 (1,0)
0,03
3,8 (0,9)
3,5 (1,0)
3,6 (0,8)
0,16
4,3 (0,8)
4,3 (0,8)
4,1 (0,6)
0,38
4,3 (0,8)
4,3 (0,7)
4,0 (0,8)
0,1*
RESULTS
Smokers’ and non-smokers’ mean and standart deviation responses to
different types of framed messages for weight gain
Smokers
Reducing
smoking level
Improving
ability to quit
Non-smokers
Reducing
smoking level
Improving
ability to quit
p-value of
two-way
ANOVA among
LF, GFA and
GFB
Lossframed
(LF)
Gain-framed
avoidance
(GFA)
Gainframed
benefit
(GFB)
3,0 (1,2)
2,8 (1,2)
2,8 (1,2)
0,26
3,2 (1,2)
3,0 (1,1)
2,9 (1,3)
0,35
3,7 (0,9)
3,8 (1,0)
3,5 (1,4)
0,48
3,8 (0,8)
3,8 (0,9)
3,6 (1,3)
0,48
RESULTS
Smokers’ and non-smokers’ mean and standart deviation responses to
different types of framed messages for the overall risks
Smokers
Reducing
smoking level
Improving
ability to quit
Non-smokers
Reducing
smoking level
Improving
ability to quit
p-value of
two-way
ANOVA among
LF, GFA and
GFB
Lossframed
(LF)
Gain-framed
avoidance
(GFA)
Gainframed
benefit
(GFB)
3,4 (1,1)
2,9 (1,4)
3,1 (1,1)
0,009
3,4 (1,1)
3,1 (1,1)
3,2 (1,1)
0,046
3,9 (0,9)
3,8 (1,0)
3,8 (1,1)
0,45
3,8 (1,0)
3,8 (1,2)
3,7 (1,1)
0,89
RESULTS
• risk perceptions of smokers for continuing smoking
and quitting smoking
• Loss-framed messages are not found to be
significantly the most effective framed message for
smokers for weight gain.
• Gain-framed messages are not found to be more
effective than loss-framed messages for risks
associated with teeth spots and heart attacks for
smokers.
• It cannot be accepted that smokers perceive quitting
smoking riskier than continuing smoking.
CONCLUSIONS
• No enough evidence that cigarette smokers are more risk
seeking than non-smokers.
• Adults, both smokers and non-smokers, exposed to lossframed messages perceive that those messages are more
effective in reducing general smoking level than gain-framed
messages.
• Adults exposed to loss-framed messages do not perceive that
those messages are more effective in increasing one’s ability to
quit than gain-framed message.
• The most effective framed message for smokers is found to be
the loss-framed but this conclusion is not statistically
meaningful in cases of teeth spots and weight gain. Yet, it is
statistically significant in cases of heart attacks.
CONCLUSIONS
• The most effective type of framed message for the
overall risks is significantly discovered to be the lossframed for smokers.
• Prospect theory is not valid for smokers.
• It is effective to have only loss-framed messages on
cigarette packages nowadays in Turkey.
• Cigarette smokers do not perceive quitting smoking
riskier than continuing smoking.
LIMITATIONS
• Must be evaluated carefully since smokers and non-smokers
samples are seperately small samples.
• Small number of questions asked to respondents
• Risk indicators other than CIR and PIR can be employed to
measure risk perceptions more accurately.
• Another risk perceived from quitting smoking such as loss of
attention and/or concentration, social ostracism, loss of
enjoyment and craving for cigarettes can be exemplified.
• As a future study,
 a more comprehensive questionnaire
 a higher number of adults
 another example of quitting smoking risk as the highest risk of quitting
smoking.
THANKS FOR LISTENING
Destan KIRIMHAN
Lecturer, Economics Department, Baskent University,
Ankara – TURKEY
[email protected]

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