July 11, 2007 — Ad Intervention

Do nicotine replacement therapy ads actually encourage smoking?
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.