Graphic Health Warning Messages on Cigarette Packs - The Case of Germany
Gustav Schwab, Str 13-138 Konstanz, Baden Württemberg, Germany
- *Corresponding Author:
- Aleksejus Podpruginas
Gustav Schwab, Str 13-138 Konstanz
Baden Württemberg, Germany
Received Date: Oct 13, 2017; Accepted Date: Oct 28, 2017; Published Date: Nov 3, 2017
Citation: Podpruginas A. Graphic Health Warning Messages on Cigarette Packs - The Case of Germany. Global Media Journal. 2017, 15:29.
Copyright: © 2017 Podpruginas A. This is an open-access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
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Global Media Journal
The warning ads on cigarette packs are well known almost in every country on the globe. The anti-smoking campaigns which are managed and directed by the governments include several types of warning: textual, pictorial and combined. This work will focus on the newest campaign in Germany, which combines the graphical and the textual warnings and will try to discuss the advantages, the disadvantages and the ethical issues of such type of warnings by an overview of the literature. Also, this paper will try to suggest alternative methods for health warnings on the packs that according to the literature may cause to the same or even improve the goals and its results. A new theoretical model will be suggested as well when the goal of this model is to provide a new point of view based on literature and previous researches about the effectiveness of the warnings among those who are heavy smokers and those who are not. However, this model is a theoretical one and is not proven yet in the field.
Cigarette packs; Health warnings; Smokers
The health warnings presented on many products that we
are purchasing and using in a daily life. It can be a warning
about allergenic ingredients, chemical warnings on cleaning
goods, regarding alcohol usage and many others. However,
one of the most popular and well known warnings is related to
the damages caused by tobacco usage. Important to note that
the international guidelines for cigarette health warnings
“have been established under Article 11 of the WHO’s
Framework Convention on Tobacco Control (FCTC)” .
According to him, in 2011, 165 countries have ratified the
treaty. Also, it can be noted that those warning ads mostly use
the fear in order to influence the human behavior and to try to
avoid people from smoking. In 2016 the German parliament
and its health department decided to implement pictorial
warnings combined with textual warnings when according to
Burkhard Blienert, the drug policy spokesman for the Social Democrats group in the Bundestag, the "goal is to prevent
young people from starting to smoke” . In Germany, about
120000 people are dying annually  and the goal of the
German government and the German ministry of health was
to reduce the numbers of deaths. The German politicians hope
that the new gruesome and shocking images will affect the
smokers. Germany is following the European Union’s law that
according to at least two thirds (about 65 percent) of the front
and the back of the packaging will be covered by the graphical
ad  and a textual warning should be added to the pictorial
one. The pictorial warnings, such as blackened lungs and
rotten teeth will try to shock the smokers and to prevent them
from buying cigarettes when the main goal is smoking
cessation among the German population in general and
among the youth in particular.
Till the new law, about one-third of the surface of the
cigarette pack was covered by warnings, and probably was not
effective enough. The German politics looked for a way for
improving the anti-smoking persuasion and based on
researches concluded that adding pictorial warning together
with the textual one will give the most effective way of
persuasion . However, the first country that implemented
the pictorial warning was Canada in 2001. Then, according to
the local new law precedents, the graphical warnings had to
cover at least 50 percent of the potential display area . Since
then, a large amount of researches were carried out trying to
support or to criticize the pictorial warnings that are using
threats and fear. Both will be discussed in derails in the work.
However, the implementation of pictorial warnings by many
governments seems for now as the more successful antismoking
campaign comparing to the textual warnings.
This research is based on literature review, which was
analyzed in two main categories: those that are arguing for the
warning ads which are using threats as the main method of
persuasion and those who are claiming against. In this
literature review it was also an attempt to analyze the
advantages of the graphical warnings over the textual one. In
the second stage of the research, the current German pictorial
anti-smoking campaign was presented as a study case and was
analyzed basing on the literature review.
Health warning as a media tool and a target
Cigarette packages provide a high level of exposure.
Smokers, especially those who are smoking about a pack per
day, are potentially exposed to the warnings over 7000 times
per year . Based on this claim it was suggested by
Hammond that these warnings (written and graphics) are an
important media tool for communicating with the target
audience - the smokers about the health risks of tobacco use.
A survey among smokers in Canada in 1990s found that the
smokers have referred to the warnings as to an important
source of health information and had increased the awareness
to the risks .
Besides the smokers which were mentioned above, the nonsmokers
and the second-hand smokers (passive smokers) can
be seen as a target audience themselves . The goal of these
ads in this case is to prevent them from smoking . The same
scenario can be discarded on those who stopped smoking. The
cigarette packs and the warnings are displayed each time the
product is used and in many cases the packs are often left in
public view [1,4]. As a result, the smokers and the nonsmokers
are exposed to the ads. The ethical issue of this
exposure and the results of it will be discussed later.
Graphical warnings as an alternative method
Several researches about the efficacy of the graphical
warnings suggested that comparing to the textual warnings;
the pictorial warnings have more effect. Fisher, Richards and
Krugman  found that small text warnings are hooked up
with low level of awareness to the warnings. Therefore, based
on Shanahan and Elliott  it can be suggested that grater is
the size of the ad, the grater is its impact. Hence, the bigger is
the ad, much more effective it is. The Australian research
examined local cigarette packs where 90 percent of the front
side and 30% of the backside are covered with graphical
warnings and found that the effectiveness of warning depends
on the size of the ad [1,4].
However, the size is also crucial in text warnings. Hammond
 suggested, based on Fathelrahman et al‘s. research , that
large warning text is increasing the perceptions of risk and the
message is more informable when it is bigger and easier to
read. Pictorial warnings also increase the perceptions of the
warning credibility .
Health warnings with pictures attract much more attention
than the textual warnings since it is the first thing that the
smoker is looking at, thus supplying him more information.
The pictorial warnings are better remembered than the textual
warnings and therefore the health information is remembered
better for a long term period [1,7]. Researches in countries
where the pictorial warnings have been implemented showed
that the smokers can identify more smoking risks than in the
countries with textual warnings [7,8]. For example, a research
on Chinese smokers in 2008 showed that the smokers rated the pictorial warnings as a much more effective tool than the
textual warnings for motivating smoking cessation and for
preventing smoking in general . In a later research,
Hammond  also claimed that “health warnings with pictures
are rated by smokers and non-smokers as more effective than
text only warnings”. The pictorial warnings help to understand
the message and therefore have a greater impact than the
regular textual warnings. Gospodinov  who investigated
the effects of the pictorial warnings in Canada three years
after its implementation, found that the graphical warnings are
helping in reducing the daily consumption of cigarettes. Evans
et al.  suggested that “the presence of graphic images
(compared to text-only) caused more negative affect toward
smoking, a process that indirectly influenced risk perceptions
and quit intentions”. Moreover, they found in their research
that text elaborated messages, reducing the credibility of the
warning while the graphical warnings increased the knowledge
about the smoking risks. The graphical warnings will be
remembered better than textual warnings when the pictorial
warning will contain more detailed information than is
available in short textual warning . Here, it can be suggested
that by having more detailed information, the pictorial
warning becoming to be more “scary’ than the textual
warnings. That's to say, that amount of information in the
picture, increasing or decreasing the level of the fear that the
Slovic et al.  argued that emotional reaction to danger
evoking quick perception and reaction to the risk. That's to say,
that the emotions can influence behavior directly and to
motivate the target audience for the required changes .
Besides the mentioned above, both, the pictorial and the
textual warnings motivate people to use cessation services .
However, the appearance of a helpline on the packages is
increasing the calls for these centers [1,12]. But the
appearance of the graphical warnings is highlighting the
health-risk information and promoting greater processing and
acceptance of the information comparing to the textual
Pictorial Warnings and Youth
According to Hammond , the pictorial warnings, are
effective also among the youth. A Canadian research found
that the local youth said that the pictorial warnings are
providing them important information about health and the
smoking risks, and that the warnings made smoking less
attractive . An Australian research found that the youth who
were exposed to the graphical warnings were more aware to
the risks and attended to look for more information to the
results of the smoking . Another research  found that
in 2008 about 80 percent of youth smokers in the UK noticed
that the pictorial warnings led for smoking cessation .
The advantages of using threats in warnings -
the case of anti-smoking campaigns
The warnings on the cigarette packs increased the
awareness of the smokers when the main information about the risks and the dangers of smoking came directly from those
warnings . This can be explained by the fact that the
government and its anti-smoking policy is the responsible
authority for these warnings. As a result, the smokers are
seeing in the country as a reliable source of information and
therefore, it can be assumed that the warnings are true and
the smoker can trust them. Also, several researches suggested
that fear emotions may play an important role in the
effectiveness of the pictorial warning ads and helping in
message acceptance, thinking about the health risks and
helping to quit from the dangerous addiction [1,15,16].
Besides fear, the pictorial warnings, such those in the
current German anti-smoking campaign can cause to a disgust.
This feeling may also play an important role in message
acceptance. The goal of the warning ads that are causing to a
shock, disgust, fear and other strong emotions is to evoke
these exact emotional feelings that will lead to a cessation .
Millar and Millar  in their research about fear as a tool
for changing behavior found that fear might increase the
elaboration of the message and even to reduce the anxiety.
The threat is helping in understanding the danger and
motivating the person to control the danger by engaging in
behaviors and by that reduces the threat . The threats and
the fear that they are causing can create some negative
emotional reactions to the warning. However, “negative
emotional reactions to cigarette health warnings have been
associated with increases in key outcomes such as intentions
to quit, thinking about health risks, or engaging in cessation
behavior” . Similar results were found in Evans et al.
research  where they concluded that these negative
emotions increase risk perceptions and evoke quit intentions.
In a research that carried out by Millar and Millar  it was
found that messages that are causing high anxiety are
associated with behavior changing. According to the parallel
process model, increasing the anxiety for the target audience
about their health will increase their concern about their
behaviors . However not necessarily increasing the threat
will increase the message acceptance . A later expectancyvalence
model suggesting that the effectiveness of feararousing
communications is based on four variables: the
understanding of the severity of the threat, the perceived
probability of its appearance, the efficacy of the protective
response, and the perceived self-efficacy to accept the
response. This model claims that these variables are
interacting, thus it produce the level of motivation that
calibrates the level of change in the recommended behavior
As it will be presented later, one of the critiques to the use
of fear is that it is working for short term period. However,
Evans et al.  argued that this short exposure of the smoker
to the ad may cause to emotional impacts that would change
smoker’s feelings about smoking and may motivate him for a
better processing procedure of the risk information that will
lead to a faster cessation.
Threats as a strategy in anti-smoking campaign
- the critique
Despite that threats and fear is the main tool of persuasion
in the written and graphical anti-smoking campaigns on
cigarette packs it seems that there is no clear evidence that
these threats are serving the goal. Also, several ethical
questions are raised during the analysis of such campaigns
when the pictorial warnings are increasing the questions.
Hastings, Stead and Webb  suggested that ads that are
causing to fear can cause to a chronic heightened anxiety and
instead of preventing the danger, the ad can increase it. Also,
fear and anxiety can cause to different effects such as sadness
and confusion regarding the danger, and as a result the
message is wrongly accepted .
Here, it is also important to note the limitations of the
researches that examined the efficacy of fear. The first issue is
that the majority of these researches have been done in
laboratories and the results have never been examined in a
“real world”. Also, in most of the cases the examined audience
was students in colleges and universities when the reaction of
non-academic audience to the threats hasn’t been measured
enough. Another aspect that should be scrutinized is the long
term effect of the fear appeal ads . Hence, it can be
suggested that the efficacy of pictorial warnings on cigarette
packs has never been examined deeply and the question about
its efficacy remained to be unanswered.
Another issue that should be mentioned as a limitation is a
lack of tuition for correct and healthy behavior. Hastings and
MacFadyen  who examined the limitations of fear
messages suggested that those, such as youngsters, who are
able to recognize that the anti-smoking ad is trying to scare
and to convince by that not to smoke finding it personally
irrelevant and are trying to ignore and avoid the messages.
It was suggested, that fear arousing campaigns are effective
in raising awareness to the danger and helping to change the
attitudes , however, only few researchers have found that
campaigns that are raising fear showed changes in behavior in
target audience .
Moreover, it was suggested that “it is unlikely that a
response to a repeated fear ad remains static” . After
prolonged exposure to the same ad, it becomes predictable,
boring and sometimes laughable to the target audience and by
losing its efficacy . To wit, the threating ads are working
only in short term period while after numerous exposure, the
effectiveness of the ad and the message is decreasing.
Hastings, Stead and Webb  suggested in their research that
long term exposure to the same warnings can give rise to
habituation, annoyance and to tune out the message itself.
Schoenbachler and Whittler  suggested that fear appeals
with physical threat are effective only for a short term period
in the beginning, and during the time the efficacy of those ads
will diminish. As a result of long expose to health warnings on
cigarette packs, the smokers become to be inured to the
messages and developing adepts at avoiding the messages
Ethical issues in using threats and provoking
As it was mentioned above, the main tool using the textual
and the pictorial warnings on cigarette packs is a threat that
provokes fear when the main goals of it is to prevent smoking
and to cause to smoking cessation. However, threating ads use
the fear as a manipulating tool in order to change human
behavior . Moreover, the manipulation limiting the rational
and free choice. In the case of graphical warnings, the target
audience (and anyone who is exposed to the warnings) is
unwillingly exposed to those upsetting and even shocking
images . Allen and Witte  suggested that a target
person who is “catching” the manipulation and feeling that he
is forced to change his behavior unwillingly, may ignore the
messages and behave in an opposite way to the one
suggested. Hence, it can be suggested that the pictorial
warnings should also contain motivating messages that will
cause to a positive feelings among the target audience and will
Other issues to be discussed are the unintended audience
who is exposed unwillingly to the threats and may cause
psychological damage by creating unnecessary anxiety. The
graphical anti-smoking campaigns that contain hard-hitting
images are likely to be seen by the children of the smokers
that can be affected by those images . The non-smokers
and even the smokers who are exposed to these ads may
evoke a dread scenario about their own or their family
members’ death as a result of smoking [20,28].
Also, using threats on cigarette packs may cause to the
demonization of the target audience by those who are not
smoking and seen them by the society as a public enemy and
as a social deviants that are damaging and harming to the
public health [20,29]. As a result of the social blaming, the
smoker can feel loneliness and that he is abandoned by the
society and even by his family, who sees him as a threat to the
other non-smoking members of the family. This can cause to
mental weaknesses and other psychological disorders among
the smokers and it's helping for creating stigmas about the
smokers that are cause by themselves to personal blaming
among the smokers .
The anxiety that caused by the threats can cause to the very
same behavior that the message is trying to prevent .
Mayne  suggested that the anxiety can cause to increase
the risky behavior. That is to say, that the smokers who were
treated by the ads that can cause to a hard feelings that they
have to take a cigarette.
The government, the limitations and the
According to the basic laws, the government is the
responsible authority for the public health, it is responsible for
preventing disease, to supply medical assistance and health
information for the citizens. Hence, the government is also the
responsible authority for the anti-smoking campaigns. The
government, perceived as an authority which is supplying correct and truthful information. In Australia, for example,
about 85% considered that it is important that the government
is promoting the pictorial health warnings on cigarette
However, Flaskerud  arguing that by preventing us to
live unhealthy, the “nanny state” is restricting our liberty and
freedom. Moreover, Flaskerud raising a question “When did
we lose our right to be lazy, unhealthy, and politically
incorrect?” . However, it is also important to raise another
critical issue that asks at what point the personal freedom and
the well-being of the group are conflicting? The government,
as the responsible body for public health in the most of the
cases will prefer the general well-being and by that will enforce
the individuals to flex with the rules and the obligations
[32,33]. However, the anti-smoking campaigns due to their
preventions and warnings have been controversial. Flaskerud
 who examined the anti-smoking campaigns claimed that
long term strategies are required for changing smoking
behavior and has to be followed by increased taxes, extensive
media campaigns, large written and graphical warnings on
tobacco products, bans on smoking in public area, etc. All
these, according to the jurisdictions and supporters are the
required steps for preventing smoking and for improving the
public health rates. However, the opponents are claiming that
these limitations are harming to the individual freedom and
limiting their personal responsibility for their personal health.
Their main worry is that the government may take more and
more individual and private choices in the service of better
population health . However, the common good is coming
first when the government, that is playing the role of a
“nanny“, as it was mentioned above, the government is the
responsible authority for the common good and this is
allowing for the state to limit the minorities in the name of the
common good. Andre and Velesquez  who investigated the
common good, concluded that in our period when each and
every person is free to achieve his goals and to promote itself
freely, the individual is steel obligated to sacrifice some if its
freedom and self-interests for the sake of the common good
[32,34]. Therefore, it can be suggested that the newest
pictorial anti-smoking campaign in Germany that is supported
by the national health ministry, is serving the goals of the
common good despite that it can be uncomfortable for those
who are smoking and feeling harmed by the new anti-smoking
campaign. As it was mentioned above, the common good in
the case of the public health is coming first to the private
freedom and responsibility. The goal of public health is “to
protect and promote the health of communities or groups of
The German anti-smoking warnings on cigarette packs
combine two types of warnings: pictorial and textual. The
pictorial warnings showing shocking pictures such as a dead
body, blackened lungs and rotten teeth. The textual warnings
together with a helpline are trying to shock as well with
warnings such as: “Smoking harms your potency”, “smoking
causes fatal lung cancer”, “smoking causes to heart diseases”, and “smoke contains benzene, nitrosamine, formaldehyde,
and blue acid”. The appearance of a helpline on the packages
is an important and positive way of percussion for smoking
cessation. The existence of the helpline is increasing the calls
for centers and organizations that are helping in cessation
progress [1,13]. The appearance of the helpline is important
not only to the smokers themselves, but also to their family
members and friends who are also exposed to the warnings
and to the helpline. They are able to contact the organization
which will give them relevant tips in helping in the cessation
progress of the smoker.
The target audience of this campaign is the smokers in
Germany, where about 120000 people are losing their lives
each year as a result of smoking, when the more spotted
target audience is the youth who are considered as potential
smokers . However, the ads that are covering the major part
of the cigarette packs may also be viewed by unintended
audience. As it was mentioned in the literature review,
Hastings, Stead and Webb  arguing that this unintended
expose can cause to unnecessary anxiety among those who
were not targeted as an audience of the ad. Children and
mentally weak persons may be affected by the shocking ads
that are showing dying men (Figure 1) as a result of smoking
and may associate it with their smoking family members and
friends. This can lead to unintended anxiety. Black lungs and
rotting teeth (Figure 2) evolving disgusting feelings that may
scare children who will be unintendedly exposed to the
warning. Also, it can be suggested that the disgust feelings may
lead to avoidance from buying the “disgusting” cigarette
packs. Additionally, using threats and causing to anxiety can
lead to the very behavior that the warning is trying to prevent
[28,30]. That's to say, a smoker who will be over-affected by
the threat may take a cigarette in order to be relaxed after the
shocking images. Here, it is important to note that all the
images were taken from a German news web site Deutshe
Welle and are presenting the cigarette packs and the pictorial
warnings on them before the implementation. Therefore, the
helpline will not appear on the images while in reality this
helpline is added to the warnings.
Figure 1: Examples for graphical warnings in Germany.
Figure 2: Rotting teeth as an example for German shocking
The decision of the German politics to implement pictorial
warnings was based on researches. Shanahan and Elliott 
argued that the graphical warnings have much more effect
than the regular textual warnings. However, the textual
warnings were added to the graphical. However, Fathelrahman
et al.  suggested that large warning text increasing the
perceptions of risk and the message is more informtable.
Hence, it can be suggested that pictorial warnings have to
come together with a text in order to gain its power as a
warning. However, the pictorial warnings have more potential
to be remembered better than the textual warnings . As a
result, the graphical warnings are more informative than the
textual. Therefore, adding both of them allowed the German
authorities to present two different warnings to the customer
and by that to increase his knowledge about the smoking
dangers. Being treated, the customer may use the helpline
which is added near to the warnings. The existence of the
helpline together with the warnings is a very positive notion.
Gray, et al.  argued that fear arousing campaigns are
effective in raising awareness to the danger while they are not
suggesting ways for dealing with the threats. Therefore, it can
be argued that the helpline can be seen as the next step after
getting aware to the danger. The smoker doesn’t need to look
for a helpline after the shocking and the awareness progress
that caused the graphical and the textual warnings; the phone
number appears together with the warnings. Willemsen, et al.
 argued that the appearance of the helpline increasing the
calls for the centers of smoking cessation. This can be
explained by instant moment. That's to say, as it was
mentioned above, the smoker can call to the center at the
same time that he is taking a cigarette, the smoker is
exempted from looking for the phone on the internet or in the
phone book. The instant moment is very critique in taking a
decision of smoking cessation. Being shocked or scared by the
ad, the smoker has more chances to get contact with the
smoking cessation helpline. After a while, this effect is losing
its power. Schoenbachler and Whittler  arguing that fear
appeals with physical threats such as those that are appearing
on the cigarette packs in Germany are effective only for short
term period, only during the first exposes. During the time
pass, the smoker may forget about the threat or to get used to
it  and therefore to ignore the message in the future. Millar and Millar  suggested that the threat is helping in
understanding the danger and motivating the person to
control the danger. The appearance of the helpline is helping
to the smoker in controlling the behavior and to get help and
advices for changing his behavioral attitudes.
As it was mentioned above, the graphical threats can cause
for unnecessary anxiety among the unintended audience ,
but it also can be a very effective tool that can cause to
initiation to quit from smoking, and to bring the smoker for a
better risk perception . Here, it is important to note that it is
one of the main goals of this campaign. Besides preventing
smoking, this campaign is trying to cause for a better risk
perception by adding the pictorial warnings. The previous
textual warnings, besides being much smaller they failed in
supplying the relevant level of risk perception . Therefore,
adding pictorial warning together with the textual one,
enlargement of the ad’s size, and finally adding a helpline, may
be the optimal solution in case of cigarette warnings.
However, using positive and supporting pictorial and textual
messages or role models may even increase the result . It
can be suggested that supporting message together with the
shocking image may have a greater impact than two different
warnings by evoking positive feelings that will lead to a phone
call to a helpline.
Altogether, it seems that the dysfunction of textual warnings
led the German authorities for this new campaign. As it was
mentioned above, pictorial warnings together with textual
warnings and a call for using the helpline, may lead to a better
result among the target audience.
Hastings, Stead and Webb  argued that the effectiveness
of fear ads is temporary and works only for a short term
period. Based on this claim a simple model can be suggested
here. The effectiveness of the threat is limited and shortly
becomes to be familiar, predicted and even boring .
Schoenbachler and Whittler  also arguing that warnings
which are using threats and fear are effective only for a short
term period, only during the first exposes. Hence, those who
are smoking less would be less exposed to the threats and
therefore have more potential to be affected by the warnings.
As it was mentioned above, smokers, who are smoking about a
pack per day are exposed about 600 times per month and
approximately 7000 times per year for these warnings Based
on this it can be suggested that the “heavy smokers” develop a
habituation and “immunity” to the warnings due to their
familiarity with the warnings. Therefore, it also can be
suggested that those who are smoking less and also less
exposed to the warnings may not evolve such “immunity” as
those who are smoking a lot. Each time that they will take a
cigarette, they may be exposed and be affected by the warning
as in the first time when they meet it. That's to say, that the
warning may not be remembered by the smoker who is
smoking less. As a result, this expose to the shocking warnings
can lead to a cessation among this type of smokers. Here, it
can be suggested also that the high frequency of changing threats in the warnings may be more effective among the
smokers which will get more health information and may not
develop immunity to the warnings. This can also lead to a
behavioral change. However, this model should be scrutinized
in order to be valid.
Suggestions for improving the anti-smoking
The new graphical anti-smoking campaign in Germany may
lead to a reduction in the smoking rate. However, studies have
found that adding names and ages of the individuals that are
appearing in the graphical pictures on the packs will increase
the effectiveness of the warning . Besides that, scientific
information on the packs near the graphical warnings can
enhance the emotional reaction and to lead to a better
message acceptance . It was also assumed that pictorial
warnings have to be periodically updated in order to have a
greater impact. This update can be even the smallest one like a
size change or position. Moreover, the health warning has its
greater impact on the target audience shortly after its
implementation [37,38]. Witte  suggested that messages
with effective guidance how to cope with the danger are much
more efficient. This can promote their self- efficacy for doing
the required changes and giving to the target audience the
required tools how to challenge the threat. Therefore, it can be
suggested that adding motivating messages and advices for
smoking cessation on the cigarette packs together with the
pictorial warnings could be more effective than presenting the
graphical warnings only.
Another important issue is planning and suggesting helping
actions to the target audience. Millar and Millar 
investigated the effects of threat and anxiety in health
warnings and found that “anxiety in the absence of a plan of
action can motivate persons to defensively avoid thinking
about the behavior”. Therefore, messages that are promoting
behavior change with supportive and directives will be more
effective than a regular treating add.
Another suggestion for successful ad is to use a replacement
method for persuasion instead of fear. The alternative to fear
can be “positive reinforcement appeals aimed at the good
behavior, the use of humor, and, for younger audience, the use
of postmodern irony” . Anderson  suggested that the
level of fear should be moderated and the message should
lead to a behavior changing. Hastings, Stead and Webb  suggested that positive emotions will presumably be equally
effective as the ads that are using fear. Ads that are based on
elements such as love, sex, excitement, hope and other that
evoke positive emotions may be convincible at least at the
same level as threats. Isen  argues that positive messages
are remembered better due to his direct influence on the
target audience compared to the negative message which
acceptance is harder. Therefore, positive messages such as
positive advices together with the pictorial warning could be
more effective. For example, ads which are describing smoking
as an addiction that is not controlled by the smoker may be
more effective than ads which are encouraging not to smoke
due to dangerous and deadly diseases . The less effective anti-smoking campaigns are those that based their ads on the
negative results of the smoking as their main persuasion
method for smoking cessation .
Another positive way for successful persuasion is the role
models who are carrying out and acting by the suggested way
of behavior (such as avoidance from smoking and doing sports
instead of it) and giving positive advices. These role models
may be imitated by the target audience and increasing the
self-efficacy among them . Also, using positive messages
may decrease the number of ethical issues about the using of
fear. For example, the unintended expose to a positive
message will not decrease the chances for anxiety among
children and mental week people.
Millar and Millar  also suggested that the efficacy of the
warning messages is better when it calls for behavioral
changings and not only informational about possible disease.
However, as it was already mentioned in this paper, the
warnings could be seen as a source of health information .
This information is produced by the government that may be
seen as a source of a reliable one. Therefore, adding messages
that are convincing for behavioral changings together with the
helpline may be effective as well.
Also, short period of life of the threat may be more effective
than using the same warning. The efficacy of the warning is
short  and through the time becoming to be predictable
and not effective . Therefore, refreshing the warnings from
time to time may give a better result.
This research was based on literature review and the
researches that were described and analyzed there. The
suggestions and the observations which were presented
during the work have never been examined by the author in
reality and never been proven as well as the theoretical
method which was constructed based on the literature review.
Graphical warning combined with textual threats and a
helpline is the newest way of the German authorities to call for
smoking cessation among the population. The decision of the
local authorities to implement this change based on
researches which supported the use of pictorial warnings. The
pictorial ads are better remembered and are the first thing
that the smoker will be looking at during the smoking action.
However, despite being mentioned above, the opposite claim
criticizing this way of persuasion claiming that it is increasing
the awareness while it is not really helping in behavioral
changings and that the effect of ads that are using fear is
Still, it is early to adjudicate the current anti-smoking
campaign. It will have to be analyzed by researches in the
future. However, it seems that more and more countries
implementing the graphical warnings instead of the textual.
This can hint about the advantages of the pictorial persuasion
in the case of the health warnings on cigarette packs.
Based on the literature, it seems that there is no clear
answer about the efficacy of fear in warning ads. The claims of
the supporters and the protesters are also dependent on
researches and their results. However, the limitations of the
researches, such as the duration, the researchable, the
experimented subjects, the place and time of the research. All
these and other aspects are influencing the results. Therefore,
it can be suggested that in this kind of research about the
efficacy of pictorial warnings may never be answered. It can
therefore also explain the decision of the German authorities
to combine graphical and textual warnings together for getting
the best impact on the target audience. However, as it was
mentioned above, it is early to critique and to analyze the
efficacy of the German anti-smoking campaign.
Special thankfulness for Professor Nurit Guttman for guiding
in the writing of this paper. Also, a unique thankfulness for
Professor Nili Liphschitz in helping editing this work and in
preparation for submission.
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