[Federal Register Volume 60, Number 231 (Friday, December 1, 1995)]
[Proposed Rules]
[Pages 61670-61679]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-29299]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Food and Drug Administration
21 CFR Parts 801, 803, 804, and 897
[Docket No. 95N-0253]
Regulations Restricting the Sale and Distribution of Cigarettes
and Smokeless Tobacco Products to Protect Children and Adolescents:
Findings of the Focus Group Testing of Brief Statements for Cigarette
Advertisements
AGENCY: Food and Drug Administration, HHS.
ACTION: Notice of findings.
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SUMMARY: The Food and Drug Administration (FDA) is announcing the
findings of focus groups concerning the brief statements that would be
required on all cigarette advertising. On August 11, 1995, FDA issued a
proposed rule which, among other things, would require cigarette
advertising to carry a brief statement on the relevant warnings,
precautions, side effects, and contraindications pertaining to
cigarette use. The agency said it would perform extensive focus group
testing on the proposed brief statement. This document announces the
findings of that focus group testing.
DATES: Written comments by January 2, 1996.
ADDRESSES: Submit written comments to the Dockets Management Branch
(HFA-305), Food and Drug Administration, rm. 1-23, 12420 Parklawn Dr.,
Rockville, MD 20857.
FOR FURTHER INFORMATION CONTACT: Philip L. Chao, Office of Policy (HF-
23), Food and Drug Administration, 5600 Fishers Lane, Rockville, MD
20857, 301-827-3380.
SUPPLEMENTARY INFORMATION: In the Federal Register of August 11, 1995
(60 FR 41314), FDA published a proposed rule that would restrict the
sale and distribution of cigarettes and smokeless tobacco products in
order to protect children and adolescents. The proposed rule, among
other things, would require cigarette advertising to carry a brief
statement, such as ``About one out of three kids who become smokers
will die from their smoking.'' The preamble to the proposed rule stated
that FDA would conduct focus group testing of this proposed brief
statement to evaluate the content and various formats for the brief
statement to determine if the warnings are communicated effectively (60
FR 41314 at 41338). FDA also stated that it would base the design,
format, and content of the brief statement which is required by section
502(r) of the Federal Food, Drug, and Cosmetic Act on all
advertisements and other descriptive printed matter pertaining to
restricted devices) on the results of the focus group testing and on
comments to the proposed rule.
-FDA has completed the focus group testing and, through this
document, is announcing the focus groups' findings. FDA will use the
report, as well as comments submitted on the report, to determine the
design, format, and content of the brief statement when preparing a
final rule. The report is accompanied by sample graphics illustrating
how a brief statement might be presented and by two moderator's guides.
-Interested persons may on or before January 2, 1996, submit to the
Dockets Management Branch (address above) written comments on the focus
group report. Two copies are to be submitted, except that individuals
may submit one copy. Comments are to be identified with the docket
number found in brackets in the heading of this document. Received
comments may be seen in the office above between 9 a.m. and 4 p.m.,
Monday through Friday.
-The report, entitled, ``Findings of the Focus Group Testing of
Brief Statements for Cigarette Advertisements,'' is as follows:
Executive Summary
Macro International, a research firm which provides survey,
market research, and focus group services worldwide, was awarded a
contract from the U.S. Food and Drug Administration (FDA) to conduct
a series of focus groups with adolescents to compare and evaluate
brief statements directed to teens that address the risks of
smoking. Macro has done nationally-representative surveys and
demographic studies in 80 countries and has offices with state-of-
the-art focus group facilities in its headquarters outside
Washington DC, New York City, Moscow, Warsaw, Prague, Budapest, and
Burlington VT.
This contract included two series of focus groups. The purpose
of the first series of groups, held in Calverton, Maryland, was to
examine a number of brief statements about smoking to determine
which of several kinds of messages teens found most compelling. The
purpose of the second series of focus groups, held in cities around
the U.S., was to evaluate a shortened list of messages and consider
methods of presentation that would be most effective in informing
teens about the risks of smoking. Participants in these focus groups
were 12-17 year old males and females, and included both smokers and
non-smokers. The focus groups were held during October and November,
1995.
I. Assumptions and Basic Perceptions of Adolescent Smoking
According to the participants in the focus groups, smoking among
teenagers is widespread. Almost all teens will try smoking at some
point during their adolescence. There is little stigma attached to
experimentation with smoking, since many teens consider it to be a
``rite of passage''. Few teens who are just beginning to smoke
consider themselves at risk for becoming addicted to cigarettes
because they are convinced that they can quit at any time. The
groups said that teens try smoking because of peer pressure; the
desire to do something that they perceive to be an adult activity;
and as a way to rebel against their parents, either overtly or
covertly.
Some of the focus groups did have active, regular smokers as
part of the group, and the attitudes about smoking expressed by
these participants was quite different than those expressed by non-
smokers or occasional smokers. Participants who indicated that they
were regular smokers did not mention any of the reasons given by
``social smokers'' as their reasons for smoking. They do not smoke
in groups, nor do they smoke for social acceptance. Rather, they
smoke because it ``calms them down'' or satisfies a physical need.
Non-smokers or infrequent smokers indicated that they felt most
people could stop smoking at any time; the teens who said they were
addicted to smoking made it clear that, for them, smoking was no
longer a matter of choice but a matter of need.
II.- Perceptions of Cigarette Advertising
All of the groups expressed familiarity with the cigarette
advertisements shown to them, and many were aware of incentive
programs sponsored by major cigarette manufacturers, whereby
cigarette smokers could receive clothing items or other products by
cashing in ``Camel dollars'' or ``Marlboro miles'' for products from
a catalog. The focus groups said that they felt the
[[Page 61671]]
primary target of cigarette ads were teens and young adults, and that
ads show people having a good time so that kids will think that
their lives will improve if they smoke.
III. Perceptions of Surgeon General's Warnings
Unless prompted, the participants did not think of the Surgeon
General's warning as part of the advertisement. They are aware that
it is there, but it is considered a required element that is skipped
over as a matter of course. Participants thought that it was
required by the government or that it was there to keep people from
suing the manufacturer for smoking-related illnesses or death.
Participants did not think that the current Surgeon General's
warnings were effective. They said that the terminology used was too
complex (emphysema and carbon monoxide were two terms cited
repeatedly as being too complex for them to understand), and that
the ads seem to be designed to make the messages as unnoticeable as
possible.
IV.- Perceptions of New Brief Statements
All groups were shown a variety of new brief statements that
were intended to be directed primarily toward teenagers. Responses
to the messages appeared to fall into three general categories:
positive responses from most or all of the participants; mixed
responses, where some groups responded positively but others did
not; and messages that were poorly received by all groups. A
``positive'' response was defined as one where participants
indicated that teens their age would read the message, consider the
implications of the message, and perhaps change behavior because of
it. Mixed responses included some positive responses, but also
included neutral or negative responses to the brief statement. A
response was categorized as negative if a whole group never liked
the message.
The message that received the most positive response from groups
across the country was one that said, ``Tobacco kills more Americans
each year than AIDS, alcohol, accidents, murder, suicides, illegal
drugs, and fires * * * combined.'' Other messages that received
generally positive responses from most groups were, ``About one out
of three kids who become smokers will die from their smoking,'' ``Of
the 3000 young people who begin smoking each day, 1000 will die from
their smoking,'' and ``Tobacco causes shortness of breath, coughing,
yellow teeth and wrinkles.'' It is notable that the messages that
received the most positive responses from the groups were those
which presented facts and figures.
Messages that received mixed consideration from the groups were
those that were directed at a limited audience such as ``Smoking
hurts your athletic performance''; or those that the groups
considered to be ``slogans,'' such as ``Addiction happens much
faster than you think'' or ``Everyone now addicted to cigarettes
started out `just trying' cigarettes.''
Several brief statements received negative responses from all
groups to whom they were shown. They included most of the messages
addressing the issue of addiction, such as ``Addiction sucks you in
to a lifetime of smoking,'' ``Smoking is a deadly addiction,'' and
``Kids who start smoking find they can't stop--once it's too late.''
V.- Perceptions of Possible Design Elements for the Brief Statements
The major design elements that groups saw as leading to visual
prominence were type size, distinctive borders, a color that
contrasted with the rest of the ad, and to a lesser extent use of a
distinctive icon. Most groups recommended using a very large type
size to increase the visual prominence of the brief statement and to
make it easier to read. All groups were enthusiastic about the use
of a jagged border to draw attention to the brief statement. They
also recommended varying the message and varying its appearance over
time so that consumers would not habituate to its appearance.
Participants said that a brief statement would be most effective
if it was visually prominent in the ad, and that the optimal design
of the brief statement would necessarily depend upon the design of a
particular advertisement. Thus, several groups recommended that the
brief statements should be added after the advertisement was
designed to minimize the likelihood of it being designed to reduce
the impact of the brief statement. If that was not possible, many
groups indicated that placing the message at the top of the
advertisement or in the middle would be optimal for getting
attention.
Many of the groups said that the new brief statement should be
more visually prominent than the Surgeon General's warning, and that
the new statement should be distinct from the Surgeon General's
warning.
VI.- Other Findings
1. A common sentiment expressed by participants in some groups
was that the best way to present the information would be as a
stand-alone advertisement portraying the risks of smoking rather
than as part of a cigarette advertisement.
2. Smokers and non-smokers expressed similar sentiments about
messages that were effective, and about how to convey messages about
the risks of smoking in ways that would appeal to adolescents.
3. Most groups expressed the belief that any messages about the
risks of smoking would be most effective with younger children or
with people who had not yet started to smoke, rather than with
current smokers.
Methodology
Number and Composition of Groups
A total of 19 focus groups were held in five cities across the
United States. Cities were selected to reflect a diversity of
populations. The cities used for this study included Calverton,
Maryland (a suburb of Washington, DC); Minneapolis, Minnesota;
Charlotte, North Carolina; Houston, Texas; and San Francisco,
California. Groups included participants that represented the ethnic
diversity of the geographical area. All groups were segmented by
age, with approximately one-half of the groups comprised of 12-14
year olds and the rest of 15-17 year olds. All groups were single
sex groups with the exception of a mixed group of 15-17 year old
males and females in Calverton. The groups in Calverton, Charlotte
and Minneapolis were pre-screened to determine smoking status of
participants; the groups in San Francisco and Houston were not pre-
screened for smoking status since the recruiting experiences from
Calverton, Charlotte and Minneapolis assured the project personnel
that both smokers and non-smokers would be included in all groups
regardless of whether or not participants were pre-screened.
All of the focus groups for this project were 90-120 minutes
long. During Phase I of the project (the Calverton groups), the
primary objective was to determine which of 15 messages presented to
participants were received the most positively. During Phase II of
the project, the primary objectives were to refine the list of
acceptable messages even further; and to obtain feedback about how
the brief statements could be presented to showcase the message most
effectively.
Schedule of Groups
Calverton, Maryland: 3 groups at Macro's focus group facility
October 17, 5:30 p.m. - 8 Boys, 12-14 years old - Smokers
October 18, 4:30 p.m. - 8 Girls, 12-14 years old - Mix of
smokers and non-smokers
October 18, 6:30 p.m. - 8 Boys and Girls, 15-17 years old -
Smokers
Charlotte, North Carolina: 4 groups at FacFind, Inc.
October 24, 4:30 p.m. - 7 Girls, 12-14 years old - Smokers
October 24, 6:30 p.m. - 8 Girls, 15-17 years old - Mix of
smokers and non-smokers
October 25, 4:30 p.m. - 8 Boys, 12-14 years old - Mix of smokers
and non-smokers
October 25, 6:30 p.m. - 9 Boys, 15-17 years old - Smokers
Minneapolis, Minnesota: 4 groups at Orman Guidance Research
October 24, 4:30 p.m. - 8 Girls, 12-14 years old - Mix of
smokers and non-smokers
October 24, 6:30 p.m. - 8 Girls, 15-17 years old - Smokers
October 25, 4:30 p.m. - 8 Boys, 12-14 years old - Mix of smokers
and non-smokers
October 25, 6:30 p.m. - 8 Boys, 15-17 years old - Mix of smokers
and non-smokers
Houston, Texas: 4 Groups at CQS Research Inc.
October 31, 4:30 p.m. - 8 Girls, 12-14 years old - Mix of
smokers and non-smokers
October 31, 6:30 p.m. - 5 Girls, 15-17 years old - Mix of
smokers and non-smokers
November 1, 4:30 p.m. - 9 Boys, 12-14 years old - Mix of smokers
and non-smokers
November 1, 6:30 p.m. - 7 Boys, 15-17 years old - Mix of smokers
and non-smokers
San Francisco, California: 4 groups at Fleischman Field Research,
Inc.
November 8, 4:00 p.m. - 8 Girls, 12-14 years old - Mix of
smokers and non-smokers
November 8, 6:00 p.m. - 8 Girls, 15-17 years old - Mix of
smokers and non-smokers
November 9, 4:00 p.m. - 8 Boys, 12-14 years old - Mix of smokers
and non-smokers
November 9, 6:00 p.m. - 8 Boys, 15-17 years old - Mix of smokers
and non-smokers
Recruitment
Calverton Groups
[[Page 61672]]
Macro used Olchak Market Research, Inc. (OMR) to recruit the 3
groups in Calverton. OMR had been used successfully by Macro in the
past to conduct recruitment efforts for focus groups. OMR maintains
a randomly collected database of individuals who are likely to
participate in focus groups or other market research projects. To
maintain and add to this database, OMR calls individuals at random
and explains that they are a market research firm which periodically
performs market surveys and recruits for focus groups. They inform
the individual that participants in these projects are paid for
their time, then they ask whether the individual would be interested
in participating in a future project. If the individual is
interested in participating, his/her demographic information is
recorded for future use. OMR does not use address lists provided by
organizations, nor does it use individuals who contact them and ask
to be placed on their list since many of these people are
``professional'' survey and focus group participants.
To ensure that a sufficient sample of adolescents attended, 14
youths were recruited for each group so that each group had 9
participants. OMR called adult individuals who were known to have
children in the desired age range (12-17 years old), and used the
attached screening instrument in their recruiting efforts. OMR made
first contact with the parents of each youth. If the parents
approved of their child's participation in the group, the child was
then screened to determine if his/her age group (12-14 or 15-17
years old), gender, ethnicity, and smoking status fit the profiles
called for in any of the 3 Calverton groups. If the youth's profile
matched the desired profile for one of the groups, he/she was asked
to participate and offered a $40 incentive. Cash incentives are
routinely used in focus group projects to ensure that participants
attend groups that they have been asked to attend. All recruits were
sent a confirmation letter by OMR, and OMR also telephoned them
within 36 hours of the focus group to confirm their attendance. Each
confirmation letter also contained a parental permission form which
had to be completed and signed before any youth was allowed to
participate in a group or receive the incentive payment.
Other Cities
Recruiting in Charlotte, Minneapolis, Houston, and San Francisco
was performed by the individual focus group facilities with guidance
from Macro staff. Each facility's recruiting methodology mirrored
OMR's in most respects, except that the facilities in Houston and
San Francisco did not screen participants for their smoking status
for any group. Pre-screening for these groups was not required
because the recruiting patterns in Calverton, Charlotte and
Minneapolis indicated that a mix of smokers and non-smokers would
result whether smoking status was pre-screened or not.
Statement of Limitations
In market research, the focus group approach seeks to develop
insight and direction rather than quantitatively precise or absolute
measures. Because of the limited number of respondents and the
restrictions of recruiting, this research must be considered in a
qualitative frame of reference.
This study cannot be considered reliable or valid in a
statistical sense since the recruiting of participants cannot be
replicated, nor can the moderator ask the same questions of other
respondents. This type of research is intended to provide guidance
in determining knowledge, awareness, attitudes and opinions about
concepts, products, or advertising formats.
Certain biases are inherent in this type of study and are stated
here to remind the reader that focus group data cannot be projected
to any universe of individuals. First, participants tend to be risk
takers and may be somewhat more assertive than non-participants.
Second, participants in a focus group study ``self-select''
themselves by the very fact that they are those people who were
available at a time a particular group was scheduled. Participants
thus were not selected randomly so that each person in a pool of
possible participants did not have an equal chance of being
selected. Third, participants who attend focus group sessions may be
more articulate and willing to express opinions in a group than non-
participants. And finally, people in groups may respond differently
to a question than if asked the same question individually. They may
follow the lead of a strong speaker or someone they perceive as
``expert,'' despite efforts of the moderator to eliminate this bias.
This report cannot accurately detail the wealth of information
in the non-verbal area, such as ``body language,'' (posture,
sleepiness, wiggling in the chair, etc.) or the amount of time
elapsed between questions from the moderator and actual responses
from the group. It also cannot report on the subtle area of ``peer
pressure''--the willingness to avoid making a particular response
because of fear of what others in the group might think, or quickly
changing a response when others in the group appear to oppose a
particular position.
Finally, the reader is reminded that this report is intended
primarily to clarify cloudy issues and point the direction for
future research, and that data here cannot be projected to a
universe of similar respondents.
Moderators
Two moderators were used for this project. Both are Macro
employees with professional moderator training and significant
practical experience moderating focus groups. The moderator for the
Charlotte and San Francisco groups was trained at the Burke
Institute in Cincinnati, Ohio. The moderator for the groups in
Calverton, Minneapolis, and Houston was trained at the Riva
Institute in Bethesda, Maryland.
Data analysis
All of the focus groups were taped. The tapes were used to
develop transcriptions of the sessions for preparation of the
report. All direct quotations in this report were identified via the
professional transcriptions, which were produced by SAG Corporation
in Washington, DC with tapes supplied by Macro.
Protection of privacy of participants
All participants and their parents were promised anonymity for
their participation in this study. Thus, no participant names or
other identifying characteristics appear in this report.
Format for Discussion
Phase I--Calverton
The primary objective of the Calverton groups was to obtain
adolescents' reactions to 15 messages that had been developed as
possible brief statements directed towards teens. In addition,
participants were queried about attitudes toward smoking among their
contemporaries and attitudes toward cigarette advertising among this
population. Thus, the discussion for these groups followed the
following format:
A. Discussion of Cigarette Advertising
Participants were queried about their knowledge of cigarette
advertising and their perceptions of what messages cigarette
advertisements were attempting to convey. Sample cigarette
advertisements were present to aid the discussion.
B. -Discussion of Surgeon General's Warnings
The moderator focused discussion upon the Surgeon General's
warnings currently appearing on cigarette advertisements and
elicited reactions to those warnings.
C. -Presentation of Sets of Brief Statements
Participants were presented with four sets of brief statements,
with each set containing messages that addressed different aspects
of smoking. Statements were presented in sets to ease the process of
comparison and selection of the most effective messages, due to the
large number of brief statements that were presented to this group.
The four sets of messages presented to the Calverton groups were:
Set 1
Kids who smoke like adults get addicted like adults.
Tobacco kills more Americans each year than AIDS, alcohol,
accidents, murder, suicides, illegal drugs and fires * * * combined.
The earlier you start smoking the greater your risk of lung
cancer.
Smoking harms your baby.
-Set 2
Most teen smokers believe they can quit but after six years 75%
still smoke.
About one out of three kids who become smokers will die from it.
Tobacco causes shortness of breath, coughing, wheezing, yellow
teeth and wrinkles.
Cigarette smoke has more than 4000 chemicals including ones that
cause cancer.
-Set 3
Tobacco kills more people every day than 2 jumbo jets crashing
with no survivors.
Smoking is a deadly addiction.
Smoking today leads to fewer tomorrows.
-Set 4
-Kids who start smoking find they can't stop--once it's too
late.
-Everyone now addicted to cigarettes started out `just trying'
cigarettes.
-Most smokers wish they could quit but can't.
-70% of smokers wish they could quit.
[[Page 61673]]
-Addiction happens much faster than you think.
D. -Discussion of Similarities and Differences of Preferred Messages
Based upon the responses to the messages listed above, each
group selected their preferred messages and discussed the reasons
why they chose certain messages over the others presented.
Phase II--Charlotte, Minneapolis, Houston, San Francisco
The primary objective of the groups in the cities outside the
Washington, DC area was to further refine the list of appropriate
messages and then develop presentation criteria that would make the
brief statements most effective within the context of cigarette
advertisements.
A. -Discussion about Kids and Smoking
Participants were asked to talk about the number of their peers
that smoked, reasons teenagers smoke, and situations in which teens
would most likely be smoking. The topic of addiction and how teens
perceive addiction also was discussed in many of the groups.
Participants were told at the outset that whether or not they
personally smoked was their own business, and that what the
moderator was interested in was their perception of how teens in
general regarded smoking. Participants also were told about and
asked to discuss recent trends in the rate of adult and teen
smokers.
B. -Cigarette Advertising
Examples of cigarette ads on pasteboard displays were shown to
the groups and the participants' familiarity with the ads, as well
as their reactions to them, were discussed. The moderator also
focused discussion upon the Surgeon General's warnings currently
appearing on cigarette advertisements and elicited reactions to
those warnings.
C. -Presentation of New Brief Statements
Based upon the responses to the brief statements of the
Calverton groups, seven message were tested in the focus groups held
in Charlotte and Minneapolis. These messages were discussed
individually and favorite messages were selected by each group. The
messages presented included:
-Smoking today leads to fewer tomorrows.
-Of the 3000 young people who begin smoking each day, 1000 will
die from their smoking.
-About one out of three kids who become smokers will die from
their smoking.
-Tobacco kills more Americans each year than AIDS, alcohol,
accidents, murder, suicide, illegal drugs and fires * * * combined.
-Everyone now addicted to cigarettes started out ``just trying''
cigarettes.
-Tobacco causes shortness of breath, coughing, yellow teeth and
wrinkles.
-Addiction happens much faster than you think.
-In addition to the seven messages listed above, three new
messages were tested in Houston and San Francisco. These messages
were:
-Smoking hurts your athletic performance.
-Addiction sucks you into a lifetime of smoking.
Non-smokers run faster than smokers.
D. -Discussion of Message Format and Placement
Each group then was asked to discuss the issue of presentation
of brief statements on advertisements. Using the pasteboards of
existing advertisements, each group examined issues such as: the
size of the message; position of the message; different types of
boundaries; whether or not attribution of the message was effective
(for example, attribution of a factual statement to the Centers for
Disease Control); the use of icons to draw attention to a message;
or other factors identified by the groups. To evaluate each of these
factors, sample messages in different sizes, shapes, with/without
attribution, with/without icons, and with/without specialized
borders were developed so that the moderator (or participants) could
demonstrate placement of the brief statements in various
configurations.
-Participants were presented with sample brief statements in
three sizes. The ``large'' messages were 25 percent of the total
height of the ads used as samples for the groups. The statements
identified as ``medium'' sized were 15 percent of the total height,
and the ``small'' versions were 8 percent of the total height, which
is the approximate size of the Surgeon General's warning.
E. -Summary of Preferences
Each group summarized its preferences for the messages that
participants preferred and the placement and design elements that
would be most effective in drawing the attention of adolescents to
the dangers of smoking. Participants also used this occasion to make
other recommendations that might make the messages more effective.
-General Findings
I. -Assumptions and Basic Perception of Adolescent Smoking
1. -All of the groups indicated that a high percentage of
adolescents will try cigarette smoking at some point during their
teenage years. Estimates of the number of teens who will try smoking
ranged from 50 to 99 percent. The major reasons given for why teens
try smoking included: peer pressure; doing something that adults
would not approve of; the perception of smoking as a ``cool''
activity; curiosity; and being around parents, other family members
and friends who smoke.
-``pressure from your friends''
-``It's kind of like you go out and somebody offers you a
cigarette and everybody else has one * * *.''
- ``It's more they're being rebels.''
-``Some people, well, you know, like, do it to be cool.''
-``Lots of people, most of the kids I know, my friends, their,
like, their brothers and sisters give them a cigarette, saying, `You
want to try it yet?'''
2.- The adolescents in our groups indicated that teens attach
little stigma to smoking because it is seen as an exploratory
behavior rather than as a permanent lifestyle choice. Smoking
appears to be not a lifestyle choice, but rather a matter of
``trying it out,'' ``exploring what it is like,'' and an
informational pre-decisional behavior.
``* * * you know, other people are doing it, so why not try
it?''
-``At the beginning, it would be like just curiosity and wanting
to know what it's like.''
3. -When asked where they get cigarettes, the adolescents in
these groups indicated that they get them from family or friends who
smoke; they buy them at convenience stores or other retail outlets
known for allowing minors to purchase cigarettes; or they steal
them.
-``Well, I'm speaking from experience because when I was growing
up my brother would buy them for me.''
-``You just go up to the counter, and even if you don't have any
ID, you can still get them.''
4. -Teens that are just trying smoking stated very different
reasons for smoking than teens who regularly smoke. The teens in
these focus groups said that people try smoking to feel cool; to
experience something that they consider to be ``adult'' behavior;
and because of social pressures to try smoking in group situations.
In contrast, the participants who identified themselves as smokers
said that they smoked because it calms them down, or because smoking
satisfies a physical and mental need. They indicated that they do
not smoke in groups, nor do they smoke for social acceptance, but
rather to meet bodily needs.
-``It's like, oh, I smoke but I just do it after school. Have a
cigarette to calm down or something.''
-``I used to be real jittery and nervous all the time, and it
really calms me down.''
-``Your body craves it. You don't think about it anymore. It
just becomes part of your life, just to have a cigarette.''
5. -Some of the practiced smokers in the groups expressed a very
fatalistic attitude about their lives, and they questioned the
likelihood of whether they would live a long time.
-``They're going to die anyway. At least they're doing something
they want to do.''
6.- Non-smokers in these groups were often critical of people
who smoke regularly as adults, calling the behavior ``stupid'' or
``unhealthy.'' However, their criticism often was tempered by the
fact that they know family members, relatives or other respected
adults who are or have been longtime smokers.
-``People smoke because they're putting lots of nicotine in
their blood and killing themselves.''
``I mean, it's like suicide, you know?''
II. Perceptions of Cigarette Advertising
1. The adolescent participants in the focus groups were very
familiar with cigarette advertising. There was 100% recognition of
familiar ads, such as Camel, Marlboro, Virginia Slims, and Newport
ads. There also was high awareness of the availability of
promotional items with cigarette logos on them, such as T-shirts,
book bags, etc. Participants explained how one could accumulate
``Marlboro Miles'' or ``Camel C Dollars'' to acquire such items.
-``Yeah, you get, like, at certain brands you get points for
them and you can turn them points in for, like, Zippo lighters or
jackets and bags.''
[[Page 61674]]
``They're every camel with a cigarette in his mouth. They go
like, 'Everyone have a good time.'''
2.- There was high awareness in all of the groups of familiar
slogans, logos on billboards, and point-of-purchase displays. Some
participants expressed the belief that cigarettes are advertised on
television, although others in the groups usually pointed out that
cigarette advertising was not allowed on TV.
-``It showed him smoking a Winston and said, `See, you really
can be a winner!'''
``Everyone associates that orange and green with Newport * * *''
3. -Most of the participants indicated that they did not believe
that they were influenced by cigarette advertisements.
``I mean, it has nothing to do with the ads. They don't keep me
from it, nor they don't make me do it.''
``If you're just flipping through a magazine and you see it, you
might stop and you might see something you like about it, and then
flip on through. You don't really think of smoking or not smoking.''
4. -Participants in all of the groups responded that text-only
ads are less attractive and less likely to be effective than ads
with pictures. Although they indicated that consumers would be less
likely to read the new warnings on text-only advertisements, they
felt that text-only ads may serve to lessen teen smoking. The
younger participants in particular said that anything requiring
reading was boring and much less likely to attract their attention.
``I probably wouldn't look at it in the first place because it's
black and white.''
``People like pictures, not a whole bunch of words.''
``Yeah, you won't even look at it. It's just a bunch of words.''
``It's like a birthday card. You get a birthday card that has
too many words, you just skim through it and get the money out of
it.''
III. Perceptions of Surgeon General's Warning Statements
1. -All of the groups recognized the Surgeon General's warnings,
but unless they were prompted, they did not appear to consider the
Surgeon General's warning a part of the advertisement. Participants
expressed the belief that it was there because it was required by
the government, or because cigarette manufacturers were trying to
protect themselves from lawsuits.
``They are required by law. They wouldn't put it on there if
they weren't.''
``If they didn't put them on there, they would get sued.''
2. -Participants also commented that the Surgeon General's
warnings often were too small and camouflaged within the context of
the ad, either through the use of colors that helped the warning
``blend in'' with the background colors--the Marlboro ad, for
example, which features white snow or sand surrounding the white
Surgeon General's warning--or with images that directed the eye away
from the warning message. Most groups also mentioned that the
warning itself was often quite small in relation to the ad on which
it appeared.
``You can see, like, on that one [Virginia Slims ad], they put
it down in the bottom corner, when you're looking, like, at that
lady.''
``They glance at it, but what they see is the thing that's being
advertised. They don't notice that little small print.''
``They blend it in with that white with the white snow on it,
they just put it right at the bottom in the white snow.''
3. -Many participants expressed the belief that the Surgeon
General's warnings were difficult to understand. They did not know
what effect carbon monoxide would have on them, for example, and
many participants did not know what emphysema was.
``Kids are not going to know what carbon monoxide is.''
IV.- Perception of New Brief Statements
1.- There was a high degree of consensus about which statements
were more or less liked.
2.- The statements that were received most positively were those
that included factual statements about the health risks associated
with regular (i.e. long term) smoking.
``Dying means a lot.''
``I think the numbers * * * might make it a little more
noticeable.''
``It makes it more real.''
``Picture like 1,000 people dying at once, you know?''
3.- The one brief statement that consistently was identified as
effective was the one that stated, ``Tobacco kills more Americans
each year than AIDS, alcohol, accidents, murder, suicides, illegal
drugs and fires * * * combined.'' Most of the participants indicated
that, although they knew that smoking was not good for them, they
were unaware that smoking was as dangerous as this statement
indicated. They mentioned AIDS, accidents, illegal drugs, and
suicide as well-publicized causes of death, but that cigarette-
related deaths were not so obvious because they generally occurred
among older people as a result of long illnesses rather than in
sensational situations that were covered by the nightly news.
-``You are always hearing about how many people die from AIDS
and alcohol and murder, and tobacco kills more than all of them
combined. That ought to freak them out.''
-``I think even little kids who are younger, people do realize
the serious effect of AIDS, and if they think that AIDS is bad then
they have to realize that tobacco is worse.''
-``Because you hear about those things more than you ever hear
about tobacco.''
4. -A message that stated that ``About 1 in 3 kids who become
smokers will die from it'' also was considered effective by many of
the groups. A similar statement that said ``1000 out of 3000'' was
also considered effective by some participants, while others said
that teens would be likely to think that they could ``beat the
odds'' if they became smokers.
-``Well, they'll think, 'It won't happen to me. I'll go ahead
and do it anyway.' They'll think they'll be one of the two.''
5.- Many of the groups indicated that, if one of the brief
statements listed above was included on advertising, it is likely
that people who were considering smoking might reconsider, due to
the seriousness of the consequences.
6.- The message about the short term effects of smoking on
physical appearance and fitness appealed to some groups,
particularly the girls, who were more concerned about yellow teeth
and wrinkles. Groups thought that such a message about the more
immediate effects smoking would be useful because it spoke to
everyday concerns of kids.
-``That will make them realize that if they are going to smoke,
it will have an effect on their looks.''
-``I think people like are more worried about what they look
like on the outside than like maybe like lung cancer or something.''
-``* * * that's one of the main reasons why I don't smoke
because it affects how I run and stuff like that.''
7.- No other message of those tested received support from more
than a few groups. Individual groups were favorable toward
``Everyone now addicted to cigarettes started out 'just trying,''
``Smoking today leads to fewer tomorrows,'' or ``Smoking hurts your
athletic performance,'' but other groups did not see these messages
as particularly effective.
-8. -Other messages were universally disliked or ineffective.
-9. -There was no discernible difference in reactions to
messages between smokers and non-smokers. Both smokers and non-
smokers appeared to have similar taste in messages.
10.- Several messages addressing the addiction aspect of smoking
were tried and proved ineffectual.
V.- Perception of Possible Design Elements for New Brief Statements
1.- All groups indicated that the guiding design principle for
the brief statements was for the statements to be visually prominent
in the ad.
2. -All groups recognized that the optimal design of the brief
statement, particularly placement, would necessarily depend on the
design of the particular advertisement. For example, all groups
indicated that advertisers would try to design their ads to diminish
the visual performance of the brief statement, like they do with the
Surgeon General's warning. Some groups recommended that the brief
statements be added after the advertisement was designed to minimize
the possibility of it being designed to reduce the impact of the
brief statement.
``Well, if it's in the middle then they will be forced to read
it, because you have to look at it.''
``If it's possible, right in the middle.''
``I am an artist and I notice that a lot of propaganda is, they
have a pattern through the picture, so your eyes tend to follow the
pattern. Like when you see the cigarette it sort of points to her
face, you see the pizza and her laughing and you see him, and the
Surgeon General's warning is always somewhere obscured.''
``They'll design the picture to avoid it, I think.''
3.- Many of the groups said that the new brief statement should
be more visually prominent than the Surgeon General's warning--which
led them to say that the new
[[Page 61675]]
brief statements needed to be distinct from the existing Surgeon
General's warning.
``I mean, because if you have one of those, except bigger, you
know, 'Oh, it's another Surgeon General's warning.' I mean, you skip
over it again. But they do it, say, right in the middle, if they do
write it in the same kind of style but make it look different some
sort of way, you know, have it kind of in similar writing but not
necessarily the block writing, it might be--people are more apt to
read it.''
``The little one is almost the size of the Surgeon General's
itself, so you're not improving it too much.''
4.- Although placement was seen as the design element most
dependent upon the specific advertisement, many groups recommended
that, if possible, the message be put at the top of the ad or in the
middle to ensure the greatest visibility.
``Because when you pick it up that's where you start reading.''
``If you put it in a place where it stays away from all the
words, it would do a lot to make it stand out.''
``Put either one [Surgeon General's warning or brief statement]
at the top. You are going to read that before you read the thing
[ad].''
5.- The major design elements that groups saw as contributing to
visual prominence were type size, distinctive borders, and to a
lesser extent, the use of a distinctive icon. Most groups said that
the bigger the type size, the better, because it made it easier to
read and more likely that the brief statement would be read. In
fact, none of the groups felt that the smallest type size would be
acceptable, although several groups approved of the middle type size
if it would be placed appropriately. Several of the groups said that
the middle size represented the best trade-off of the needs of the
advertiser and the need to have the brief statement noticeable.
``Something flashy.''
``If they're going to allow people to sell cigarettes, then I
don't think they should have them put big letters on the cigarette
box that make people not want to smoke.''
6.- Groups were mixed about the desirability of the ``arrow-
type'' border for a brief statement, but were universally
enthusiastic about the properties of a jagged-type border as a way
to capture the attention of readers.
``Because it's [the jagged edge border] almost like a coupon.''
``It catches your eye more.''
7.- Some groups were positive about the icon, with others less
so. While most group said it would marginally improve the salience
of a message, some groups thought the icon itself was not optimal
and suggested other alternatives. Some groups worried that the
trade-off between the extra space required by the icon and a larger
message was not justified.
8.- Groups frequently suggested that the appearance of a message
be changed regularly so that consumers would not habituate to its
appearance.
``You ought to change it periodically. I don't know what all you
could change it to, but have it somehow different because I'm sure
when they first started putting the Surgeon General's warning on
there it caught peoples' eyes because it was new.''
9.- Most groups mentioned that color would be a good way to
increase the prominence of a message. Almost every group mentioned
neon shades, either in jest or in a serious manner, or at the very
least a shade that contrasted with the colors in the advertisement
itself.
``I just think that in general a different color from the whole
poster, but still where it doesn't look tacky. It still blends in,
but not in a similar color.''
``If it was in a different color, that stands out no matter how
much you try to avoid some of the stuff, it's going to catch your
eye no matter what.''
``A vibrant color.''
``I think it should be like a neon orange.''
``I think there should be like two or three colors that it can
be and you have to not use that color in your ad.''
10.- Some participants suggested that the best way to present
the information would be as a stand-alone advertisement rather than
as part of a cigarette advertisement.
``Just have more ads against smoking.''
``I know. Yeah, for a good commercial, you go, put, like, for a
commercial, somebody smokes, put, like, you know, on the Indiana
Jones where all his skin comes off and the blood's running out!''
11.- The reaction to attribution to a source of information
(Centers for Disease Control, FDA, other sources of attribution)
also received a mixed response. While some groups said that
attribution would strengthen a statement, others disagreed with that
viewpoint.
``It doesn't really matter (who said it) * * * as long as it's
fact.''
``Someone with a degree who graduated--the Surgeon General.''
Addenda
1.- Sample graphics
2.- Moderator's Guides
a.- Phase I
b.- Phase II
BILLING CODE 4160-01-F
[[Page 61676]]
[GRAPHIC][TIFF OMITTED]TP01DE95.038
BILLING CODE 4160-01-C
[[Page 61677]]
Cigarette Advertising Focus Groups Phase I Moderator's Guide
Outline
1. Introductions
2. Presentation of Examples of Cigarette Ads
3. Discussion of Cigarette Advertising in General
4. Discussion of Warning Statements
5. Presentation and Discussion of First Set
6. Presentation and Discussion of Second Set
7. Presentation and Discussion of Third Set
8. Presentation and Discussion of Fourth Set
9. Discussion of Similarities and Differences of the Winners
Materials:
3-5 Examples of Cigarette Ads (Relevant to this Age Group).
Sheets of Paper with 3 or 4 Possible Brief Statement Wordings.
Each Participant Will Get Four of These During the Session.
1. Introductions
Summary:
Moderator and respondents introduce themselves to one another.
Overall plan for the focus groups is discussed. ``Today, we'll be
looking and talking about some examples of cigarette advertising.''
Important points to emphasize in the introduction. We are not here
to talk about whether you do or do not smoke. That's your business.
Nothing you say in the group will get back to your parents or anyone
else. We care about how cigarette advertising works, and we want to
talk to people of your age to get a better idea of how they see and
understand advertising.
2,3. Discussion of Cigarette Advertising: General
Materials:
Examples of cigarette ads on pasteboard displays are shown to
the group and remain on display throughout the session.
``Here are some examples of cigarette advertising.''
Have you seen these kinds of ads before?
Where do you usually see them?
Do you notice anything different or special about cigarette ads
compared to other kinds of products that are advertised, or are they
basically the same as other ads?
What other kinds of ads do cigarette ads remind you of?
What kind of person is most likely to look at cigarette ads?
Who is not likely to pay much attention to these kinds of ads?
--The 3 ads are present at this point, but they are not the
focus of the discussion. Smokers and non-smokers will almost
certainly be brought up in this discussion, but we do not want
participants to focus on their own behavior at this point.
--Warning statements are not cued by the moderator, but will
probably come up in the discussion. Moderator needs to explore
issues as they arise, but there is no need to focus on warning
messages at this point.
--An important point here is to let people reveal their own
natural categories about cigarette advertising and warning
statements before the concept of ``warning statements'' is
explicitly introduced.
Do you think these 3 ads are different from each other, or are
they basically the same?
How are they different/same?
4. Discussion of Warning Messages
--The discussion is turned toward issues related to the warning
statements, which may or may not have been discussed already. The
moderator needs to explore the issues below without being repetitive
or redundant with any previous discussion.
``Let's talk a little bit about the warning messages in the
ads--which you may or may not have noticed.''
--The moderator refers here to the Surgeon General's Warning
statements in the ads as examples of warning messages.
Why are these messages there?
Do you think they work?
Why? Why not?
Who looks at these messages?
Who is supposed to look at these messages?
When did you first notice that these messages were in cigarette
advertising? What did you think when you first saw them?
How could you improve these kinds of messages?
5. Presentation of Set of Warning Messages
Materials: 81/2" 11" pages, containing several different
possible warning messages.
``The warning messages that we have seen so far are not the only
possible warning messages. What I'd like to do now is show you
possible wordings for warning statements and get your reactions to
these. These messages could be used in cigarette advertisements in
the same way as in the ads we have here today.
``Here are some possible wordings for warning statements.''
--Each participant gets a sheet with examples of possible
warning messages. The sets of possible warning messages will have to
be determined. The intent is to present participants with a small
number of statements they can compare and contrast rather than one
at a time or in one big list. The selection of statements should
take advantage of the ability to elicit direct comparisons.
Do you feel any of these statements is particularly good or bad?
credible/not credible personally relevant/not relevant Why?
What does (pick one of the messages at a time/but get reactions
to as many as you think are necessary) mean to you?
How would you describe the differences, if any, between these
messages?
Would you be more likely to pay attention to some of these
messages? Which ones? Why?
What sort of young person would be likely to pay/not pay
attention to these messages?
Do they all have the same target audience?
Which messages will appeal to which groups?
Which one(s) do you like best? (Get them to rate the messages
and record consensus choice(s).)
6,7,8. Repeat the same discussion above for each new set of warning
statements
9. Discussion of similarities and differences of the 4 winners.
``Here are the messages the group thought were best''
Are there other kinds of warning messages that we haven't
included that you think should be in cigarette advertising? What
would those be? Why do you think they would be good?
--moderator needs to include suggestions that are reasonably
well received by the group as part of the final set of messages that
will be discussed below.
How would you describe the differences, if any, between these
messages?
Is there anything that these messages have in common that makes
them superior to the other kinds of messages that did not make the
final cut?
How would you describe the intended audiences for the different
messages? Same? Different? Which messages appeal to what kinds of
people?
Of all these messages, which one do you think is most likely to
be effective? Why?
Which one(s) do you personally like the most?
At the end of the session, the participants will fill out a
short outtake questionnaire that will contain some questions about
smoking status, number of cigarettes smoked, brands smoked, and
other relevant information.
Cigarette Advertising Focus Groups Phase II Moderator's Guide
Outline:
1. Introductions
2. Kids and Smoking
3. Information Piece
4. Cigarette Advertising
5. Warning Messages
6. Presentation of New Warning Messages: Content
7. Size of Message
8. Position
9. Boundaries
10. Attribution
11. Icons
12. Summary
Materials:
3-5 Examples of Cigarette Ads (Relevant to this Age Group).
Visuals Examples of Ads (Could Be Same Ads as Used Above) That
Embody Various Format and Design Features That We Want to Evaluate--
as Many as Needed.
1. Introductions
Summary:
A. Moderator and respondents introduce themselves to one
another.
B. Overall plan for the focus groups is discussed:
Today, we want to talk about kids and smoking. Some of you may
be smokers, but we're not here to talk about whether you smoke or
not. That's your business.
But what we do care about is how kids in general think about
smoking. In particular, we want to get a better idea of how kids in
your age group think about smoking.
Nothing you say in the group will get back to your parents or
anyone else. The best way
[[Page 61678]]
you can help us is to tell us what you really think, not what you think
we want to hear, or what you think you should say.
2. Kids and Smoking
This is a warmup activity. Questions below are suggestions, not
requirements. You don't need to ask every question. Try to get
people interested and comfortable. Should take about 5-10 minutes
A. Do kids smoke at your school? How many kids smoke? Who
smokes? Are boys as likely to smoke as girls?
B. When do kids first try smoking? How old are they? Is it the
same for girls and boys? What kinds of things make a difference in
kids' decision to try a cigarette?
C. What kinds of situations are kids in when they try smoking?
Is this the same for girls and boys? Is the situation the same for
younger and older kids?
D. Are the kinds of things that lead kids to try a first
cigarette the same kinds of things that lead them to smoke
regularly? If not, what are the differences?
E. Where do kids get cigarettes? Where do they smoke?
Other possible questions.
Who do they smoke with? Do they smoke alone, or mostly with
others? Who are the others? Does this change as they smoke more
regularly? Is how kids get cigarettes different if they smoke
occasionally or regularly?
3. Information Piece
I want to get your reaction to this piece of information--I
assure you that it is true.
Did you know that over the last 25 years the number of adults
who smoke has gone down. And the number of adults who smoke keeps
going down.
But the number of young people who smoke has not gone down, and
is actually going up in some groups--such as 12-14 year olds.
Are you surprised by this? Why do you think this is happening?
4. Cigarette Advertising
Materials:
Examples of cigarette ads on pasteboard displays are shown to
the group and remain on display throughout the session.
Here are some examples of cigarette advertising.
Have you seen these kinds of ads before?
Where do you usually see them?
What other kinds of ads do cigarette ads remind you of?
Who is most likely to look at cigarette ads?
Who is not likely to pay much attention to these kinds of ads?
--Warning statements are not cued by the moderator, but will
probably come up in the discussion. Moderator needs to explore
issues as they arise but does not need to focus on warning messages
at this point.
--An important point here is to let people reveal their own
natural categories about cigarette advertising and warning
statements before the concept of ``warning statements'' is
explicitly introduced.
5. Discussion of Warning Messages
``Let's talk a little bit about the warning messages in the
ads--which you may or may not have noticed.''
--The moderator refers here to the Surgeon General's Warning
statements in the ads as examples of warning messages.
Why are these messages there?
Do you think they work?
Why? Why not?
Who looks at these messages?
Who is supposed to look at these messages?
What do you think about the placement of the Surgeon General's
warning?
What about the size of the warning message?
How could you improve these kinds of messages?
6. Presentation of New Warning Messages: Content
Materials: Sheet containing six messages
As background for the next section, laws are being considered to
require that all cigarette advertisements have information about the
risks of teenage smoking. This would be in addition to the Surgeon
General's warning already required on cigarette advertisements.
What I want to do now is show you some examples of possible
messages and see what you think.
Let's look at these 6 messages. Moderator reads the 6 messages.
Moderator re-reads the first message.
What does this mean to you?
Do you think it is effective?
Would it appeal to kids your age?
Repeat with the other 5 messages--re-read each, one at a time,
and discuss the content.
What does this mean to you?
Do you think it is effective?
Would it appeal to kids your age?
Ask them which they think is most effective. As much as
possible, use that one for the example in the other tasks.
7. Size of Message
Materials: A message (perhaps the message chosen in 6) in the three
different sizes on appropriate ads
Here are some examples of how these messages might actually look
in cigarette advertising.
Which of these ads presents the warning information in the best
way? Why do you say that?
Does the size of the warning information change the way kids are
likely to react to an ad.
Will the size of the message have the same kind of effect on all
ads, or will it work differently for some ads.
Would it make a difference whether the ad it was on was in color
like this or only black and white?
8. Position
Materials: Three more ads with the same message and size in the 3
different placements on the ad.
Which of these ads presents the warning information in the best
way? Why do you say that?
Does the placement of the warning information change the way
kids are likely to react to an ad.
Will the placement of the message have the same kind of effect
on all ads, or will it work differently for some ads.
Would it make a difference whether the ad it was on was in color
like this or only black and white?
9. Boundaries
Materials: Three more ads with messages in the same size and placement
(probably top placement) but with different boundaries.
Which of these ads presents the warning information in the best
way? Why do you say that?
Does the boundary of the warning information change the way kids
are likely to react to an ad.
Will the kind of boundary for the message have the same kind of
effect on all ads, or will it work differently for some ads.
Would it make a difference whether the ad it was on was in color
like this or only black and white?
10. Attribution
Materials: Two ads with the same message, size and placement, but one
with the CDC attribution
Which of these ads presents the warning information in the best
way? Why do you say that?
Does giving the source of the warning information change the way
kids are likely to react to an ad.
Will giving the source for the message have the same kind of
effect on all ads, or will it work differently for some ads.
Would it make a difference whether the ad it was on was in color
like this or only black and white?
Are there other organizations that kids would be more likely to
believe? What?
11. Icons
Materials: Three ads with more or less the same message,
boundary, size, placement, but one without an icon, one with a
larger icon, and one with a smaller icon.
Which of these ads presents the warning information in the best
way? Why do you say that?
Does having an icon for the warning information change the way
kids are likely to react to an ad.
What does the icon look like to you.
Will having an icon for the message have the same kind of effect
on all ads, or will it work differently for some ads.
Would it make a difference whether the ad it was on was in color
like this or only black and white?
Are there other icons that kids would be more likely to
understand? What?
12. Summary
As you see, there are many possible features that make up a
total presentation. We couldn't show you all possible combinations,
but we want your opinions and ideas about how different features go
together or don't go together. You may have suggestions about trying
combinations that we haven't tried, and that's good. Let's look
think about the whole picture you have put together from your
choices.
Do you think this message, size, placement, with this boundary
and picture (icon), and with the organization you chose it should
come from, would look right? Would it be an
[[Page 61679]]
effective whole ad? Why or why not? How might it be improved?
At the end of the session, the participants will fill out a
short outtake questionnaire that will contain some questions about
smoking status, number of cigarettes smoked, brands smoked, and
other relevant information.
Dated: November 28, 1995.
William B. Schultz,
Deputy Commissioner for Policy.
[FR Doc. 95-29299 Filed 11-30-95; 8:45 am]
BILLING CODE 4160-01-F
