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

Federal RegisterDec 1, 1995

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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.

-----------------------------------------------------------------------

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?