PULLMAN, Wash. — Graphic anti-smoking ads can lead smokers to reconsider their habit, but in the absence of similar warnings for e-cigarettes, they make some smokers more inclined to vape than quit.
That’s the key finding of new research from Washington State University demonstrating unintended consequences of using vividly graphic images of health consequences from smoking as a deterrent. The paper, published in the Journal of Business Ethics , found that, in the absence of such warnings on e-cigs, consumers may get the impression that they are a safe alternative.
“The federal government has made the decision to require health warnings that are very graphic — actually shockingly graphic — on cigarette packages,” said Elizabeth Howlett, Gardner O. Hart Distinguished Professor in the Carson College of Business’s Department of Marketing and International Business and a co-author of the paper. “We looked at the unintended consequences of such a fear-eliciting approach, and what we find is that it basically reduces the perceived threat associated with e-cigarettes.”
The use of disturbing, visceral images of the health consequences of smoking have been shown to be effective in getting the attention of smokers, creating a fear of consequences and a motivation to stop.
Such ads are already used in many countries. The U.S. Food and Drug Administration has adopted regulations requiring the use of 11 such images in addition to written warnings, but implementation of the rules has been hung up in legal challenges. The new warnings depict different forms of damage done by smoking, from heart disease to stroke to various cancers.
Warnings on e-cigarette packaging, by contrast, are brief verbal statements that nicotine is addictive.
The new paper demonstrates, over the course of four separate experiments conducted online, that smokers exposed to this disparity in health warnings shifted their attention and attitudes toward favorable views of vaping, and demonstrated an intention to try e-cigs rather than quit smoking. In one of the studies, however, when people were confronted with more balanced health warnings, they were less likely to have positive attitudes or intentions about vaping.
Understanding what works in health messaging is important with nicotine products. Smoking kills nearly half a million people a year in the U.S., and remains the leading cause of preventable death and disease. While there are indications that vaping may be healthier, there are growing signs that it is by no means healthy: vaping has been associated with cardiovascular, respiratory and gastrointestinal conditions, and nicotine itself has negative health consequences. Furthermore, while the risks of smoking are widely known, research indicates that knowledge of vaping risks among consumers is substantially less, and many see it as having minimal health risks.
“We know cigarettes, when used as directed, cause all kinds of problems,” Howlett said. “We also know that, realistically, if you are going to use tobacco and smoke, it is a safer option to use e-cigarettes. But ‘less horrible for you’ doesn't mean safe.”
Also, while the messaging environment affects smokers, it also influences young people who may consider vaping without ever entertaining the idea of smoking.
“The original intention of the permitting these e-cigarettes for the market was, if we can get smokers switching to e-cigarettes, that would be a health benefit,” she said. “But what's very negative is that you have younger people who never considered smoking, but then jumped into the e-cigarette space.”
Howlett conducted with research with Kamal Ahmmad and Mitchel R. Murdock of Utah Valley University.
The best way for public policymakers to approach health warnings with nicotine products is to consider not just individual warnings, but the messages being sent across the entire market.
“When you present warnings on both e-cigarettes and conventional combustible cigarettes. you are going to make consumers much more informed of the actual risks of that tobacco use,” Howlett said. “That's the really big takeaway here.”
Journal of Business Ethics
Survey
People
Unintended Consequences: The Effects of Cigarette Graphic Health Warnings on Electronic Cigarette Risk Perceptions and Intentions
20-Apr-2026
All authors declare that there is no financial or non-financial conflict of interest to report.