The latest round of government anti-smoking ads targets e-cigarette use for the first time and highlights links to a variety of diseases that aren't typically associated with tobacco use.
The Food and Drug Administration decided to regulate e-cigarettes less than a year ago and has not determined a course of action. Research on the harms of the inhaled chemical vapor and whether the devices can help smokers wean themselves off tobacco has been mixed.
But one of the new ads directly takes on e-cigarette use. "I started using e-cigarettes but kept smoking. Right up until my lung collapsed," a 35-year-old woman named Kristy says in the print ad. She displays a long surgical scar on her right side.
Asked about the approach in an interview, Tom Frieden, director of the Centers for Disease Control and Prevention, which produces the ads, said that "there's still a lot we don't know about e-cigarettes, and we have to remember they are tobacco products...There are things we don't know about their toxicity."
In August, the CDC released a study showing that adolescents who vape are more likely to try traditional cigarettes. Rather than helping people stop smoking, Frieden said, e-cigarettes may provide a pathway to tobacco use.
The $68 million ad campaign also expands on previous efforts by highlighting tobacco's role in diseases such as colorectal cancer, macular degeneration and chronic obstructive pulmonary disease, such as emphysema and chronic bronchitis.
"That's a terrible way to die," Frieden said of COPD. "I will never forget one of my patients...she had the worst death I've ever seen. She was gasping for every breath."
The CDC considers the graphic, sometimes shocking anti-smoking ads — which run on television and radio and in print — a huge success. Its reviews have shown that as a result of one ad campaign, 100,000 people gave up smoking for six months or more, considered permanent abstinence for the purposes of the research. Another 100,000 quit for shorter periods, and 1.6 million tried to quit after seeing the ads.
At $480 per quitter and $393 per year of life saved, the $48 million campaign also is considered tremendously cost-effective. One standard used in evaluating such interventions considers them cost-effective at $50,000 per year of life gained. The tobacco industry, Frieden said, spends about $8 billion annually marketing its products.
"This is one of the things I'm most proud of in my time as CDC director," Frieden said, noting the lives saved. He called the ad wars a "David vs. Goliath fight. But because we have truth on our side, these ads make a difference."
Smoking is considered the single most preventable cause of death and disease in the United States, according to the CDC. About 443,000 people die annually from smoking or exposure to second-hand smoke, while 46.6 million continue the habit.
The new ad campaign begins March 30 and will run for 20 weeks.