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From tax to texts – the evolution of quitting smoking

From tax to texts – the evolution of quitting smoking

Today is World No Tobacco Day, symbolising the World Health Organisation’s battle against one of the biggest epidemics of the 21st century – smoking.

Or, to put it more accurately, the battle against millions of people’s decision to smoke. Because ultimately personal choice is where the battle lines are drawn. What drives someone to light up and, the next logical step, what influences them to give up?

While the older among us will remember Nick O’Teen, the Health Education Council-sponsored villainous foe of Superman, it is in the area of quitting that most government effort has gone.

In the context of 2,000 years of smoking, efforts to get people to quit are in their infancy. But the science of behaviour change is evolving rapidly. Its understanding and use over the past decade has become exponentially deeper and more sophisticated.

It has long moved on from the simplistic 20th century trinity of intervention – increasing the cost of tobacco, regulating sales and advertising, and providing health information – which failed to stop the epidemic. In 1947 a 43% increase in cigarette tax resulted in just a 14% drop in cigarette consumption among British men.

Health warnings on tobacco and cigarette packs have had a little more impact on attitudes. And graphic images of diseased organs went a step further, aiming in the right direction as they tugged at hearts and minds. As one study put it: “…Without emotions, we can’t make decisions. We require having feelings in order to feel motivated to act. Graphic warnings help people to think more carefully about the risks and to consider them more.”

The study found that the imagery reduced the number of children who began smoking and increased the number of smokers who quit.

The power of positive thinking

But the success of outlining the negatives has been limited. In the face of education around the overwhelming physical, financial and emotional risks of smoking, more than one billion of us worldwide light up every day.

So behaviour change thinking has now turned towards framing the gains. We know that public health campaigns that emphasise negative stereotypes often lead smokers to relapse, compared with those that promote positive messages.

A study of 5,800 smokers conducted in the UK by Free et al in 2011 found that those receiving positive motivational and behaviour change messages had higher rates of abstinence than those receiving non-motivational messages. 11% of the intervention group hadn’t smoked after 6 weeks, compared with 4% of the control group.

Add to that the power of text messaging, apps and social media to provide personalised, interactive engagement and encouragement and real, lasting change can be achieved.

Fjeldsoe et al. (2009) reviewed 14 studies on the effectiveness of SMS messaging in smoking cessation interventions and diabetes management interventions. 13 of the 14 studies had positive behaviour change outcomes. Tailoring of SMS content and interactivity were found to be important features of SMS-delivered interventions.

Keeping in touch regularly is also key. Rogers et al (2005) found that regular, personalised messages resulted in more people quitting (28% quit rates) in comparison to a control group (13% quit rates) which received messages once a fortnight.

And goal setting is another important factor in behaviour change. Mitchie et al. in 2009 reviewed 13 interventions promoting smoking cessation, healthy eating and/or physical activity targeted at low-income groups. They found that setting goals made people more aware the behaviour changes needed to achieve them. Smaller, shorter-term goals also allow people to build on small successes.

Peer pressure plays a fundamental role in decision-making, whether that’s through a smoker’s feelings of inclusion or marginalisation. Cultural norms spread through distant as well as close social networks and people tend to take or give up a behaviour in unison, often encouraged by persuasive individuals. Social networks now provide the ideal opportunity to help smokers quit in supportive groups, especially when they include key influencers.

Behaviour change that works

Tackling the global smoking epidemic is a World Health Organisation priority. It’s not surprising when the statistics are so sobering. Smoking kills about 7 million people a year, about 80% of whom are in low to middle-income countries. Around 890,000 are non-smokers who’ve been exposed to second-hand smoke.12 Meanwhile smoking-related illnesses worldwide cost $1 trillion.

Effective behaviour change relies on understanding what makes individuals smoke, what will motivate them to stop, how to help them overcome the barriers to stopping and – crucially – support them while they try to give up.

Regular, positive messages that are inclusive, that engage and that set goals provide the interest, motivation and support to users to make real, lasting change in their lives.

Talk to us about your health content or behaviour change campaign needs