Honesty is the best policy

Who wants wrinkly skin or bad breath?

Who wants wrinkly skin or bad breath?

The practice of having a smoking (and non-smoking) area in food establishments in Singapore stopped in 2006, according to Wikipedia. The ban was extended in 2009 to include open spaces such as bus stops, covered walkways, and lift lobbies. With the additional burden of cigarette tax, it’s no surprise that only 12.6% and 14.3% of the adult population were smokers in 2004 and 2010 respectively.

But smoking is not easily extinguished. A epidemiological study reports that 16% of the 6,616 adults sampled (aged 18 years or older) were current smokers in 2012. And over 4% met the criteria for dependence on nicotine. Dissuading over 150,000 residents from smoking in 6 years time is a lofty ambition indeed.

Among younger adults, smoking has, if anything, become more common. In 2004, 12.3% of adults aged 18 to 29 years were smokers. There were even more of them after that (17.2% in 2007 and 16.3% in 2010). So the Health Promotion Board will be trying new, innovative methods of persuasion to bolster the effects of legislation, tobacco taxes, and previous campaigns.

Far more men than women smoke in general (1 in 4 men smoke; 4 in 100 women smoke), but the balance is less striking among young adults. In 2007, 1 in 4 men in the 18 to 29 age range were smokers, while 9 in 100 women in the same age range were smokers.

And there is evidence that smoking begins early. A survey of 13,000 teenagers in 2000 found that a whopping 25% had smoked before, and more than 1 in 10 teenagers had smoked in the past month.

So it’s worth taking a look at what does work:

1. Vanity is one way to go
Current ads from the campaign, “The Real Cost“, have been found to be effective with smokers because the ads tell them about the adverse effects of tobacco which they are about. Teenagers are motivated to quit smoking because they don’t want wrinkly skin, yellow teeth, bad breath, or to perform more poorly at sports. Who does?

2. Keep parents out of it
A 2006 study did not find campaigns which featured parents talking to their teenagers about smoking to be effective. Watching the “Talk. They’ll Listen” campaign made older teenagers more likely not to perceive the adverse effects of smoking, more likely to smoke, and more likely to endorse smoking. 

3. Capitalize on emotional messages
A 1998 JAMA study found that campaigns which revealed industry manipulation and effects of second-hand smoke best at reducing cigarette consumption. This explains the success of “Truth“, a campaign which began in 2000. A 2010 study found that not only was the target audience of this campaign (children) more likely to express an intention not to smoke, but their secondary audience (young adults) were also more likely to express an intention to quit.

4. Anger is better than sadness
A 2014 study found that ads were more effective in improving anti-tobacco attitudes when actors delivered the same message with anger than when it was delivered with sadness.

5. Long-term consequences are not serious considerations
The 1998 study found that telling smokers about the long-term health consequences (heart disease, stroke, lung or head-and-neck cancers) does not motivate them to stop smoking.

A study published this year however indicated that hearing the facts for the first time could push some to quit. Over a third of the 1,404 smokers sampled in the study had never heard about the health effects of firsthand and secondhand smoke, how the industry had designed cigarettes to be addictive, or health risks from low-tar and light cigarettes. Those hearing these “corrective statements” for the first time were more motivated to quit than those who had heard these facts before.

6. Birds of a feather smoke less together
A 2009 study found that not only did cost-effective campaigns use a single clear message which appealed to their target audience, but they also used people, with whom target audiences could relate to, as spokespeople to promote the message. The campaign, “Finish It“, uses all three elements. As does the “The Real Cost” campaign (view the videos here and here).

7. Use an aggressive campaign
No, not bared teeth or threats. It’s exposure to campaign ads which increases quit rates. Calls to quit lines go up when campaigns with emotional and graphic content are on the air. A 2012 study showed that ad exposure increased intentions and attempts to quit.

8. Provide frequent cues about the health risks of smoking 
2014 study found that smokers who avoided looking at warning labels on cigarette packs did continue to think about health risks associated with smoking, which led to them being more likely to express an intention to quit, and subsequently to smoke less. That is to say, text-only reminders about health risks are effective for getting some smokers to consider quitting.

9. Present fewer cues to buy cigarettes
Smokers say they have fewer urges to smoke when cigarettes are hidden from display than when they are clearly visible at the cashier (“point of sale“), so says this 2014 study.

10. Get the message to kids before they start smoking
A 2003 study suggested that campaigns would be more effective at reducing smoking if they targeted their messages at pre-teenagers and younger teenagers. Yes, that means education in primary school. It’s because “young people who don’t start using tobacco by age 18 will most likely never start” (NIH).

What works? Research advocates a multi-prong approach. There’s no one-size-fits-all. The take-home message is that a workplace smoking cessation programme would need to be tailored to its target audience — the employees. But having clever ads (like these videos and these print ads) does help, of course.