When is it a good time to talk about smoking?

Smoking begins early. A survey in 2000 found that a quarter of teenagers had smoked before, and more than 1 in 10 had smoked in the past month. Telling your children not to smoke doesn’t work. So what does?

Prisoner Holding Cigarette Between Bars

Talk to your kids about the health risks of nicotine before addictions take over!

1. Talk to your kids before they are teenagers!
It turns out that if you haven’t already started smoking by age 18, you’re not really going to start. Smokers tend to start young, so it’s important to get them to hear the message early. So talk to your kids about the effects of smoking before they are teenagers!

2. Nagging is not a communication strategy
Parent-child talks are more effective when you invite your children to participate in a two-way conversation and when you use a tone that shows that you care.

3. Speak the same language as your kids
Not every teenager cares about the long-term effects of smoking (lung cancer, head and neck cancer, heart attacks, stroke). They may not care about the effects of secondhand smoke.

Such facts don’t work as well as telling teenagers about wrinkly skin and yellow teeth, which result from tobacco use. Here’s a fact sheet that’s been designed for teens.

4. Be supportive
Teenage brains are more susceptible to becoming dependent on nicotine than those of adults. You can have a more meaningful conversation with your teenager if you can stay away from sounding judgemental, accusatory, or condescending. 

5. Using peer pressure to your advantage
A recent study found peer pressure works both ways. But it’s more common for smoking teenagers to introduce their non-smoking peers to tobacco than the other way around. Non-smoking teenagers are relatively less successful at dissuading peers from smoking. 

It might be because teenagers lack knowledge about the more effective ways to quit tobacco. Do you have The Knowledge? (Here are more resources for teenagers).

6. How to be cool (but not smoke)
Or it may be that peer pressure works because smoking is seen as being cool. Consumer research show that being cool is about breaking rules which are seen as unfair or unnecessary, while not breaking legitimate rules.

So that means campaigns will be effective if they educate teenagers that they can choose to stop smoking. And that’s what the research says: A 1999 study showed that teenagers, who made an independent decision not to smoke, reduced their smoking in subsequent months.

7. Beware the effect film noir has on your kids
Movies which glamourize smoking may have an unintended effect on you and your family.

In a recent study, young adults were more likely to endorse alcohol use after watching movie clips where alcohol was portrayed in a good rather than bad light, even though alcohol consumption was not the main theme of any of the movies watched. This likely applies to tobacco as well.

No one makes movies like they used to. But you might want to talk to your kids about the reality behind Hollywood’s golden age after you and the kids watch To Have and Have Not.

8. Children who stay in school longer are less likely to smoke
It’s been known for a while that there are fewer smokers among those with more years of education. A 2014 study found that those who smoked at age 16 were more likely to be smokers as adults and less likely to have a university degree.

But having better problem-solving abilities does not explain this trend. Rather, family factors are likely to be responsible. Teenagers who feel connected to their parents and are monitored by their parents are less likely to smoke.

9. Do what you preach
Children learn by example. Those with parents who smoke are 3 times more likely to smoke. A 2006 study conducted in New Zealand found that parental smoking was responsible for an estimated 40% of teenagers who smoked.

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Staying off tobacco

Just knowing the health risks of tobacco (including lung cancer, head and neck cancers, and heart disease) and the mental health benefits of quitting tobacco (getting better quality sleep, improved mental health, and reduced stress levels) may not be adequate reasons to motivate smokers to quit. Studies show that campaigns which emphasize the truth about the tobacco industry and the real cost of smoking are more effective in helping people quit.

Social support helps people quit tobacco

Social support helps people quit tobacco

But what else? Here are what the research says:

1. Guidance from a professional coach
Research shows that professional counselling can help smokers successfully quit: A coach or counsellor can help individuals develop a personal stop-smoking plan.

2. Reduce dependence using nicotine medicines 
There are 5 nicotine medicines which are recognised to boost the success of quitting tobacco: gum, patch, lozenge, nasal spray, and inhaler.

3. Going cold turkey isn’t for everyone
Quitting on willpower is the least successful way to quit tobacco. But counselling and nicotine substitutes are not the only available strategies. Exercise reduces the urge to smoke and withdrawal symptoms, while social support via social media is gaining popularity for its efficacy in helping ex-smokers stay tobacco-free. And there are a few more: hypnosis, acupuncture, yoga, and mindfulness are some of them.

4. Get the right kind of emotional support
Participants in a 2014 study were better at talking to their loved ones about quitting smoking if they had received face-to-face or online training on how to communicate their concern (without nagging or confrontation) than if they received only pamphlets.

5. Don’t be afraid to use your smartphone
A 2014 study showed that constant reminders from a text-messaging service helped people stay off tobacco.

6. Challenge your brain
Engaging in exciting activities (e.g., puzzles, hobbies, games), which challenge the brain, with a loved one can be an effective strategy for reducing nicotine cravings.

7. Use e-cigarettes to boost willpower
E-cigarettes create an inhalable nicotine vapour by heating a liquid nicotine solution. It’s not clear what the long-term effects are, but research shows e-cigarettes to be more effective in helping people successfully quit smoking compared to willpower alone or patches and gum. Recent reports do however caution the use of e-cigarettes (“No conclusive evidence that e-cigarettes help smokers quit: WHO report”, Today online, 27 August 2014).

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.