From tax to texts: behaviour change in quitting smoking

By Anne Balls, Digital Editor

World No Tobacco Day marks the global crusade to stub out one of the biggest epidemics of the 21st century. But what works in the battle to quit smoking?

In 1974 nearly half of UK adults smoked. That figure has been slashed by two-thirds, down to just over 15% from 46%, but there is still some way to go.

While anti-smoking strategy has moved on dramatically since the government-sponsored villain Nick O’Teen appeared in schools across the UK, smoking accounts for nearly half a million hospital admissions and 80,000 deaths a year.

The simplistic 20th century trinity of intervention of the early days – increasing the cost of tobacco, regulating sales and advertising, and providing health information – 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. And graphic images of diseased organs took a step further in the right direction, as they tugged at hearts and spoke to minds.

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.

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 mobile messaging and social media in tailoring content and providing interactive engagement and lasting change can be achieved. Fjeldsoe et al in 2009 found that 13 of 14 mobile messaging interventions for smoking cessation worked. Weekly messaging also doubles the quitting rate of fortnightly support while setting smaller, shorter-term goals allowed people to build on small, realistic 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.

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.

Anne is a Digital Editor at Thrive. Working at the forefront of health communications, she explores new ways to make expert health and behaviour change content more accessible via mobile messaging and emerging chatbot technologies.

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