Young and Proud Smokers Dig Smoking MORE when they see death warnings on the package

Ever wonder how smokers react to "Smoking Kills"? Well it depends on the smoker.

The British Psychological Society's research digest blog puts its spotlight yesterday on a study among student smokers. Those who find that derive some of their self-esteem from smoking and believe that it is cool react to these warnings differently as intended. Instead, they smoke more, "to buffer themselves against the depressing reminder of their own mortality".

Instead, authors recommend other warnings, such as, "Smoking makes you look unattractive" to reduce smoking among this group.

Finding and understanding your target group is essential for any behavioral public health intervention. Otherwise, you may be promoting the behavior you intended to discourage.

Photo: The Telegraph.

If you were a smoker, would this get you to quit?

The Centers for Disease Control (CDC) has a series of e-Cards where well-meaning friends and family can send not so subtle notes to push healthy behavior such as quitting smoking.

What if you were a smoker? Does a woman jumping in a field make you want to stop smoking? Perhaps not, but perhaps knowing (as the inside of the card says) that half of ALL adult smokers in the US have already quit may give you pause. If so many people have been able to quit, it is possible to successfully quit if you try.

Scores:

Picture: C. The Photo looks like an ad for a feminine product. Message: B- If people perceive that the norm is to quit, they are more likely to take serious steps to quitting.

Introduction to Sex, Drugs, and Behavior Change

Note: This blog seeks to find ways to better understand complicated issues of behavior change related to sexual and drug-risk related behavior. Some of the issues brought up in this blog are of a sexual nature or relate to drug use and may include notes that are (intended to be) humorous. If you think any of this may offend you, please do not read.
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Sex. We talk about it, we joke about it, we dish about it, we brag about it. Sex has many faces, it can be (re)productive, playful, or risky in more ways than one. We like it because it feels good or, in some cases (as John Mellencamp says) it "hurts so good." Yet why do some not use condoms when they know they should?

Hurts so Good by John Mellencamp

Sex is the perfect example of learning about behavior, why we do what we do, and why it changes. There are hundreds of professionals who have spent their careers working on how to change sexual behavior and yet we all still have a lot to learn.

What have we learned from more than 30 years of behavior change activites? Actually, a good amount. We just need to pay attention to what we already "know" and try to figure out what's left.

As an example, reducing sexual risk requires a focus first on condom use and talking to partners. Avoiding or downplaying condoms only hurts us in the end.

Let's think about the abstinence-focused curriculum promoted by well-intentioned but almost willfully ignorant policy makers and misled parents. The resulting change from this strategy in youth sexual behavior has been largely contrary to goals. While some young people are delaying their sexual debut (i.e. when they first have sex), they are NOT waiting until marriage, and many are not using condoms.

We have also learned that education and awareness-building alone do not change everyone's behavior.

Drug (licit and illicit) use also gives us a great example.

In 1950, Richard Doll and A. Bradford Hill conducted a case control study that first gave the world the idea that smoking and lung cancer were linked*. From 1951-2001, Doll, Hill, et al ran a prospective cohort study that followed up doctors over fifty years to see if those who were smokers had higher rates of cancer than those who were non-smokers**. Starting in 1954, articles were published on their findings to date which showed a strong causal relationship between smoking and cancer.**

In the US, an American study with similar results was described in the Reader's Digest article "Cancer by the Carton" in 1952. While there was a decline in smoking after the buzz from this article, many continued smoke and non-users continued to initiate.

While awareness of the dangers of smoking did spur some to quit, other factors were at play. There is, of course, addiction, but that is not the whole story. But what of the numbers who initiated? Cigarette advertising a la "Mad Men" could explain some of this. We live in the era where increasing cigarette taxes and city-wide smoking bans are increasingly used and have seen a measureable decrease in smoking as a result, so that must be part of the answer. As before, the answer is composed of multiple factors, some which we know, some we guess, and others we have yet to find out.

Welcome to Sex, Drugs, and Behavior Change


* Doll R Hill AB "Smoking and Carcinoma of the Lung" British Medical Journal 1950 (2) 739-748
** Doll R, Hill AB "The Mortality of Doctors in Relation to their Smoking Habits" British Medical Journal 1954 (1) 1451-1455
** Doll R, Peto R Boreham J Sutherland I "Mortality in Relation to Smoking: 50 Years' Observation on Male British Doctors" British Medical Journal 2004 328 (7455) 1519