Tobacco Control: A Wolf in Sheep’s Clothing

On February 12, 2014, in my blog, An Outlandish Thought[1], I put forward the view that Tobacco Control were trying not to stop, but to encourage people to take up smoking – it would seem that the idea was not as ‘outlandish’ as I first surmised.

 It would seem that there is a large body of academic thought which supports the view that horrific images might actually encourage some smokers to keep smoking, and, some non-smokers to take up the habit, and failing that, the images might be ignored altogether.

 As far back as 1953, psychologists were looking at the effect of fear in advertising[2]. The results of their investigations were not as you or I would expect.  The model which was being presented at that time is known as “The Drive Model.” Part of this model argues that,”… when individuals are presented with threatening information they will be motivated to search for responses that reduce the threat. When a response reduces fear, it is reinforced and becomes part of one’s permanent response repertory. The drive model therefore suggests that higher fear should result in more persuasion, but only if the recommended action is perceived as effective in averting danger.” (Janis, I. L., & Feshbach, S)

 Take a close look at the end of the quote, “…but only if the recommended action is perceived as averting danger.” This is a theme which has been continued as the decades roll by.   Following the Drive Model was the Parallel Response model (1970) which suggests that fear appeals produce two separate and potentially interdependent processes: danger control processes (efforts to control the threat/danger) and fear control processes (efforts to control one’s fear about the threat/danger)[3] And once again we find that with the horrific message, the way which one turns is decided by the efficiency of the recommendations for avoiding the danger.

  As the years passed, the idea was further and further refined; the SEU models, including, Rogers’s Protection Motivation Theory (PMT)[4]. This attempted to explain the effect of fear and when it works, however the PMT model fails to explain why it does not work. PMT and SEU[5] models deal, in the main, with high threat coupled to high efficacy of the recommendations to avert the danger – but what happens if the perceived threat is low?  What happens if the perceived efficiency of suggested measures to avoid the threat is low?

 But first, a word about the difference between threat and fear, it is assumed that when faced with a threat, fear will follow. This, it is assumed, will result in an action to avoid the threat. And this is the logic SEEMINGLY being followed by advocates of warnings and graphic images on cigarette packs. They say that the fear induced by the images and warnings will encourage people to stop or never start smoking.  However, this is not the way it works. It is true that action will follow on from a threat which induces fear, but what will be the nature of the action?

 Take the graphic warnings being issued on cigarette packs. In this instance there are two distinct groups who react to these images and warnings. Young people, both smokers and never-smokers and, older established smokers.

 What happens when a young smoker, or would be smoker, sees a horrific image on a cigarette pack? The answer, as far as avoiding cigarettes, is nothing very much at all. Why? The image does not induce fear. Why?  The threat event is too far away. It is, to the mind of a young person, very remote – it can be ignored. Perhaps this explains why horrific images are being found to be so ineffective. Perhaps this is why the uptake of cigarette smoking among the young remains so high. A month is a lifetime to many youngsters, so how long is ten or twenty, how long is thirty or forty years away? How far away is, ‘if at all?’

And with established smokers the effect is different but with a similar result Take note that “…the more one is defensively resisting a recommendation the less one is making appropriate changes in line with the message’s recommendations[6].” And, “…that messages that fail to make people believe the recommended response is effective and/or that they are able to perform the recommended response produce stronger fear control/defensive response[7].” I hear an echo reaching me from 1953… listen carefully, does it say, wait for it “…but only if the recommended action is perceived as effective in averting danger.”

 The Meta analysis of Fear Appeals: Implications for Effective Public Health Campaigns, (Kim Witte, PhD Mike Allen, PhD) sums things up rather nicely:” In sum, fear appeals appear to be effective when they depict a significant and relevant threat and when they outline effective responses that appear easy to accomplish. Low threat appeals appear to produce very little, if any, persuasive effects. Thus, regardless of which theoretical model is advocated, the advice to message designers is the same: a persuader should promote high levels of threat and a high level of efficacy to promote attitude, intention and behaviour changes.”

 So look at the gruesome image on the packet. Read the warning, “Smoking Kills.” And now look at the recommended action… Sorry, I will reword that statement, look FOR the recommended action – No, I do not see one. Ok, so it is implied, ‘stop smoking.’  Will that be perceived as ‘effective’ advice?  Well, maybe effective if it was within some range of possibility, but is it? Even the best reported results for quit attempts is hardly 10% – so the messages (implied) recommended action, in practical terms is, 90% fail. Not good. Not effective, so other defence mechanisms kick in.

 What are they?

 They might, scrutinize the message to find ways to criticize and downplay the information in order to reduce the threat. They might, engage in a biased search for inconsistencies, and evaluate the evidence with a bias in the direction of their preferred conclusion.  And always, the spectre of another failed attempt to follow the recommended action: ‘stop smoking.’

 So the young see the threat as being something in the distance, something that can be dealt with later – the threat level is low. Adult smokers despair at the recommended action, and although the messages and images may create fear, the recommendations are not realistic, the efficacy is low, and so denial takes place.

 Messages and images have only a very limited impact in smoking cessation.

 The same holds true for plain packaging and for hiding cigarette products out of sight. In fact, these actions can be seen to be an attraction for young people – a reason to start smoking, not resist.

 There is a mass of information on the psychology of the attraction of the unknown. Couple this phenomenon to the advertised (low) threat value of cigarette smoking  to locking cigarettes out of sight, and a large percentage of young people will find the allure that has been created, irresistible.

 But what is worse – I believe that Tobacco Control is aware of all of the above.

 How would they know?

 The answer is a very simple one. A very large proportion of the psychology of fear appeals, and communications, and attitude change are written for the advertising industry.  This includes the health advocates who use this particular advertising to create the effect they desire. Now, we encounter a slight problem. What exactly is the effect they desire? If they are not aware of the effects of presenting warnings without effective avoidance strategies, they are negligent. If they are aware that warnings and gruesome images, that hiding cigarettes out of sight will have no effect, and indeed be an attraction – they are culpable.

 I choose to think it is deliberate. Tobacco Control is expert at marketing. It, I believe, knows the psychology involved inside and out. Whole university departments give ‘expert’ advice on a continuous level. Why, even one prominent Tobacco Control advocate has a PhD in the subject.[8] I wonder how many millions have been spent by the various Tobacco Control groups looking into this very topic.

 But the main reason I see Tobacco Control as a wolf in sheep’s clothing has nothing to do with the above. It is simply this…

 They have fought tooth and nail against the development of e cigarettes and personal vaporizers. They have consistently argued for the over-regulation of harm reduction products. Why would any group which purports to be acting in the interest of people’s health which to stymy, to destroy a product which will save many millions of lives? And to me, again, the answer is simple. It is against their interests to see this happen. For whatever reason, I think, it is important for them to keep their respective positions, be it an organisation or individual within an organisation. It is power, it is money, it is prestige and position, and all of these are up for the taking – as long as a percentage of people continue smoking: As long as it never become known how duplicitous their activities really are.  

 

[1] https://brainyfurball.wordpress.com/2014/02/12/an-outlandish-thought-2/

[2] Janis, I. L., & Feshbach, S. (1953): Effects of Fear-Arousing Communications. Journal of Abnormal and Social Psychology, 48, 78–92

[3] Leventhal H: Findings and theory in the study of fear communications, in Berkowitz L (ed.): Advances in Experimental Social Psychology (Vol. 5): New York, Academic Press, 1970, pp.119-186

[4] Rogers RW: A protection motivation theory of fear appeals and attitude change. J Psych 91:93-114, 1975.

Rogers RW: Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation, in Cacioppo J, Petty R (eds.): Social Psychophysiology: New York, Guilford Press, 1983, pp. 153-176

[5] Sutton SR: Fear-arousing communications: A critical examination of theory and research, in Eiser JR (ed.): Social Psychology and Behavioural Medicine. London: Wiley, 1982, pp.303-337.

[6] http://www.mnt.ee/public/Fear.pdf

[7] http://www.mnt.ee/public/Fear.pdf

[8] Simon Chapman His PhD looked into the relationship between cigarette smoke and advertising. http://boltonsmokersclub.wordpress.com/author/junican/