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.  



[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.



[8] Simon Chapman His PhD looked into the relationship between cigarette smoke and advertising.

Is it Safe to Say, ‘Safe?’


It would appear that there is no such thing as ‘safe.’ If we are to believe what we are told, particularly with reference to Harm Reduction, there is no such thing exists as safe. We are told this repeatedly. We are warned against using this ‘dangerous’ term – that it leads us into an area that can be exploited by our opponents – I beg to differ.


I suppose, at a superficial level, nothing actually is safe: the water we drink; the air we breathe; the paste we brush our teeth with; the cat we love, who purrs contented on the sofa – they all bring with them that tiny element of risk: They may bring, toxins, allergens, teeth and claws.


So there is no such thing as safe?


Yes there is.


But first, with regard to Harm Reduction and electronic cigarettes, why is the word, ‘safe,’ considered by so many advocates to be, ‘dangerous?’ And why, I will also ask, do the opponents of Harm Reduction also want so very much to prevent us from saying that Harm Reduction safe? Odd, is it not – vapers do not want to say the word because of the risks involved in its use, and opponents of Harm Reduction do not want the vapers to employ the word either?


In their flight from using, ‘safe,’ advocates of Harm Reduction have turned to, ‘safer than tobacco cigarettes,’ in their discussions on the topic. They are intimidated by the, ‘nothing is safe’ argument. They feel that bodies, such as Tobacco Control, will jump on them: heap criticism on them; use this weakness to exploit the vague, unsubstantiated fears that Tobacco Control are trying to nurture in the ‘uninformed.’ As soon as , ‘safe’ is used to describe the electronic cigarette, many advocates and activists throw their hands up in horror and scream warnings that this will be exploited to the detriment of Harm Reduction.


What a tight little corner the advocates of Harm Reduction have been backed into. Safer than cigarettes…  it is correct, Harm Reduction is safer than smoking, but look  at what Harm Reduction is being compared to – cigarettes, one of the most dangerous killers anywhere. Walking down a quiet country road blindfolded and deafened is safer than walking down a motorway during the rush hour, blindfolded and deafened, but, of course neither are safe. To use the, safer than, terminology, I am afraid, does very little to assure the listener as to the relative safety of Harm Reduction. To add, ‘by orders of magnitude,’ might have meaning to scientists, but has little effect on the majority. They think, ‘safer than cigarettes… but that means they might still be dangerous.’


And Tobacco Control now sit back rubbing their hands with glee.


But allow me to assert, Harm Reduction and electronic cigarettes are safe.


You see, ‘safe,’ is a relative term. It is very rarely used as an absolute. The meanings of words depend on their use, and this is why, over time, language changes: To demonstrate that ‘safe’ is relative, try different comparisons and look at the way the connotations change. As I have already stated, when compared to tobacco smoking, ‘safe’ can end up not feeling very safe at all. At the other end of the scale, let us look at, lollipops. Now lollipops have killed, in one year alone, in the US, a hundred children. Are lollypops safe? What about peanut butter? No! Surely not…Eh! What about a hot dog?[i] So armed with the knowledge that even these ‘safe’ items present risk, if you are told that electronic cigarettes are safer than lollipops, are safer than hot dogs, are safer than your morning cup of coffee, you get a very different perspective than you do when you are told that electronic cigarettes are safer than smoking.  Oh, and electronic cigarettes are actually safer than breathing in the morning air (in huge areas of the developed world), they are safer than consuming drinking water, safer than brushing our teeth, from using mouthwash, and they are safer than the deceits being forced upon advocates of Harm Reduction through the outrageous demands and accusations  spewing from Tobacco Control.


However, the preamble above is simply lightweight preparation for the main point.


The linguistic argument that ‘safe’ is relative and not absolute is interesting and correct enough, but ‘safe’ is also often legally defined and accepted as relative: ‘Safe’ comes in scales, relative to dangers. Interestingly, one of the main areas where we find definitions of ‘safe’ is in Health and Safety, and on environmental issues – we are on home ground.



‘Safe’ is used; in legal terms with regard to atmosphere, and what we breathe, and that there are legal safe limits for different environments. That cannot be if there is no such thing as ‘safe.’… It follows that if e cigarettes’ toxicity and emissions are below these levels, they too must be, in legal terms, ‘safe.’ (And if it is possible to set levels for medical permissions and use, it must therefore be possible to set those same levels whether it is for medicalization or not)


“In the UK, under the CONTROL OF SUBSTANCES HAZARDOUS TO HEALTH REGULATIONS 1999 (COSHH regulations) the Health and Safety Executive (HSE) sets occupational exposure limits (OELs) and publishes these in a document entitled EH40. These lists have legal status and similar legislation exists elsewhere; COSHH takes into account the European Commission Directive 80/ 1107/EEC. COSHH covers all toxic substance… The best way of controlling a risk is to prevent exposure but if this is not possible, a process may have to be enclosed or ventilation and extraction equipment used or special handling procedures employed. It should be possible for most people to work in a safe environment day after day and HSE publishes Guidance Note EH40 to help employers to control their processes adequately so that workers are not exposed to levels of toxic materials above the recognised safe levels.”[ii]


So ‘safe’ can be equated with controlled risk. A risk can be controlled to a ‘safe’ level.


Now, I would suggest reading the wealth of information available on the web regarding the toxicity of electronic cigarettes. A good starting place is, Peering through the mist.[iii]


So there it is, ‘safe.’ It is measurable. It is relative to other risks. It is something that we can and should use. Advocates have made an error by avoiding the use of the word, ‘safe’ in that they (and we) have been shoehorned into using a form of terminology that suits Tobacco Control just fine and dandy. Where we are talking about, ‘safe,’ our audience is thinking about danger.


We should be fighting this and repeating over and over again, harm reduction is the ‘SAFE’ alternative to cigarette smoking. And if Tobacco Control wants a fight – give them one.