Tuesday, March 5

Smoking Guns: Why Anti-Smoking Campaigns Fail

The best guess by Gallup in determining the number of people who smoke in the United States is 20-22 percent. According to the Centers for Disease Control (CDC), this estimate fits. The CDC frequently cites that one in five people smokes cigarettes.

The number has mostly plateaued since 2000; slightly down depending on how it is sliced. But tracking the percentage can be a bit misleading as the population has grown too. In other words, the number of smokers in the U.S. is relatively constant (or may be increasing), which means it's time to face facts.

The four-decade long barrage of anti-smoking campaigns is no longer effective. 

The reason seems pretty clear. Most anti-smoking campaigns do not target smokers. They target non-smokers in an attempt to vilify people who smoke instead. And that's fine, as long as policymakers and nonprofit organizations want to spend millions or more on ineffective advertising campaigns or pass anti-smoking legislation and sin taxes to make themselves look like heroes.

I think we can do better, but it will take better campaigns. They have to be targeted and they can't all be negative. After all, there is psychological evidence that suggests negative messages produce negative results. That might be especially true for smoking — the ages most exposed to anti-smoking campaigns are overwhelming under the age of 18. Coincidentally, the majority of smokers start before they turn 18.

For many of them, it was never about smoking being cool as advertising censors claimed. It is about being defiant to authority, demonstrating a foolhardy sense of immortality, tempting fate by flirting with something potentially addictive, or being accepted by peers and adults (e.g., parents who smoke) like it was a private club. The campaigns all play into this notion.

Afterward, once someone becomes a smoker, anti-smoking campaigns take on a different feel. They either make smokers feel bad about smoking or convince them to light up in defiance. The messages aren't much different from individual abuse smokers receive on a daily basis — which is impossibly ironic, given how many states are passing anti-smoking laws but legalizing marijuana.

Creating a better anti-smoking campaign means a bigger focus on benefits. 

Many campaigns that are designed to help people quit aren't properly constructed. Most of them reinforce negative messages — how hard it will be to quit smoking, the impossibly low success rate (and significantly high relapse rate), and additional consequences commonly associated with quitting cold turkey or attempting to step down using gum, patches, e-smokes, or other nicotine replacements.

If you are are a non-smoker, think of any habit you have. If someone told you half of what they tell smokers, would you want to try to kick the habit? Probably not, especially if stress is a trigger.

A much more effective campaign would have a two-fold approach. First, it would help smokers stop smoking as opposed to quitting outright. Second, it would focus on the benefits and not the curse.

Don't quit. Just stop. 

Stopping could mean any number of things, all of which would eventually help any smoker stop completely. It could mean they stop smoking in certain locations (cars, houses, etc.), at certain times (immediately after meals, while drinking, etc.), in front of certain people (co-workers, clients, kids), etc.

With each successful 'stop,' smokers tend to become vigilant in controlling the addiction. Each 'stop' leads to another until the act of smoking becomes more annoying than pleasurable. Some people might be surprised how often they might put off smoking if it feels like a chore. At minimum, it will make them more aware of how often they smoke and what triggers (prompt to smoke) they might have.

Along with these 'stops,' many smokers have an easier time stopping after they switch to a natural/organic cigarette. While natural/organic cigarettes are not considered healthier alternatives, there may be truth to the idea that commercial cigarettes have more addictive ingredients. They most certainly have more additives, as many as 600. Nicotine is hard enough to give up. Don't risk other additive addictions.

The benefits of stopping.

The benefits of not smoking are easily undersold. When most campaigns talk about the benefits, they talk about long-term ailments (e.g., cancer) or use them to paint all smokers as an unhealthy, smelly group of vile people. That doesn't help smokers stop. What might are the immediate short-term benefits.

Stopping for even 20 minutes can lower your pulse rate and blood pressure. Stopping for eight hours will remove more than 90 percent of the nicotine from your body. Stopping for 12 hours will drop carbon monoxide levels to normal and raise blood oxygen to normal.

It only takes two days for smell and taste receptors to begin to heal. It only takes three days for the lungs to begin to heal. It only takes ten days before teeth and gums to begin to heal. Within a few weeks, the circulatory system and heart begin to heal. Even insulin returns to normal in about two months. Eventually, most damage can be reversed until even some risks return to non-smoker or even never-smoker levels.

The changes and benefits are dramatic. And while such benefits timetable lists vary (a few are paired with disturbing images), talking about them could significantly help a smoker find a short-term health benefit that means something to them — from their teeth and gums to shortness of breath after exercise.

The two times I stopped smoking. 

Even when I smoked, most people didn't know it. I seldom smoked in public and would mostly hide myself away if I did. Conversely, despite the habit, I exercised regularly, ate well, and established an aggressive teeth maintenance program. I never smoked in my house, car or in my office — always outside, rain or shine.

I stopped smoking last month. And unlike the other time I tried to stop, this time was relatively easy.

The difference was all in the approach. The first time, maybe eight years ago, I did it the way campaigns tell you to do it. I tossed out everything related to smoking. And much like they warned, I was irritable and miserable. And then I felt even worse, like I was letting everyone down. I lost.

This time was different because I had already stopped smoking 90 percent of the time. Then one day last January, I caught a cold and just stopped. I didn't tell anybody. I didn't throw anything away. I still have seven packs in the cupboard. They empower me more than tempt me. It's my choice to not smoke.

I initially made a choice that going outside in the cold was less desirable than just going to bed. When I woke in the morning, I decided to see how long I could wait. That wait never ended. Sure, there were some cravings here and there, but I already had a list of things that always made me not want to smoke — carrots, apples, cashews, sugar-free Jelly Bellies, gum, etc. (everyone has their own things). So, I would have one or two of those things instead. I was never irritable either. It felt easy.

While I would never suggest anyone take as long as I did to stop outright, I had to develop a plan that didn't exist — one that worked for me. Sure, seven years is too long, but my future self wasn't around to create a better campaign. A better campaign could have helped me stop sooner and possibly helped me avoid having surgery this year.

Unfortunately, I don't see many effective campaigns in the cards. Very few people in the medical profession want to embrace a step-down program without relying on prescription medication (all of which have higher relapse rates). Most anti-smoking advocates stress lifelong victimhood over willpower (because it helps funding). Most advertising agencies would rather have 80 percent of the population notice an ad than a fraction of 20 percent (because awareness is more valued than results). And the general negativity toward smokers is ingrained by a majority; it's as depressing as it is hypocritical (considering obesity rates and the recent legalization of marijuana).

Even some of the communication from trusted sources is off. The CDC, for example, estimates that 1 in 5 Americans dies from cigarette-related causes. Since they also say only 1 in 5 Americans smoke, the figure is either fudged or the government is suggesting that all people who smoke die from cigarette-related causes. Meanwhile, many cancer rates continue to rise anyway. Let smokers stop, guilt free.
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