Smoking: We Need to Take a Different Approach

Perhaps you’ve noticed that gruesome images of diseased lungs, rotting teeth and cancerous throats are now stuck on cigarette packets in Ireland. The idea is to shock smokers into quitting and prevent young people from starting, with a particularly lurid message.

Nobody should smoke but many do. It causes emphysema and obstructive pulmonary disease. It’s implicated in many cancers including those of the lungs and oesophagus and the breast. So you can well understand why the move would be greeted enthusiastically by public health campaigners and cancer support groups.
But will this latest initiative work?
The World Health Organisation says it does and cites Canada where, it claims, photo images on cigarette packs increased smokers’ “intentions to quit” from 20% to 87%.
The Irish Cancer Society refers to a Eurobarometer Survey in 2009, which found that 75% of Irish people think that images on cigarette packages will be effective in reducing the smoking rate. They add that Canadian research says that smokers are more likely to remember a health warning if they’ve seen it in picture form.
It also found that the Irish are the most likely to say that health warnings on tobacco packets have an impact on their attitudes towards smoking. And while 60% of Europeans back measures to make tobacco less visible and less attractive in Ireland, over 80% favour bans on advertising tobacco in shops, restricting online sales, removing colours and logos and the like.
Hmmmm…
I’m sure all of that is right, up to a point – but there’s already a raft of measures to tackle smoking in Ireland, including a ban on the display and advertising of tobacco products in shops introduced in 2009. Tobacco companies can’t sponsor anything, and cigarette packets already carry big bold warnings. And the price of cigarettes in Ireland is double the European average.
Along the way we were told that these measures have been found to be successful in research, and that if they were introduced, smoking levels would decline dramatically.
But they haven’t. Eurobarometer also reports that Irish smokers start at a younger age than other Europeans, on average 16.4 years of age compared with the EU average which is 17.6. And Irish smokers consume an average of 15.7 fags a day compared with the European average of 14.2.
There’s also a major trade in illegal tobacco here. Its scale is hard to document but EPS Consulting wrote a report for the retail industry in which they estimated that tobacco smuggling cost the exchequer €526 million a year. Even at half that amount, it is a significant problem.
The response from public health campaigners is to raise prices even more and make the bans ever broader and stricter and more coercive. Why? If it doesn’t work, surely it’s time to try another tack?
Already we hear that the new cigarette are being traded, as collectors compete to complete the set. It’s a pattern. When messages on packets were made mandatory a few years ago an email went around within days with a set of counter messages you could print off and stick on your cigarette pack like “Smoking makes you look cool”.
Irresponsible? Yes, sure. But humorously rebellious too.
The Head of Advocacy and Communications at the Irish Cancer Society says that tobacco companies spend huge sums millions “on promotional campaigns that include carefully crafted packet designs that aim to attract new smokers and stop existing smokers from quitting”, and that young people and women have been “directly targeted by the tobacco industry through marketing and branding efforts.”
It’s hard to see how, if they can’t advertise or sponsor and if the packs are withdrawn from general view. It’s high time to look for factors that aren’t addressed by controls and restrictions – and to stop blaming the other side for what may be failures of your own.
Almost certainly that means taking a new approach to research. There’s a serious risk that – as so often – research is merely confirming the prejudices of the campaigners, a risk found right across public health research. Policy should be based on evidence? Well, the fact that people are still smoking is real tangible evidence…
None of this is to endorse smoking. The Hog hasn’t a good word to say about the habit. But if external control psychology is failing, it’s time to change. Think persuasion rather than coercion. To paraphrase Einstein, insanity is doing the same thing over and over and expecting different results.