The policy termites slowly eating out the foundations of smoking

July 12, 2017 by Simon Chapman, The Conversation
Like a mound of termites, tobacco control policies are eating away at smoking in ways we’re not always conscious of. Credit: www.shutterstock.com

Across 40 years of working in tobacco control, there have been countless times when I've been asked "so, has [insert here] policy or [insert here] campaign worked?".

The question has its roots in clinical interventions where we see what happens when you take an analgesic for pain, get an injection before having a tooth pulled, or apply a fungicide on athlete's foot. These things work.

So it's natural we should ask the same about a piece of legislation or a multi-million dollar TV campaign about smoking. Do these things make a difference?

In 1993, I wrote an essay on this issue in the British Medical Journal, Unravelling gossamer with boxing gloves: problems in explaining the decline in smoking.

In the wake of Philip Morris being ordered to pay the Australian government about A$50million in legal costs over the company's failed attempt to thwart , I was asked the question again this week: "Has plain packaging worked?"

So here's an update on the direct and subtly synergistic ways has seen Australia achieve record lows in both adult and teenage smoking.

From a trickle to a deluge

Since the bad news on smoking and health began to trickle in from 1950, then deluged us, hundreds of millions of smokers have stopped smoking around the world, particularly in nations where governments have introduced population-focussed laws and regulations. These include measures like laws, taxes and mass campaigns that reach huge proportions of the population as opposed to dinky little interventions very few people ever see or are exposed to.

When a smoker decides to quit, they will have usually tried before – many with about the same conviction as attempts to exercise more or lose weight. But when they finally succeed, ex-smokers will often nominate a reason "why" they quit.

There is broad daylight between the first reason ex-smokers give about why they quit and all other reasons they nominate. Health concerns are the overwhelming reason for quitting (91.7%), followed by cost (way back at 58.7%); 90% of smokers regret they ever started.

The straw the broke the camel's back

People also often nominate a recent "straw that broke the camel's back" as the precipitating reason for the final decision to quit and resolve to see it through.

This can be a symptom they have experienced, an incident like the sudden death of a smoking friend, a particularly poignant campaign advertisement they can't get out of their head (this classic has few peers), the heartfelt pleading by a child or partner, the sudden realisation very few of their colleagues or friends smoke or the price of cigarettes going through a psychological barrier, like A$40 a pack.

These triggers are known as proximal factors that stimulate quitting: factors easily identified, nominated by smokers aware of their influence, and sometimes easy to quantify with proxy measures like immediate boosts in calls to quitlines.

Background factors that eat away at smoking

But there are also vital distal or background factors that work like hidden termites in a building. These slowly and subconsciously eat away the foundations of smokers' feelings of being invincible to disease, their apathy and act to denormalise pro-smoking environments. The effect is that smokers get fewer reminders about smoking and a growing awareness smoking is not something the great majority of people do anymore.

Examples of these distal factors are advertising bans, graphic warnings on packs, plain packaging, smoke-free public spaces and tobacco taxation.

Very few smokers tell you they quit smoking because tobacco advertising was banned.The impact of advertising bans instead works in slow-burn fashion, as it has done in Australia since 1993 when the last forms of advertising ended.

With plain packs, some experienced an increased urgency to quit after exposure to the purposefully unappealing plain packs with their goullish (but deadly accurate) large graphic health warnings. But the primary goal was to have whole generations grow up never having being beguiled by the designer edginess of pack livery and noting plain packaging of tobacco products was exceptional among all other consumer goods.

Tobacco is the only product where legislation mandates plain packaging: 17 nations have either implemented, legislated it or announced they will. Tobacco is also the only product that has to be stored out of sight in retail outlets.

All these factors do not act in isolation, but like a constant and unstoppable termite colony, working in synergy to erode the appeal of smoking.

A day in the life of an ex-smoker

In my 1993 BMJ essay, I described a day in the life of a smoker who quit. The smoker woke to news on the radio of yet more bad research news about smoking; lived with disapproving family members who often urged him to quit because they had been educated about the risks; winced every time at the price he had to pay for a pack; was acutely aware of all the places he couldn't smoke and why those laws had been introduced; was self-conscious about the stench of stale tobacco he carried about; and couldn't shake some of the powerful anti-smoking advertising that intruded his TV viewing.

A smoker might well nominate just one of these influences when a researcher calls, but all play a part in a comprehensive approach to reducing the world's leading cause of death, if you exclude poverty.

Humans are not like lab rats who can be artificially kept in strictly controlled environments and exposed to single or fixed combinations of policy variables while isolated from all others so researchers can measure the exact impact of any one factor.

People whose questions are based on that premise need to be gently reminded of that. Male lung cancer incidence rates today were last seen in the early 1960s and women's seem likely to never reach even half the peak seen at the height of the male epidemic. We need to stay the course and make history.

Explore further: Study finds plain packaging helps smokers quit

Related Stories

Study finds plain packaging helps smokers quit

March 2, 2017
Plain tobacco packaging in Australia reduced smoking and increased smoker attempts to quit the habit because it led to a fall in the way they identified with their brand, a study led by ANU has found.

Cheaper cigarettes, roll-your-own tobacco are perpetuating a public health threat

June 2, 2017
Yesterday morning, Australia's tobacco industry woke to the latest chapter in the book documenting its inexorable decline.

Smokers' acceptance for plain packaged cigarettes rose sharply after their introduction

November 10, 2014
Smokers' support for plain packaging of tobacco products rose sharply after they were introduced in Australia, according to a study published online in the journal Tobacco Control.

Higher tobacco taxes needed to reduce smoking rates in South Asia, new analysis says

April 11, 2017
Higher taxes on tobacco could reduce consumption in South Asia by at least one-third and avoid 35-45 million premature deaths, concludes an analysis published today in The British Medical Journal.

Women smokers concerned about weight are less likely to try to quit

April 6, 2015
Women who believe smoking helps them manage their weight are less likely to try quitting in response to anti-smoking policies than other female smokers in the U.S.

Plain packaging reduces allure of cigarettes: study

July 22, 2013
Scientists on Monday said they had evidence that plain packaging for cigarettes diminishes the appeal of smoking, as anti-tobacco campaigners suggest.

Recommended for you

Simple leg exercises could reduce impact of sedentary lifestyle on heart and blood vessels

August 21, 2018
A sedentary lifestyle can cause an impairment of the transport of blood around the body, which increases the risk of disease in the heart and blood vessels. New research published in Experimental Physiology suggests that ...

Seven percent of children in orthodontic care at 'high risk' for sleep disorders, according to new research

August 21, 2018
A child who is restless, hyperactive and can't concentrate could have a problem rooted in a source parents might not suspect: a sleep disorder.

If you've got MS, exercise means much more than moving

August 21, 2018
For people with multiple sclerosis, the meaning of exercise stretches way beyond health and keeping fit, shows new research revealing what life's really like with the condition.

Your office may be affecting your health

August 20, 2018
Workers in open office seating had less daytime stress and greater daytime activity levels compared to workers in private offices and cubicles, according to new research led by the University of Arizona.

Sitting for long hours found to reduce blood flow to the brain

August 20, 2018
A team of researchers with Liverpool John Moores University in the U.K. has found evidence of reduced blood flow to the brain in people who sit for long periods of time. In their paper published in the Journal of Applied ...

Healthy diet linked to healthy cellular aging in women

August 20, 2018
Eating a diet that is rich in fruits, vegetables and whole grains and low in added sugar, sodium and processed meats could help promote healthy cellular aging in women, according to a new study published in the American Journal ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.