Smoking – All in the Family
Hello, my name is Art (Father) and I am a recovering smoker (A. Selle, personal communication, September 27, 2012). Art began smoking at the age of 16 because “it was the thing to do.” He told me that both of his parents smoked, although his mother was a very heavy smoker who “smoked all the time.” He said his father smoked off and on. Art quit when he turned 40 in 1986 because he had just had a major surgery and his daughters, Lynn and Ann asked him to quit.
Hello, my name was Faith (1948 – 2010) I was a recovering smoker (A. Selle, personal interview, September 27, 2012). Faith started smoking at the age of 16. She was a very heavy smoker (2-3 packs per day). She had great difficulty not smoking, despite chronic medical problems as a result thereof, and a rather significant family history of relatives dying with or from lung cancer. She had a few successful non-smoking periods, a few months here or there, but she rarely lasted longer than six months.
Hello, my name is Annjannette and I am a recovering smoker (personal communication, September 27, 2012). Ann grew up around parents that smoked her whole life. As a child, she hated the smell and sight of cigarettes. She used to beg her parents to quit, but they never would. She swore she would “never be a smoker.” When Ann was 16, she started smoking. Ann met Rudy six months after she started smoking and quit because he did not like it. Although Ann was a non-smoker for six years when she broke up with Rudy, she started smoking again. She said, “I was angry and sad. I wanted to get back at him.” Ann smoked about a pack a day, except during her pregnancies. Ann recent quit smoking again in January 2012. She said, “I did not have a plan or anything. I just figured I quit cold turkey every time I got pregnant, so I could do it this time too. The only thing different is whenever I have a craving I play with Annemarie” (her daughter). Ann said she still gets cravings when she drives because she used to smoke to relieve boredom when she drove.
Hello, my name is Lynn and I am a recovering smoker. Smoking has been an issue throughout my life. Both of my parents (Art and Faith) and most of my extended family (aunts, uncles, grandparents) were hard-core smokers (1-2 packs per day) throughout my childhood and adolescence. I have vague recollections of being very young and trying to convince my parents to quit smoking after learning about the risks involved in school. Although I had no idea at the time, I had been exposed to the message-learning approach, which posits, “the key mechanism of attitude change is learning the content of a persuasive message. Attitude change will occur, according to this perspective, to the extent that a person attends to a persuasive message, comprehends the content of the message, yields to or accepts the message, and retains the content of the message in memory” (Hogg & Cooper, 2007, p. 198).
Unfortunately, a single persuasive anti-smoking message was not nearly enough to combat other influences upon my attitudes with regard to smoking. For instance, daily exposure to my parents smoking habits clearly operated as a type of conditioning effect influencing my beliefs towards and about smoking, such that smoking became associated with belonging (Fiske, 2010), being a mature adult, stress reduction, family, and social gatherings. These beliefs only intensified when I began smoking at the age of 16. My parents reacted to my smoking as if it was a foregone conclusion I would smoke, and in fact, actually purchased cigarettes for me, further justifying it was normal and appropriate to smoke. My family of origin experiences influenced both my attitudes towards smoking and modeled social norms wherein smoking was deemed appropriate.
The discrepancy between attitude and behavior is commonly known as cognitive dissonance (Hogg & Cooper, 2007, Fiske, Gilbert, & Lindzey, 2010, Fiske, 2010). In retrospect, I may have retained some implicit negative attitudes towards smoking creating dissonance between my behavior and beliefs. For instance, I never became a heavy smoker. The most I ever smoked was 10 half cigarettes a day. Further, I was always, always trying to quit. I smoked off and on for years. I would smoke for a couple of years, quit for a few years, smoke for six months, quit for five years. I have been a non-smoker for 13 years as of July 29, 2012. I quit for my 30th birthday that year and have gone to great lengths to reinforce more appropriate healthful behaviors in place of smoking.
There is a great deal of diversity within populations of smokers, which need to be identified and addressed to approach smoking as a public health problem. I created this visual chart to demonstrate (Figure 1).
There are three primary categories: (1) Non-smokers; (2) Smokers who explicitly state they want to quit and/or have an intention to quit; and, (3) Smokers who explicitly state they do not want to quit and/or have no intention of quitting. Within each category are subcategories of individuals with implicit attitudes (positive or negative) towards smoking. Research indicates controversial attitude objects such as smoking often evidence divergence between explicit and implicit attitudes, due to issues such as social desirability (Sherman, Chassin, Presson, Seo, & Macy, 2009, p. 313). Therefore, it is important to include both types of measures in selecting the population or risk developing an ineffective message. Clearly, the variations between and within categories of smokers add additional complexities to implementation of potential remedies. The research states the benefits of matching attitude components (affect, cognitive, behavior) to potential modifiers (Hogg & Cooper, 2007, Fiske et al., 2010).
For the purposes of this discussion, I am addressing teen and adolescent non-smokers) from the perspective that prevention is extremely important. As demonstrated by my personal family history, intervention in the early teen years may have prevented one or more of my family members from becoming smokers at all. Further, prevention of the behavior is far easier than addressing later issues of physical, emotional, and psychological addictions, situational variables, long-term habit developments, and reinforced attitudes from same. Therefore, it would be my goal to reinforce positive health behaviors and dissuade non-smokers from every starting.
The Theory of Reasoned Action “posits that individuals’ intention to perform preventive health care behavior predicts preventive health behavior. Intentions are, in turn, predicted by a person’s attitudes about the behavior and his or her perception of how significant others view the behavior (e.g., social norms). These two routes of persuasion (attitudes and social norms) represent the best means to change behavior (Cohen, Shumate, & Gold, 2007, p. 93).
This theory is also in alignment with the concept that “educational appeals make the assumption that people will change their health habits if they have correct information” (Fiske et al., 2010, p. 700). Therefore, a program can be implemented providing teens and adolescent non-smokers with persuasive information. According to Fiske et al. (2010), effective persuasive messages should incorporate the following elements:
- “The communicator should be expert, prestigious, trustworthy, likable, and similar to the audience.
- Communications should be colorful and vivid rather than steeped in statistics and jargon.
- Strong arguments should be presented at the beginning and the end of a message, not buried in the middle.
- Messages should be short, clear, and direct.
- Messages should state conclusions explicitly.
- Extreme messages produce more attitude change, but only up to a point. Very extreme messages are discounted.
- For health promotion behaviors, emphasizing the benefits to be gained may be more effective.
- If the audience is receptive to changing a health habit, then the communication should include only favorable points, but if the audience is not inclined to accept the message, the communication should discuss both sides of the issue” (p. 700).
With a model to implement and elements of persuasive messages identified, the next step is determining the mode of delivery. There are several useful delivery vehicles for reaching teens adolescent non-smokers. For instance, school programs and television commercials frequently reach this population. In addition, televisions programs can be useful to communicate appropriately persuasive messages within the context of the storyline. The added benefit being the message is embedded within popular media expressed by popular actors and/or characters idolized by the viewers.
There are a number of challenges to this approach. One particular challenge is the method of delivery. School programs may be useful, but they are also typically considered boring, and decidedly “uncool.” Further, many school districts are loathe to find more time in the schedule for yet another extracurricular program that takes away from core subjects when every school is on the chopping block due to NCLB and STAR testing demands. Further, television commercials are hit and miss. With technology such as TIVO and DVRs, there are many youth, as well as adults, who have learned the benefits of fast-forwarding through commercials. Although having a popular television show incorporate the positive message is a great idea, actually getting them to do it is probably fairly difficult. There is likely a great deal of time, politics, and red tape involved. Moreover, if the show does do it they would probably advertise just how wonderful the message is and how wonderful they are for doing it, reducing the indirect factor greatly. Then there is always the possibility that by the time the message gets onto the show it is no longer the favorite show of that population. They have moved on to another favorite show.
To address these issues I suggest a more personalized approach utilizing computer-tailored persuasion. Today, most households have at least one computer, if not more. Additionally, our youth are spending increasing amounts of time online. Therefore, a technology related delivery vehicle has potential and benefits. For instance, “in computer-tailored persuasion, a message for an individual might take into account the individual’s name, gender, religion, past behavior, motivation to change the specific behavior and situational self-efficacy expectations” (Dijkstra & Rothman, 2008, p. 238). The benefit is that “incorporating cues signaling that generic information is directed at a person may increase the perception of personal relevant” (p. 241). In accordance with the elaboration likelihood model, the personalization may encourage deeper cognitive processing of the information leading the person to change their attitudes and behavior.
Chassin, L., Presson, C. C., Sherman, S. J., Seo, D., & Macy, J. T. (2010). Implicit and explicit attitudes predict smoking cessation: Moderating effects of experienced failure to control smoking and plans to quit. Psychology of Addictive Behaviors, 24(4), 670-679. doi:10.1037/a0021722
Cohen, E. L., Shumate, M. D., & Gold, A. (2007). Anti-smoking media campaign messages: Theory and practice. Health Communication, 22(2), 91-102. http://dx.doi.org/10.1080/10410230701453884
Dijkstra, A., & Rothman, A. (2008). Social psychology of health and illness. In L. Steg, A. P. Buunk, & T. Rothengatter (Eds.), Applied social psychology (pp. 226-248). New York, NY: Cambridge University Press.
Fiske, S. T. (2010). Social beings: Core motives in social psychology (2nd ed.). Hoboken, NJ: Wiley.
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Hogg, M. A., & Cooper, J. M. (Eds.). (2007). The Sage handbook of social psychology (concise student ed.). Los Angeles, CA: Sage.
Sherman, S. J., Chassin, L., Presson, C., Seo, D., & Macy, J. T. (2009). The intergenerational transmission of implicit and explicit attitudes towards smoking: Predicting adolescent smoking initiation. Journal of Experimental Social Psychology, 45, 313-319. doi:10.1016/jesp.2008.09.012
Steg, L., Buunk, A. P., & Rothengatter, T. (Eds.). (2008). Applied social psychology. New York, NY: Cambridge University Press.