In late June the FDA announced they would start placing gruesome photos on packs of cigarettes to depict “the negative health consequences of smoking.” They apparently did research to find out which images were the most memorable and disturbing, but they failed to do research that demonstrated such images had any influence on quitting behavior – or, for that matter, buying behavior.
I can guess that this is exactly the sort of “intervention” that will backfire spectacularly, especially with teenagers. Call up your inner Surly Adolescent, and what is her reaction to gore and guts and diseased lungs on a cigarette package? “Bring. It. On!” There will be competitions for who gets the grossest packs, which brands have the most disgusting pictures, and general “You Are Not the Boss of Me” behavior that is now even more compelling since she’s now here to prove a point.
So why do public health agencies continue to use money on corporate marketing techniques, rather than seeing what actually affects the frequency of quitting attempts and the length of smoking cessation following quitting?
The parallels with messages about fear-and-loathing of fatness are striking. In both cases, the authorities within public health agencies continue to assume that fear messages change behavior. But the declines in overall smoking occurred during the period when laws were enacted banning smoking in most public places, while the fear messages have been a constant drumbeat for decades. Behavior changes when environments make specific behaviors more inconvenient, or more convenient. Punishing, on the other hand, has been shown over and over to result in unpredictable outcomes, often an increase in the behaviors targeted for elimination.
If we want people – of all sizes – to do the practices that support health, like quitting smoking, moving their bodies, sleeping restfully, getting good medical care, eating better fuel for their bodies, loving and feeling loved, we need to make it easier to do those things. We need to make access to those practices something available to anyone at any time, not just wealthy people with plenty of time on their hands. And we need to help all people feel like they are worth this effort. Instead we are practicing a policy of shaming and threatening, a message of, “if you look like this, you’re a loser.” And we shouldn’t be surprised that people react to being shunned with anger and rebellion.
I actually love that most of us have an Inner Surly Adolescent, because she is the guardian of freedom, a True Patriot, and the surprising source of a lot of our mental health. Surly Adolescents fight against rejection, bullsh*t, and tyranny. But they have a vulnerability, which is that they tend to be surprisingly manipulate-able. They do the opposite of what they’re being coerced or nagged to do, whether they want to do that behavior or not.
So the Surly Adolescent, who might love to dance, will sit with her arms crossed on the sofa watching TV if she is told she should exercise. She might love cantaloupe but if that’s what the diet allows, it will be the last thing she wants when she is proving that she gets to eat whatever she wants.
So if you want her to thrive and use her energy for good, the last thing to do is use coercion or shaming, or even fear. You have to show her respect.
We just adopted a couple wonderful little dogs. Taking them to “obedience school” (what a throwback that phrase is) has been a great review of behavioral learning theory. The course teaches the humans to think about how to arrange the environment so that it is easier for the dog to do what you are asking than not to. It teaches the humans not to ask the dog to do something that isn’t realistic. It reminds humans to keep the faith that the dog would rather find a way to behave that results in happiness and harmony. I would like to send anyone who makes public health policy through obedience school.
I think they would come out a lot more interested in Health at Every SizeSM.