Kids Resisting Tobacco with Persuasion

Smoking Kid in PoolThe single worst health habit you can develop is smoking cigarettes.  Game, set, and match, a life long tobacco addiction is the shortest, quickest, and meanest path to early illness and death.  Only youth, ignorance, or dissonance will dispute it:  Tobacco is a falling apple.

Now, since tobacco is addictive and addictive habits are terribly hard to change, the smart persuasion play here is to Do Something before the Other Guy ever lights up for the first time.  If the Other Guy doesn’t Try, She Won’t Die.  But, typically the Other Guy does Try and usually when she’s a kid and we know what that means.  She’s invincible and ever so much smarter than you are.  What’s wrong with a smoke?

So, if you have a young someone whom you love, how can you talk with them that leaves them tobacco-free?  May I suggest this persuasion play?

Implementation Intentions.

It requires no PowerPoint presentations.  No white lab coats.  No statistics.  No finger wagging.  No woeful tales of wicked choices.  Just talk about plans.

We’ve seen implementation intentions on this blog before.  This Primer page provides background (scroll to near the end).  These posts, on New Year’s Resolutions and physical activity, show current applications of II.  The premise is simple.  To change a behavior you need to plan for it – you implement your intention to change by creating detailed specific steps, actions, procedures, and on and on.  Think about it.  Write it down.  But plan the change to make the change.

Note that II does not require anything from you the persuasion source other than asking a question like, “If you were going to lose 10 pounds, what plans would you make?”  Then shut up and listen and let the Other Guy persuade herself.

That’s exactly what Mark Conner and Andrea Higgins did with their II experiment on smoking resistance.  They focused on kids between 10 and 11 years old.  The kids were randomly assigned to one of four interventions:  II, Self-Efficacy, II Control, or Self-Efficacy Control.  After the treatment, the kids were followed for four years and interviewed at the end for two measures:  self reported smoking and a biological test (saliva samples tested for presence of tobacco elements).

Think about this study and how well done it is.  Conner and Higgins identify a large population of kids.  They devise four treatments.  Consider all the Comparison they’ve got with these four interventions.  Two of them are actively aimed at tobacco resistance, II and Self-Efficacy, so this study tests the difference between two interventions that should work.  We’ll be able to see if one is better than another.  Realize also, those two Control groups provide another Comparison.  Each control group uses II or Self-Efficacy, but on a topic other than tobacco resistance.  These controls help us see whether just doing Something with a kid makes a difference.

This design is so simple, just four groups, but incredibly powerful for understanding whether something works and why it works.  Note, too, that Conner and Higgins randomly assign kids to just one condition and then track them for FOUR YEARS.  If you can find a better built experiment, buy it!

Here’s the exact statement of how they did II.

The implementation intention intervention (Higgins, 2002) involved the task of forming an implementation intention: planning how, where, and when to resist smoking. The intervention was designed to give adolescents simple responses for how to refuse a cigarette. It was also designed to link this simple response to likely situations where a cigarette might be offered. Five options were provided for how they could refuse the offer of a cigarette or resist the temptation to smoke (‘No thanks, I don’t want to smoke; No thanks, I don’t want the habit; No cancer sticks for me; No thanks, smoking makes you smell bad; No, it’s bad for your health’). Participants were required to check the options they planned to use or to write in an additional response. Similarly participants were required to check where they would not smoke (‘I will not smoke at school; I will not smoke at home; I will not smoke at a party; I will not smoke with my friends; I will not smoke if offered a cigarette’) and when they would not smoke (‘I think I can make sure I don’t smoke this term’) and to sign their plan.

Now, here’s the Self-Efficacy intervention.

The self-efficacy intervention (Higgins, 2002) involved the task of planning what to say to refuse to smoke in increasingly difficult situations. Participants first read the statement, ‘You can refuse to smoke this term!’ They were then presented with six statements each containing spaces for the participant to write in what they could easily say in that situation (‘I can say _______ to smoking, even at school’; ‘I can say _______ to smoking, even if I’m offered a cigarette’; ‘I can say _______ to smoking, even if my friends want me to smoke’; ‘I can say _______ to smoking, even if I’m the only one in the group not smoking’; ‘I can say _______ to smoking, even if I feel left out of the group’; ‘I can say _______ to smoking, even if I feel like smoking’). After completing these statements participants were asked to sign it if they thought they could say no to smoking that term.

The Control groups replicated these procedures, but on Doing Schoolwork rather than Resisting Tobacco.  Then after four years all kids self report on tobacco use and provide a saliva sample for biological testing.

What happens?  Consider this Table that shows the percentage of kids who said they had smoked or tested positive for smoking.

II Group

SE Group

II Control

SE Control

Self Report%

26.3

34.0

30.5

34.5

Test %

4.2

14.8

12.9

13.7

See in the first row that 26.3% of II kids ever smoked compared to the higher rates for everyone else.  The effect size difference between II and all the others is a d of .24, a small effect expressed in Windowpane terms as a 45/55 difference.

See, now, in the second row that 4.2% rate for II kids who tested positive versus the higher rates for everyone else.  This effect size is a d of 1.04, a very large effect size expressed as a Windowpane of 27/73.

[Steve, why are the self report percentages so much larger than the biological test percentages?  Aren't they measuring the same thing?  No.  The self report includes amount of any past tobacco use in the last four years while the biological test only measures very recent tobacco use in the last month.  The two measures are highly correlated, but measure tobacco use in slightly different ways.  Still note that II reduces both ways of measuring.]

This is a great research study that provides compelling knowledge and action.  Think about it.

Tobacco is the single biggest health harm habit.  Anything you can do to avoid it, reduce it, or stop it delivers huge health benefits to both the individual and the population.  Here’s a proven persuasion play to accomplish this.

II is an easy and effective tactic.  Consider how that one planning session with a 10 or 11 year kid translated into a four year effect.  You won’t find anything in the research literature that beats this outcome for any other kind of intervention, especially when you realize how easy and cheap this is.  Any one can do II.

Hey, persuading kids at this age is not easy, especially on something like tobacco.  Kids will see a lot of positive persuasion to try tobacco.  Lots of Cues, gimmicks, spangles, whistles, and shimmies.  II works on this tough problem with a tough target.

Consider the quality of this information.  It’s a field study of kids in their school, so it is natural.  The kids know they are talking with researchers, but it is in school and their parents and teachers know about it and approve.  Remember all the Comparison groups we’ve got.  II is not tested against Doing Nothing, but against Doing Something like a competing theory with Self-Efficacy.  They randomized.  They controlled.  They compared.  They counted.  All of this knowledge fits well within a huge body of literature on II plus and even huger body of literature on persuasion.  This is persuasion science, baby, none of that Observation Tooth Fairy “science” you get in epidemiology, evolution, economics, or environmental studies.

P.S.  If you want to read more about it, here’s the citation.

Conner, M., & Higgins, A. R. (2010). Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: A cluster randomized controlled trial. Health Psychology, 29(5), 529-538. doi:10.1037/a0020317

P.P.S.  I’ve cited Mark Conner’s work with II before.  He does great scientific work that has obvious practical benefit.  You might profit from reading more of his publications.

P.P.P.S.  I’m reading Oscar Wilde now and just saw in his “Picture of Dorian Gray” the great problem with cigarettes.  He writes, “. . .  a cigarette is the perfect type of a perfect pleasure. It is exquisite, and it leaves one unsatisfied. What more can one want?”  How about a filterless Lucky Strike?  Jeepers, Mr. Wilde.  I quit smoking twenty-eight years ago this month (who’s counting) and still remember the last one.  Snapping a Zippo lighter.  Looking at a girl through smoke rings.  The taste after a medium rare T-bone steak.  Driving with your window down at night and the glow.  Oh, Oscar.  It is exquisite and it does leave one unsatisfied.

There’s a Difference between Persuasion, and Smoke and Mirrors; With Persuasion the Illusion Lingers.