Duke Researchers to Study the Most Effective Ways To Prod Smokers To Kick The Habit

As tobacco companies settle lawsuits filed by states seeking to recover money spent treating smoking-related illnesses, the agreements, most likely, will call for the establishment of effective smoking-cessation programs. The challenge, then, will be to create the most effective programs.

In that light, researchers at Duke University Center for Health, Policy, Law and Management have initiated a study that will examine smoking risk perceptions and behavior change in long-term smokers ages 51 to 64 years. In particular, the study, funded by a $350,000 grant from The Robert Wood Johnson Foundation’s Substance Abuse Policy Research Program, will try to determine what combination of informational messages and price hikes will prompt smokers to quit.

"There are multiple reasons for investigating this. One, of course, is not everyone responds to the same sort of incentives," said Kerry Smith,PhD, a professor of environmental economics at Duke, who is the lead researcher on the project.

Gauging Incentives

Teenage smokers, for instance, would be more likely to give up cigarettes if tax hikes raise the price significantly. Older smokers, on the other hand, may be more responsive to specific messages that clearly spell out the health risks associated with smoking, especially if they or a family member developed a smoking-related illness.

"The evidence that’s available to this point suggests that older individuals will not only be less responsive to price, but may actually substitute low-tar cigarettes with higher-tar, more harmful cigarettes if the price goes up," Dr. Smith said. "They may respond by smoking somewhat less, but smoking more harmful cigarettes. The net health effect, then, will not necessarily decline."

How Perceptions Translate Into Actions

In the study, researchers will examine data from the University of Michigan’s Health and Retirement Study, a federally funded national questionnaire that compares the perceptions of risk every 2 years among the same group of current and former smokers and nonsmokers. Duke researchers, along with economists from Triangle Economic Research of Durham, North Carolina, are also devising their own study to delve further into these issues in an attempt to gain a better understanding of how a perception of risk is actually translated into action.

"How perceptions actually influence smoking behavior is crucial to judging whether information-based efforts are likely to prove successful," the researchers said in their project narrative. "We want to transform our understanding of how people make smoking decisions."

Frank Sloan, PhD, director of the Center for Health Policy, Law and Management at Duke, said the current messages that the American public receives about cigarettes are too general, eg, "that the surgeon general has determined that smoking is hazardous to your health." "Those messages don’t suggest anything about the sequence of health effects that accompany heart disease or lung disease or the other serious respiratory-related ailments that limit one’s activities and are associated with smoking," Dr. Sloan said. "They don’t mention how smoking can impede your activity for long periods of time and cause considerable pain and suffering."

Better Response With Strong, Specific Messages

"It’s the more specific messages that have proven in other research to be far more effective in getting people to understand the full consequences of their actions and change the way in which they use information about risk."

Dr. Smith explained that while adults may understand that smoking is a hazardous activity, they may not "internalize that fact. They may believe that they’ll be the better-than-average person" who does not develop smoking-related health problems. In that case, he said, it may be that smokers are processing information differently from nonsmokers.