“Stop Smoking” stopped working

The link between lung cancer and smoking was confirmed in the 1940s.  The surgeon general’s warning was put onto cigarette packs in 1966.  And the deluge of stop-smoking messages has only grown ever since.  So, why do three times as stop_smokingmany adults with less than a high school education (30%) still smoke compared to as adults with a college education (10%)? The Stop Smoking campaigns don’t speak their language. 

It’s not Spanish or French – it’s poverty.  People living in poverty generally have an oral-culture background, which emphasizes getting information from trusted friends and relatives, not from television, radio, or newspaper ads. (Terrific book on the culture of poverty, read See Poverty . . . Be the Difference by Dr. Donna M. Beegle.)      Stop Smoking ads have an impact on people who are accustomed to getting information from reading or other external sources; call them print-culture folks.  For people in an oral culture, media messages do not sway them nearly as much.

The ultimate reason to stop smoking is to avoid illnesses, lung cancer being the worst.  People are motivated to quit, if they foresee their future.   The oral culture emphasizes the present moment, not the future.  So the prospect of developing emphysema or lung cancer at some foggy future date is not compelling evidence to quit smoking.  The challenges of living in poverty reinforce this present-moment focus, since surviving the daily challenges consumes so much energy.

The ads highlight the logical consequences of smoking – step one leads to step two, etc.  “Stop smoking today because you might have serious illness later” is the main message.  This type of linear thinking is foreign to an oral-culture person, for whom relationships and emotions are much more important.

Finally, many stop smoking programs require a complex set of steps:  make and keep a medical appointment, talk to the doctor, and go to a pharmacy to pick up medications.  None of these steps seems challenging to a middle-class person, but they may be insurmountable to someone who has unpredictable work hours and a clapped-out car.  Further, a low-income person will struggle to effectively communicate with a medical professional, who very likely uses print-culture norms and techniques.  You can see why ads calling for people to stop smoking by talking to their doctor fall on deaf ears.

I’m tired of all the noise about health disparities among economic groups, followed by renewed efforts at print-culture-driven tactics.  The people whose health is the most affected by smoking are almost completely ignored by these efforts.  Public health programs need to “speak” the audience’s language, which is very different from the program designers’ mother tongue.  I can imagine a program that trains pastors and community leaders to host quit-smoking support groups.  This would capitalize on the oral-culture traditions of learning from other people, and valuing relationships.  Surely there are plenty of other approaches that would be more effective than the current singing to an empty auditorium.  Let’s find more things that work!

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