The Logic of How to Quit Smoking

The U.K., France, and Ireland recently became the latest countries to require cigarette manufacturers to use plain packaging. People interested in buying cigarettes will be confronted not with company logos but with health warnings printed in large fonts. Other packages will feature graphic images of diseased, tarry lungs and clogged arteries. And in some places, packages will even include what’s been dubbed the “world’s ugliest color,” the greenish-brown hue “Opaque Couché."

These are laudable steps in the fight against tobacco and tobacco-related diseases. And on an intuitive level, it is hard to imagine how they could hurt the cause. But how likely are they to help, or to be effective, in getting people to quit?

Smoking cigarettes, eating unhealthy foods, and buying things outside our budget are often impulsive choices—ones we make again and again, despite knowing in some broad sense that they are bad for us. And so to understand why strategies to combat them so often fail, we have to first consider how impulsivity influences our decision-making and interferes with learning.

We know, for example, that people tend to learn more quickly when a certain behavior and its consequences (reward or punishment) are close in time. When children misbehave and are immediately sent to “time-out,” they learn to associate the behavior with the outcome.

But when a behavior and its consequences unfold over months and years, as is the case with smoking or eating unhealthy foods, we have to adopt a longer-term mindset. For people who aren't addicted to nicotine, taking into account longer-term outcomes (including things like cancer) is fairly straightforward. And warnings on cigarette packages might indeed help prevent them from ever lighting up in the first place.

But the process becomes considerably more effortful when the impulsivity associated with nicotine addiction sets in. When we’re impulsive we, by definition, have trouble thinking outside the moment—and consequences that come down the line are precisely the types of things that are unlikely to modify our behavior.

Note that there are a few troubling implications here. First, so long as the consequences of impulsive choices are delayed, we're remarkably insensitive to their actual severity. That’s why reminding smokers that the habit kills—arguably the most severe outcome of all—is so psychologically flimsy. The magnitude of the cost doesn’t matter if we fail to take it into account in the first place.

Second, those consequences are even less effective at modifying behavior when they might not come at all. While smoking is a strong predictor of lung cancer, COPD, and a host of other ailments, none of these are guaranteed outcomes. And when we’re focused on immediate gratification, more reasoned appeals to probability aren’t likely to stick—the uncertainty gives us a psychological loophole that we can exploit in the moment. (For a similar argument in the context of crime see here).

When we put these things together, we can start to understand the 'logic' underlying impulsive choices—that impulsivity actually shifts the perceived payoffs of the undesirable behavior in question (smoking, in this case). In particular, it inflates the benefits and minimizes the costs, and people act accordingly.

To get people to quit, then, we have to find a way to intervene and change the payoff structures underlying the decision. Here, graphic packaging might have an effect on buying behavior among smokers—but mostly in the sense that it triggers an unpleasant, visceral reaction (i.e., simply viewing it imposes a small “cost”), and not because it prompts some sort of broader soul-searching about long-term health consequences. More effective strategies intervene and impose direct, external costs that make the immediate and certain payoffs of smoking less than the payoffs of not smoking.

Practically speaking, what might those strategies look like? At the level of individual behavior, we might impose "artificial" consequences, and ask those around us to enforce them. For example, you might decide that if you smoke, your spouse is allowed to take the night off from doing the dishes—that same night and every time (the public policy expert Mark Kleiman calls this "swift and certain" punishment). The prospect of long-term health problems might not recalibrate the perceived payoffs in our minds. But the certainty of having to do the dishes in 10 minutes might very well cause us to rethink our choices in the present.

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At the governmental level, it is relatively easy to implement the logic of "swift and certain" punishment in the context of something like smoking, as a financial transaction is built into the decision. And in fact, the country already uses things like taxes in an attempt to shift the payoffs of consumers' decisions. Every time someone chooses to light up, they pay an immediate premium, beyond the intrinsic costs associated with the habit.

And tax hikes have worked in terms of getting people to quit, especially those most vulnerable (youth and the poor, including poor minorities). But smoking persists in some portion of the population because, for these individuals, we have yet to sufficiently recalibrate the perceived payoffs of the decision. Further raising taxes will accomplish this—and note that when consequences are already immediate and certain, people high in impulsivity will respond to severity.

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(C) Sarah Cotterill. All rights reserved.