Using behavioural science to reduce UK smoking rates

This essay aims to lay down a plan to help reduce UK smoking rates by applying behavioural science, guided by the Behavioural Insights Team’s EAST framework.

The first step in achieving this goal will involve convincing the 60% of smokers who already want to quit (Public Health England, 2018), to start now. This will be done by emphasising the visible and present negative effects of smoking, as well as using regionalised social proof messages to position quitting as popular. The call to action for this campaign will ask smokers to make a public pledge to a friend or relative to go smoke-free for a month, with the ultimate goal of convincing them to quit for good when they reach the end of the programme.

Secondly, it is also key to come up with a strategy that ensures that the smokers who have decided to take part in the programme make it through the entire month without relapsing. This will be achieved by supporting smokers with a quitting app designed to provide them with ongoing positive reinforcement and reward mechanisms throughout their quitting journey, as well as powerful commitment devices designed to combat cravings.

Before attempting to tackle this widespread social problem, it is important to first consider the reasons why smokers are finding it so hard to quit. A common tactic currently being used by governments across the world to dissuade people from smoking is the use of shock imagery on tobacco packaging. These images often attempt to elicit a visceral reaction on smokers by displaying worst-case scenario health effects caused by smoking, hoping this will be enough to convince them to stop. Unfortunately, this tactic often misses the mark, as the problem is that as human beings, we tend to suffer from overconfidence bias (Shotton, 2019). When seeing these dramatised health warnings on tobacco products smokers think these won’t apply to them, even when they are aware of the statistics that go against them.

Another well-established human bias that makes it incredibly difficult for smokers to successfully quit is the present bias. This bias refers to our human tendency to be “disproportionately more motivated by costs and benefits that take effect immediately than those delivered later” (Behavioural Insights Team, 2014 p.40). When smokers choose to quit, they feel the cost of their decision almost immediately in the form of nicotine withdrawal and cravings, whereas the benefits of quitting aren’t felt nearly as quickly. This often results in smokers relapsing shortly after their quitting attempt begins, as they go back to the immediate gratification that the cigarette brings them over the health benefits that feel too distant in the future to encourage them to action.

Encouraging smokers to make a pledge

The EAST framework proposed by the UK’s Behavioural Insights Team operates on the premise that to successfully encourage a behaviour, you must first make it Easy, Attractive, Social and Timely.

According to Public Health England (2018), 60% of smokers already want to quit, so the first behaviour we need to encourage is to get them to quit today. To achieve this, we will first focus on making the desired behaviour social by drawing on the social proof bias, which outlines that as humans, “we are strongly influenced by what others do, especially the closest we can relate to those people” (Shotton, 2019). The practical application of this will be to frame current smoking facts and statistics in a way that positions smoking as unpopular, such as the fact that 81% adults in the UK don’t smoke (Cancer Research UK, 2019), or that the adult smoking rate in England is fast declining and is now at a record low (Public Health England, 2018). The more this data can be localised, the better, as bringing it home to smokers will make it much more effective.

Moreover, something else we can do to increase the likelihood of meeting our goal is to make the desired behaviour timely by highlighting the immediate costs of smoking as well as the immediate benefits of quitting. As mentioned previously, smokers often feel detached from the fatal, longer-term negative health effects of smoking, so we must focus our efforts on emphasising the most common, visible costs of smoking instead: bad odour, bad breath, stained teeth, and dry, discoloured skin. Contrastingly, instant rewards from quitting to highlight would include improved body odour and your sense of taste returning, for example.

Another powerful bias affecting humans is loss aversion, which refers to our tendency to prefer avoiding losses twice as much as acquiring equivalent gains (Kahneman, 2011). Knowing this, it will be more effective to communicate the high monetary cost of smoking as a loss (i.e. “your habit is making you lose £100 each month”), rather than frame it as a gain (i.e. “if you quit you’ll save £100 a month”).

Once we’ve drawn smokers’ attention with the tactics outlined above, we’ll encourage them to make a public online pledge to a friend or relative to go smoke-free for a month. This social commitment device will increase the likelihood of smokers keeping their promise, and will act as a foot in the door technique by getting them to complete a small easy task first (making a simple pledge), before moving on to the bigger task (quitting for a month). Moreover, once they successfully achieve a whole month smoke-free, it will be much easier to encourage them to quit for good.

Timing our campaign

It is important we also consider how to time this campaign to make it more effective. New habits are often formed at times of high disruption (Shotton, 2019), making life events optimal occasions to target smokers with this type of messaging. One of the most frequent life events experienced by adults in the UK is changing jobs, with the highest rate of job quitting happening during the month of January (Crunch, 2017). Moreover, following the Christmas holidays, more than one in four Britons are set to struggle financially due to overspending during December (The Money Advice Service, 2016), increasing the impact of the loss aversion message outlined earlier.

On top of that, something that can disproportionately discourage a behaviour is adding friction (Behavioural Insights Team, 2014). Timing our campaign during January will do this as smokers are forced to endure the cold weather when going outside to smoke, making the discouraged behaviour less attractive. Last but not least, January is also a time awash with new year’s resolutions, which can easily resonate with our pledge call to action.

Helping smokers keep their promise

Once our smokers embark on their quitting journey, we need to ensure we eliminate any cause for relapse. As identified previously, one of the reasons people often fail to quit successfully is that the benefits from quitting feel too tenuous and distant. To overcome this barrier, we would ask all smokers to download a specially designed quitting app following their online pledge submission, which will track their journey and will provide them with ongoing positive reinforcement in the form of numerous health progress bars, milestones, and a live counter of money they’ve prevented from losing thus far. It will be important to include a variety of short and long term achievements they can start earning from day one, that way keeping them engaged and encouraging them to continue with this process. Examples of what these could be include: eliminating tobacco odour; % of nicotine expelled from body; pulse rate back to normal; risk of heart disease reduced; etc.

Friends and family will be able to track their journey online, increasing the social elements of the programme, and the smokers will be able to compare their progress to that of their friends and other members in their local area – fostering competition.

However, the main feature of the quitting app will be the craving button. Smokers will be instructed to press and hold the craving button for 10 seconds every time they feel like they need a cigarette but manage to resist the urge. This will automatically send a notification to the friend or relative they made the pledge to, rekindling the commitment device put in place at the beginning and providing them with a renewed sense of achievement to keep them from relapsing. Moreover, the number of cravings resisted will prominently appear on their personal profile for everyone to see, further displaying their achievements.

Once the participants complete an entire month without smoking, the worst of the withdrawal symptoms will have passed (Smokefree, 2019), making it easier to convince them to quit for good. Moreover, the sense of achievement acquired during their journey will make them more likely to want to keep going, so as not to waste all the progress they’ve already made. Finally, the total money counter will help them visualise just how much money they would lose monthly if they were to go back to smoking, further reinforcing the tangible negatives of smoking by channelling the loss aversion bias to keep them from relapsing.

Paula Torres Moneu is a Junior Creative Planner at Epoch Design and is currently on the IPA's MIPA Pathway, which is a toolkit for individuals who are working towards becoming MIPA accredited.

This essay earned her a Distinction for April's Applied Behavioural Economics course, which will run in London, Manchester and Newcastle in October and November 2019, championing a different social cause in each city.