SECOND OPINION:Using scare tactics to change lifestyle behaviour is beginning to creep back into public health practice.
Since February 1st, 2013 cigarette packs have included graphic photographs of diseased lungs, throat tumours, and children struggling to breathe. I visited some shops in my neighbourhood last week to see if these images were having any effect on sales.
Without exception, shopkeepers reported that the same people were buying cigarettes in the same quantities and the new images were not putting them off.
The images are not all equally horrible so some shoppers ask for a pack with a less graphic photograph, and most do not want the ones with the throat tumour.
However, the new images do not stop smokers buying cigarettes.
I am amazed that a Government which has introduced effective smoking regulations is now reverting to scare tactics.
These were widely used in the 1970s and 1980s and were as ineffective then as they are now. Many media commentators have recently suggested that the HSE and Department of Health should start using frightening messages about food and alcohol as a way of tackling Ireland’s seemingly intractable obesity and drink problems.
Scare tactics do not work, they never have worked, and never will work.
Road safety adverts
The awful scenes shown in road safety ads are often credited with the decrease in fatal traffic accidents. Not so, what has worked is legal and structural change: law enforcement, penalty points and better roads.
Using scare tactics as a way of changing health behaviour is actually against the Government’s own guidelines.
Two new reports: Action Plan on Bullying – Report of the Anti-Bullying Working Group to the Minister for Education and Skills; and Well-being in Post-primary Schools – Guidelines for Mental Health Promotion and Suicide Prevention,specifically rule out the use of scare tactics in schools as a way of influencing the health behaviour of children and teenagers.
“Information that induces fear and exaggerates negative consequences is inappropriate and counterproductive.” Adults are no different to young people in their response to scare tactics.
The two reports list other commonly used ineffective health behaviour change techniques, one of which is the use of testimonials.
While people’s life stories can produce riveting reading and great radio and TV entertainment, they do not influence anyone else’s health behaviour. This is particularly true when the lifestyle story includes dangerous practices such as drug addiction, alcoholism and weight problems.
Personal testimonials actually encourage poor health behaviour by making heroes and heroines out of those who give testimony.
Recovering alcoholics, drug addicts, and those who are now a healthy weight can be very charismatic. They have been through a tough time and come out the other end as better people.
Readers of, and listeners to, their stories internalise the message “I can do that and survive [like they did].”
Wrong impression
Once-off interventions are also ineffective. Talks in schools and to community groups by guest speakers on sex, drugs, alcohol, road safety, and so on, not only do not work, they give the mistaken impression that the topic is now covered.
Unfortunately, one-off health talks are alive and well in Irish schools despite Department of Education guidelines.
There is convincing evidence that the most effective strategies for changing population health behaviours are regulations and fiscal policies.
Alcohol prices and taxes are inversely related to drinking: the higher the price, the less people drink. The effects are large compared with other prevention policies and programmes.
New research published in the journal Addiction shows that a 10 per cent increase in the price of alcohol is associated with immediate and delayed decreases in alcohol-related mortality.
A 10 per cent increase in the number of off-licences doubles alcohol-related mortality rates. Ireland already has many effective tobacco regulations and needs more.
Studies conducted over the past 20 years show that packaging strongly influences young people’s decisions to start smoking. Instead of graphic images,tobacco should be sold throughout the EU in plain brown paper packaging with no logos, colours or trademarks.
Regulation and fiscal policies are resisted by the tobacco, food and drinks industries because they work. Putting graphic images on cigarette packs is a retrograde step.
They won’t stop anyone smoking and may lead to an increase in the use of scare tactics to change other health behaviours, such as overeating and alcohol abuse.
If this happens, the food and drinks industries will be rubbing their hands with glee. They read the research too and know what works.
Dr Jacky Jones is a former HSE regional manager of health promotion