Salovey study may help smokers quit

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Photo by Ken Yanagisawa.

Yale researchers — including University President Peter Salovey — may have just made quitting cigarettes a little bit easier.

While clinicians have long known to advise patients against smoking, the most effective way to do so has remained unclear. Researchers of the Yale School of Medicine discovered that most smokers quit after hearing the benefits of smoking cessation, instead of the risks of continuing.

This new knowledge could equip doctors with better tools for helping smokers quit, as well as inform anti-smoking public health campaigns, said Benjamin Toll, lead author and program director of the smoking cessation service at Smilow Cancer Hospital.

“The gain-framed message is better to promote smoking cessation,” Toll said.  “A gain-framed message is something like, ‘If you quit smoking, you’ll live longer; if you quit smoking, you’ll save money; if you quit smoking you’ll, smell better, breathe easier.’ They are statements that stress the benefits.”

The intellectual inspiration for the study came from prospect theory — a central pillar of behavioral economic theory that describes the way people make choices based on risk and probabilistic outcomes, said Lisa Fucito, professor of psychiatry at the Yale School of Medicine and study co-author. The theory states that individuals are risk averse when circumstances involve sure gains but risk seeking when circumstances involve sure losses.

The researchers conducted two studies in which they exposed treatment-seeking smokers to different smoking messages. In the first, treatment-seeking subjects took an anti-smoking drug along with video and print messages encouraging smoking cessation that emphasized either the benefits of quitting in the gain condition or the costs of continued smoking in the loss frame.

Those who received gain-framed messages had higher quit rates than those who received loss-framed messages, Fucito said.

In the second study, conducted through the New York State Smoker’s Quitline, the research team trained 28 counselors to provide callers with either gain-framed or loss-framed or counseling based on the previously used standard of care. Gain-framed counseling was associated with higher quit rates in this study as well, Toll said.

Fucito said there are many potential reasons why the loss-framed messages were less effective at encouraging quitting.

“Loss-framed messages, which emphasize the costs of continued smoking, can be threatening,” she said. “If smokers do not feel confident in their ability to deal with the threat … then social psychology research evidence suggests that they may avoid the message and therefore, not benefit from the information. In contrast, gain-framed messages are less threatening.”

Fucito warned the findings might not translate to all smokers. While the subjects in the two studies were heavy smokers dedicated to quitting, Fucito said other studies suggest that individuals who smoke less and may be less dedicated to quitting may not respond to gain-framed messages.

In addition to informing physician treatment of patients, the studies have public health implications, said Stephanie O’Malley, a professor of psychiatry at the Yale School of Medicine and co-author of the paper. While anti-smoking campaigns on billboards and television may be effective in discouraging young people from starting, the study suggests that such negatively framed messages may not be ideal for helping long-time smokers quit.

According to the Centers for Disease Control and Prevention, cigarette smoking is the cause of about 20 percent of deaths in the United States each year.

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