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Saturday, November 9, 2019


Here is an idle thought I had this morning while walking in sub-freezing temperature.  In my adult lifetime there have been two full scale public education campaigns aimed at getting everyone to alter his or her settled habits, and both, surprisingly, have been quite successful.

The first was the campaign to get people to use their seatbelts, and the second was the effort to get people to stop smoking.  In both cases, it is instructive to compare old movies, especially black and white movies, with modern movies.  In the old movies, everyone smokes, seemingly all the time, even in intimate love scenes.  It really turns me off.  In modern movies, almost nobody smokes.  In old movies, gangsters drive away from a bank heist and cops jump in their cop cars and give chase, and no one buckles up.  In modern movies, even when the lead’s life is at stake, she carefully puts on her seatbelt before speeding away.

In both cases, there has been backsliding, with young people both vaping and texting while driving.  But I would never have thought that a conscious, deliberate public health campaign would have any effect at all.


Charles Pigden said...

A transitional phase is when some people smoke but the smoking is designed to make a point about the character, I would cite in this connection Universal Soldier 1992. The female lead (excellently played by Ali Walker) is a hard-bitten hard-driving a rather ruthless young journalist with her career on the line and the selfish desire to bag the big story. ( There’s a moral growth story arc she becomes a better person as the movie goes along.) She’s just the kind of person who lives on her nerves and can consequently be expected (as of 1992) to smoke too much and to drink too much.
In later movies and TV dramas featuring similarly ruthless and ambitious women who live on their nerves, they drink but they don’t smoke and they often start the day with a run. I’m thinking in particular all Grey’s Anatomy during its glory days in which it was dominated by the hyper ambitious and hyper talented Christina Yang played by Sandra Oh or the Good Wife featuring the rather older and kinder , but still very driven and ambitious Alicia Florrick, (played by Julianna Margulies). After a hard day’s courtroom drama spiced with boardroom or electoral politics, Alicia repairs to a bar to knock back the tequilas or relaxes at home in the company of her teenage children with some very large slugs of red wine. They are both portrayed as heavy drinkers but a cigarette never touches their lips

aall said...

Smoking was likely a result of taxation that made it expensive and the clear association of smoking with property damage and second hand effects which led to serious restrictions on where one could smoke. The Surgeon General's report in the 1960s justified restrictions. Never smoked myself but cigarettes used to be cheap - adjusted for inflation, a little over a dollar a pack in the 1940s to $5 - $10 today depending on ones state.

Autos didn't have seat belts in film noir days. They weren't mandated Federally until the late 1960s and state laws date later. Making seat belts mandatory and going from lap belts to cross-chest belts made compliance easily visible to law enforcement. Some states like CA seriously enforce seat belt and child seat laws.

You might also have mentioned helmet laws for motorcycles. Laws that have a clearly rational basis and are enforced change behavior.

Dean said...

Apropos of the reference above to helmet laws for motorcycles, see this story in the NYT about proposals for a national rule requiring helmets for cyclists:

The story offers a glimpse of a public health education campaign at its inception. Its gist is summed up near the end in this sentence: "One key question, Dr. Walker said, is how far societies are willing to go to use legislation to protect people from themselves." I do not want to enter the cyclists vs. automobile drivers "debate" that tends in my experience to go nowhere. However, that phrase "protect people from themselves" frames the question in terms of individual freedoms -- I get to choose whether to wear or not to wear, whether to cycle or not to cycle -- when the purpose of a requirement, whatever side effects it promotes, is obviously to reduce injury and fatalities.

aall said...

Dean, the problem with framing laws and "sin" taxes as "protect[ing] people from themselves" and focusing on individual freedoms is that once diagnosed with cancer or presenting at ER with head injuries from a windshield or pavement, neither they nor we follow through with the logic of that meme and deny them care beyond their ability to pay. "Assumption of risk" seems to end as soon as the risk becomes reality. Folks using that frame never want to deal with the public costs - fatalities with individual actors aren't the problem so much as the injuries and collateral damage to themselves and others.

Dean said...

I agree, aall, but as I prepare to take my 8YO daughter to a kids' play gymnasium this afternoon I consider that there are situations in which assumption of risk is in fact the end of the line. Before our visit, I will have signed a waiver in which I explicitly assume the risk of injury to my child. But of course my signing the waiver is an exercise of individual freedom, not a response to a legislative constraint. How, then, will we afford cyclists and drivers the "freedom" to contract among each other as to where the burden of injury will fall, helmet or not? We won't, and so we legislate.

Christopher J. Mulvaney, Ph.D. said...

If bikers want to ride with no helmet, then I am fine with it on one condition - they have a multi million dollar policy to cover their nursing home care after their traumatic brain injury has reduced them to a vegetative state. I don't want to protect them from themselves, just society from hving to pick up the costs of their actions. For several years I chaired a Traumatic Brain Injury Committee and have more than a lifetime full of horrible, tragic stories, and decisions regarding who among the injured could be helped, and who couldn't. BTW, the same goes for cyclists.

Unknown said...

Imagine when people in the future look back at our media now. Besides all the political tuff which will surely amuse.
I wonder if seeing people promote certain everyday products and consume meat without thought will give a nice little shock and laugh?


s. wallerstein said...

Why is texting "backsliding" from using a seat belt?

Dean said...

Texting while driving relaxes the routine rigors of caution. Some jurisdictions -- mine, California, for instance -- make it illegal to use a so-called smartphone hands-on while driving. People do it all the time here, and not just kids.

s. wallerstein said...


People text while driving here too, but that has nothing to do with whether they wear seatbelts or not. You can text while wearing a seat belt. A seat belt is a device which protects you in the case of a collision and texting can lead to collisions, but it is not
backsliding from wearing a seatbelt in the way that vaping is from the decision to stop smoking. Texting while driving and not wearing a seatbelt are simply two out of many non-prudent behaviors that drivers can and do exhibit.

Dean said...

Agreed, but that's why I framed my comment in more general terms of behavior than the specified one. The behavior, texting -- one out of many non-prudent behaviors -- backslides from a long accepted exercise of caution while driving. Texting is one among many ways drivers "fall away from attained excellence" (OED). (Not that I believe most drivers have attained excellence.)

LFC said...

I'm surprised no one has mentioned, as a factor in the decline of smoking in the U.S. at any rate, the federal legislation banning advertising of cigarettes on TV and radio. I think (cd be wrong) such advertising is still legal in print media but one never sees it these days (or at least, I don't, maybe I'm not paying attention...).

These days the only places I see people smoking are (1) occasionally outside (e.g., in a parking lot, sidewalk, concrete walkway outside a strip mall etc, or (2) in their cars w the windows rolled down. Cigarettes are still sold (go into any convenience store, e.g. 7-11) and some people are still buying them, but the tobacco industry I think is now making most of its profits in what used to be called the Third World.

I'm glad about the decline in smoking in the U.S. and many other places for a bunch of reasons incl. personal ones (family history) which I won't go into rt now.

Jim said...

The thing about smoking cigarettes is that very few (if anyone) these days denies the causal link between cigarette consumption and cancer. That was not the case as recently as the 1970s. Vaping was seen as a cancer free substitute -- that is until other consequences started to pile up. Once the causal links of vaping are accepted, that practice will fall by the wayside as well. (A correction to aall: In 1981, a standard commercial pack of 20 cigarettes cost 55 cents. Over the course of the 80s and 90s, the price per pack would steadily climb. A common refrain from smokers at the time was, "When the price hits $1, I will quit!" As fate would have it, most smokers kept on paying the higher prices. Someone I knew once used hypnosis to quit [she was a two-pack a day smoker]. It worked for 6 months until she relapsed.)

How about public campaigns that failed to gain traction? Does anyone remember the "Give a hoot, don't pollute" ads from the late 60s and early 70s? Nothing of the sort exists now, and living in an urban metropolis, I see people pollute with abandon on a daily basis. This includes undergraduates who simply toss their refuse on the sidewalk.

Another failed campaign: switching the US to the Metric system. As Jimmy Carter currently struggles for his life, his dream of bringing the US up to speed with the scientific community and the rest of the world by adopting the Metric system continues to be an unrealized -- if not abandoned -- goal.

The next public campaign for behavior change will have to focus on changing habits about energy consumption. Not too optimistic on how that will go.

-- Jim

-- Jim

Anonymous said...

Well they're single point easy campaigns that don't offend anyone.

Smoking is bad for your health in that it gives cancer and emphysema etc...

There's also a simple solution. Don't buy cigarettes. Don't start.

For seat belts I don't think it's comparable. It's illegal not to wear one for one, and I don't know, I may be misinformed here, but they were introduced and went through what might be considered a normal adoption phase before reaching an equilibrium.

I don't think it's fair to characterize vaping and texting while driving as backsliding either. Vaping doesn't cause cancer (at least what is known currently), and seems to cause addiction and increased heart rate, from the nicotine, but relatively benign. Texting just falls under the general category of safety while driving but then that's like saying that there was a successful cardio encouragement campaign that we've seen backsliding in because people are weight training less.

Something deeper?

1. Simple action to take to avoid negative outcome, i.e. don't buy cigarettes (to children, no addiction), quit smoking, wear a seatbelt

2. Negative outcome that is weighty, clearly outweighs the pleasure, in this case it's death weighed against smoking or the freedom of not having to wear a seatbelt.

So to guide public health we'd need honest programs that evaluate the potential harm, that is of grave nature, and to present that to people, which then they would have a simple action, or a small set of simple actions, to implement behavior.

I wonder what teeth brushing statistics look like, when programs were implemented, etc. There you have a lesser outcome that also isn't sudden and irreversible.

Or maybe it's that those two programs hit upon basic urges, as said, like death. Programs should tell people that they're going to die, or that they're not going to have sex if they don't do X,Y,Z.

If you eat too many carbs, you'll become fat, unattractive, and not have sex.

I wonder if it's Freuden to tell children that they need to please their mothers, and it's effective because they associate pleasing the mother with sex? e.g. Timmy, if you eat to many carbs, you'll become fat, and your mother will prefer such and such.

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