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CIGARETTE SMOKIIIC, I-]~AI,THu AND DISSONANCE (PROJECT ~ IBRA) I. INTRODUCTI0}; A~D lff~T}IOD 23.4.1979 AUTHOR: M. Oldman ISSUED BY: D.J. Wood PKOG. RE~. 13.02.05 DISTRIBUTION: Dr. S,J. Green Dr. I.W. ~igh~s Dr. R.A. San~ord R.M. Gibb, Esq. RoB. Wade~ Esq. R.G. Nichull~, E~q. Herz E. Rintezshaus Dr, F. Seehofer Mr. A.J. Kr~szynski Dr. C.J.P, de Siquelra Dr. D.G. Feltcn Library Copy No. I, 2, 3 4 5, 6 7 B, 9, lO ii, 12 13 14 15 16 17 IE, 19 coPY NO. ~

Group ~esearch & Develupment Centre, British-American Tobacco CO. Ltd., SOUTHAMPTON. 23rdApril 1979. CIC/~ETTE ~MDKINC~ ~EALTH, AND DISSONANCE (p~OJECT LIBRA) I. INTRODUCTION AbID ~TIIOD (Report No. 11D.1670 Ke~r{eted) 8U~A~Y Project LIBRA is a comprehensive quantitative survey undertaken amcn~ cuTre~t Ci~ar~tt~ smokers~ ~x-smok~ ~d nev~r-s~ok~s i~ the United Kingdom. The principal oDj~tives ~f the ~search are to ~rpl~rc (1) the ~ays i~ which Smo~ers~ ex-smokers a~d ~ever-smokers can be distinguished in terms of their attitudes to health i~ g~eral, am~ smoking and health in ~articul~ ang (il) th~ indica~ o~ p~y~hological dlffer~nce which b~t predict the modeCs) of conflict resolution an i~dividual will employ i~ rela~icn to smoking and concer~ for heal~h. Th~s report dc~crlh~s thc ~a~gro~nd to the ~tudy, th~ select~o~ oE items £oc inelu~in~ in the qttastionn~ire, and datail~ o~ the ~ampling an~ administration procedure~ adopted. The results of the da~a anal~ses will be ~re~en~ed ~ future rep~rt~. ~I

-2- INTRODUCTION It is no~ nearly thirty years since Wy~der and Graham reported that ~0hacco smoking "seem~ to be an i~ortan~ £~c~or i~ the i~du~d0~ Of br~nchloge~ c~re~nom~" (i). $d~ce then a~-~mok~n~ ~amp~gn~ h~ve U*K. and U.S.A., and other countries, health warnings Save appeared on ~igar~t~e packets, ~moki~g ~ ~er~adn public place~ has been r~8~ric~ed a~ advertising on televi~io~ ~ ~e~n b~n~d in ~o~ =~untr~e~ ~nd prohibited al~og~t~r in o~her~. A~ a ~o~quen~e, th~ ~ci~ c~ate regardi~ ~okin~ h~ chau~ed ~nd it is ~nlikely tn~t anyone in toe U.k,s ~ l~a~ i8 u~aw~ of ~o~ ~ly Lh~y ~h~uld n~ ~laok~. ~en~s most ~m0~er~ ~i~h ~o quit ~moking. Re~ult~ from the ~eee~ Operation Aquarius (2~ have i~di~ated that more ~h~n ~i~ty ~ercent o~ the U.K. smoker p0pu[atiou ~an ~ described a~ ~i~on~. T~t i~ t~ey ~re e~per~dng ~e conflict between wh~t Lh~y ~o ~d ~a~ ~hey bel~eve ~ey ~hould do. ~pe~ifi~ally, the7 w~h ~o step smoking. ~or mo~e £han half of those smoke~ w~o Sad attempted to ~£v~ up ~mo~ng By h~1~h ~on~er~i I~ i~ p~s~ible to de~ine ~our gr0~s withi~ a ~mok~ population, expressed by their h~v~ou~ a~d ~tiLude~ to sm~k~g: ~ig~ly ~onso~a~ - tho~ wh~ ~av~ ~o~ tried ~or wish ~o quit; Consonant - thcs~ who h~ve tried but ~o ~ot ~o~ish ~ qui~; ~isso~n~ - ~h~s~ who wi~h ~ qui~ buL h~ve ~L tried; Hd~ly Dissonant - tho~ who wi~h to qui~ and h~ve attempted to do ~o. 650032500

-3- According to da~-a derived from Operation Aquarlus= the relative sizes of thes~ segments are as follows: Highly Consonan= 20% Consonant 16% Disson~t 13% Highly Dissonant 50% The high/y dissonant smoker is most likely to 5e in the abe range Z5 to 34 years a~d ~o smoke 15 to 29 clgare~tes per day, In cuuL~ast~ si~ty percent of all highly Consonant smokers are aged ah least ~5 years and one quarter of them smoke five or les~ cigarettes per d~y. When asked "~at ,;ere the reasons that made you give ~p?" (ex-smokers), or ~'~ha~ were the reasons ~hat mad8 you ~ry ~c give up.~'F (smu~eu~)j Lh~ following distribution of responses was obtaineR: E~-sm~k~s SMokers Cost 3~ 43 Health (specific) 35 30 Heal~h (~eneral) 30 g8 O£llcr 9 13 0;~ particular intero~t in =hose data is the apparent dlffcrcncc in the r~latlve importance of ~ost an~ he~Ith. ~or ~mokers wh~ had fgil~g to quit, Cost was cited m0s~ often as th~ mo~iva~io~ to at~E~Ipt~ whereas l~s~ ~-smokcr~ w~rc ~romp~ed by this reason* Th~ obvious in~erpretatlon o~ ~hi~ finding is cha~ tho~a £o~ who~ quitting i~ ~he only ~isfac~ry m~ns t~ re~olve the e~n~llct b~tw~e~ ~ok~n~ ~n~ he~Ith cor~ern h~e A ~Iready done so. Therefore~ ~he difference betwee~ s~oker~ a~nd ex-smokers

-4- in ~his re4ard, is historical. An alternative hypothesis can, however, hc advanced: tha~ those who ha~'e attempted to qu~ hug £ail~d, deny the importance el concern for h~th ~ a ~o~ve ~n or~r to as~L~Ze ~he dissonance which remains. Whils~ such a~ hypvthe~is i~ ~11y L~nLaLivu~ iL hi~hlighLs an important g~p in our le%owled~ of the ~onsum~r: how do~s he rcmaln a ~moher despite the apparently good re~sons her him to stop ~oklng? It is our contention that all dissonant smokers, and probably some apparently consonant smokers~ maintain their hehavlour only by making some psychological adjustments to r~ducc th~ conflict h~tw~e~ smoklm~ an~ Co~c~r~ fo~ h~slth. It ha~ ~Iready heen suggested tl~t one way of r~dueing conflict is to deny or devalue the health argument. We would suggest tha~ th£re are at least llv~ modes ~hr~ugh which s~h a defense may be ~b~ained. (a) ~ ratlon~li~ing the healt~ i~ue. For exampl~ ~ smoher may maintain ~hat there is too m~ch ~uss being made about ~he lisks a~Eaehing to smoking~ or ha may assert that "smoking does not hur~ anyone ~o lo~g as they show no signs of heal~h problems". (~) By "statistical" rationalisation of the health issue. This mode wo~Id he r~lle~tud in agreemczi~ wlch s~ch s£~men~s as; l'Cigaretto ~moklng only makes it nero likely thnt you %'ould get an illness you would get anyway" a~d "~4any non-~nokers die of illnesses that are often said to be CaUSed by smoking clgaregL~u", i Both nodes (a) and (h) share a fatalistic disposition and offer the rationalization that, through accidents or ageing, people die anywsy .....

-5- (¢) By modifTimg smohlng heh~v:our. This is a more truly rational approach and would eli~i~ concordance with such s~a~e~en~ as: "There is ~oL~Lin~ w--o11~ wiLh ~mokiL~g ~o long as i~ is ~n ~o~er~tlont1~ ~d "Lo~ t~r ~B~ette~ ar~ safer th~n hish tar ~ig~ettes"~ However, bellef an~ ~tlo~ ma~ no~ ma~h. Faith in "~er" smoking is pr0b~bly no~ s~ffi~ie~t ~0 re~olve ¢onfli¢~ and would .~eed to ~e ~uppor~ed by appropriate buying a~d ~onsumption bchaviour t~ be ~ff~tive. (d) ~y denyln~ th~ authority o~ ~t~mokln$ information. Evidence from Operatio~ ~q~a~ius (o~,cit°) suggests that smokers ~re l~ss likely than ~on-smo~ers ~o b~li~v~ "th~ ~hi~gs L|~ ~h¢ ~ovcrnm~nt say~ about clga~cttc smol~ing and its 9f~¢ct~ on he~ith" ~nd les~ likely ~o a~e~t I~th~ things ~o~t0~s say about cigarette smoki~ arF/ i~s ef£ec~- o.~ healthI' - ~he latter becaus~ do¢~0rs themselves ~k¢ amd "do¢~o~ donTt a~&ys ~ w~th one a~o~h~r". ~ ls not ~ested that th~ ~%ode~ o~ ~onfli~ r~oi~o~ or r~d~tlon a~e exclusive cr ~n~epende~. Recent Canadian data (3) supports ~h¢ existence of s~veral f~to~ in this ar~a. The fi-~th suggested mode o£ deai~ wi~h ~cr~flic~ i~ pcrhap~ ~h~ mcs~ ~ionnl and ~ likely to (e) BY ackn0wled~in~ the risks ~ttache~ to smoking. SUC~ a mode "smo~£ng might ~ ha_~aful but ~ cannot stop" or "th~ ~njoym¢~ 6: I get from ~m0kii~g is w0r~h any small ri~ks it might involve". I~ ~he latter case, agre~me~ p~esupposes that ~h~ risks a~e ~'~ genuinely p~rceived ~s I1~m~ll1~ ~r that ~me ~ati~ali~Lio~ ha~

-6- ~or the smoker, ~hese and perhaps other ways o= recon~'illng smokini with concern for health ~re available and operating ~ingly or in comhi~tlon, They ar~ h~w~ve~ uusu~i~l, Oth~wi~c~ h~if of Lh~ smoker population w~mid not ~pr~ss th~ wi~h to qui~ h~camse of th~i~ health co~cern. Beceuse len~l, or ~educ~i~n of its fmpcrta~ne, ~s itself a means of partially resolving conflict, then concern ~or health, detel~ined solely by direc~ questioning, is likely =o yield am underesnima;e of its importance ~o some cmolears. In terms of sustained c~ntinuat~on of smokgni hehavfour, only twenty percent of ~he current U.K. mmrket can be considered "safe", that i~ ~hey ar~ highly ~onsonaut, nelLh~r wi~hlni to nor ~'~r hav~zi attempted tD quit, The i~odiato ~'loss potc~tlal'F of dissonant smokers, who wish to hut have not yet attempzed to give up smoking, is estimated at 13~, with a further 5Og hiihly dissonant, who have tried to q~it and failed ~o far, ~t is 0%,~ v~w that the tr~e loss pot~ntlal is much ~reater than those waiting to try but tha~ we do no~ have sufficient means of identifying the long term hehavioural fate of eurxen~ smokers, The pr~sen~ research~ Project LIBRA~ will bclin = prosra~ue to better charae=ariue the smoker popll~at~o. ~n re]at~on to concPrn ~ hee~th, wh{eh ~men~o~ ~ clearly one of th~ most influeRtial in the Be~mentati0n of a ConteMporary market. FROJECT LIBKA pro~ect LIBRA addresses itself to the folloi~i-ng questions: l~i what ~-ays can smokers, ax-smokers arid never-smokers he disti~gulshed in terms of their attitudes Co heal~h in general, and sleohlng a~d health in particular? (Attitudes to health.)

-7- 2. Which indices of psychological difference best distinguish 5etweea ingividuals ~ko redl*ee conflict bet~n smoking and h~ith concern by various mesn3 (such as modifying their smoking behaviour, adopting variou~ ~ud~ u£ di~so1~auee reduetlon, etu.) and betwee~ ~lese and successf~l quitters and n~ver-smo~ers? (Individual ~iffer~nces.) Att~,~e~ tn ~e~Ith Data obtained from Operati0~ Aquarius indicate that smokers, ex-smokers and u~v~L-smok~s ~x~r~s~ difi~L~t ~LtlL~d~ toward~ ~moklug ~ud h~alLh° - For ~xample, 87% o~ ex-smok~ and 89% of never-smoker~ agreed wi~h th~ statement ~hat "e~Ear~tte smmkiug is harmful to health", w~ereas only 7g~ of s~okers a~reed with this assertion. Althaugh the majority of smokers agree ~i~h ~he proposi~io~ in a general way~ ~hey ar~ le~ ~neern~d when a~k~d about the possible effo~t~ o£ ~moking on their own h~alth. This a~pareut coutradietlo~ is a f~rther reflection of cognitive dissonance (4). In a re~ent market segmentatio~ study carried out in Canada (3)s fcu= meier se~nents o~ the ~mok~r population were id~n~ifiGd. Concern for health, or lack of it, was a major differentiating feature for each of the segments. Members o~ Eke largest segment appear to have resolved their conflict 5y modifying their smoking behavlour. Such eonsu~rs :m w~re found to more of~em want a Io~ tar and nicotln~ product, perceive mildness ~o be of greater importance, to smoke fewer cigarettes, and to generally present a ~or~ health conscious profile. In terms of a soeio- M~ ~conomi¢ index they ~re classified ms predominantly medlum-hlgh to high. An ~lmoat diametrically opposed segment was ~lso r~vealed, comprising- about 25% oi all ~anadiam smokers. High imner mead motivation, a decided lack of conceri~ ab~n:C tas and nieuuine, a high smoking volu~e, a

-8- requlrement for a strong proguet~ a~d a low level of health concern ehnraeterlsed this group. TheF were predominantly'young and male and proportionately more represented in tile medium-low to low .~o~io- econou~e ~roup. ~rom the --o~going, two important points srise. Firstly, overt queszio~ing about smoking a~i health concern differentiates smoke~s, ex-$mokers and never-smokers and, within the smoker populatio~ has an important role to play in segmenting a ¢o~t~porary market. Secondly, questions abou~ hsalth have hitherto always bee~ linked ~ith smoking hehavlour with no attempt being made to view expressions sf concern about specific health issues (i.e. related to smoking) in a wider context of ~eneral attitudes t~ healtk. Coulg it heI for ex~/n~le~ that non-smoke~s are, as a group, mor~ generally conscious of their health and physical well-being ~ha~ smokers? Because we doubt that for ~onle smokers~ real concern for health ds adequately reflected in their answers ~e specific smoking and health questions, {t is azl important a~pect of this study ~o aompar~ general a~ti~des to health getwae~ smokers, ex-s~okers a~d never-s~okers. This will puovlde a COilte~z in whluh £u ~udge ~p~uifi~ e~pie~bluns r~a=dlu~ smoking ~ health. Fur~ker~ore, it ~ilh be impor~&nt to gete~ne ~hether, for example, consonant and dissonant smokers ~re dlfferentiahle in t~rms of general a~tltudes to health. We might ~pect tha~ the rat£ona!~ 6on~on~t smoker is likely to ha%-e a fatallstlc attitude to health gene.~&lly~ ~hereas the ~isso~l~ ~moker~ gepen6g~g ~po~ his partleular mode of conflict reduction, ~ight have a more "arc<ious" .perception of his well-being. Comparisons between smokers and ex-smokers , )