关键词: 戒烟, 控烟行动, 助推, 行为干预, 行为公共健康

Abstract:

Smoking is one of the major public health challenges around the world. Traditional tobacco control strategies, which include health education, taxes on tobacco products, and restrictions on smoking in public spaces, have greatly contributed to the reduction of smoking behavior around the world. However, these strategies are not always effective in helping smokers successfully quit smoking. As the traditional strategies do not consider the “irrational characteristics” of smoking behavior and its underlying mechanisms, their effects are usually discounted in real-world contexts. Recent advances in applied behavioral sciences during the past several decades provide new approaches for nudging smokers to quit smoking, which could be used to develop more effective tobacco control strategies at both the individual and population level. This article systematically reviews recent empirical research on behavioral intervention strategies to nudge smoking cessation according to the framework developed by Duckworth and colleagues for improving self-control. Specifically, behavioral nudge interventions for promoting smoking cessation could be classified by the people or organization implementing the intervention (e.g., smokers versus governments and public health agencies) and their underlying mechanisms (e.g., cognitively oriented versus context oriented). Context oriented interventions implemented by governments and public health agencies include reducing the accessibility of tobacco retail outlets in residence areas, restricting the display of tobacco products in stores and supermarkets, so as to reduce exposure of tobacco products, offering smaller size of cigarette products, and establishing separate smoking areas and removing tobacco-related irritants from the environment; cognitively oriented interventions implemented by governments and public health agencies include printing prominent warning pictures on cigarette packets, removing marketing information from cigarette packs, and increasing the usage of smoking cessation services; context oriented interventions implemented by smokers include making a public commitment to stop smoking and inviting important others to monitor one’s smoking behavior, using loss aversion to motivate quitting behavior among smokers; cognitively oriented interventions implemented by smokers include making specific, actionable smoking cessation programs, promoting a future-oriented time perspective, and cultivating incremental theories of smoking behavior. This framework makes it easier for governments and smokers to select appropriate behavioral nudge interventions. It also has implications for informing the development of culturally sensitive and adaptive behavioral intervention strategies for promoting smoking cessation in China, improving the efficiency and effectiveness of smoking cessation interventions, and contributing to the achievement of the “Tobacco Control Initiatives” of the “Healthy China 2030 Initiatives”. Although there is progress in developing effective behavioral nudge interventions for smoking cessation, future research is warranted to comprehensively evaluate the effects of these interventions, including both positive and negative effects, short-term and long-term effects, especially in real-world contexts. Future research is also needed to adopt behavioral change strategies in the development of stop-smoking APPs and digital smoking cessation services. By fully understanding the irrational characteristics of smoking behavior and its underlying mechanisms, we can develop tailored, targeted, context adaptable, and applicable smoking cessation intervention strategies. These types of interventions can greatly increase the effectiveness and efficiency of smoking cessation services. Future research is also needed to preclude the negative impacts of e-cigarettes and prevent the misuse of these behavior nudge strategies, especially among young children and adolescents who are vulnerable to the attraction of e-cigarettes. We believe that behavior science-informed interventions, if successfully implemented with the collaboration of governments, public health agencies, and smokers, can greatly contribute to safeguarding the health of both smokers and the general public.

Key words: smoking cessation, tobacco control initiative, nudge, behavioral intervention, behavioral public health