Tobacco control through the lens of moral psychology

The tobacco control debate can get testy at times as advocates on both sides of the issue — those who favor abstinence-only approaches to cigarettes and other tobacco products and those who support harm reduction — wage spirited campaigns in support of their respective positions.

Harm reduction seeks to minimize the use of the most harmful tobacco products (cigarettes) and, for those who will not quit using any tobacco or nicotine product, maximize the use of much less harmful products such as e-cigarettes or smokeless tobacco.

In a new paper, a UB tobacco control expert says both positions in this important public health policy debate can be better understood through the lens of moral psychology.

“After decades of work in this area, I thought the perspective of moral psychology helped inform why these debates are often so vitriolic and yet so often based on limited science,” says Lynn T. Kozlowski, professor of community health and health behavior in the School of Public Health and Health Professions. Kozlowski’s paper will be published in the December issue of the Journal of Health Politics, Policy and Law.

Supporters of an abstinence-only approach want primarily to stop the use of any tobacco/nicotine product. The harm reduction view is that as long as cigarettes are a legal product under the U.S. Food and Drug Administration, safer alternatives to the much more deadly combustible cigarette should be available, and their use encouraged. FDA Commissioner Scott Gottlieb recently endorsed this view.

In his new paper, Kozlowski draws attention to what he says are “biases that lead some to focus more on the protection of ‘good’ kids from harm versus the protection of ‘bad’ kids from greater harm.”

He explains: “‘Good’ kids are those who are not using any tobacco/nicotine products and are at low risk of ever doing so. ‘Bad’ kids are already involved with using tobacco/nicotine products and engaging in other risky activities, such as drinking alcohol and using other drugs. Neither position should be viewed as bizarre or immoral. Each is a position that is supported by strong moral intuitions. It is a call to try to better understand where the ‘opposition’ is coming from, so to speak.”

The increased use of electronic cigarettes has further intensified the tobacco control debate, Kozlowski says, noting that some public health experts have zero tolerance for promoting the use of less harmful products like e-cigarettes and smokeless tobacco, while others argue that these products should be encouraged as alternatives even for youth who smoke because they are safer alternatives to deadly cigarettes.

When it comes to tobacco and nicotine use among young people, there doesn’t have to be an all-or-nothing approach, he says. Sex education offers a good example. “It has been found that comprehensive sex education programs can encompass both an abstinence-only focus and a safer sex approach, with an ability to help those who can benefit from one or the other approach,” he says.

“Trying to maximize abstinence from tobacco products or maximize the use of less harmful tobacco products have become opposing options in part due to the emotional reactions that influence views of these approaches,” Kozlowski adds. “I think there is room for trying to do both and benefit public health if there is an appreciation of the diverse group of youth who can benefit from a variety of tobacco control efforts.”

The arguments on both sides are rooted in a quick emotional reaction that’s followed by a slower thought process that plays out in which a person makes the case either for abstinence from tobacco products or a harm reduction approach.

“It is as if scientists were thinking of their own teenager and, if the teenager had not been engaging in any risky behavior, the priority would be to prevent that from ever happening,” Kozlowski says. “But if the son or daughter had already started smoking, the parent might be hoping at least to be able to move the teenager to using a much less risky product.”

The desire to protect a ‘pure,’ uncontaminated child from the contamination is opposed by the desire to have the already contaminated child protected as much as possible from doing any more harm to themselves, he says. In both cases, though, “Advocates for either position may have already decided on their preferred policy on the basis of their initial, rapid, moral psychological response to what is the more important course of action.”