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Behavior Change: Five Lessons Learned From The Tobacco Wars

by Sharon Carothers

Smoking is the leading preventable cause of death in the United States.”

Compelling? Urgent? Makes you think, “Sign me up to help,” right?

Well, not necessarily. As with any transformational change, it depends on where you sit in the world – your job, priorities, and cultural norms. For more than a decade, my work in the field of tobacco control was focused on helping to build a world where young people reject tobacco and anyone who wants to quit can. In that time, my understanding of how to engage industry partners, specifically in the pharmaceutical and entertainment worlds, evolved.

I began with the belief that the public health/science argument was cogent enough to attract and secure meaningful partnerships and what had been missing was a bridge (me!) to leverage resources and identify the right contacts.  However, through challenging impasses and missteps I came to understand the multitude of domestic crises—across multiple sectors including health, environment, employment, and education that vie for attention and resources from industry. I also realized that subject matter experts and advocates must think about how to influence likely—and perhaps more importantly—unlikely partners in a way that educates them about the issue using metrics, return on investment models, and rewards that make sense. And, finally, that upon doing the hard work of building alliances, you may be surprised how those likely and unlikely partnerships turn out!

For example, pharmaceutical companies make nicotine replacement therapy drugs (e.g., nicotine patch); it seemed only natural that they would make a likely and eager partner. There was certainly overlap in terms of intention, but when research was conducted it became apparent that sales for this product category were relatively small and that this segment of the consumer market was challenging. Upon implementing a pilot with some short-term wins, we came to realize that there were much more complex messages and behaviors at play than originally envisioned (e.g., increasing smokers demand for paid cessation resources, effectively communicating the value of quit methods). While we felt that we had identified the right partner, we had not fully understood their unique challenges and perspectives.

The entertainment industry wields enormous power in media and culture, and at times had even been viewed as being part of the problem. At first blush, they seemed an unlikely partner in the effort to end smoking. In fact, some in the industry held strong views that tobacco control had a zealotry that was unshakeable. This perception made it difficult to start a conversation, get meetings, discuss the issue and truly partner. In order to influence the entertainment industry, spending time building trust and understanding was necessary. Once individuals finally met and realized that the other “side” was not entirely unreasonable, a willingness to work together and ideas for a partnership began to flow. This shift in relationship laid the foundation for the development of programs that targeted tobacco use within the industry itself.

These examples underscore the power of nurturing influence by gaining an understanding of your partner’s issues, challenges and perspectives. Unlikely (and even likely) partners do not think about the smoking epidemic every day and are often pitched to support competing crises. As uncomfortable as it may feel, there are benefits to assessing, cultivating and measuring collaborative partnerships via a competitive market framework. Understanding the marketplace of likely and unlikely partners generates an advantage amidst fierce competition for attention and scarce resources within and outside of the specific social problem (e.g., breast cancer vs. lung cancer).

As you think about approaching partners to help solve social problems, keep the following in mind:

  1. Science alone does not a compelling value proposition make – appeal to stakeholders “world view” and understand the currency they use (e.g., data, public relations, money).
  2. You cannot successfully fight social problems alone – you need to use everything at your disposal and include both likely and unlikely partners for resources, support, and integrity.
  3. Do your homework – show an intentional seriousness, respect, and empathy for their industry and unique challenges by learning about what they do and how they do it. This is critical to finding common ground for partnership.
  4. Language matters – avoid using your “this is the most important issue in the world” vernacular. Potential partners tend to be turned off by “advocacy” or “insular” messages that emphasize differences and feel dominating.
  5. Be creative and be willing to fail  – co-brand, co-fund pilots, iterate, and share your experiences!


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