Rethinking Anti-Tobacco Campaigns: Why Mukesh and Sunita’s Stories Aren’t Enough to Stop Tobacco

“Afsos Mukesh bach nahi saka,” is a sentence all of us have heard more times than we can remember. In fact, as you read this sentence, you might have pictured the faces of Mukesh and Sunita or even heard the melancholy background music that is supposed to convey the tragedy of their story, in your head. This advertisement, conceived as a part of the campaign against smokeless tobacco in 2009, showed graphic images of cancer and was expected to make people consider the ill effects of tobacco and stop its use.

Following that, the COTPA Act of 2003 was amended in 2014 where the size of graphical warnings on tobacco products was increased from 40% to 85% percent. Every audio-visual campaign against tobacco is flooded with grotesque images of lung-shaped sponges soaked in tar. So all this fear-mongering should have worked, right?

Well, as an ex-smoker, I had continued to puff one after another as I sat through the tobacco warnings displayed in every movie, TV show, and billboard and wondered, “If awareness is all that is required, then why do doctors like me smoke?” 

By then, I knew of doctors who smoked, while also working day in and day out with patients who suffered from horrifying diseases due to tobacco use. In fact, I knew doctors working with cancer patients and in cancer wards who used tobacco. The subset of people likely to have the most awareness about tobacco continues to use it. Why is that? 

This question requires us to analyze the concept of ‘awareness’ as it relates to the problem of tobacco consumption in various ways – namely, how effective is it, and how can it be made more effective?

“Data from the Global Adult Tobacco Surveys 1 and 2 show that people exposed to tobacco warnings did demonstrate an increased willingness to quit,” says Dr. Dheeraj Kattula, an Addiction Psychiatrist. “The problem, however, is that there is a massive difference between wanting to quit and actually quitting. Make no mistake, nicotine is the most addictive substance known to man!” he adds. 

“Nicotine creates actual changes in the brain, causing intense cravings like nothing else. So much so, that a current smoker craving for their next hit will be able to look at the image of a grotesque tumor on the cover and still be able to light up without any worry for their own wellbeing. And the craving can last about 6 months to 1 year after stopping smoking, so a person remains in danger of restarting anytime.”

So yes, these advertisements might put an idea of eventually quitting in one’s head, but they fail to generate the urgency needed for that person to embark on the kind of Sisyphean uphill battle that is quitting tobacco. 

Let’s get back to Mukesh and Sunita for a moment. Is it just the addictive potential of nicotine that renders them unable to tug at our heartstrings, or is there something fundamentally wrong about the way their stories are being told?

To answer this question, all one needs to do is Google some permutation or combination of the words “Mukesh”,” tobacco”, “ad” or “cinema”. The sheer number of memes and jokes that show up on our feeds then makes one realize that these advertisements have been rendered powerless by repetition. 

Mukesh and Sunita have become constant fixtures in our cinema experience, much like popcorn and cool drinks. And just like the way our eyes automatically gloss over the anti-tobacco warnings that appear in TV shows, our mind is now trained to not engage with the message anymore.

“There is a need to tell new, fresh stories,” adds Dr. Dheeraj. “Tobacco companies constantly spend money on researching new ways to sell tobacco to people. Anti-tobacco campaigns are falling behind on this behavioral research aspect. We need to look at what pictures and what stories people relate to the most and keep shuffling them so that people stop becoming desensitized,” he adds.

There is also a need to focus on problems caused by tobacco that are not heart disease or cancer. “Most people perceive cancer as something that happens to a very few people, always to someone else and never to them. Not only that, most people also perceive all forms of cancer as deadly and terminal. So faced with that image, the overwhelming human instinct would just be to give up hope,” says Dr Dheeraj. 

How long do these alarming consequences take to appear? One or two decades at least. Studies show that people are simply not good at making decisions based on what is good for them in the long run. Habit formation (or in this case, habit breaking) cannot be affected by making people think about consequences they consider to be not highly prevalent and that won’t affect them for a long time to come.

However, there may be several alarming effects of tobacco that if communicated well can stop people in their tracks and make them consider stopping. Erectile dysfunction is the obvious example. Smokers are three times as likely as non-smokers to have erectile dysfunction, something that is not conveyed in any anti-tobacco campaign.

While having a good sex life is considered a very important need, in a son-preference patriarchal culture like India, the inability to perform sexually could potentially be damaging to a person’s identity as a man. But this is not being talked about enough.

Say, we double down on this information and make more audiovisual ads explaining the association of tobacco with erectile dysfunction. The examples of Mukesh and Sunita show us that it is possible to saturate the public consciousness with a message. Then, would we be able to dethrone tobacco from its brand positioning as a ‘masculinizing product’ if it was well known to be associated with an ‘emasculating condition’?

We don’t know the answer. But, we do know that juxtaposing the image of a tobacco user with erectile dysfunction strikes at the root of one of the most important priorities a person has, his identity of being a man. And Indian men seldom like to do anything that makes them appear emasculated. And for that reason alone, it appears that this answer is worth exploring.

My last perspective on awareness is gleaned from my therapist’s office, as I sat there seeking help for my own journey of quitting. “Well imagine that your leg is broken and you are using nicotine as a crutch, Christianez,” said my therapist patiently. “If I remove your crutch without your leg healing, I will force you to go through unimaginable pain. My job is to help you cope in other ways so that you will stop needing this crutch eventually.” 

This awareness that tobacco is a crutch sold to the masses - an empty solution for problems that aren’t being solved well - is an important one for everyone to keep in mind while designing campaigns. People smoke or chew tobacco for various reasons - when education, healthcare, and social security are distant dreams, tobacco might be a guilty pleasure. 

Laborers chew tobacco to keep themselves from getting tired, doctors smoke before night duty so that they do not fall asleep on shift  - and this awareness of tobacco use as a coping mechanism in the face of broader socio-economic issues underscores the need for comprehensive support systems alongside awareness campaigns. 

Ultimately, a multifaceted approach that combines innovative messaging with robust support for quitting could be the key to reducing tobacco use more effectively. As we redesign campaigns, we must ensure human behavior lies at the heart of our efforts. To truly make an impact, we must move beyond generic warnings and delve deep into the intricacies of what drives individuals to smoke. Only by understanding the psychological, social, and cultural factors at play, can we tailor our messages to resonate with diverse audiences. And only then, will our messages lead to any meaningful change.

Edited by Radhikaa Sharma.

Image by Janvi Bokoliya.