Giving up to save face? Investigating the impact of age-appearance facial morphing on women's smoking
Submitting Institution
Staffordshire UniversityUnit of Assessment
Psychology, Psychiatry and NeuroscienceSummary Impact Type
SocietalResearch Subject Area(s)
Medical and Health Sciences: Public Health and Health Services
Psychology and Cognitive Sciences: Psychology
Summary of the impact
Clark-Carter and colleagues' research on impact of facial morphing
technology on smoking
cessation has given national and international smoking cessation programmes
a strong evidence
base for the importance of focusing on the negative effects of smoking on
personal appearance as
well as on health. The work has impacted internationally; the developers of
the software utilised in
our studies (
Aprilage Inc.) have used the research as evidence for
effectiveness of their software,
and stop smoking websites in the USA, Canada, and Ireland cite our research
in full. In the UK, at
least three Stop Smoking Services have incorporated age-appearance morphing
programmes into
their practice as a direct result of workshops on our research findings, and
the
Operation
Smokestorm smoking prevention initiative (used by more than 100
schools across the UK) uses
our research findings as part of the rationale for focusing on the
appearance-damaging effects of
smoking in the intervention.
Underpinning research
Outline of research
Researchers in the Centre for Health Psychology have been involved in
research linking
appearance to health promotion since 2001. Our focus on smoking began in
2009, in which pilot
work (Grogan et al., 2009) established that young women smokers
were more concerned about
the impact of smoking on appearance than on their health. It was therefore
decided to investigate
the effectiveness of an age-appearance technique that showed young women
smokers the impact
of smoking on their own faces. We did this using sophisticated
age-appearance morphing software
which enabled us to show women their own faces aged up to 72 years old
with and without
smoking. A qualitative study (Grogan et al. 2010) used focus
groups and interviews to investigate
47 women smokers' accounts of being exposed to these images both while
they were looking at
the images and retrospectively. A quantitative study investigated impact
of the age-appearance
intervention in a randomised controlled trial that compared 35 women
exposed to the intervention
with 35 in a control condition (Grogan et al., 2011). The work has
led to an MRC NPRI grant on
smoking prevention 2012-2017.
Key researchers, dates, roles
This work has been led by a team at Staffordshire University. Professor
David Clark-Carter has
been involved from September 2001 to present. Keira Flett was employed as
Research Assistant
between September 2009 and April 2011, and continues to assist on the
project. This research
also involved collaboration between the Staffordshire University
Psychology team (including
Professor Sarah Grogan now at Manchester Metropolitan University) and
Professor Rachel Davey
at University of Canberra, Professor Mark Conner at University of Leeds,
and Professor Brendan
Gough now at Leeds Metropolitan University and with health professionals
involved in public health
and smoking cessation (Deborah Richardson and Giri Rajaratnam at Stoke and
East Midlands
Primary Care Trusts).
Context
Smoking presents a significant economic burden to the National Health
Service and most quit
attempts fail. Health-related anti-smoking campaigns fail to motivate most
smokers to quit, and
there is growing evidence that young women respond better to threats to
appearance than risks to
health. The studies carried out by Staffordshire University on effects of
facial morphing on smoking
attitudes and behaviour are the first to investigate in a controlled way
the psychological impact of
this kind of intervention on smoking cessation.
Findings
Women reported being highly motivated to quit smoking as a result of the
intervention, with two
thirds of participants saying that they intended to quit after exposure to
the intervention, linked with
increased perceived personal responsibility for quitting. There were also
statistically significant
changes in attitudes to quitting smoking and increased intentions to quit
smoking immediately after
exposure. Nicotine dependence and self-reported smoking were also
significantly lower in the
intervention compared to control group at four weeks follow-up. These
studies suggest that facial
morphing interventions may be useful adjuncts to traditional cessation
programs, especially with
young women smokers. Work is continuing, to investigate impact of the
intervention on men.
References to the research
Details of key outputs
All publications below are published in peer reviewed journals with high
impact factors. Full
references for each and impact factors are supplied:
Grogan, S., Flett, K., Clark-Carter, D., Gough, B., Davey, R.,
Richardson, D., & Rajaratnam, G.
(2010). Women smokers' experiences of an age-appearance anti-smoking
intervention: A
qualitative study. British Journal of Health Psychology, 16,
675-689. Impact factor: 2.336.
Grogan, S., Flett, K., Clark-Carter, D., Conner, M., Davey, R.,
Richardson, D. & Rajaratnam, G.
(2011). A randomized controlled trial of an appearance-related smoking
intervention. Health
Psychology, 6, 805-9. Impact factor 3.982.
Flett, K., Clark-Carter, D., Grogan, S., & Davey, R. (2013). How
effective are physical appearance
interventions in changing smoking perceptions, attitudes and behaviours? A
systematic review.
Tobacco Control. 22, 74-79. Impact Factor: 3.077
Grants Supporting This Research
Grogan, S., Clark-Carter, D. Appearance and smoking: An Investigation of
effectiveness of an age-
appearance morphing intervention. Stoke Primary Care Trust September
2009-April 2011,
£132,000.
Details of the impact
Process of dissemination
Two papers were published high-impact international peer reviewed
journals (British Journal of
Health Psychology and Health Psychology), and papers were
presented at the Appearance
Matters conference (that attracts both academics and health care
professionals) in July 2010 and
July 2012. This led to contacts from academics and health professionals
from the UK and USA as
well as significant media interest (see below). The work was reported in
full in a number of health-
related websites (see below) and in newspaper articles (e.g. The
Sentinel) and magazines (e.g.
Marie Claire). A report on both studies was passed to Stoke Primary
Care Trust (who had funded
the work) and we discussed the applications of the work with them. As part
of the report we
produced a list of recommendations for practice.
Data from the research were also disseminated through workshops with
health professionals
engaged in smoking cessation within a 30 mile radius of Stoke on Trent in
September 2010 and
March 2011 at Staffordshire University, and through a session at the Royal
Free hospital in London
in May 2013. These sessions incorporated details of psychological
underpinnings of the technique,
and led to several new links between us and local stop smoking services.
We trained stop smoking
staff from Staffordshire County Council and South Staffordshire Primary
Care Trust (PCT) in how
to use the technology, which is now incorporated into their routine
practice. We have discussed
with them how to use this most effectively, based on our research
findings, and have carried out an
evaluation of their stop smoking services, including their use of this
software.
Who has benefitted?
- 63 Health Professionals involved in smoking cessation (smoking
cessation advisors,
consultants and public health professionals, clinical psychologists, and
a pharmacist) have
attended research dissemination workshops at Staffordshire University,
Staffordshire
County Council, and at the Royal Free hospital.
- 249 smokers have been exposed to the software as part of the research,
and more than
4,200 through South Staffordshire Stop Smoking Services.
- Groups developing smoking-related interventions and needing evidence
on whether to
incorporate an appearance-related element (such as Kick Butt).
- 95 health psychology trainees at Staffordshire University, and Deakin
University, Melbourne
have been taught about the research intervention.
-
Aprilage Inc. (distributers of morphing software used in
studies).
How have they benefitted?
People running Stop Smoking Services in Staffordshire and across the UK
have benefitted by
being made aware of the potential effectiveness of facial morphing
software and being trained how
to use it most effectively. Smokers around Staffordshire have also
benefitted since this software is
now used as part of their package of stop smoking materials. We have
demonstrated statistically
significant increases in quit rates in these smokers in follow-up research
studies, and anecdotal
reports from stop smoking services in these areas suggest that our
training has enabled stop
smoking workers to increase their clinical effectiveness. Our work is used
as part of the evidence
base for Operation Smokestorm (used by more than 100 schools in
the UK) to provide a rationale
for an appearance focus in stop smoking materials. Health psychology
trainees and other health
professionals have also benefitted from learning about the psychological
underpinnings of
appearance-related interventions based on our research. Aprilage Inc.
have benefitted through
research evidence supporting effectiveness of software.
Dates
- Public health events at Staffordshire University: September 2010 and
March 2011 (50
attendees).
- Dissemination to health professionals: May 2013 (Royal Free Hospital,
London; 10
attendees).
- Dissemination to trainee health psychologists: March 2012, March 2013
(95 students).
- Training event at Staffordshire County Council (3 attendees): July
2011. Dissemination of
the BJHP paper to Aprilage Inc.: December 2010.
- Dissemination of the Health Psychology paper to Aprilage
Inc.: July 2011.
-
Sentinel articles December 2010, December 2012, April 2013. Marie
Claire article
December 2010.
- Health-related website coverage December 2010-present (see below).
-
Operation Smokestorm report: August 2011.
Evidence
-
Aprilage Inc. use our research as one of the key elements of
the evidence base for
effectiveness of their age-appearance software and cite Staffordshire
University as their
key academic source on www.april.com.
- The developers of the Operation Smokestorm resource cite our
research as evidence for
effectiveness of age-appearance interventions and for incorporating
these into the resource
aimed at young people. See quote below and:
www.lockinlearning.org.uk/oss_report_aug2011.pdf
- South Staffordshire Stop Smoking Services are now using the software
extensively in their
practice as a direct result of lead staff reading our research articles.
See quote below and
http://nhslocal.nhs.uk/story/lifestyle/white-van-used-deliver-smoking-cessation-services
Sources to corroborate the impact
Aprilage Inc. - can corroborate the claim that they use our
research as one the key elements of
the evidence base for effectiveness of their age-appearance software.
The developers of the Operation Smokestorm initiative cite our
work as evidence for
effectiveness of age-appearance interventions saying:
"Based upon recent research findings that highlight the benefits of
using age progression
software [REF: Grogan et al., 2010] and Kick Butt's own positive
experience of using this
morphing technology on young people, the decision was made to view
health risks in a broader
sense and widen focus to include smoking's negative effect on personal
appearance. Therefore,
in addition to more serious smoking related health risks, such as
cancer, action was taken to
include premature ageing of the skin and eyesight in the resource
(p.9)."
South Staffordshire PCT Stop Smoking Services can corroborate extent of
impact on their Stop
Smoking services.
A tobacco control coordinator at South Staffordshire PCT (who approached
us to organise
training for his staff after the initial publication in British
Journal of Health Psychology) was
impressed by the research finding that people were shocked into quitting
smoking after seeing
the morphed images: "The software is able to give a direct comparison
between how someone
would look if they aged normally and how they would appear if they
continued to smoke, such as
drying out their skin, having lots more wrinkles, and affecting their skin
tone. That can be a real
shock to people and is certainly a great draw." (http://nhslocal.nhs.uk/story/lifestyle/white-van-used-deliver-smoking-cessation-services.)
Websites in USA, Canada, Ireland, the Netherlands, Russia, Italy and the
UK cite our work in full.
For instance:
-
http://www.sciencedaily.com/releases/2010/12/101206211709.htm
http://news.softpedia.com/news/Shock-Is-the-First-Step-to-Stop-Smoking-170926.shtml
- http://www.irishhealth.com/article.html?id=18323
- http://www.news-medical.net/news/20101207/2042/Dutch.aspx
- http://www.news-medical.net/news/20101207/Smokings-effect-on-face-induces-women-to-quit-the-habit.aspx
-
http://www.tvojapluca.rs/clanak.php?id=45&tip=novost
(Russian article)
http://www.newsfood.com/q/f05ec712/il-fumo-ti-fa-brutta-cos-le-donne-smettono-con-le-quot-bionde-quot/
(Italian article)