Guilt alone doesn't work.  I suspect that gruesome anti-smoking campaigns we
have seen here are more fear-based than guilt based (pictures of a
gangrenous foot, mouth cancer or child wearing an oxygen mask).  If the NYC
campaign is modelled on the Australian Quit Campaign (or vice verca) mass
media messages were supported by significant policy and legislative change;
a well funded counselling service; education for health professionals and
the wider community about the dangers of smoking - and the support services
available - and a significant attitudinal change amongst that community.
There is a significant body of work discussing the ethics of fear and guilt
appeals in the social marketing literature.  (Google "social marketing" and
guilt or fear)  Social marketing is not just about PSAs.  It is a
multifaceted approach to behaviour change.  
In Australia we have breastfeeding initiation rates approaching 90%.
However, our continuation rates are about the same as in the US and the UK.
Mothers here know that breastfeeding is important.  They want breastfeeding
for their babies.  But their efforts are usually met with insurmountable
opposition in real, day-to-day, life.  Health professional don't often have
the skills to help them overcome the practical difficulties they encounter;
breastfed babies do not live up to the expectations of many mothers, health
professionals and others - and mothers are judged accordingly; women often
need to return to paid work apart from their babies sooner than they would
like; child care centres are not always comfortable handling human milk;
employers are usually not comfortable providing lactation breaks or flexible
return to work; some mothers are uncomfortable with breastfeeding in public
- as are some members of our community.  Doesn't matter if mothers know that
formula feeding will increase their kid's likelihood of hospitalisation in
the first year if they also know that there is no other choice realistically
available to them.
Cheers
Nina Berry
Australia

-----Original Message-----
From: Lactation Information and Discussion
[mailto:[log in to unmask]] On Behalf Of Susan Burger
Sent: Sunday, November 30, 2008 2:56 AM
To: [log in to unmask]
Subject: Guilt doesn't work? Oh Really!!

Dear all:

In my prep for a talk to Cornell Medical Students I was going to go over the
history that 
preceded breast is best, when even that was in question and move on to best
is best and 
then why that was not enough.  Since I get bored on the subway now that my
eyesight is 
not good enough to read over someone else's shoulder or even read a
newspaper I picked 
up myself on my own lap, I constantly scan ads.  I started taking photos of
ads on the 
subway which include the NYCity ads on quitting smoking.  The most gruesome
is the 
woman who has had some horrible number of amputations who shows her hands
with 
stumps instead of fingers. I actually thought these ads were probably far
too gruesome to 
have an impact, but I ran across an article that shows that the highly
guilt-drive NY City 
approach has had a huge impact on lowering smoking rates.  Then, I ran
across the ad that 
shows the impact on children of second hand smoke.  If you watch this one,
you can see 
very clearly how we have a complete double standard for different
industries.  Talk about 
guilt-inducing ads.

http://www.nyc.gov/html/doh/html/smoke/smoke.shtml

Best, Susan Burger, MHS, PhD, IBCLC

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