The role of positive emotion in harmful health behavior: Implications for theory and public health campaigns

Abstract

Meta-analyses have concluded that positive emotions do not reduce appetitive risk behaviors (risky behaviors that fulfill appetitive or craving states, such as smoking and excessive alcohol use). We propose that this conclusion is premature. Drawing on the Appraisal Tendency Framework and related theories of emotion and decision-making, we hypothesized that gratitude (a positive emotion) can decrease cigarette smoking, a leading cause of premature death globally. A series of multimethod studies provided evidence supporting our hypothesis (collective N = 34,222). Using nationally representative US samples and an international sample drawn from 87 countries, Studies 1 and 2 revealed that gratitude was inversely associated with likelihood of smoking, even after accounting for numerous covariates. Other positive emotions (e.g., compassion) lacked such consistent associations, as expected. Study 3, and its replication, provided further support for emotion specificity: Experimental induction of gratitude, unlike compassion or sadness, reduced cigarette craving compared to a neutral state. Study 4, and its replication, showed that inducing gratitude causally increased smoking cessation behavior, as evidenced by enrollment in a web-based cessation intervention. Self-reported gratitude mediated the effects in both experimental studies. Finally, Study 5 found that current antismoking messaging campaigns by the US Centers for Disease Control and Prevention primarily evoked sadness and compassion, but seldom gratitude. Together, our studies advance understanding of positive emotion effects on appetitive risk behaviors; they also offer practical implications for the design of public health campaigns.

Keywords: addictive behavior; emotion; public health; public service announcements; smoking.

Fig. 1.

Study 2: Among all five positive emotions measured, only gratitude consistently predicted reduced smoking. (A) At the individual level, gratitude significantly predicted lower behavioral intentions to use tobacco (e.g., smoke/vape) and other recreational drugs after controlling for age, gender, education, negative affect, and other positive emotions measured. (B) At the country level, gratitude significantly predicted lower prevalence of tobacco use after controlling for other positive emotions, negative affect, and log GDP per capita. (C) At the country level, gratitude significantly predicted lower retail volumes of cigarettes per capita after controlling for other positive emotions, negative affect, and log GDP per capita. Error bars represent 1 SE. To examine potential concerns of multicollinearity, we computed the variance inflation factor (VIF), which measures how much the variance of a regression coefficient is inflated due to multicollinearity in the model. A VIF value that exceeds 10 indicates a problematic amount of collinearity (47). We observed VIFs below 10 and thus concluded that the analyses included acceptable collinearity.

Fig. 2.

Study 3: Gratitude significantly decreased cigarette cravings relative to all other conditions. Compassion did not significantly change cigarette cravings relative to a neutral state. Sadness significantly increased cigarette cravings relative to all other conditions. Error bars represent 1 SE. We report raw means and SDs in SI Appendix.

Fig. 3.

Study 4: Gratitude significantly increased enrollment in a smoking cessation program relative to a neutral state. Error bars represent 1 SE.

Fig. 4.

Study 5: Among the 44 emotions reported by smokers when they watched the videos from the Tips campaign, gratitude ranked 21st in intensity (A) and 20th in frequency (B). Error bars represent 1 SE.