A new study published in the Proceedings of the National Academy of Sciences (PNAS) describes the powerful role of gratitude in mitigating harmful health behaviors. A collaboration between investigators at the Harvard Kennedy School, Harvard Chan School of Public Health, and Georgetown University has generated new findings that could re-shape public health campaigns and help lower the 480,000 deaths caused annually by smoking in the United States. The study also suggests broader applications for curbing other “appetitive” risk behaviors like excessive alcohol use and overeating.

Historically, public health campaigns have evoked negative emotions, such as sadness and fear, to capture attention and motivate behavior change. Positive emotions are rarely used in anti-smoking communications, and previous meta-analyses concluded that positive emotions generally do not diminish “appetitive” risk behaviors such as smoking. However, in this new work, the team tested their theory of emotion and decision making, known as the Appraisal Tendency Framework, hypothesizing that the positive emotion of gratitude could lead to reductions in appetitive risk behaviors.

Gratitude is an emotion “kindled by others’ acts of kindness and generosity” and is associated with “an enhanced sense of gain and focus on others,” the authors write. Unlike other positive emotions, such as happiness, compassion, or hope, they theorized that gratitude uniquely makes people less focused on immediate gratification and more focused on long-term relationships and health.

The team tested their prediction with cigarette smoking as the target behavior, as smoking continues to rank as the foremost preventable cause of premature death. Nearly one in eight American adults still smoke—more than 28 million, by recent estimates—and smoking is considered the leading preventable cause of death in the country. Billions more smoke worldwide, with similarly dire health consequences.

The team first developed initial evidence using analyses of national health surveys. They found that people who reported feelings of gratitude were less likely to smoke. “Using nationally representative samples that covered a wide age range, we identified robust associations between trait gratitude and a lower likelihood of smoking,” the authors write. “Moreover, gratitude predicted cessation among smokers five to ten years later. In contrast, trait compassion, also a positive emotion, was not related to smoking at any point.”

In another international study, “current feelings of gratitude were associated with significantly lower intentions to use not only tobacco but other recreational drugs as well, even after controlling for factors such as age, gender and income.”

The researchers then conducted a series of randomized experiments, recruiting hundreds of adults who smoke. Participants were randomly assigned to different emotion conditions: gratitude, compassion, sadness, or neutral control. The target emotion was induced by having participants watch a corresponding video clip followed by a reflective writing task. As predicted, gratitude was associated with a reduced craving to smoke. Effects were not limited to self-reported craving; gratitude also increased participants’ enrollment in an online smoking cessation program by eight percentage points.

Jennifer Lerner headshot.

“By focusing on gratitude, public health campaigns could better support smokers in overcoming their cravings and ultimately quitting. Our studies offer a promising new direction for improving the emotional content of these campaigns.”

Jennifer Lerner

The findings have significant implications for the design of public health campaigns. The researchers examined the largest federally funded anti-smoking public service campaign, “Tips from Former Smokers,” by the Centers for Disease Control and Prevention. Unfortunately, this landmark campaign predominantly triggers negative emotions such as sympathy and sadness, which create emotional wear and tear among viewers and may not optimally promote smoking cessation. In fact, earlier research by the team found that evoking sadness can actually increase the desire to smoke and the intensity of inhalation immediately afterward. Notably, the Tips campaign rarely evokes gratitude.

"The implications of these findings extend beyond smoking, offering new pathways for addressing various harmful health behaviors, such as excessive alcohol use, risky sexual behavior, and unhealthy eating," said lead researcher Ke Wang PhD 2024, postdoctoral fellow at the University of Virginia’s Darden School of Business. "Our work suggests that public health campaigns should consider inducing gratitude, a positive emotion that triggers cascading positive effects."

“By focusing on gratitude, public health campaigns could better support smokers in overcoming their cravings and ultimately quitting,” said Jennifer S. Lerner, co-author and the Thornton Bradshaw Professor of Public Policy, Decision Science, and Management at Harvard Kennedy School. “Our studies offer a promising new direction for improving the emotional content of these campaigns.”

This research significantly advances our understanding of how specific positive emotions like gratitude can influence health behaviors, challenging existing beliefs and offering new tools for public health practitioners. As public health campaigns continue to evolve, the inclusion of gratitude as a core emotional component could lead to more successful outcomes in reducing harmful health behaviors and improving public health.

The author team also included Vaughan W. Rees, a senior lecturer and director of the Center for Global Tobacco Control at Harvard T.H. Chan School of Public Health; Charles A. Dorison PhD 2020, Assistant Professor at Georgetown University’s McDonough School of Business; and Ichiro Kawachi, the John L. Loeb and Frances Lehman Loeb Professor of Social Epidemiology at Harvard T.H. Chan School of Public Health.

Banner photo by Peter Dazeley/Getty Images

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