Warning: Habits May Be Good For You highlights the anthropologist Val Curtis’ work to synthesize anthropology, public health, and consumer behavior. She has a simple problem, how to teach children in sub-Saharan Africa to habitually wash their hands, thus lowering significantly the risk of many diseases. As Charles Duhigg writes, Curtis turned to consumer-goods companies for insight into her work.

She knew that over the past decade, many companies had perfected the art of creating automatic behaviors — habits — among consumers. These habits have helped companies earn billions of dollars when customers eat snacks, apply lotions and wipe counters almost without thinking, often in response to a carefully designed set of daily cues.

“There are fundamental public health problems, like hand washing with soap, that remain killers only because we can’t figure out how to change people’s habits,” Dr. Curtis said. “We wanted to learn from private industry how to create new behaviors that happen automatically.”

The companies that Dr. Curtis turned to — Procter & Gamble, Colgate-Palmolive and Unilever — had invested hundreds of millions of dollars finding the subtle cues in consumers’ lives that corporations could use to introduce new routines.

If you look hard enough, you’ll find that many of the products we use every day — chewing gums, skin moisturizers, disinfecting wipes, air fresheners, water purifiers, health snacks, antiperspirants, colognes, teeth whiteners, fabric softeners, vitamins — are results of manufactured habits. A century ago, few people regularly brushed their teeth multiple times a day. Today, because of canny advertising and public health campaigns, many Americans habitually give their pearly whites a cavity-preventing scrub twice a day, often with Colgate, Crest or one of the other brands advertising that no morning is complete without a minty-fresh mouth…

“Our products succeed when they become part of daily or weekly patterns,” said Carol Berning, a consumer psychologist who recently retired from Procter & Gamble, the company that sold $76 billion of Tide, Crest and other products last year. “Creating positive habits is a huge part of improving our consumers’ lives, and it’s essential to making new products commercially viable.”

Habits

Habitual behavior is one topic that concerns brain science, psychology, economics and anthropology, each with disciplinary specific ways of trying to explain these everyday patterns. However, most of those explanations have two flaws: some variety of rationality as the way to understand habits, and some causal force (e.g., genetics, reward, subjective utility, culture) as forming the pattern. But things are not quite so simple, as “Habits May Be Good For You” shows:

Those and other studies revealed that as much as 45 percent of what we do every day is habitual — that is, performed almost without thinking in the same location or at the same time each day, usually because of subtle cues.

For example, the urge to check e-mail or to grab a cookie is likely a habit with a specific prompt. Researchers found that most cues fall into four broad categories: a specific location or time of day, a certain series of actions, particular moods, or the company of specific people. The e-mail urge, for instance, probably occurs after you’ve finished reading a document or completed a certain kind of task. The cookie grab probably occurs when you’re walking out of the cafeteria, or feeling sluggish or blue…

“Habits are formed when the memory associates specific actions with specific places or moods,” said Dr. Wood, a professor of psychology and neuroscience at Duke. “If you regularly eat chips while sitting on the couch, after a while, seeing the couch will automatically prompt you to reach for the Doritos. These associations are sometimes so strong that you have to replace the couch with a wooden chair for a diet to succeed.”

The researchers at P.& G. realized that these types of findings had enormous implications for selling Febreze. Because bad smells occurred too infrequently for a Febreze habit to form, marketers started looking for more regular cues on which they could capitalize.

The perfect cue, they eventually realized, was the act of cleaning a room, something studies showed their target audience did almost daily. P.& G. produced commercials showing women spraying Febreze on a perfectly made bed and spritzing freshly laundered clothing. The product’s imagery was revamped to incorporate open windows and gusts of fresh wind — an airing that is part of the physical and emotional cleaning ritual.

“We learned from consumer interviews that there was an opportunity to cue the clean smell of Febreze to a clean room,” Dr. Berning said. “We positioned it as the finishing touch to a mundane chore. It’s the icing that shows you did a good job.”

In a sense, a product originally intended for use on piles of smelly, dirty clothes was eclipsed by its exact opposite — a product used when women confronted a clean and tidy living room. And the more women sprayed, the more automatic the behavior became.

Today, Febreze is one of P.& G.’s greatest successes. Customers habitually spray tidied living rooms, clean kitchens, loads of fresh laundry and, according to one of the most recent commercials, spotless minivans. In the most recent fiscal year, consumers in North America alone spent $650 million buying Febreze, according to the company.

Here we have cues, meaning (doing a good job), specific contexts, business and more, all wrapped up in one. Proctor & Gamble have a pragmatic knowledge of what works and what does not. While still not an explanation for habitual behavior, it does prove useful in applied anthropology.

The Anthropologist at Work

Val Curtis saw potential for this sort of approach, for trying to generate habits that would lead to public health outcomes rather than for-profit behavior change. The situation she confronted was not one of lack of resources or lack of cultural knowledge—providing more soap or educating them about germs were not the best solutions. Rather, it was taking advantage of what was already there.

For Dr. Curtis and the Global Public-Private Partnership for Handwashing With Soap, such tactics offered enormous promise in a country like Ghana.

That nation offered a conundrum: Almost half of its people were accustomed to washing their hands with water after using the restroom or before eating. And local markets were filled with cheap, colorful soap bars. But only about 4 percent of Ghanaians used soap as part of their post-restroom hand-washing regime, studies showed.

“We could talk about germs until we were blue in the face, and it didn’t change behaviors,” Dr. Curtis said. So she and her colleagues asked Unilever for advice in designing survey techniques that ultimately studied hundreds of mothers and their children.

They discovered that previous health campaigns had failed because mothers often didn’t see symptoms like diarrhea as abnormal, but instead viewed them as a normal aspect of childhood.

However, the studies also revealed an interesting paradox: Ghanaians used soap when they felt that their hands were dirty — after cooking with grease, for example, or after traveling into the city. This hand-washing habit, studies showed, was prompted by feelings of disgust. And surveys also showed that parents felt deep concerns about exposing their children to anything disgusting.

So the trick, Dr. Curtis and her colleagues realized, was to create a habit wherein people felt a sense of disgust that was cued by the toilet. That queasiness, in turn, could become a cue for soap.

A sense of bathroom disgust may seem natural, but in many places toilets are a symbol of cleanliness because they replaced pit latrines. So Dr. Curtis’s group had to create commercials that taught viewers to feel a habitual sense of unseemliness surrounding toilet use.

Their solution was ads showing mothers and children walking out of bathrooms with a glowing purple pigment on their hands that contaminated everything they touched.

The commercials, which began running in 2003, didn’t really sell soap use. Rather, they sold disgust. Soap was almost an afterthought — in one 55-second television commercial, actual soapy hand washing was shown only for 4 seconds. But the message was clear: The toilet cues worries of contamination, and that disgust, in turn, cues soap.

“This was radically different from most public health campaigns,” said Beth Scott, an infectious-disease specialist who worked with Dr. Curtis on the Ghana campaign. “There was no mention of sickness. It just mentions the yuck factor. We learned how to do that from the marketing companies.”

The ads had their intended effect. By last year, Ghanaians surveyed by members of Dr. Curtis’s team reported a 13 percent increase in the use of soap after the toilet. Another measure showed even greater impact: reported soap use before eating went up 41 percent.

In other words, changing a proximate behavior was the key to getting a larger outcome. The process mattered. Not changing the genetics, psychology, economics, or culture. The one-cause approach did not prove useful in trying to design an effective campaign. Instead, Val Curtis, as she argues in a recent article, focuses on behaviors and emotions in context and how those get connected into belief systems—biological anthropology and cultural anthropology need to work together.

Larger Application

Other researchers and public health officials are already getting on the bandwagon, as Charles Duhigg reports in the conclusion to his article:

Today, public health campaigns elsewhere for condom use and to fight drug abuse and obesity are being revamped to employ habit-formation characteristics, according to people involved in those efforts. One of the largest American antismoking campaigns, in fact, is explicitly focused on habits, with commercials and Web sites intended to teach smokers how to identify what cues them to reach for a cigarette.

“For a long time, the public health community was distrustful of industry, because many felt these companies were trying to sell products that made people’s lives less healthy, by encouraging them to smoke, or to eat unhealthy foods, or by selling expensive products people didn’t really need,” Dr. Curtis said. “But those tactics also allow us to save lives. If we want to really help the world, we need every tool we can get.”

Here at Neuroanthropology, Greg has addressed how understanding behavior, particularly skilled, habitual actions, can lead to improvements in physical education and in preventing falls in elderly people.

I have not spoken much here about how this sort of approach applies to addiction (it does!), but certainly compulsive substance abuse represents a cycle of behaviors and experiences that proves very difficult to break (especially when reinforced by inequality). However, I did lay out some larger patterns in globalization in Cellphones Save the World, and habits represent one major proximate (or everyday) aspect of those people-driven processes.

And for those of you wondering about the ethics of such a move, there is an interesting debate among readers over at the Economist’s View about the Duhigg article. Greg, in providing his own take on the article, speaks of his “ethical vertigo” in the switches back and forth between marketing “new needs” and public health campaigns. My off-the-cuff take? These techniques are already being used against us. Why don’t we put them to use in some more positive ways?

There are some major public health problems out there, and changing laws and raising awareness and all the other rationally-derived approaches have not had as much impact as we might hope. The habit approach might prove more effective.