Special Session Summary Making It Real: Antecedents and Consequences of Health Risk Perceptions

Nidhi Agrawal, New York University
Geeta Menon, New York University
[ to cite ]:
Nidhi Agrawal and Geeta Menon (2003) ,"Special Session Summary Making It Real: Antecedents and Consequences of Health Risk Perceptions", in NA - Advances in Consumer Research Volume 30, eds. Punam Anand Keller and Dennis W. Rook, Valdosta, GA : Association for Consumer Research, Pages: 205-207.

Advances in Consumer Research Volume 30, 2003     Pages 205-207



Nidhi Agrawal, New York University

Geeta Menon, New York University

Health risk perceptions play a major role in increasing people’s awareness about diseases and willingness to take preventive or corrective action to avoid or cure a disease. The inherent tendency is for people to assume that they are invulnerable, and therefore, one of the greatest challenges in advertising health-related information is making the threat of the disease real and enhancing the target audience’s perception of vulnerability to a disease. The literature has determined various factors and processes may influence health risk perceptions (Block and Williams 2001; Luce and Kahn 1999) ranging over memory factors (Raghubir and Menon 1998) and contextual factors that are used to frame the message (Block and Keller 1995; Menon, Block and Ramanathan 2002).

The three papers in this session added to the existing literature by examining internal factors such as a tendency to self-enhance, risk status and self-related constructs (e.g. self-construal), and external factors such as message characteristics and emotions. These papers demonstrated that the content of health-related messages and the way they are phrased can have a powerful impact on attitudes and behavior (Raghubir and Menon paper; Agrawal, Menon and Aaker paper). It was also shown that external factors such as the likelihood of someone else (e.g., a casual sex partner) engaging in a risky sexual behavior affect self-perceptions of risk of HIV (Sen, Bhattacharya and Johnon paper).

The first paper by Nidhi Agrawal, Geeta Menon and Jennifer Aaker examined the impact of internal factors such as self-construal and emotions on health risk perceptions, but moderated by an external factor, whether the ad asks people to think about themselves or their family. Existing literature suggests that people with a certain accessible self-construal are more likely to experience emotions related to that self-construal. The authors reported that messages that focus on self-construal compatible references (self versus family) are more effective in increasing self-risk perceptions, and that emotional states may make appeals with the compatible focus more effective. The second paper by Priya Raghubir and Geeta Menon studied the domain of depression, a physiological health problem that depends initially on self-diagnosis using self-reported psychological inventories (an external factor). Given that self-diagnosis is contingent on the measurement instrument, question construction and the nature and sequence of items are of critical importance. The authors demonstrated that risk perceptions and intentions to seek help are contingent on the interpretation of behaviors in the inventory, beliefs that behaviors are symptomatic of a disease and beliefs of how controllable a disease, which are further affected by the inclusion of extreme behaviors such as "thoughts of suicide/death", the order in which the behavioral symptoms are presented, and the range of response alternatives used. Finally, the third paper by Sankar Sen, C B Bhattacharya and Rose Johnson extended our session into the area of the consequences of proactive behaviors (like HIV testing) on subsequent health practices. They investigated the key prediction of an economic model of sexual behavior that widespread HIV testing can actually increase the willingness of those tested to engage in risky sexual practices.

Together, these papers underscored the importance of understanding how best to communicate health-risk issues to people who may have different response mechanisms in such a way as to affect their intentions to get tested and compliance behavior positively. In addition, Barbara Kahn’s comments as discussant helped tie together the various issues raised in these papers.



Nidhi Agrawal, New York University

Geeta Menon, New York University

Jennifer Aaker, Stanford University

This research seeks to identify self-construal related factors (emotions and advertising focus) that might affect the effectiveness of health-messages. It has been well documented across various domains that people’s self-perceptions are in general self-enhancing, even in the face of (adverse) reality (Perloff and Fetzer 1986; Weinstein 1980). If people underestimate the likelihood of contracting a disease and feel impervious to a disease, they might avoid information that would actually help them prevent the disease. On the other hand, if we can make people feel vulnerable to a disease, they might process disease-related information and may also be more likely to take pro-active measures to prevent it. Several studies in the area of health risk suggest that message cues (e.g., Menon, Block and Ramanathan 2002) and accessibility of information (Raghubir and Menon 1998) may systematically affect people’s self-risk perceptions. For example, it has been shown that messages that list frequently performed behaviors (that could lead to contraction of a target disease) are more effective than messages that list infrequent behaviors in increasing self-risk perceptions and concern about contracting the target disease. Prior research has shown that health risk perceptions are affected by the different emotions experienced by people (Salovey and Birnbaum 1989). For example, a message may increase self-risk perceptions by threatening positive emotions and/or eliciting negative emotions.

An increasing number of health related messages that ask the reader to think about the consequences of an unhealthy life for themselves or their close others underscore the importance of advertisement focus (self or family). The literature on self-construal suggests that people can see themselves as independent (i.e. unique and different from others) or interdependent (as part of a group). Consumers’ response to advertising may be influenced by the self-construal that is accessible at the time of decision-making. Several studies have shown that people with a certain accessible self-construals (independent vs. interdependent) are more likely to experience and respond to certain emotions (happy vs. calm). We suggest that ad appeals with different focus (self or family) might systematically affect the self-risk judgments of people with different self-construals and people experiencing different emotions. In three experiments, we examine the factors that might influence the effectiveness of appeals that are focused on the individual themselves or their families.

Our results suggest that appeals with a focus that is compatible with the self-construal of or emotion experienced by the person are more effective in increasing self-risk estimates and concern about contracting a disease (in this case, Hepatitis C). In study 1, we examine the effect of people’s self-construal on messages focused either on themselves or on their family. We find that people who had an independent (interdependent) self-construal were more responsive to messages with a self (family) focus. In subsequent studies, we extend these results by examining the effect of emotions experienced at the time of exposure to the message on health-risk perceptions. We demonstrate that when the experienced emotion is congruent with the subject’s self-construal, messages are processed more effectively, and perceptions of self-risk are higher. Additionally, people who were primed to feel happy (calm) were more responsive to self (family) focused appeals. By understanding the underlying process by which these mechanisms work, we are able to provide diagnostic theoretical and practical implications for health message communication.



Priya Raghubir, University of California, Berkeley

Geeta Menon, New York University

Depression is a common and sometimes serious disorder of mood that is pervasive, intense and attacks the mind and body at the same time. The DSM IV (2000, page 356) characterizes depression as a loss of interest or pleasure in activities a person enjoyed, and/or their feeling unusually sad or irritable over a two-week period. The presence of one or both of these symptoms, coexisting with 4 or more other symptoms (including sleep disturbances, decreased ability to concentrate, changes in appetite, feeling more tired than usual, feelings of guilt or worthlessness, restless or slowed activity, and thoughts about suicide or death), are the typical guidelines used to categorize a person as a depressive. Most depression inventories try to capture these symptoms. Depression belongs to the unique genre of physiological health problems that are initially diagnosed using self-reported psychological inventories. This context allowed us to examine the role of such inventories as survey method tools as well as persuasive devices leading to inferences that affect people’s judgment of their own risk and their likelihood of seeking treatment. In both roles, validity of the behavioral response is key.

The thesis of this paper is that the manner in which this information is captured, i.e., the format and content of self-diagnosis inventories, plays an informative role in disambiguating behavioral symptoms, systematically and significantly affecting people’s beliefs about whether or not they are at risk of being depressed, and whether or not their depressive symptoms are controllable, which in turn affects beliefs in their vulnerability to the risk of depression, and their likelihood of seeking treatment. The specific research questions investigated are:

$ To what extent do people correctly report behaviors symptomatic of depression?

$ To what extent do they believe that such behaviors are symptomatic of depression?

$ To what extent do they believe that such behaviors can be controlled through treatment?

$ Do these beliefs affect their intentions to seek medical assistance?

The results of five suggest that the manner of construction of the self-report inventory affects behavioral responses, risk estimates, beliefs in controllability, and intentions to seek help. Study 1 starts by showing that merely administering an inventory has a positive persuasive effect, and increases people’s perception of their own risk. Studies 2-5 examine the effect of the inclusion/exclusion of a single extreme behavior symptomatic of depression (thoughts of suicide or death) along with an 8-item inventory. Given the ambiguity of the remaining 8 behavioral symptoms, Study 2 shows that the use of subjective frequency scales versus checklists in recording behavioral responses increases affirmative responses to behavioral symptoms and risk estimates. Studies 3 and 4 examine the effect of the extreme behavior in the checklist: they demonstrate that its presence allows potential for reinterpreting the remaining behavioral symptoms, allowing respondents to self-select out of the "at-risk" category. While Study 3 shows that the extreme behavior reduces the diagnosticity of the behavioral responses of the 8 other behavioral symptoms in the list, Study 4 shows that the behavioral symptom, "thoughts of suicide or death," is a double-edged sword, with its presence persuading people that the symptoms of depression are more controllable. This positive effect on risk estimates conflicts with the negative effect on perceived controllability, leading to ambiguous effects on intentions to seek help. Study 5 introduces a contextual manipulation that overcomes the negative effect of retaining the extreme behavior on the self-diagnosis inventory and demonstrates the effect of response scales provided on intentions to seek assistance. Across the studies, there is strong evidence that the manner in which one asks a question affects the manner of use of a self-diagnosis inventory, and, further, affects the manner in which the inventory is used to make judgments about the risk of depression.



Sankar Sen, Boston University

C.B. Bhattacharya, Boston University

Rose Johnson, Strategic Business Research Inc.

In the absence of either a cure or a vaccine, behavior modification continues to be the primary means of harnessing the deadly AIDS epidemic. Since the human immunodeficiency virus (HIV) is transmitted primarily through sexual contact, this has lead to an urgent, universal and sustained call for the adoption of safer sexual practices. Central to this preventive strategy is the issue of HIV testing. Spurred by the belief that HIV status awareness is a key motivator for the adoption of risk reduction measures, several public health agencies and policy makers have called for widespread, and even mandatory, testing for the antibodies to the human immunodeficiency virus (HIV testing) as a primary means of modifying high risk behavior.

However, there is considerable controversy regarding the beneficial effects of HIV testing on behavior modification, both at the empirical and theoretical levels. In this research, we investigate the key prediction of an economic model of sexual behavior (Philipson & Posner 1993) that widespread HIV testing can actually increase the willingness of those tested to engage in risky sexual practices. At the heart of this model is the widely adopted notion that eery individual’s incentive to engage in risky sex is articulated in terms of the benefits they receive from such behavior (e.g. increased pleasure for self or partner) minus the expected costs of such behavior (e.g. inconvenience of wearing a condom, contracting HIV). If the probability of contracting HIV from a sexual partner is high, the costs will clearly far outweigh the benefits. However, in situations where an individual’s estimate of the probability that his/her prospective partner is infected is very low (e.g. 1/5000), the benefits may well outweigh the now discounted costs of risky sex with this partner. This model predicts that HIV testing increases the demand for potentially infective behavior whether or not a person tests negative or positive (see Philipson & Posner 1993 for details).

We investigate the ability of this model to accurately predict the behavioral consequences of HIV testing among undergraduate college students. In two experiments, we use projective scenarios to examine the effect of subjects’ estimates of both their own risk for HIV infection as well as that of a potential casual sex partner on their likelihood of engaging in risky sexual behavior. In particular, we focus on predicted changes in the protagonist’s likelihood of engaging risky sex caused by his knowledge of both his own HIV risk status (i.e. HIV-positive or HIV-negative) as well as that of his prospective partner. The findings of the two studies together establish the notion that HIV-testing can, under certain circumstances, lead to an increase in risky sexual behavior. Specifically, not only are members of a high-risk groupByoung heterosexualsBmore likely to engage in risky sex when they perceive themselves to have a low infection likelihood and their partner tests negative for HIV, but also their partners’ likelihood of engaging in risky sex with them does not diminish due to their negative test status. Moreover, we find that this risky sex-enhancing dynamic is restricted primarily to those with more permissive attitudes toward casual sex. The second study also examines the moderating effect of HIV-testing communication on the HIV testingBrisky sex relationship to find predictable reductions in risky sex intent upon exposure to specific HIV-testing and post-test behavior messages. This study also demonstrates that in making a risky sex decision, this population takes into consideration the costs of infection not only to themselves but also to their partners, even in a casual sex setting.


Block, Lauren and Punam Anand Keller (1995), "When to Accentuate the Negative: The Effects of Perceived Efficacy and Message Framing on Intentions to Perform a Health Related Behavior," Journal of Marketing Research, 32(May), 192-203.

Block, Lauren and Patti Williams (2001), "Undoing the Effects of Seizing and Freezing: Decreased Defensive Processing of Personally Relevant Messages," Journal of Applied Social Psychology, forthcoming.

Luce, Mary Frances and Barbara E. Kahn (1999), "Avoidance or Vigilance? The Psychology of False Positive Test Results," Journal of Consumer Research, 26 (December), 242-259.

Menon, Geeta, Lauren Block and Suresh Ramanathan (2002), "We’re at as Much Risk as We’re Led to Believe: Effects of Message Cues On Judgments of Health Risk," Journal of Consumer Research, 28 (March), 533-549.

Perloff, Linda S. and Barbara K. Fetzer (1986), "Self-Other Judgments and Perceived Vulnerability of Victimization," Journal of Personality and Social Psychology, 50, 502-510.

Philipson, Tomas J. and Richard A. Posner (1993), Private Choices and Public Health: The AIDS Epidemic in an Economic Perspective, Cambridge, MA: Harvard University Press.

Raghubir, Priya, and Geeta Menon (1998), "AIDS and Me, Never the Twain Shall Meet: The Effects of Information Accessibility on Judgments of Risk and Advertising Effectiveness, Journal of Consumer Research, 25 (June), 52-63.

Salovey, Peter, and Deborah Birnbaum (1989), "Influence of Mood on Health Relevant Cognitions," Journal of Personality and Social Psychology, 57 (September) (3), 539-551.

Weinstein, Neil D. (1980), "Unrealistic Optimism About Future Life Events," Journal of Personality and Social Psychology, 39 (October), 806-820.