Fear Appeals in Anti-Tobacco Campaigns: Cultural Considerations, the Role of Fear, Proposal For an Action Plan

ABSTRACT - While fear appeals messages have become an important consideration in social marketing studies, little has been done outside the anglo-saxon culture and in the tobacco health context to evaluate their efficiency. This article deals with the use of scare tactics in French anti-tobacco prevention. Whereas most practitioners are reluctant to use this strategy, results of our study show that French young people do appreciate fear appeal messages. Concerning mechanisms underlying persuasion, findings reveal that fear and self-efficacy play central roles in explaining intentions. We also observe that the cessation program proposed to smokers is not sufficient to help them quitting their habits.

Citation:

Karine Gallopel and Pierre Valette-Florence (2002) ,"Fear Appeals in Anti-Tobacco Campaigns: Cultural Considerations, the Role of Fear, Proposal For an Action Plan", in AP - Asia Pacific Advances in Consumer Research Volume 5, eds. Ramizwick and Tu Ping, Valdosta, GA : Association for Consumer Research, Pages: 274-279.

Asia Pacific Advances in Consumer Research Volume 5, 2002      Pages 274-279

FEAR APPEALS IN ANTI-TOBACCO CAMPAIGNS: CULTURAL CONSIDERATIONS, THE ROLE OF FEAR, PROPOSAL FOR AN ACTION PLAN

Karine Gallopel, UniversitT de Rennes, France

Pierre Valette-Florence, UniversitT Pierre MendFs-France, France

ABSTRACT -

While fear appeals messages have become an important consideration in social marketing studies, little has been done outside the anglo-saxon culture and in the tobacco health context to evaluate their efficiency. This article deals with the use of scare tactics in French anti-tobacco prevention. Whereas most practitioners are reluctant to use this strategy, results of our study show that French young people do appreciate fear appeal messages. Concerning mechanisms underlying persuasion, findings reveal that fear and self-efficacy play central roles in explaining intentions. We also observe that the cessation program proposed to smokers is not sufficient to help them quitting their habits.

In response to Andreasen (1993), Latour and Snipes (1996) and Laroche, Toffoli, Zhang and Pons (2001) who propose to stimulate research by applying the principles and concepts of social marketing outside the traditional anglo-saxon context, we study here French anti-tobacco scare tactics. There are three principal reasons why we think this topic is worth the analyze we propose.

The first one refers to the uncertainty about the way fear-arousing messages work. Fear has bee studied in many health contexts, and a recent meta-analysis concluded that "the stronger the fear appeal, the greater attitude, intention, and behavior changes" (Witte and Allen, 2000). However, other studies have led to inconsistent results. This lack of convergence in findings shows that the way fear can influence responses is not very well known.

The second reason of this study is that cigarette consumption in France is very high (34% of people regularly smoke compared to 20% in the United States) and, as a consequence, 60 000 people die every year because of tobacco. In this paper, we focus on young people who are a very involved target in tobacco practices (50% of French male and 55% of French female people aged of 18 regularly smoke).

The third reason for studying fear appeals messages is that most French practitioners consider that scare tactics used in many Anglo-Saxon countries do not "fit" "Latin culture". However, an exploratory studys implemented on a French young sample revealed on the opposite that anti-tobacco campaigns would be more efficient if they used scared tone, emotional appeal and realistic stories (Gallopel and Petr, 2000).

The first part of this paper provides background informations are needed on research in scare tactics. Note that it is not our intent to present a full review on fear literature [For a review of fear literature, see Higbee (1969), Sternthal and Craig (1974), Sutton (1982), Mongeau (1991), Chapman (1992) and Witte and Allen (2000).]. Next, the study implemented to test threatened messages on a French target and results will be described. Finally, a discussion about outcomes will conclude this paper.

FEAR-AROUSING MODELS IN ANTI-TOBACCO CONTEXTS

The principle of scare prevention is to associate a practice (smoking) with a threatened negative consequence (lung cancer) in order to generate fear experienced as apprehension, uncertainty and the feeling of danger (Izard and Buechler, 1989).

Past research efforts have been done to provide theory for the process of influencing attitude, intentions and behavior through fear. However, in spite of the seriousness of the smoking problem, consumer researchers have generally made scant contribution to this social marketing issue (Fox and Kotler, 1981).

In the context of tobacco, fear was first viewed as a facilitator to message acceptance (Niles, 1964, Janis and Mann, 1965, Insko, Arkoff and Insko, 1965). By contrast, Janis and Terwilliger (1962), Leventhal and Niles (1964) highlighted a negative relationship between fear and recall, attitude toward anti-tobacco behavior and intentions to quit smoking, whereas Leventhal and Watts (1966) concluded to a negative or no relationship between threat and intentions to take X-ray for smokers, a positive one for non smokers, and a positive link between fear and real behavior. Several theoretical models were proposed to explain these inconsistent results. Leventhal (1970) proposed the "parallel process model" in which two reactions occur with fear appeals message: a cognitive process ("danger control process") where people focus on existing ways to avert the threat (quitting smoking), and an emotional process ("fear control process") in which individuals develop denying and avoiding strategies to reduce their fear. Processes both occur but if the cognitive route is superior to the affective one, researchers assume acceptance of the recommendation (quitting smoking), whereas the contrary results in failure of the message. Later, the protection motivation model (PMM) focused on cognitive responses that conduct to message acceptance (the danger control process ) (Rogers, 1975). Many researchers highlighted that fear, generated through severity and susceptibility of a danger, is not sufficient to insure efficiency of a campaign. To improve persuasion, they suggested to include details on the efficiency of the recommended response (the efficacy dimension, i.e., quitting smoking significantly reduce risk of cancer ) and specific instructions that will rise the target’s ability to perform the response (the self-efficacy dimension, Bandura, 1977). As regard smoking, high levels in severity and susceptibility of the danger as well as high levels in efficacy and self-efficacy of the recommended response produce message acceptance (danger control process ) whereas high levels of threat and low levels of efficacy result in message rejection (fear danger process ) (Leventhal, Watts and Pagano, 1967, Rogers and Thistlethwaite, 1970, Rogers and Deckner, 1975, Rogers and Mewborn, 1976, Rogers, Deckner and Mewborn, 1978, Rosen, Terry and Leventhal, 1982, Maddux and Rogers, 1983).

To sum up, threatened anti-tobacco messages have been found to be effective if the recommended response is perceived as efficient and if perceived "self-efficacy" for the target is high. In the present time, those general hypothesis are well accepted by researchers. However, the relationship between threat and persuasion is not very simple and yet generates controversy among authors. Especially, they do not all agree on the role played by fear when fear control process or danger control process occurs. In the same way, the reason why people follow fear rather than danger control route is not very clear. So far, more research is needed to answer the question "how do fear-arousing messages work ?". The present study focuses on three main problems. We first evaluate the way French young people accept scare tactics messages. Note that this has never been evaluated before in such a cultural context. Second, to better understand the way fear influences persuasion, our study also investigates, on a target of smokers, the relationships between this negative emotion and reactions of rejection, intention to implement a cessation program and intention to quit smoking. Third, we study the effect of a real tobacco cessation program on intention to adopt the recommended response. Detailed hypothesis are described below.

RESEARCH QUESTIONS

Cultural considerations

It is essential to take into account the cultural dimension of social marketing practice if we want to improve it (Thompson, 1998). That is why we adopted an etic approach in our study. Such a framework enables researchers to better understand the cultural and conditions that underlie consumer resistance and differences. We started with exploratory studies on French practitioners and young people. Some of the French practitioners we questioned consider that fear-oriented strategies are not adapted to Latin culture for two main reasons. The first is related to the reactions of rejections that scare tactics can produce on people who feel attacked in their freedom of behavior (but such a belief has never been tested on a French sample). The second reason is an ethical one: some French practitioners consider that it is not acceptable to manipulate people. As a consequence, most of the time, anti-tobacco messages are educational, informative or humoristic. In order to evaluate French young people’s reactions, we used the results of a previous exploratory study on nine focus groups (48 respondents) which revealed that, in practice, the favorite anti-tobacco messages were described as high fear (Gallopel and Petr, 2000), so we postulate that higher threat will generate higher positive attitude toward an anti-tobacco message on a bigger sample (H1).

The Role of Fear in persuasion

Researchers do not agree on the role played by fear in the persuasion process. In the psychological literature, the importance of this negative emotion slowly declined: in the sixties, the "fear drive model" gives a central place to emotion whereas in the seventies and eighties, the cognitive models considered that fear has very few impact on responses. In the "Protection Motivation Model" for instance, only cognitive mediational processes (severity, susceptibility, efficacy and self efficacy) seem to explain the likelihood of engaging in the recommended response. Fear is seen as a facilitator variable whose role is to attract attention and to improve memory (Rogers, 1985). Several limits of these models have been pointed out by Witte (1998) and Tanner, Hunt and Eppright (1991) in the marketing literature. First, in focusing on cognitive appraisals that mediate persuasion, the link between fear and message rejections that can conduct to failure of a campaign (the fear control process ) was never studied (Witte, 1994). However, scare tactics sometimes involve negative reactions towards a message and it is important to understand the underlying mechanism in order to avoit it. Second, the link between fear and responses to the message when "danger control occurs" also needs further research. In recent models called the extended Parallel Process (Witte, 1994) and the "Ordered Protection motivation" (Tanner, Hunt and Eppright, 1991), researchers re-incorporate fear as a central component in explaining adaptive coping responses ("danger control route"). This orientation is consistent with recent developments in marketing literature where important and direct effects of emotion on consumer behavior have been demonstrated (Zajonc, 1968, Erevelles, 1998,).

Summarize, following recent proposals to re-consider fear as a central variable, we first postulate that this negative emotion can act as a motivator through a direct effect on final responses to message when "danger control route" occurs. More precisely, we assume that fear has a direct and positive influence on intention to adopt a cessation program proposed to smokers (H2a) and on intention to stop smoking (H2b). In addition, we take into account that while "fear control process" occurs, the stronger the fear, the stronger rejections of the message are experienced by respondents and, in turn, the less behavioral intentions are observed (Rippetoe and Rogers, 1987, Witte, 1994). In other words, we postulate that there is a positive influence of fear on the number of rejections expressed by respondents (H3a), a negative influence of the numbers of rejections on intention to adopt the specific program proposed to smokers to quit smoking (H3b) and on intention to quit smoking (H3c) (see figure 1).

The need for a cessation program to help smokers quitting

Fear can act as a motivator if smokers perceive quitting as an effective way to avoid the threat (efficacy ) and if they believe they are able to quit smoking (self-efficacy ). Concerning this recommended response, our exploratory studies showed that most people perceived giving up cigarettes as an efficient means to reduce the risk for developing cancers (perceived efficacy is high). However, given the physical and psychological addiction to tobacco, a large part of young smokers feel unable to stop their bad habit (Gallopel and Petr, 2000). In turn, self-efficacy is perceived as low and could generate failure of anti-tobacco campaigns. As a consequence, any research dealing with fear appeals communication has to focus on existing means that will rise self-efficacy for smokers (Leventhal, Singer and Jones, 1965, Janis, 1984, Leventhal, 1982, Maddux and Rogers, 1983, Prentice-Dunn and Rogers, 1986, Witte, 1994,).

In our study, we propose to build, with the help of experts in tobacco (doctors and health practitioners), a real and specific cessation program that could be proposed to smokers to help them stopping. We suggest that recommended response will be more easily adopted if an action plan is proposed to smokers and if it is perceived as efficient to help quitting. Thus, we wait for a positive influence of perceived efficacy of the action plan on intention to adopt the action plan (H4a) and on intention to quit smoking (H4b). Furthermore, we assume a positive impact of intention to adopt the action plan on intention to quit (H4c). In the end and according to theory, we suggest a positive influence of perceived self-efficacy on intention to adopt the action plan (H5a), on intention to adopt the recommended response (H5b) and, in addition, a negative influence of perceived self-efficacy on the number of rejections expressed by respondents (H5c) (see figure 1).

STUDY

Stimulus materials

In order to test French acceptance of scare tactics, three printed messages inducing different emotion of fear were created. They were built following Witte (1994), Raghubir and Menon (1998) Keller and Block (1996)’s recommendations. Their content was a compilation of existing anti-tobacco campaigns for pictures, slogans and testimonies. The "low fear" brochure contained less pictures on damages and less severe consequences compared to the "moderate fear" brochure or the "high fear" messages. In all printed messages, harmful outcomes were followed by the sentence "quit smoking" (the solution). Concerning the cessation program, we used a full behavior-modification action proposed by doctors and health practitioners of the university of Rennes to students from January to April 2001. It offered regular and free one-to-one counseling, free group sessions dealing with stress and tobacco , food and tobacco ..., free interactive counseling (through an e-mail address), and a competition (Quit and Win international competition: student who succeeds in his/her project to stop smoking during four weeks will be eligible to win prizes). An address and a number phone were given on the flyer for more information on the program.

FIGURE 1

INFLUENCE OF FEAR, PLAN EFFICACY AND SELF-EFFICACY ON RESPONSES TO ANTI TOBACCO MESSAGE

Subjects and procedure

Because students are a relevant target for tobacco issues, the sample consisted of 739 scientific undergraduate students of the state university of Rennes (France) (54% male, 46% female, 37% smokers, 63% non smokers, 19-20 years old for most of them). Participants were randomly exposed to either low- (240 people), moderate- (237 people) or high-fear (262 people) anti-tobacco message condition. Just before presenting the campaign, respondents were asked to fill out questions assessing their prior smoking behavior (non smoker / smoker / occasional / regular / motivation to stop). Then people were shown one out of the three brochures (without the action plan) and were asked to answer several questions. We used scale measures proposed by Witte (1994, 1998), Rippetoe and Rogers (1987), Tanner, Hunt and Eppright (1991), Keller (1999) and we adapted them to the French cultural context. [Two pretests were conducted on a limited (18) and a bigger sample (120 people). Some items from the original scales were taken off when questions were not well accepted nor understood by French respondents and when they reduced Cronbach=s coefficient.] All variables, except message rejections and refutations, were measured on 5-points Likert scale. As defensively avoiding responses are difficult to assess because they occur in someone’s head and differ among individuals, we rather used self-report method instead of scales to measure message rejections, following Eagly and Chaiken (1993), Witte (1998), McCrae (1984), Bagozzi and Moore (1994)’s procedures and recommendations. In our study, subjects were given two minutes to write down all the thoughts they had during the exposure. Later, these thoughts were classified in different categories using guidelines on the nature of discounting responses (Stuteville, 1970, Witte, 1998, Keller, 1999, McCrae, 1994), and number of rejections by respondents were next counted. The emotion of fear was measured using five adjectives (frightened, tense, nervous, anxious, and uncomfortable). Four items measured attitude toward the message (liked, disliked). Then, smokers were asked about their ability to quit smoking (self-efficacy, a single item). In a second step, the cessation program proposed by the health center of the university was presented. After reading it, smokers filled out questions on efficacy of the program (four items), their intentions to use it (four items) and their intentions to quit smoking (two items). Finally, respondents indicated their age and sex. [Severity, susceptibility of the threat and efficacy of the recommended response were also measured according to the Ordered Protection Motivation model (Tanner, Hunt and Effright, 1991). Results concerning these responses will not be presented here as we focused on fear and self-efficacy dimentions.]

Results

Manipulation checks. As exepcted, a significant main effect for threat messages was found on manipulated responses to the message. ANOVA’s procedure test revealed that increasing the threat also increased the feelings of fear (F=78,56, p<.0001). [Subjects exposed to the high-threat message feel more negative emotion (average=2,09) than did subjects exposed to the moderate-(average=1,53) or low-threat message (average=1.34).]

Research findings. According to Gallopel and Petr (2000), we found that higher threat significantly produce higher positive attitude toward anti-tobacco message (F=59,47, p<.0001), so H1 is validated. Structural equations were then performed on smokers in order to test other hypothesis (see table 1 for results). [Interelations of the independent variables were not estimated because they were manipulated independently in the factorial experiment.]

TABLE 1

RESULTS (H2a=>H5c)

Results show that when "danger control route" occurs, there is a positive impact of fear on intentions to adopt the cessation program (p<.05) and on intention to stop smoking (p=0.0734). Therefore, H2a and H2b are validated. Concerning the fear control route , we note a significant but negative link between fear and the number of rejections expressed by smokers. We expected a positive influence of fear on rejections, so H3a is not validated either. Moreover, there is no relationship between intention to adopt the action plan (H3b) and intention to quit smoking, so H3c is not validated.

Next hypotheses concerned the cessation program proposed to smokers and the self-efficacy dimensions of the recommended response (stop smoking). Analysis revealed a significant effect of plan efficacy on intention to adopt the plan but no effect on intention to quit smoking. Moreover, intention to adopt the action plan has no effect on intention to stop smoking. Therefore, H4a is validated whereas H4b and H4c are not. All relationships regarding self-efficacy are supported. This variable has a positive influence on intention to adopt the action plan (H5a), on intention to quit smoking (p=0.0536) (H5b), and a negative impact on the number of rejections (H5c).

DISCUSSION, LIMITATIONS AND IMPLICATIONS FOR FUTURE RESEARCH

Our research empirically shows that high fear messages generate positive attitude on the opposite to most French practitioners’ beliefs. Moreover, a negative relationship was observed between fear and the number of rejections by smokers whereas other studies revealed a positive relationship (Rippetoe and Rogers, 1987, Witte, 1994), This result could be explained by the repetition of informative or educational anti-tobacco messages in France over past years. Indeed, most of the time, French young people are widely exposed to low or moderate threat campaigns (that is to say informative campaigns). Such a repetition context could generate lassitude and more rejections when seeing this kind of campaigns in opposite to an unusual fear-arousing tone.

To better understand the way fear influences smokers, our study also investigated relationships between responses to anti-tobacco messages. Regarding the danger control route , a positive and direct influence of fear is measured on behavioral intention when the high-affectively target of smokers is concerned. These results are important because they highlight that the role played by fear in persuasion process in previous model is obviously too limited. Indeed, more than increasing attention and generating cognitive responses, the introduction of a negative emotion in a message has a positive and direct influence on persuasion when "danger control route" occurs on smokers. These conclusions are consistent with studies that shows the direct effect of emotion on responses to ads (Zajonc, 1968, Srull, 1984, Burke and Edell, 1989). In addition and concerning the fear control route , no relationship was observed between the number of rejections and the intention to quit smoking.

The last topic we tackle n this paper deals with solution appraisals. Our results reveal that, in a context of addictive behavior like tobacco, high self-efficacy is necessary to rise the intention to adopt a cessation program and the adaptive responses. This conclusion shows the importance to encourage smokers by proposing them an efficient cessation program if health practitioners want a campaign to be more efficient. Nevertheless, the specific program we used in our experiment does not significantly influenced smokers’ intention to stop. Two theoretical models could explain this result. The first one is the "Extended Parallel Process Model" (Witte, 1994, 1998). The author considers that when perceived efficacy and self-efficacy are superior to perceived severity and susceptibility of the threat, people engage in the "danger process control" (adaptive coping mode) whereas when perceived efficacy and self-efficacy are inferior to perceived threat, people feel unable to escape the threat and employ techniques that resolve dissonance crises and reduce the emotion of fear (the "fear process control"). In other words, Witte proposed a threshold that could explain failure or success of fear-arousing campaigns by comparing perceived threat to perceived efficacy. In our study, the cessation program may not be sufficient to rise smokers self-efficacy and thus, to reduce the emotion of fear. In future research, we encourage the use of more complete cessation programs including nicotine replacements (patch or chewing gum) and medicine for instance.

The second model that could explain our deceiving results is the Prochaska and DiClemente (1982)’s transtheoretical model. The authors posit that difficult behaviour change, such as giving up smoking, occurs in incremental stages of change . The key stages of change include precontemplation (smokers who have no plans to quit), contemplation (smokers who are considering giving up), preparation (smokers seriously consider quitting in the next 30 days), action (smokers who have recently quitted) and maintenance (ex-smokers). Anti-tobacco messages do not produce the same effects on people in precontemplation, contemplation, preparation, action or maintenance stages. Smokers in the precontempation stage are hostile to campaigns whereas smokers in the preparation stage are more receptive to a campaign whose aim is to change smoking behavior. Concerning our study, most smokers were in the precontemplation stage (65.7% of respondants were not really motivated to stop smoking). As a consequence and following the transtheoretical model, the best we can expect from a campaign is to create awareness or to reduce cigarette consumption, but not to generate intention to quit.

As in all studies, there exist some limitations in our experiment. The first concerns the tested sample: only young people (actually students) were questioned, which makes the generalization of our findings difficult. The second refers to the scale measures: it could have been interesting to measure intention to reduce cigarette consumption, behavior and self-efficacy after the presentation of the cessation program (in order to evaluate its efficiency).

In spite of these limitations, our study provides insights into how health services prevention influences, through fear appeals messages, the decision to stop smoking. More precisely, it reveals how fear influences responses to campaigns and how French young people react in front of threat messages. As health practitioners must engage in a world tobacco war, it is necessary to spot efficient international standards to persuade young people not to smoke. Our investigation suggested that scare tactics are quite interesting to fight against this scourge in global communication oriented toward French and Anglo-saxon targets.

We also noted many opportunities for future research. First of all, more scientific studies are needed to explore acceptance and efficiency of scare tactics strategy in other cultural backgrounds (Spanish, Italian, central and south America, East of Europe). Second, future research realized on tobacco will ave to target people in regard to the motivation to quit smoking. Furthermore, considering the stage of change and the degree of addiction would be certainly interesting to better understand the mechanisms underlying responses to fear-arousing messages. Finally, it would be important to evaluate a more complete cessation program and its effect on perceived young smokers self-efficacy.

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