Communication Currents

​​​​Motivating Adult Smokers to Kick the Habit: Fear Alone May Not Be Enough

February 1, 2009
Health Communication

During late-night TV commercials or in between songs on the radio, it is not uncommon for people to come across public service advertisements or PSAs. These messages are broadcast by TV and radio stations for the public good. Specifically, health-related PSAs try to persuade people to either start practicing healthier behaviors (e.g., eating more fruits and veggies, getting a mammogram) or break unhealthy habits (e.g., smoking, drug use). Although health-related PSAs use a variety of appeals, the most common approach is to scare people into changing their unhealthy lifestyles.  

Fear appeals are persuasive messages designed to arouse fear by describing the negative outcomes that people will experience unless they stop risky behaviors or start practicing healthier behaviors. Decades of research show that such appeals are effective at motivating behavior change across a wide domain of health behaviors. In fact, fear appeals are argued to be most effective at promoting behavior change when perceived efficacy is high. That is, the more people believe they can do something to reduce their threat, the more effective the fear appeal.  

The Extended Parallel Process Model, formulated by communication expert Kim Witte, sheds light on how fear appeals work to motivate behavior change. More importantly, the model specifies conditions under which fear appeals work and conditions under which they fail. For example, simply showing smokers an image of black lungs or a smoker hooked up to a ventilator on a hospital bed as ways of scaring smokers into quitting will not work by itself. People are likely to just turn away from these frightening images to reduce their fear. In addition to scaring smokers with frightening images, they need to be provided with solutions for how they can quit smoking. For example, showing a smoker calling a quit line or using a nicotine replacement product to help him or her quit successfully would make the fear appeal message more likely to work.  

A recent study by Norman C. H. Wong and Joseph N. Cappella sought to test the Extended Parallel Process Model using PSAs that highlighted the risks of smoking and the risks of not kicking the habit. For example, one ad talked about how smoking harms the brain and causes strokes to occur by showing blot clots that occur in a smoker's brain. Another ad talked about how smoking is socially unacceptable by showing a smoker being tricked into leaving a bar alone by an attractive patron. Along with the PSAs, ads that promoted solutions for helping smokers quit were also used. For example, one ad talked about how one smoker, Chuck, was able to quit by calling a quit line. Another ad was a commercial for the Commit Lozenge (a nicotine replacement product) that talked about how smokers double their chances of quitting by using the product rather than doing it cold turkey. All of the ads were shown in various combinations to determine their effects on smokers' intentions to quit or seek help quitting.  

Participants in the study were adult smokers—some of whom were ready to quit, others who were more reluctant to do so. These smokers were assigned to watch one of two conditions: a high threat antismoking ad or a low threat antismoking ad. Both ads were followed by either an ad for a nicotine lozenge, an ad urging the smoker to call a quit line, or no ad at all. After viewing the ads, participants were asked to respond to a survey measuring their readiness to quit smoking, intentions to quit, intentions to seek help to quit, the degree of threat they perceived in the ad, and how effective they perceived the ad to be.  

The results of the study yielded several interesting findings. Intentions to seek help for quitting were highest among those who felt at risk because of their smoking and felt confident that calling the quit line or using the nicotine lozenge would make quitting easier. For smokers who were not ready to kick the habit, it was important for them to both feel at risk because of their smoking and confident in the solution promoted to help them quit successfully. Interestingly, among smokers with a high readiness to quit, the key motivator for these individuals was to feel confident in their abilities to quit successfully by either calling the quit line or using the lozenge. This makes sense because such individuals already feel their health is at risk due to smoking. They need to feel reassurance that they can quit successfully using either a nicotine replacement product or calling the quit line.  

A noteworthy finding was that on average, the smokers in this study perceived both the quit line ad and the nicotine lozenge ad to be low in efficacy (i.e., neither ad really made them feel any easier about quitting smoking).  

The findings from this study could be used to more effectively promote smoking cessation. First, it is important for public health campaigns aimed at reducing smoking to create ads that include both information that highlights the risks of smoking, and effective strategies for quitting in the same message. Second, a smoker's readiness to quit may be used to help design more personalized messages for smokers who are ready to kick the habit (placing more emphasis on the solutions for quitting and acknowledging their desire to quit) and for smokers not ready to quit (placing more emphasis on the reasons why they should quit and directing them to sources where they can take the first step to quitting, such as calling a quit line). Above all, antismoking campaigns should continue to use emotionally evocative messages to urge smokers to quit. Emotional messages push those with low readiness to quit to think about quitting, and serve as a reminder to those with high readiness to quit to make a plan to kick the habit for good.

About the author (s)

Joseph N. Cappella

University of Pennsylvania

Gerald R. Miller Professor