That’s the 54-million-dollar question. The CDC is betting they do, and has launched a series of graphic ads, featuring real smokers, to answer it. Entitled “Tips from Former Smokers,” the videos show what it’s like to live in the aftermath of health disasters caused by smoking. The series can be viewed here: http://www.cdc.gov/tobacco/campaign/tips/resources/videos/
But do scare tactics really work? There have been reams of studies to fuel the debate, on a wide variety of topics ranging from dental hygiene in the 1950s to the more recent DARE and gruesome pre-prom efforts in high schools nationwide. The short answer is: it depends.
According to a FastCompany article from 2005 entitled “Change or Die,” the odds of you making a difficult and enduring behavioral change that would literally save your life are 9 to 1. That’s a hard, scientific fact: people would rather die than change their behavior. Want proof? Dr Edward Miller, Johns Hopkins University medical school dean and hospital CEO, studied patients whose heart disease was so severe they underwent bypass surgery. Bypass surgery is traumatic, expensive, and temporary. Half the time, the grafts clog up in just a few years—mostly due to the fact that 90% of coronary-artery bypass patients do not change their lifestyle, despite the fact that they could avoid the pain and need for repeated surgery—never mind arrest the course of their disease before it kills them—simply by switching to a healthier lifestyle.
Part of the reason that traditional death threats don’t work is because people fall back on denial. When a heart attack happens, patients are scared enough to follow doctor’s orders for a few weeks. After that, death becomes too frightening to think about, denial returns, and old lifestyle habits come back.
OK, you say, so that’s heart attacks. That’s a one-time (hopefully) event. Smoking is a chronic behavior. Isn’t that different? Well, sort of. One could argue that it’s even harder to scare someone out of a chronic habit, as magical thinking dictates that if it hasn’t happened so far, it probably won’t. Then again, if you haven’t started smoking yet, would a fear-based message help prevent you from starting altogether?
An article in Prevention First from 2008 seems to say the answer to the last question is an emphatic NO. In assessing numerous studies aimed at preventing alcohol, tobacco, or other drug use in youth, Prevention First concluded that scare tactics are not effective in preventing teens from trying certain behaviors because:
- The audience doesn’t believe the fear appeal or scare tactic, as they do not match their own personal experience
- Audiences ignore or minimize the importance of negative, sensational information
- Messages that emphasize guilt, tension, or anxiety motivate the audience to ignore or minimize the importance of the threat
- Scare tactics may result in a feeling of powerlessness—“I can’t control that, so why bother trying?”
- Young audiences feel invincible, and think “that won’t happen to me”
- Messages may have the opposite effect in risk-taking individual
However, what if you could develop a compelling campaign that utilized scare tactics in a unique way to empower the audience to change? Enter the Truth Campaign. Originally created in 1998 to market antismoking, anti-industry messages to teenagers in Florida, the campaign was taken nationwide in 2000 by the American Legacy Foundation. This campaigned harnessed the $100-million power of Legacy and hard-hitting creativity to address the “truth” behind tobacco. One of its most memorable and effective ads showed a group of teens pulling up to the Philip Morris headquarters in NYC and stacking 1200 body bags on the sidewalk outside. All throughout, someone was yelling into a megaphone that these body bags represented the number of people killed by smoking every day. Other ads focused on diseases caused by smoking, toxic ingredients in cigarettes, and pointed out that cigarette companies profited by selling products that killed people. As a result of these and similar ads, teen smoking decreased in the 2000-2002 timeframe that the campaign ran.
So why was this fear-based campaign successful, when so many others were not? The answer lies in the approach. Unlike campaigns that simply threatened the viewer with horrible consequences, this one turned not smoking into a statement against industry power, manipulation, and authority, appealing to the teen desire to rebel. The use of fear was focused and channeled towards making the audience outraged at the tobacco companies for using them. Body bags were symbolic of death, but not their death. The diseases were caused by tobacco company tricks, and were signs of corporate indifference. The audience was empowered to do something after viewing these ads—specifically, to not smoke.
But what if you were already a smoker? Would fear tactics work on you? An Australian study suggests that they might. In 1997, the Australian minister of health assigned a commission to take on current smokers by reviewing 40 years of psychological research and reports commissioned by various Quit campaigns. The resulting campaign used insights that showed a “personal agenda” approach would work best. Utilizing graphic medical imagery, the ads crafted a connection between the desire to smoke and the inevitable medical consequences of doing so. One ad showed fatty deposits being squeezed by a surgeon’s hand from a human aorta. Another took the viewers along as inhaled smoke traveling into the lungs, where it begins to rot them. Each of these scenes was followed by a typical “smoker’s moment” showing someone lighting up and inhaling, apparently ignorant of the damage being done. By focusing on relatively certain rather than uncommon events, the campaign was able to show in real time that “every cigarette is doing you damage” and to make it relevant to the here and now, rather than the distant future. Now, there was a tangible connection between deciding to smoke and what that decision did to your body. Every time you lit up, you thought about that and maybe decided the damage wasn’t worth it. So how did this campaign do? In testing, it scored the highest among its target audience when compared with approaches that elicited a less visceral reaction, and with antismoking ads created by tobacco companies themselves. An evaluation of Phase I showed that three out of five smokers and ex-smokers said the campaign encouraged them to stay off or quit cigarettes. Also, the yearly quit rate increased from 19% to 24% following the campaign—meaning that the increase in the number of those attempting to quit rose by 20,000 smokers
So will the CDC effort bear fruit? It has many of the traits that made the aforementioned smoking campaigns successful: it shows real-time consequences, uses real people to underscore that indeed, this could happen to you; and isn’t overly threatening or dramatic. Most importantly, like the “trust” campaign and the “every cigarette does damage” campaign, the scare part is focused and relevant to the audience—a conduit to the main message instead of the whole message. The smokers featured are on the young side—diagnosed in their 30s and 40s—ages that aren’t considered “old,” people who are easy to relate to. The tonality is straightforward and real: these people really, really, really wish they had never started smoking. They genuinely seem to want to make sure you don’t. Or that if you do, that you stop before you look like they do. It’s strong stuff, but I’d argue it’s not traditionally fear-based. While showing the awful aftereffects of smoking, there’s an emotional connection there that makes the threat more real, as you can so readily empathize with the narrators. You like them, and you don’t want to be them. And therein lies the real power of these former smokers: by quitting the very thing that damaged them so much, you don’t have to be.
- Centers for Disease Control and Prevention. Smoking and tobacco use. Available at: www.cdc.gov/tobacco. Accessed April 18, 2012.
- Deutschman A. Change or Die. Available at www.fastcompany.com. Accessed April 18, 2012.
- Prevention First. Ineffectiveness of fear appeals in youth alcohol, tobacco, and other drug (ATOD) prevention. Springfield, IL: Prevention First. 2008.
- Apollonia DE, Malone RE. Turning negative into positive: public health mass media campaigns and negative advertising. Health Educ Res. 2009;24(3):483-495.
- Hill D, Chapman S, Donovan R. The return of scare tactics. Tab Control. 1998;7:5-8.