The effects of repeated exposure to graphic fear appeals on cigarette packages: A field experiment.

Experimental studies on the effects of graphic fear appeals on cigarette packages typically expose smokers in a single session to a fear appeal, although in practice the exposure is always repeated. The present study applied an improved study design with repeated exposure to fear appeals on cigarette packages. In this field-experiment, 118 smokers were assigned to 1 of 2 conditions with either graphic fear appeals or textual warnings on their cigarette packages. During 3 weeks, fear and disgust were assessed 6 times. The intention to quit smoking after 3 weeks and quitting activity during the 3 weeks were the dependent measures. The effects of 3 pretest individual difference moderators were tested: disengagement beliefs, number of cigarettes smoked a day, and readiness to quit. Three weeks of exposure to the graphic fear appeals led to a stronger intention to quit, but only when smokers scored low on disengagement beliefs, or were heavier smokers. In addition, smokers low in disengagement more often reported to have cut down on smoking in the graphic condition. There were no indications of habituation of fear and disgust over the 3 weeks. The effects of graphic fear appeals depended on smokers' characteristics: The moderators may explain the mixed findings in the literature. The lack of habituation may be caused by the renewal of the graphics every few days. The used field-experimental design with natural repeated exposure to graphics is promising.

[1]  Jonathan Van ’t Riet,et al.  Defensive reactions to health-promoting information: an overview and implications for future research , 2013 .

[2]  Gerjo Kok,et al.  Threatening communication: a critical re-analysis and a revised meta-analytic test of fear appeal theory , 2013, Health psychology review.

[3]  J. Thrasher,et al.  College student reactions to health warning labels: sociodemographic and psychosocial factors related to perceived effectiveness of different approaches. , 2011, Preventive medicine.

[4]  David Hammond,et al.  Health warning messages on tobacco products: a review , 2011, Tobacco Control.

[5]  Lyndall G. Steed,et al.  Does exposure to cigarette health warnings elicit psychological reactance in smokers , 2011 .

[6]  Scot Burton,et al.  Understanding how Graphic Pictorial Warnings Work on Cigarette Packaging , 2010 .

[7]  Kevin K. John,et al.  Adolescents' Attention to Traditional and Graphic Tobacco Warning Labels: An Eye-Tracking Approach , 2010, Journal of drug education.

[8]  Fred Vultee,et al.  When a Fear Appeal Isn't Just a Fear Appeal: The Effects of Graphic Anti-tobacco Messages , 2010 .

[9]  R. Ruiter,et al.  Increased attention but more efficient disengagement: neuroscientific evidence for defensive processing of threatening health information. , 2010, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[10]  James F. Thrasher,et al.  Impact of graphic and text warnings on cigarette packs: findings from four countries over five years , 2009, Tobacco Control.

[11]  A. Dijkstra,et al.  Disengagement beliefs in smokers: Do they influence the effects of a tailored persuasive message advocating smoking cessation? , 2009, Psychology & health.

[12]  Glenn Leshner,et al.  Scare' Em or Disgust 'Em: The Effects of Graphic Health Promotion Messages , 2009, Health communication.

[13]  Tina M. Lowrey,et al.  The Effectiveness of Cigarette Warning Label Threats on Nonsmoking Adolescents , 2009 .

[14]  P. Quester,et al.  Impact on the Australian Quitline of new graphic cigarette pack warnings including the Quitline number , 2009, Tobacco Control.

[15]  Joseph N. Cappella,et al.  Antismoking Threat and Efficacy Appeals: Effects on Smoking Cessation Intentions for Smokers with Low and High Readiness to Quit , 2009, Journal of applied communication research : JACR.

[16]  E. Volchan,et al.  Avoidance of smoking: the impact of warning labels in Brazil , 2008, Tobacco Control.

[17]  E. Borgida,et al.  Effects of Including a Graphic Warning Label in Advertistements for Tobacco Products: Implications for Persuasion , 2008 .

[18]  hris,et al.  Effects of Including a Graphic Warning Label in Advertisements for Reduced-Exposure Products : Implications for Persuasion and Policy , 2008 .

[19]  James F. Thrasher,et al.  Estimating the impact of different cigarette package warning label policies: the auction method. , 2007, Addictive behaviors.

[20]  K. Mccaul,et al.  The motivational effects of thinking and worrying about the effects of smoking cigarettes , 2007 .

[21]  Peter R Harris,et al.  Self-affirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[22]  Paul Slovic,et al.  The impact and acceptability of Canadian-style cigarette warning labels among U.S. smokers and nonsmokers. , 2007, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[23]  R. Engels,et al.  Excuses to continue smoking: the role of disengagement beliefs in smoking cessation. , 2006, Addictive behaviors.

[24]  Hyunyi Cho,et al.  Fear Appeals for Individuals in Different Stages of Change: Intended and Unintended Effects and Implications on Public Health Campaigns , 2006, Health communication.

[25]  P. Sheeran,et al.  Does changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. , 2006, Psychological bulletin.

[26]  Arie Dijkstra,et al.  A match-mismatch test of a stage model of behaviour change in tobacco smoking. , 2005, Addiction.

[27]  R.H.M. Timmers,et al.  Images as anti-smoking fear appeals. The effect of emotion on the persuasion process , 2006 .

[28]  Arie Dukstra,et al.  Physical threat and self-evaluative emotions in smoking cessation , 2005 .

[29]  G. Kok,et al.  Saying is not (always) doing: cigarette warning labels are useless. , 2005, European journal of public health.

[30]  Roy Cameron,et al.  Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers. , 2004, American journal of public health.

[31]  G. Fong,et al.  The Impact of Cigarette Warning Labels and Smoke-free Bylaws on Smoking Cessation , 2004, Canadian Journal of Public Health.

[32]  A. Dijkstra,et al.  Worry about health in smoking behaviour change. , 2003, Behaviour research and therapy.

[33]  M. Zanna,et al.  Enhancing the effectiveness of tobacco package warning labels: a social psychological perspective. , 2002, Tobacco control.

[34]  John J. B. Allen,et al.  The Role of Affect in the Mere Exposure Effect: Evidence from Psychophysiological and Individual Differences Approaches , 2001 .

[35]  M. Allen,et al.  A Meta-Analysis of Fear Appeals: Implications for Effective Public Health Campaigns , 2000, Health education & behavior : the official publication of the Society for Public Health Education.

[36]  Hein de Vries,et al.  Self-efficacy expectations with regard to different tasks in smoking cessation , 2000 .

[37]  G. Kok,et al.  Self-Evaluation and Motivation To Change: Social Cognitive Constructs In Smoking Cessation , 1999 .

[38]  P. Cleary,et al.  Perceived risks of heart disease and cancer among cigarette smokers. , 1999, JAMA.

[39]  J. Beck,et al.  Repeated exposure to interoceptive cues: does habituation of fear occur in panic disorder patients? A preliminary report. , 1997, Behaviour research and therapy.

[40]  D. Krugman Do adolescents attend to warnings in cigarette advertising? An eye-tracking approach , 1994 .

[41]  J. Hollis,et al.  Biochemical validation of smoking status: pros, cons, and data from four low-intensity intervention trials. , 1993, Addictive behaviors.

[42]  John C. Norcross,et al.  In Search of How People Change: Applications to Addictive Behaviors , 1993 .

[43]  K. Witte Putting the fear back into fear appeals: The extended parallel process model , 1992 .

[44]  Shelly Chaiken,et al.  Defensive Processing of Personally Relevant Health Messages , 1992 .

[45]  W F Velicer,et al.  Assessing outcome in smoking cessation studies. , 1992, Psychological bulletin.

[46]  M. Kozak,et al.  Emotional processing of fear: exposure to corrective information. , 1986, Psychological bulletin.

[47]  A. Bandura Social Foundations of Thought and Action: A Social Cognitive Theory , 1985 .

[48]  Shelley E. Taylor,et al.  Stalking the elusive "vividness" effect. , 1982 .

[49]  Jacob Cohen,et al.  Applied multiple regression/correlation analysis for the behavioral sciences , 1979 .

[50]  John O. Summers,et al.  A Study of The Role of Beliefs and Intentions in Consistency Restoration , 1974 .