By Garwood Tripp, Marketing and Communications Program Manager, Health Promotion Directorate, Health and Welfare Canada, Alix Davenport, a Director of Tandemar Research Inc., Toronto and Montreal. From Health Promotion, Winter 1988/89.

This article reports on a research study which examined advertising directed at smokers and found, notably, that fear tactics were a most ineffective means of encouraging smokers away from their smoking behaviour. On the whole, smokers were much more receptive to messages containing positive reinforcement or encouragement.

These disclosures may not be surprising, but for many health educators or social marketing practitioners they are at odds with a natural tendency to think a problem can be solved simply by identifying it. They think that if a person who is doing something which is deemed unhealthy is told of the dire consequences of this behaviour, the offending behaviour will automatically cease.

However logical that theorem may seem to some people, it is deeply flawed. Fear paralyses. If you want people to do something (to stop smoking, for example) why would you paralyse them with fear? A piece of advertising that repels more than it attracts does not work effectively for the advertiser. Yet the "Tell 'em it'll kill 'em" school of thought persists, even though smokers report a correlation between increased stress levels and increased smoking - and scare tactics in advertising do produce stress.

It is important to understand why positive messages work. This study examines and illustrates the relative strengths of the positive-encouragement approach in contrast with the fear-inducing approach.

The Study

To examine how smokers reacted to non-smoking advertisements, eight discussion groups were conducted with smokers in Halifax, Montreal, Toronto and Winnipeg. Each group was composed of about eight smokers between the ages of 25 and 45. All the discussion sessions were moderated by an experienced market research professional.

The groups were shown three different sets of advertising. These varied in terms of their objectives, messages, content, style and medium (television or radio).

The first set of advertising was sponsored by Physicians for a Smoke-Free Canada. It consisted of three commercials, which represent standard fear-based approaches to encouraging non-smoking. One shows a group of doctors and other medical staff working over a patient on the operating table. The commercial ends with the message "Smoking creates all kinds of jobs" displayed on the screen. A second commercial shows a woman's funeral taking place while in a voice-over her husband recalls his efforts to encourage her to stop smoking. As the coffin is carried out of the church, we are told "Joan Armstrong quit smoking today." The third commercial in the series pictures a graveyard scene. In the voice-over, the viewer hears conversations between restaurant and airline personnel and smokers who are requesting smoking accommodation. The final message superimposed over the graveyard scene is "Yes, we have a smoking section."

The basic message of these commercials is that smoking is dangerous, bad for the health, and can kill you. We shall refer to this group as the "tombstone" ads.

The second set of advertising was also sponsored by Physicians for a Smoke-Free Canada. We have called these commercials the "addiction" ads. One of them shows, in animation, a very tall cigarette next to a small person who grows as the cigarette shrinks. The second depicts a chain of cigarettes in the form of a train, representing the way smokers keep smoking one cigarette after another. Both commercials highlight the addictive nature of smoking and indicate that smokers who wish to quit can get help from their doctors.

The third and final set of advertising consists of three radio commercials prepared by the Canadian Council on Smoking and Health and Health and Welfare Canada. The ads represent the "positive-reinforcement" approach. They contain messages designed to encourage attempts to quit and provide tips on quitting. Originally developed for female smokers between the ages of 18 and 30, they were included in the research study to help evaluate consumers' reactions to the positive reinforcement style.

Reactions to the Advertising

The tombstone advertising aims at frightening people about the health risks of smoking so that they will quit. To non-smokers, quitting seems the only rational response to this type of advertising. However, in practice, the groups did not react according to this seemingly logical course. They described the ads as shocking and scary, and agreed that the message of the ads was, as one woman put it, "Quit or die.." But the ads did not generate any motivation or desire to quit - in fact, the reverse occurred: people became more dedicated smokers than they had been before they saw the ads.

What happened was that the smokers rejected the message of the tombstone advertising and attacked the credibility of the commercials. Most became very defensive about smoking and referred to articles they had read which seemed to show that smoking does not necessarily kill. Several became obviously agitated and actually started smoking while watching the advertisements. One woman explained this as a response to the shocking style of the ads: "The ad frightened me. It makes me feel so nervous that I just want to have a cigarette."

Several participants pointed out that the ads did not prove that the people had died of smoking, and went to great lengths to think of other reasons that might have led to their deaths. Others tried to discount the sponsor of the ads, Physicians for a Smoke-Free Canada. Thus, the tag line on one of the commercials, "Smoking creates all kinds of jobs (for doctors)" was criticized for showing how the government and doctors take advantage of smokers: "It makes me think that not only (does) the government make money off your whole life smoking (through taxes), but doctors also make a fortune when you get older."

These reactions are particularly interesting in view of the fact that prior to seeing the ads, nearly all the participants agreed that they were concerned about the health effects of smoking. The advertising seems to have moved them from a position of being unhappy about their smoking to a position of strong support for their smoking habit. This does not seem to be a very useful achievement, and it is certainly not in keeping with the sponsor's intention of helping to motivate people to quit.

The second set of ads present smoking as an addiction, for which help can be obtained. While the addiction concept is mildly negative, it is not nearly as threatening as the tombstone approach, which associates smoking with death. The purpose of addiction ads is to persuade smokers to seek help for their smoking problem, rather than to shock them into quitting.

Reactions to this set of ads were favourable. There was general endorsement of their main message, that smoking is an addiction. People welcomed the tone of the advertising, which they considered mature and non-threatening. ("These commercials address you like an adult whereas the other ones were like a threat.") They liked the more positive messages of these ads and their suggestions for quitting or getting help to quit. These ads were constantly contrasted with those that used the negative tombstone approach: "The ad shows (that) if you really want to quit, you can. It was not depressing. You won't die."

These ads seemed to motivate people to a moderate degree. After seeing them, participants shifted from feeling concerned about their smoking to feeling that they were right to feel concerned because it is so strongly addictive and that maybe they should do something about it.

The third set of ads, the positive-reinforcement radio commercials, were designed for a young female audience. Rather than portraying smoking in a negative light, their main thrust was to assist and encourage quitting behaviour. They also attempted to demonstrate an understanding of smokers and the problems related to quitting.

Reactions to these ads were consistently enthusiastic. In contrast to reactions to the tombstone ads, no one responded by trying to defend smoking. Instead of responding defensively, the participants listened to and thought about the message.

They particularly liked the tone and manner of the advertising. Several commented that the advertising showed an understanding of smokers and sympathy with their problems. The most encouraging reaction was that the ads seemed to make smokers more interested in quitting and more optimistic that they might succeed. This was a typical comment: "I really want to quit after hearing a commercial like that; it would make me try harder. But I wouldn't be down on myself if I couldn't. I would just try harder next time."

This indicates that the smokers found the message relevant. In the discussions held prior to viewing these ads, most had indicated that they would like to quit. These ads, which focused on the process of quitting, were therefore of great interest.

The ads appeared to generate the kind of reactions that the advertiser sought. That is, they moved people from a position of being concerned about their smoking to one in which they were motivated to try to quit.

Lessons Learned

Overall, the reactions of these smokers presented a strong case against the use of fear tactics in public education advertising. To outline the basis of this case and the lessons this study holds for advertisers who wish to promote non-smoking to smokers, we turn to the key research findings.

Finding #1: Smokers don't want to be threatened.

Smokers repeatedly stated that they did not want to be bullied or made to feel ashamed of their smoking.

There is considerable research to indicate that it is difficult to use threatening, advertising effectively, and that such advertising can even boomerang. Novelli suggests there are three types of reactions to fear (or arousal) advertising. People may:

• defensively avoid the message rather than deal with the problem;
• distort and/or selectively perceive the message in ways that reduce the threat; or
• discount the message source.

All these reactions emerged when smokers were shown the tombstone ads. They denied the message that smoking kills you; they claimed the deaths in the ads were due to non-smoking causes; and they discounted doctors as a credible advertiser because they make money from smoking-related diseases. There was also tangible evidence of a boomerang effect - the ads made some participants so nervous that they needed cigarettes.

A television commercial can only be effective if people will watch it more than one time. It was clear in this study that some participants would only view the tombstone ads once initially, when they did not know what they were watching. Afterwards, they would see it and tune out. Said one participant: "I wouldn't watch it. I would just flip the channel."

It is important to ascertain why the smokers reacted so negatively. Most of them had previously said that they were not in favour of smoking and wished they had never started. About 80 percent had tried to quit, but in the process of doing so had discovered that they were psychologically and physically dependent on cigarettes. These people wanted both to give up smoking and to continue smoking. In view of this ambivalence, it should not be surprising to find that ads such as the tombstone commercials can actually lead to behaviour change that is the opposite to that desired.

Finding #2: A message that smoking causes death is not credible.

All participants in the study knew that smoking causes health risks and that it is associated with a variety of health problems. Nevertheless, they strongly rejected the tombstone advertising's implication that smoking kills. This kind of rejection is often dismissed by non-smokers as a display of how defensive smokers are. Non-smokers believe the most important thing is to communicate the "death message" clearly, and that in the long run smokers will do the rational thing and quit.

Certainly, smokers are defensive about the association between smoking and death, and not without some foundation. Consider the arguments they present:

• smoking is not banned as a life-threatening activity, although drug use is;
• many doctors - who surely know the facts - are smokers;
• they know many old people who are healthy, yet have smoked regularly for many years; and
• they know young people who are sick, yet have never smoked a cigarette.

In an early classic study on public education advertising, Mendleson drew some interesting conclusions about the reinforcement value of the wrong behaviour. From a study conducted on speeding drivers of automobiles, he concluded that every time a driver speeds, he is reinforcing his own actions in two ways: his speeding "pays off' (he gets to his destination quickly) and he proves the ads wrong (speeding doesn't necessarily kill you). Similarly, the smokers in our study knew from personal experience that smoking does not always kill people. And they proved this to themselves over and over again as they continued to smoke, yet continued to remain relatively healthy.

For these people, the concept that smoking kills is neither convincing on objective, factual grounds, nor is it in tune with their own experience of smoking. It is highly unlikely, therefore, that the "Smoking Kills" message can provide the basis for a powerful anti-smoking message to smokers.

Finding #3: Smokers need encouragement to quit.

From their own experience, smokers know that quitting is difficult. Many participants had tried to stop smoking and failed. Many indicated a sense of despair about quitting, and believed it was just too difficult.

This dilemma of wanting to quit, but feeling they cannot do so, is exacerbated by changing social attitudes towards smoking. While some felt that increasing anti-smoking sentiments made them more motivated to quit, others considered it was dividing society and forcing smokers into smoking ghettos.

Smokers want more than punitive measures to help them stop smoking. Their enthusiastic response to the positive-reinforcement radio ads was largely due to the encouraging, supportive tone of the ads. The ads made the smokers feel understood, reassured them that they were not failures and supported them in their efforts to quit. In contrast to the threatening approach of the tombstone commercials, the ads were interpreted as extending a helping hand to the smoker.

Finding #4: Smokers want realistic guidance about quitting.

The groups were not interested in the tombstone commercials' message about the harmful effects of smoking. They already knew that smoking was bad for them. However, since many of them wanted to quit but were finding it hard to do so, they expressed great interest in the radio spot which dealt with the difficulties of quitting. Several recounted similar problems that they had experienced. In particular, they responded strongly to the idea that people often fail to quit in the first few attempts, and that this kind of failure is normal. This was new and reassuring information, which gave them a reason for trying again. Another commercial, which focused on the fact that weight gain is not necessarily a consequence of quitting, also led to considerable discussion. It was particularly relevant to several women who had abandoned efforts to stop smoking because they had begun to gain weight.

This study clearly demonstrated that advertising which uses fear tactics to convey the negative effects of smoking is unlikely to motivate smokers to quit. Among other reasons, it is perceived as being personally irrelevant to most smokers. It fails to address their real concerns, which centre on the difficulties and frustration involved in breaking an addiction.

Endnotes

1. Novelli, J.D. Time Bombs and Tar Levels. Applying and Assessing Fear in Marketing
Communications. Presented to the American Marketing Association's Attitude Research
Conference, February 7-10 in Scottsdale, Arizona. Washington, 1982, 13 pp.
2. Mendleson, H. "Safety Communication Study for the National Safety Council", 1964. In Public
Telecommunications Review, October 1973, p. 64.