The purpose of this study was twofold: (a) to test for the predicted two-way interaction effect between message threat and message efficacy on smoking cessation intentions based on the EPPM, and (c) to test for a possible three-way interaction effect between message threat, message efficacy, and readiness to quit (i.e., stages of change) on smoking cessation intentions, extending from the work of Cho and Salmon (2006)
In the test of the EPPM predictions, there was only partial support found for the interaction effect between message threat and perceived message efficacy on smoking cessation intentions. Of the two intention outcomes explored, the effect was found for intent to seek help for quitting, but not intent to quit smoking. Although the results provide partial support of the EPPM, this is of one the first tests of the theoretical model using video-based threat and efficacy appeals. Previous studies were limited in that the model was tested using primarily text-based appeals. Consistent with the EPPM, smokers who perceived high message threat and high message efficacy had the strongest intentions to seek help for quitting smoking, whereas intent was low for those with either low message threat and/or message efficacy perceptions.
Extending on the EPPM, Cho and Salmon (2006)
argued that fear appeal effects would differ for individuals at different stages of change. In this study, stage of change was conceptualized as a smoker's level of readiness to quit smoking. A three-way interaction effect was found between message threat, perceived level of message efficacy, and readiness to quit on intentions to quit such that for those with low readiness to quit, both high message threat and high levels of message efficacy were necessary to motivate intentions to quit. Alternatively, for smokers with a high readiness to quit, either high message threat or high levels of message efficacy was sufficient to motivate intentions to quit. These results are consistent with Cho and Salmon's (2006)
assertion that those in early stages of change (i.e., low readiness to quit) likely possess weaker efficacy beliefs about quitting than those in later stages of change (i.e., high readiness to quit). For those smokers who are not yet ready to quit, they require both the motivation and confidence to quit. Exposing them to high threat antismoking messages as well as high efficacy cessation appeals would satisfy both of these requirements. On the other hand, for smokers who are highly motivated to quit, they require primarily the confidence to act on their motivations. And so, for these individuals, exposure to information that increases their perceptions of efficacy about quitting would be the key to reinforcing their commitment to quitting. Perceived message efficacy was found to be more predictive than message threat on quitting intentions among this subgroup of highly motivated smokers.
The results of this study have several important implications for designers of health campaigns aimed at promoting greater smoking cessation among adults. First, both high threat-oriented and high efficacy-oriented information need to be present for smoking cessation messages to be most effective at motivating quitting. Future studies will need to explore whether sequencing of the two types of information matter (e.g., does threat necessarily have to precede efficacy), and to identify the maximum allowable lag time between presentation of threat and efficacy information before the effects begin to taper off. Ideally, it may be best to sequence efficacy ads right after threat-based messages. However, this is likely impractical and the “take home message” is to be sure to have strong efficacy information (whatever the type or source) in close proximity to the threat information.
Second, smokers' level of readiness to quit may serve as an effective way to segment the audience for future antismoking campaigns. Specifically, the results of this study show that the effectiveness of antismoking threat and efficacy appeals differ for those with low and high readiness to quit smoking. Tailoring messages to focus either on increasing motivation and/or confidence to quit smoking in line with the smoker's level of readiness to quit would be an important strategy for improving the effectiveness of fear appeals. Particularly for those smokers with a high readiness to quit, increasing their efficacy perceptions about quitting is critical.
Lastly, antismoking campaigns should continue to use emotionally evocative messages to motivate smokers to quit by reminding them of the serious health threats they and/or their loved ones could experience as a result of their smoking behaviors. The present study provides evidence that fear appeals continue to be an effective message tactic for motivating smokers to quit smoking. It is important to point out that the two high threat ads used in this study both contained strong arguments for why smokers should quit. Health message designers should pretest their antismoking messages carefully to make sure that they contain high quality arguments (i.e., those perceived to be convincing and persuasive). Threatening messages low in argument quality may be less effective at motivating smokers to quit, and could provoke reactance-type responses (e.g., defensive avoidance, denial of the threat, and other forms of biased processing) among smokers. Although the results of this study have some important implications for antismoking campaigns, there were several limitations worth discussing.
Limitations and Suggestions for Future Research
One main limitation of this study is the use of a self-selected sample of smokers. Participants who agreed to take part in this study may have a stronger readiness to quit smoking (even among those in the low readiness to quit group) than those who chose not to participate. Also, smokers were asked to carefully attend to the antismoking threat and efficacy ads shown to them so that they could respond to questions about the ads afterwards. Exposure to threat and efficacy appeal messages was required, a condition that cannot be guaranteed in the field. Although participants viewed the ads outside of a lab, they were also not seeing the ads as part of their everyday television watching limiting ecological validity.
Another limitation of this study is that the neither the NRP or Quitline ad were perceived as highly efficacious (i.e., both had ad efficacy means below 2 on a 4-point scale with higher scores reflecting greater ad efficacy). In terms of testing the EPPM, this study provided only an indirect test because there was no true “high efficacy” condition. Despite this limitation, evidence consistent with EPPM predictions was found and so it is expected that the effects would be enhanced with a stronger efficacy manipulation. It is interesting to see that smokers did not perceive either of the efficacy ads as highly efficacious because both ads are representative of those currently shown on television. It is important then to focus greater research efforts on developing more effective ways to frame efficacy information about quitting smoking so that smokers feel more confident in their ability to quit successfully.
A third limitation of this study was that only proximal (i.e., immediate) effects were examined. Smokers were immediately shown the NRT/Quitline ad after exposure to the two high threat or low threat antismoking ads. In the natural mass media environment, it is unlikely that antismoking threat ads immediately precede antismoking efficacy ads. In fact, the practice of many public health communication campaigns is to use “flighting” for threat-oriented and cessation ads making it necessary to test for distal or lag effects of these appeals on smoking cessation behaviors in future studies to determine whether or not they work with a “distraction” (e.g., within the context of a show) embedded in between the two types of appeals.
A final limitation is that this study assessed only participants' smoking cessation intentions but not their actual quitting behaviors. It is important to determine whether intentions to quit or seek help for quitting are translated into smoking cessation behaviors. In a recent meta-analysis of the relationship between intentions and behaviors, it was reported that for experimental studies, a medium-to-large change in intentions (i.e., effect size of .66) leads to a small-to-medium change in behavior (i.e., effect size of .36) and so changes in intentions does have a significant impact on subsequent behaviors (Webb & Sheeran, 2006
). Nevertheless, it is important to do a follow-up study to determine whether or not smokers acted on their reported intentions to quit or seek help for quitting.