This week, the Centers for Disease Control and Prevention raised a few eyebrows and turned a few stomachs with the debut of their $54 million campaign of graphic anti-smoking ads. The TV spots show regretful ex-smokers who have lost toes or a voice-box in graphic detail; such images are sure to make a strong and lasting impression. They also raise a basic question: is scaring the crap out of someone an effective way to make him change behavior?
It is, after all, a venerable approach—induction of fear is one of the pillars of parenthood (if you eat that, your teeth will rot), the U.S. educational system (if you don’t study for your chemistry test, you will flunk and end up homeless), and organized religion (hell, anyone?). Fear is like a traded commodity—we move it between ourselves every day at high volumes, across multiple situations, and with remarkable velocity.
But does fear work? In other words, if I REALLY scare you, will you give up cigarettes, unsafe sex, driving too fast, drinking too much. The simple answer: yes (PDF). Overwhelmingly (click here for a slightly less intense literature review). Not only does the evidence support fear as the best way to move people, it’s also clear that the scarier the message the stronger the effect. In fact, some in the public-health world are mad because the CDC ads don’t go far enough.
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Since at least the 1950s, there has been an enormous interest in what is called “fear appeal,” the use of fear to make people do one thing when their heart (or id) tells them to do something else. It’s the basis of the entire American advertising industry, the purview of those giants of Madison Avenue. Indeed, the unconvinced or forgetful need watch only a single episode or Mad Men to realize once and for all that ad guys are smart, heartless, shameless, and cynical bastards who will do anything to sell their product. Scare people senseless to get them to spend a extra few bucks? Sure—no biggie.
Plus consider that fear is the vital organ in that other ubiquitous American sales pitch—political advertising. Here it is called “going negative”—a systematic attempt to portray the other guy as a slightly less severe version of Stalin and with worse taste in food, someone to be feared first, last, and everywhere in between. The iconic "Daisy" ad run by the 1964 LBJ campaign remains the single most forceful commercial ever run for any product; it played squarely on the fear of a nuclear holocaust.
The efficacy is irrefutable but not everyone is enthusiastic—even those who are vehemently against smoking. Some who have seen the new CDC ads wonder if the jarring intrusiveness is somehow wrong and ultimately counterproductive. After all, no one wants to see amputated toes during the evening news; the image of a man shaving around the stoma in his neck where he now breathes because part of his throat was removed due to a smoking-related cancer is even tougher to watch than American Idol or, for that matter, a preseason Mets game.
The squirm factor is considerable and we don’t watch TV because we are looking to squirm. In fact we don’t watch TV if we are looking for anything even faintly uncomfortable. TV provides endless comfort—that’s why we’re all such potatoes. Indeed, many think that such uneasiness is an infertile ground to try to make a sale (or for relief of an unbearable urge). But, according to the evidence, that too is wrong. Indeed, countless studies have shown that though we are annoyed, frustrated by the intrusion, ready to change the channel—something meaningful sinks in. In fact such messages may have the most durable effect on behavior, an effect that extends across cities and rural areas, to young and old.
A frequent criticism of the approach is that it doesn’t cure all the people all the time. Graphic public-service messages have been brought forward on AIDS, automobile safety, alcoholism, and other issues, with at best a variable success. Cigarette fear-appeal campaigns already running in many cities have helped curb but in no way have resolved the problem. Yet right now and for the foreseeable future, fear, admittedly the bluntest of blunt objects, is our best strategy.
Plus this isn’t the easiest time for the government, even an agency without a hint of political allegiance, such as the CDC, to stick their neck into the American mainstream and scare the crap out of people. For some, it’s the perfect nightmare of government overreach—what’s the damned government doing on the TV in my bedroom? I’ll show them—why I’ll keep smoking JUST TO SHOW THEM they can’t tell me what to do. Such a response, known in psychology as reactance, generally is short-lived. Some people, though, referred to as “high sensation seekers” (to distinguish them from “low sensation seekers”—people like you and me who would read article about sensation but never, you know, do much) may be so addicted to the feel of danger as to be intractable.
For those still unconvinced at either the efficacy or the advisability of fear as a public-health strategy, consider the decades when the cigarette companies ruled. For the first half of the 20th century, they sold the product as a way to relax, feel good, calm those rattled nerves—a good sales pitch but not good enough for global domination. For that, they needed sex appeal—also known as cool. And so they set out, with unprecedented success, to make smoking irresistible. Bogie and Duke, Marilyn and Sharon Stone, all of them knew how to handle a smoke. And for the youngsters there was Joe Camel and his ilk, the cartoons of cool, to carry the message.
In their golden age, the tobacco oligarchy showed the path to total addiction, a path that anti-smoking zealots now have begun to retrace to lead the public back to sanity and health. Anywhere Big Tobacco built cool, anti-smoking has begun to introduce the uncool. It’s like reprogramming the entire human race. Joe Camel, meet the uncool—death, disfigurement, suffering, and loss. The CDC has set out to beat the cigarette companies at their own game—and the early returns are quite promising.
