Yeah it's Gross, but is it Effective?

Some past research has questioned or even evaluated the effectiveness of using fear appeals in anti-tobacco campaigns.  Unfortunately, one major element that is included in these appeals is often overlooked…the element of disgust.  This raises the question: Is the use of disgusting images in fear appeals a more effective way to change smoking attitudes, intentions, and behaviors globally?

What exactly is disgust?  In order to discuss disgust, I will provide a quick overview of disgust.  Disgust is described as an unpleasant emotion that often evokes specific facial expressions and feelings of nausea (Davey, Forster, & Mayhew, 1993).  Nabi (2002) simply describes disgust as being “grossed out”.  Typically disgust makes individuals want to withdraw or avoid the item that is bringing forth the emotion (Davey, Forster, & Mayhew, 1993). Disgust may have developed as a protective mechanism to prevent humans from ingesting toxic or poisonous items (see Haidt, McCauley, & Rozin, 1994).  In other words, it may aid in basic human survival. 

There are three different types of disgust: core disgust (Rozin, Haidt, & McCauley, 1993), animal reminder disgust (Rozin & Fallon, 1987) and moral disgust (Nabi, 1998).  Core disgust is connected to food and ingestion.  Animal reminder disgust is associated with anything that reminds us of our mortality or that we are animals.  This includes disgust evoking stimuli related to death or bodily organs and fluids.  Moral disgust is linked to acts and behaviors that are perceived to be culturally or socially unacceptable.  For example, some sexual acts are viewed as disgusting because they are deemed to be socially unacceptable.

In addition, Haidt, McCauley, and Rozin (1994) found seven domains of disgust elicitors.  These include: food, animals, body products, sex, envelope violations, death, and hygiene (Haidt, McCauley, & Rozin, 1994)

Now, I return to my original question.  Is the use of disgusting images in fear appeals a more effective way to change smoking attitudes, intentions, and behaviors globally?  Much like with studies on fear appeals, the findings are mixed.  Some studies argue that disgust combined with fear is overwhelming and leads to defensive reactions (Leshner, Bolls, & Wise, 2011).  Others argue that these types of appeals are effective across cultures (Durkin, Bayly, Cotter, Mullin, & Wakefield, 2013).

Recent policies and regulations for tobacco control have mandated the inclusion of graphic health warnings on all cigarette packaging (see the Family Smoking Prevention Control Act, 2009).  Many countries have implemented these policies. 

Below, I provide a few examples of these graphic health warnings.  Caution, the images below are pretty graphic!

Images Source: World Health Organization (2014).  WHO FCTC health warnings database.  Accessed Dec 3, 2014.

Venezuela Ad: Smoking causes bad breath, tooth loss, and oral cancer.

Iran Ad: Smoking will cause irremediable damages to the eye tissue, vision central nerves and finally will result in blindness.

Malaysia Ad: Cigarette causes neck cancer.

Soo...what is your reaction to these images?  Do you think they are effective? 

Interestingly, tobacco companies in the United States filed litigation against the use of these ads in 2011 (Strasser, Tang, Romer, Jepson, & Cappella, 2012). So for now the use of these warning labels have been temporarily blocked in the United States.

I think the new graphic health warnings that employ disgust and fear are extremely interesting.  The issue introduces several global health questions about the effectiveness of emotional appeals and the role of policy and large corporations in health.

Works Cited:

Davey, G. L., Forster, L., & Mayhew, G. (1993). Familial resemblance in disgust sensitivity and animal phobias. Behavior Research and Therapy , 31, 41-50.

Durkin, S., Bayly, M., Cotter, T., Mullin, S., & Wakefield, M. (2013). Potential effectiveness of anti-smoking advertisement types in ten low and middle income countries: Do demographics, smoking characteristics and cultural difference matter? Social Science & Medicine , 98, 204-213.

Haidt, J., McCauley, C., & Rozin, P. (1994). Individual differences in sensitivity to disgust: A scale sampling seven domains of disgust elicitors. Personality and Individual Differences , 16 (5), 701 -713.

  

Leshner, G., Bolls, P., & Wise, K. (2011). Motivated processing of fear appeal and disgust images in televised anti-tobacco ads. Journal of Media Psychology , 23 (2), 77-89.

Nabi, R. (2002). Anger, fear, uncertainty, and attitudes: A test of the cognitive-functional model. Communication Monographs , 69 (3), 204-216.

Nabi, R. L. (1998). The effect of disgust-eliciting visuals on attitudes toward animal experimentation. Communication Quarterly , 46 (4), 472-484.

Rozin, P., & Fallon, A. (1987). A perspective on disgust. Psychological Review , 94, 23-41.

Rozin, P., Haidt, J., & McCauley, C. R. (1993). Disgust. In M. Lewis, & J. Haviland (Eds.), The handbook of emotions (pp. 575-594). New York: Guilford.

Strasser, A. A., Tang, K. Z., Romer, D., Jepson, C., & Cappella, J. N. (2012). Graphic warning labels in cigarette advertisements: Recall and viewing patterns. American Journal of Preventative Medicine , 43 (1), 41-47.