An application of terror management theory in the design of social and health‐related anti‐smoking appeals

• Marketers and public policy makers continue to be plagued with the problem of creating effective communications, which can increase the probability of complying with risk avoidance behavior related to smoking. Using Terror Management Theory (TMT) as a theoretical basis, we provide a rationale as to why traditional anti‐smoking appeals focusing on negative health consequences are not impactful. We use the implications of the theory to predict and show that an appeal focusing on social exclusion should be more motivating than a health appeal to encourage smokers to quit in the short and long run. Specifically, we conduct an experiment designed to investigate the impact of mortality salience and self‐esteem on whether college‐age smokers will comply with anti‐smoking messages. We observe that social exclusion messages compared to health effect messages are particularly effective in reducing intentions to smoke for college‐age smokers who derive their self‐esteem in part from smoking. Overall, our results show that mortality salience interacts with self‐esteem in terms of influencing the probability of smoking in the short run and that social exclusion appeals have a stronger impact than health‐related appeals both in reducing long run smoking intention and emphasizing the salience of health‐related consequences of smoking.

Copyright © 2009 John Wiley & Sons, Ltd.     

Effects of short‐term cosmetic versus long‐term health fear appeals in anti‐smoking advertisements on the smoking behaviour of adolescents

A field study exposed 235 high school students to anti‐smoking advertisements over a five‐month period to test the effectiveness of short‐term cosmetic versus long‐term health fear appeals in preventing or reducing smoking. The study was a longitudinal experiment with two experimental groups and a control group. Smoking behaviour was measured prior to message exposure on television, in magazines and on the internet, and at the end of the study period. The primary results were that average smoking declined for subjects exposed to either type of anti‐smoking fear appeal but not for the control group and short‐term cosmetic fear appeals were more effective for males but long‐term health fear appeals were more effective for females. Copyright © 2003 Henry Stewart Publications.     

Preventing Adolescent Cigarette Smoking

Recent studies have supported the efficacy of approaches to smoking prevention that focus primary attention on social and psychological factors implicated in initiation of adolescent cigarette smoking. This article reports first year data from a large-scale smoking prevention study conducted within three geographic regions of New York State. The sample consists of 5,954 seventh graders from 56 middle/junior high schools. Schools were randomly assigned to (1) receive the Life Skills Training (LST) prevention program with a one-day teacher training workshop; (2) receive the LST prevention program with teacher training provided by video tape; or (3) serve as a comparison group. This study was designed to further test the efficacy of this type of smoking prevention program and to compare the relative effectiveness of two different types of provider training in an effort to learn more about the potential effectiveness of this prevention strategy when implemented under "real world" conditions. Pretest and posttest data were collected by questionnaire concerning self-reported tobacco use and several hypothesized mediating variables. Results indicate that the prevention program significantly impacted on several hypothesized mediating variables in a direction consistent with non-smoking. Within one region, the students in both experimental conditions reported significantly less current cigarette smoking and reported themselves less likely to smoke in the future than the students in the control condition.     

Four pathways to young-adult smoking status: adolescent social-psychological antecedents in a midwestern community sample.

Evaluated the ability of social-psychological factors, measured in adolescence, to predict young-adult smoking outcomes. Results showed substantial continuity in the antecedents of adolescent and young-adult smoking but important discontinuities as well. Beliefs in the negative social consequences of smoking and beliefs about academic success and independence were important to adolescent but not to adult smoking. Conversely, beliefs in the negative health consequences of smoking were more important to adult smoking than to adolescent smoking. Results also showed an appreciable amount of smoking onset after the high school years, as well as an appreciable amount of adolescent smoking that did not persist into young adulthood. Antecedents of late-onset smoking and of nonpersistent smoking are described.     

Social smokers: Smoking motivations,behavior, vulnerability,and responses to antismoking advertising

Antismoking campaigns have traditionally ignored the differences between social and regular smokers. This paper reports the results of three studies: interviews with 17 college students describing themselves as social smokers, a survey verifying the interview results with a larger sample of undergraduates, and an experimental test of advertising appeals based on the survey results. In the interviews, social smokers differentiated themselves from regular smokers and described smoking mostly in situations where drinking and smoking goes hand in hand. They did not feel vulnerable to the long‐term consequences of smoking. The survey confirmed differences between the behaviors, motivations, and perceived vulnerability of social and regular smokers. The experimental study found that both social and regular smokers were persuaded by an advertisement describing the risk of cancer, but social smokers expressed the lowest vulnerability to this risk. A message strategy describing the risk of addiction was particularly effective in capturing the attention of social smokers. Copyright © 2012 John Wiley & Sons, Ltd.     

Developing Data-Based Communications in Social Psychological Research: Adolescent Smoking Prevention1

The present paper deals with how pre-intervention data were gathered from a sample of junior high school students to whom a smoking prevention program was addressed and how these data were used in the creation of trigger films which were an important element in the prevention program. The coping techniques used by students who are successfully able to withstand social pressures to smoke were determined from pre-intervention group interview-role-playing sessions with samples of students from two schools representative of the intended target population of the smoking prevention program. These data were used in the production and editing of ten-minute, sound, color films which reflected simulations of the student responses in the interview-role-playing sessions. Assessment of the impact of these filmed social-inoculation coping strategies indicates that they appear to be a promising component of smoking deterrent programs for adolescents.     

School-Based Intervention for Social Skills in Children from Divorced Families

Divorce is an increasingly prevalent occurrence in society that has the potential to result in many adverse short- and long-term consequences for children and their parents. Social skills, such as those with peers, are one of the problems that may emerge for children of divorce. Despite this growing problem, there is a paucity of research available to effectively address the social skills needed to build and maintain positive peer interactions and subsequent relationships in students whose parents are no longer married. It was hypothesized that a social skills training program would be effective in remediating social skill deficits related to building relationships with peers in students from divorced families. The purpose of this study was to employ COPE, a school-based social skills program, to examine the effect on social skills in elementary students whose parents are divorced. Results of the social skills intervention indicated that the treatment was effective for most participants, but generalization of the COPE program had mixed results.     

CO-WORKER SOCIAL SUPPORT IN A WORKSITE SMOKING CONTROL PROGRAM

We evaluated the effects of adding a social support component to a worksite controlled smoking treatment program. Twenty-four participants were randomly assigned to either a controlled smoking or a controlled smoking plus partner support condition. Within a multiple baseline across behaviors design, smokers in both conditions made efforts to achieve sequential 50% reductions in: (a) nicotine content of brand smoked, (b) number of cigarettes smoked per day, and (c) percentage of each cigarette smoked. Self-monitoring records, laboratory analyses of spent cigarette butts, and carbon monoxide determinations indicated that both conditions were effective in producing significant reductions in each of the three target behaviors and in carbon monoxide levels. All participants who quit smoking during the program maintained their abstinence at a 6-month follow-up, and those who did not quit were smoking less at follow-up than they had at pretest on all dependent variables. However, few differences were observed between controlled smoking and controlled smoking plus partner support conditions either during treatment or at the 6-month follow-up. Results are discussed with regard to previous worksite studies, future directions for research on social support, and variables that may have mediated treatment outcome.     

BULLY PREVENTION IN POSITIVE BEHAVIOR SUPPORT

Bullying behaviors are a growing concern in U.S. schools. We present here a behavioral approach to bully prevention utilizing a schoolwide intervention. Bully prevention in positive behavior support (BP‐PBS) teaches students to withhold the social rewards hypothesized to maintain bullying. A single‐subject multiple baseline design across 6 students and three elementary schools was implemented in an empirical evaluation of the intervention's effectiveness. Results indicated that implementation was functionally related to decreased incidents of bullying for all 6 students observed. In addition, we observed a decrease in the social responses from victims and bystanders. Finally, school staff implemented the program with a high degree of fidelity and rated the program as effective and efficient. Limitations and implications of these results are discussed.     

Smoking prevention among urban minority youth: assessing effects on outcome and mediating variables.

We tested the effectiveness of a social resistance/competence enhancement approach to smoking prevention among predominantly Hispanic seventh graders (N = 3,153) from 47 New York City schools. After blocking on school type (public and parochial) and ethnic composition (percent Hispanic), schools were randomly assigned either to receive the 15-session prevention program or to serve as no-contact controls. Using the school as the unit of analysis, significant program effects were found for cigarette smoking, normative expectations concerning peer and adult smoking, smoking prevalence knowledge, social acceptability knowledge, and knowledge of smoking consequences. Using structural modeling techniques, a significant relation was found between the normative expectation and knowledge variables affected by the intervention and posttest smoking, suggesting that changes on these variables mediated the impact of the intervention on cigarette smoking. This study extends the results of previous prevention research and demonstrates the generalizability of this approach to predominantly Hispanic urban minority students.     

Evaluation of the school-based smoking-prevention program "BE smokeFREE"

This article examines the impact of the school-based smoking-prevention program "BE smokeFREE" on adolescent smoking. A national representative sample of 99 schools (195 classes, 4,441 students) was used when the intervention started in November 1994. Schools were allocated to one of four groups: a comparison group (A) and three intervention groups (B, C, and D). Group B received the most comprehensive intervention. A baseline (autumn 1994) and three follow-up data collections (1995, 1996, and 1997) were conducted. There were no significant differences in smoking habits among the four groups at baseline. The smoking habits in the group that was involved in the most comprehensive intervention (group B) changed more favourably than those of students in the comparison schools over the three follow-up data collections. At the third follow-up, the proportion of students smoking weekly or more in the comparison group was 29.2%, compared with 19.6% in the model intervention group. The two less comprehensive interventions (no teacher in-service courses in group C, and no involvement of parents in group D) appeared to be less effective than the model intervention. Multilevel multiple logistic regression analyses, comparing changes in smoking habits between students in group B with those among students in the comparison schools, confirm the conclusion that the comprehensive intervention was the most effective. This school-based intervention, based on a social influence approach, proved to be effective at reducing smoking rates among participants.     

Knowledge and beliefs regarding the consequences of cigarette smoking and their relationships to smoking status in a biracial sample

The purpose of this investigation was to evaluate carefully smoking-related knowledge and beliefs and their relationships to smoking status in a large, heterogeneous sample of smokers and nonsmokers in two settings: (a) a large, biracial southern city and (b) a small midwestern community. Participants were 611 (198 male, 413 female) adult respondents to a random-dialing telephone survey in Fargo, North Dakota (n = 200), and Memphis, Tennessee (n = 411). Each participant was given the Smoking Attitudes Survey, which assesses generalized health beliefs as well as health-related problems associated with smoking. Participants' knowledge of smoking-associated diseases (e.g., lung cancer) and of diseases not associated with smoking (e.g., kidney stones) was assessed. Stepwise regression analysis of composite knowledge scores revealed four independent predictors of the health consequences of smoking: education, race, smoking status, and income. Smokers, compared to nonsmokers, reported less knowledge related to the health consequences of smoking, were more likely to be male, were less concerned with the health consequences of smoking, and were more concerned about the health consequences of cholesterol. The best predictor of smokers who had never attempted cessation was their greater concern over weight control when compared to smokers with a history of smoking cessation attempts. The results are discussed in terms of smoking prevention and intervention efforts.     

Deterring the Onset of Smoking in Children: Knowledge of Immediate Physiological Effects and Coping with Peer Pressure,Media Pressure,and Parent Modeling1

Entering seventh grade, most children believe that smoking endangers their long-term health. Nevertheless, three sources of social pressure were found to often have an overriding influence to begin smoking: peers, models of smoking parents, and media. Interventions were developed to train children to cope with these pressures. Also stressed were immediate rather than long-term physiological effects of smoking. A dependent measure was utilized that generates increased validity of self-reports of smoking. A 10-week investigation was completed with 750 male and female students entering the seventh grade. Rates of onset of smoking in treatment groups were significantly lower than in a pretest-single posttest control group.     

Smoking Prevention and the Concept of Risk1

Sixth-grade children in 22 schools received either a social-influences smoking-prevention program or routine health education. The social-influences program was designed to teach youth about peer, parent, and media influences affecting smoking onset and to provide them with skills in resisting these influences. Comparison schools were given no program, but were permitted to continue their usual provision of health education. Program impact was evaluated as a function of pretreatment risk of future smoking. Risk was defined with respect to both (a) the prevalence of social models who smoked and (b) previous smoking experience. Two-and-a-half-year results show program impact to vary with both kinds of risk. Smoking-experience risk interacted such that, at first, there was greater impact on children with experience, but on later follow-up the pattern reversed, with the greater treatment effects seen for those initially with limited experience. Social-models risk showed a direct relationship, with greater risk being associated with greater program impact. Implications both for evaluation research and prevention programs are discussed.     

Psychosocial approaches to smoking prevention: a review of findings

Twenty-seven school-based studies of psychosocial approaches to smoking prevention are reviewed. Two major approaches are represented: the "social influences" approach and the broader "life/social skills" approaches. The research studies are considered in four "generations": the seminal work by Richard Evans and colleagues at the University of Houston; seven "pilot" studies of improved programs at Stanford, Minnesota, New York, and Washington, with one school or classroom per experimental condition; twelve improved "prototype" studies by these four groups and others, with two or three units randomly assigned to conditions; and six studies in which maximizing internal validity was of prime concern. Reported results were fairly consistent, with each tested program seeming to reduce smoking onset by about 50%. However, none of the pilot or prototype studies considered alone provided easily interpreted results. The major contributions were improved programs and methods. The findings from the fourth generation of studies were more easily interpreted, though only two of them were interpreted with high confidence. It seems that psychosocial approaches to smoking prevention, particularly the social influences approach--fourth generation tests of the broader life/social skills approaches have yet to be reported--are effective, but at this time we know very little about why, for whom, or under what conditions. Suggestions are provided for improved future research.     

Courseware for observational research (COR): A new approach to teaching naturalistic observation

Naturalistic observation is one of the most basic and widely used techniques of scientific research, yet it often receives only a cursory treatment in the research methods course. In this paper, we describe a new interactive multimedia software program that teaches interval, frequency, and duration coding with the use of brief digitized video clips and model check sheets. The program teaches basic observational techniques by leading students through the stages of developing a behavioral coding scheme, collecting data, establishing interrater reliability, and analyzing with chi square. It also has a laboratory component that allows students to practice their skills.     

Common Themes and Treatment Approaches in Working with Families of Runaway Youths

Running away behavior in youth has long been recognized as a significant social problem affecting not only the youth themselves but their families, schools, the local community, and law enforcement efforts. We describe common themes these youth and their families present when they enter treatment in a program that works in conjunction with local law enforcement. These themes include problematic interactions in relation to school performance, parents' inabilities to cope with their children's mental health concerns, cultural differences, divorce-related issues, and inappropriate family boundaries. The treatment philosophy and approach of the program are provided as are case examples.     

The motivational effects of thinking and worrying about the effects of smoking cigarettes

We tested a strategy to encourage cigarette smokers to think more frequently about the negative consequences of smoking, reasoning that increased thought might lead to greater worry and motivation to quit. College students who smoked daily were randomly assigned to one of three conditions in which they wore watches for one week that sounded an alarm randomly four times each day. When alerted, the students read one of eight cards that either had a written statement about studying (control condition), a statement about the negative effects of smoking behaviour (text condition), or a negative smoking statement accompanied by a picture (e.g., a blackened lung; image condition). Measures collected at week's end revealed that the smoking cards had no effects on perceived risk, but they increased worry and reports of intrusive thoughts, and had a small but reliable effect on plans to quit. Correlational data also supported the relationship between worry and motivation to quit, and we discuss the possible benefits of “normal” worrying and strategies for capitalising on the worry–motivation relationship to encourage smokers to abandon cigarettes.     

A follow-up of a media-based,worksite smoking cessation program

Described an examination of data collected 2 years following the onset of a media-based, worksite smoking cessation intervention. Thirty-eight companies in Chicago were randomly assigned to one of two experimental conditions. In the inital 3-week phase, all participants in both conditions received self-help manuals and were instructed to watch a 20-day televised series designed to accompany the manual. In addition, participants in the group (G) condition received six sessions emphasizing quitting techniques and social support. In the second phase, which continued for 12 months, employees in G participated in monthly peer-led support groups and received incentives, while participants in the nongroup (NG) condition received no further treatment. Twenty-four months after pretest, 30% of employees in G were abstinent compared to only 19.5% in NG. This study is one of the few experimentally controlled worksite smoking cessation interventions to demonstrate significant program differences 2 years following the initial intervention. Our thanks to Lori Klett and Libby Yeager-Turner for their help in data collection. Work on the project was supported in part by National Institute on Drug Abuse grant DA-04406-01 and a grant from the Chicago Lung Association to the second author.     

Continuity of aggression from childhood to early adulthood as a predictor of life outcomes: implications for the adolescent‐limited and life‐course‐persistent models

Using data from the Columbia County Longitudinal Study, a 40‐year longitudinal study following an entire county's population of third‐grade students from age 8 to 48, we examine questions about the long‐term consequences of aggressive and antisocial behavior in childhood, adolescence, and young adulthood. We found moderate levels of continuity of aggression from age 8 to 48 both for males and for females. Contrary to what some have proposed, we found that continuity of aggressiveness is owing to not only the high‐aggressive participants staying high but also owing to the low‐aggressive participants staying low. Compared with life‐course‐persistent low aggressives, we found that life‐course‐persistent high aggressives had consistently poorer outcomes across domains of life success, criminal behavior, and psychosocial functioning at age 48 (e.g., arrests, traffic violations, aggression toward spouse and divorces, depression, health, occupational and educational attainment). In contrast, adolescent‐limited and child‐limited aggressives did not differ from life‐course‐persistent low aggressives on the age 48 outcomes. Finally, the outcomes for late‐onset (early adulthood) aggressives were also problematic in some domains though not as problematic as those for life‐course‐persistent aggressives. Aggr. Behav. 35:136–149, 2009. © 2009 Wiley‐Liss, Inc.