"In Switzerland, the general public does not want to be exposed to certain images".

Claudia Poggiolini completed her doctorate on the topic of tobacco prevention this year at the Institute of Communication Science and Media Research at the University of Zurich. Her dissertation project involves the evaluation of the tobacco prevention campaign "Smokefree," which appeared in Switzerland from 2015 to 2018. She evaluated the campaign in a large-scale study and did accompanying experiments with fear appeals. 

Werbewoche.ch: Grieving widows of speeders, black lungs of smokers, tortured animals from the lab: You see such cruel images again and again in prevention campaigns. Personally, I react to them with aversion. And I ask myself: Do such prevention campaigns have the desired effect at all?

Claudia PoggioliniSuch fear appeals certainly stir up and activate negative emotions. Whether prevention works in this way is the big controversial question in research. But the images usually have one effect: the target group may react with resistance, but it does react. Under certain circumstances, this is better than showing no reaction at all. We still know relatively little about the long-term effect of an initial defensive reaction. It is quite conceivable that such fear appeals still have an effect after an initial defensive reaction.

In your dissertation, you dealt with the "Smokefree" campaign of the Federal Office of Public Health. The claim is "I am stronger". What was the ulterior motive behind it?

The idea was to encourage people to quit smoking without scare tactics. "I'm stronger," not "You have to stop smoking right now or you'll die." Not going to extremes in advertising is part of Switzerland's communicative philosophy. In this country, stop-smoking campaigns have been appearing since 2001 and shock images have never been shown.

The FOPH has always avoided fear appeals in the area of tobacco prevention.

Does research answer whether such positive-motivational messages work better than fear appeals?

No, there is not. There is always research into whether fear appeals are effective. But this research is difficult. It would actually be necessary, for example, to accompany ex-smokers over a period of years and observe whether they really persevere with the smoking cessation initiated by the campaign. Instead, it is usually only possible to study whether there is an intention to quit smoking, whether people remember the campaign and how it is received. This approach has been criticized by some researchers as being of little value. What is known, however, is that fear appeals should be combined with self-efficacy-enhancing information to give the target group something to do to avert the danger. In other words, you should never just point out the danger. Otherwise, fear is likely to increase - but because people don't know how to avert the danger, they react with defensiveness to the campaign content.

Can you give us an example of a fear-mongering campaign that was successful?

For example, the "Tips from former Smokers" campaign from the USA. In it, real ex-smokers tell their story and the damage they have suffered. Terrible pictures are shown. Nevertheless, positive effects were recorded.

In the U.S., tobacco prevention works with shock images - and real people telling their stories.

How do you explain the success in this case?

Certainly, one reason was that real people had their say. That makes the message of the campaign credible. Something that happened to a real person - not an advertiser's idea. The combination of real person, deterrence and a story behind it - that apparently works very well in the US. So it's not that deterrence just doesn't do any good.

Prevention campaigns usually see the whole population - including people who are not part of the target group. One argument against fear appeals is therefore often, "Do you have to watch something like that?"

This is one of the reasons for the Swiss practice: one does not want to expose certain images to the general public.

Another argument you hear regarding tobacco prevention is: smokers feel so stressed by images of black lungs that they have to reach for a cigarette right away to calm down....

Yes, that can certainly happen. But the decisive factor is what happens later and whether the images have an influence after all. And you don't know that for sure.

The very successful "Lovelife" campaign of the Federal Office of Public Health, for example, has always managed without fear images.

One must distinguish: Anti-smoking campaigns refer to a behavior that one already has and should change. They may be less effective per se than campaigns that advocate starting over with a particular behavior. For example, to use condoms. Therefore, it is easier to achieve high effectiveness with such campaigns. Nevertheless, a fear appeal also resonates in the Lovelife campaigns: After all, the point is to prevent getting AIDS. Everyone knows that.

How would you rate the latest Lovelife campaign with the claim "Let's go"?

What is certainly good about it is the play on words. It stimulates the thoughts. Digitec Galaxus also works with the fact that you still have to draw a conclusion yourself ("Ah yes, that has a double meaning."). There's also the humor aspect. And humor makes it easier for a message to be accepted. A third means with which the campaign works is the prior knowledge of the recipients. The basis is that the population knows that you can get infected if you don't use condoms.

The FOPH's latest Lovelife campaign relies on wordplay and humor.

Other prevention campaigns have a raised finger: "Get tested!", "Use condoms!", "Eyes on the road!". Do people feel addressed by this?

This moralizing is not normally well received. You also have to give recipients the opportunity to develop their own thoughts about the content. You don't develop a defense against your own thoughts, and they stay in your memory longer. On the other hand, there is of course the danger: If you don't specify what a person has to think, you don't know what they think either...

When you look back on the "Smokefree" campaign: Were the goals and the idea behind it achieved or should something have been done differently?

What we were able to determine: People who wanted to quit smoking before the campaign were encouraged to quit by the campaign. People who did not want to quit, however, did not. They were not impressed. What worked well, for example, was that support services for quitting smoking became better known. I can also point out as positive that the TV commercials worked well. One of the TV spots, for example, was about lung cancer and how people think it only happens to others. A spokesperson then said: He was not one of the others. Smokers who had seen this TV spot reduced the extent of their unrealistic optimism.

The unrealistic optimism?

This means that one underestimates personal risks compared to risks that one attributes to others. In the area of tobacco consumption, this means that although one is aware of the health consequences of smoking, one thinks that one is less at risk than others. The reasons for this are manifold.

For example?

For example, because you're still young and will quit later anyway. Or because everyone in the family smoked and nothing happened to anyone. Or because you do sports and eat a lot of vegetables on the side. Those affected think: Yes, there are health consequences, but it won't affect me. That's why many continue to smoke, even though they know they are harming themselves. This is exactly the problem with fear appeals, which present, publicize and recall health risks of smoking. If smokers do not attribute them to themselves, they are of little use.

Looking back, could anything have been done better with "Smokefree"?

As a point of criticism, one could perhaps add that the campaign was not very present. Precisely because the content was actually good, it might have had a stronger impact if it had been seen more often.

What makes a prevention campaign successful according to research?

It will probably rarely be the case that someone sees a picture of a black lung and then quits right away. But it can, in combination with other factors, for example friends who motivate you to quit or a doctor who talks to you, help to tackle quitting smoking. And the norm can be changed.

What do you mean by that?

Smoking is no longer considered as cool as it used to be. When I was in high school, the "cool ones" smoked. I don't think that's the case anymore. The campaigns have contributed to this change.

Is this proven to be the case?

Yes, that is what long-term impact studies show. It is clear that norms cannot be changed by legislation alone - but campaigns can help to achieve this.

How do you counter the common accusation that federal awareness campaigns are money down the drain?

The unique selling point of campaigns is that they are a mass media approach to get people to voluntarily change their behavior. Laws and price increases force the target group to behave in a certain way. It is known that voluntary behavior changes are long-term in nature, while involuntary, forced ones are more likely to be reversed once the law changes. According to research, the best impact is achieved through combinations of measures. So, for example, if new laws are introduced, cigarette pack prices go up at the same time, and a campaign is underway. The overall package works best.

The interview was conducted earlier this year as part of the research for the focus story on sensitization campaigns ("Is fear a bad advisor?") in the print edition of Werbewoche 4-5/2020.