Journal of Experimental Social Psychology 46 (2010) 226–228

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Journal of Experimental Social Psychology

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When the death makes you smoke: A terror management perspectiveon the effectiveness of cigarette on-pack warnings

Jochim Hansen a,b,*, Susanne Winzeler b, Sascha Topolinski c

a New York University, Department of Psychology, 6 Washington Place, New York, NY 10003, United Statesb University of Basel, Department of Psychology, Missionsstrasse 60/62, CH-4055 Basel, Switzerlandc University of Würzburg, Lehrstuhl für Psychologie II, Röntgenring 10, D-97070 Würzburg, Germany

a r t i c l e i n f o a b s t r a c t

Article history:Received 16 July 2009Revised 11 September 2009Available online 18 September 2009

Keywords:Terror management health modelTerror management theorySmokingWarning messageMortality salienceSelf-esteem

0022-1031/$ - see front matter � 2009 Elsevier Inc. Adoi:10.1016/j.jesp.2009.09.007

* Corresponding author. Address: Department of Psity, 6 Washington Place, New York, NY 10003, Unite

E-mail address: jochim.hansen@nyu.edu (J. Hansen

One of the principal vehicles for informing tobacco consumers about the risks of smoking is the warningmessage on each cigarette package. Based on terror management theory, the present study investigatesthe impact of mortality-salient warnings on cigarette packages compared to warnings with no mortalitythreat. Results suggest that to the degree that smoking is a source of self-esteem, later attitudes towardssmoking become more positive if the warning message is mortality-salient. On the contrary, if the warn-ing is terrifying but not mortality-salient and relates to the source of self-esteem, smoking attitudesbecome more negative with higher smoking-based self-esteem. Thus, mortality-salient warnings mayincrease the tendency to favor smoking under certain circumstances. This fatal ironic effect highlightsthe importance of a risk communication that matches the self-esteem contingencies of the recipients,and it has urgent implications for health care policy.

� 2009 Elsevier Inc. All rights reserved.

Smoking is responsible for millions of deaths all over the world;and the figure is estimated to continue to rise (US Department ofHealth, 2004). In an effort to help to reduce the number of tobaccoconsumers, governments started several anti-smoking strategies,such as raising the taxation on tobacco products, publicizinganti-smoking advertisements, or making certain public placessmoke-free.

Labeling of tobacco products is yet another anti-smoking strat-egy. In many countries, every tobacco product has to have a mes-sage printed on the package that warns against the negativeconsequences of smoking for one’s health. Such warnings shallmake consumers aware that smoking leads to death (e.g., ‘‘Smok-ing kills”), to health problems (e.g., ‘‘Smoking clogs the arteriesand causes heart attacks and strokes”), and to social problems(e.g., ‘‘Protect children: Do not make them breath your smoke”).Thereby, many of such warning messages remind us of our mortal-ity, but others do not (e.g., ‘‘Smoking makes your skin agequicker”). How effective are such warnings in reducing smokingattitudes?

In the present research, we hypothesize that warning messagesmay have different effects on smoking attitudes, depending on (1)how salient mortality is in the messages, and on (2) how stronglyrecipients base their self-esteem on smoking. Specifically, we pro-

ll rights reserved.

sychology, New York Univer-d States.).

pose that, on the one hand, terrifying but death-unrelated warn-ings (such as ‘‘Smoking brings you and the people around yousevere damage” and ‘‘Smoking makes you unattractive”) are effec-tive in reducing attitudes towards smoking to a greater degree themore people base their self-esteem on smoking. This is becausesuch warnings may challenge the very reason for smoking particu-larly for those who believe that smoking allows them to feel valuedby others or to boost their positive self-image. Thus, a high smok-ing-based self-esteem may make people especially susceptible forinformation that undermines their self-esteem.

Based on the terror management health model (Goldenberg &Arndt, 2008), we predict on the other hand that the opposite pat-tern would emerge when the warnings are related to death andtherefore make mortality salient. That is, the more individuals basetheir self-esteem on smoking, the more they would adopt a posi-tive attitude towards smoking after being provided with mortal-ity-salient warning messages because awareness of mortalitymotivates self-esteem striving (Pyszczynski, Greenberg, Solomon,Arndt, & Schimel, 2004). This hypothesis can be derived from terrormanagement theory (e.g., Greenberg, Solomon, & Pyszczynski,1997; Solomon, Greenberg, & Pyszczynski, 1991), which is basedon the notion that all human beings are aware that their own deathis inevitable. This knowledge creates the potential for extreme anx-iety (or terror) because of being helplessly exposed to this threat.In order to manage this distress, people are motivated to maintainfaith in their cultural worldview and to keep a positive self-esteem(i.e., they are motivated to increase the subjective belief that one is

J. Hansen et al. / Journal of Experimental Social Psychology 46 (2010) 226–228 227

a valuable member of one’s culture). Keeping a positive self-esteemcan give a feeling of security and function to buffer people from thedeeply rooted existential fear when mortality is made salient(Pyszczynski et al., 2004). To the extent that smoking is a sourceof self-esteem, mortality-salient on-pack warnings would thusironically cause more positive attitudes towards smoking.

A comparable example for the buffer function of self-esteem hasbeen shown by an experiment that examined the effects of mortalitysalience on risk taking while driving (Taubman Ben-Ari, Florian, &Mikulincer, 1999; see also Jessop, Alberty, Rutter, & Garrod, 2008).Mortality salience inductions led to more risky driving than the con-trol condition among individuals who perceived driving as relevantto their self-esteem. Similarly, it has been demonstrated that wo-men for whom their looks were an important source of self-esteempreferred to eat fruit salad (compared to chocolate cake) if mortalitywas salient, whereas women who based their self-esteem on otherthings showed the opposite pattern (Ferraro, Shiv, & Bettman, 2005).

In the present research, we assessed smoking-based self-esteemand afterwards presented smokers with fear-evoking warningmessages on cigarette packages. These warnings were either re-lated to death or not. After a delay, we measured smoking atti-tudes. We included a delay because any effects of mortalitythreats can only be found when death-related thoughts have beenremoved from conscious awareness, either by delay, by distraction,or by subliminal presentation of the mortality threats (Goldenberg& Arndt, 2008; Greenberg, Pyszczynski, Solomon, Simon, & Breus,1994). When thoughts of death are in focal attention, behavior isguided by a motivation to overcome these thoughts. Only afterthoughts of death have become nonconscious, motivations to bol-ster one’s self-esteem may override such proximal defenses.

Because reminders of one’s mortality may lead to attempts tobolster one’s self-esteem in response to an existential threat, wepredicted that mortality salience would paradoxically cause morepositive smoking attitudes for individuals who build their self-es-teem on smoking. Therefore, death-related anti-smoking warningsshould be less effective in changing smoking attitudes the morepeople base their self-esteem on smoking. In contrast, death–neu-tral (but self-esteem related) anti-smoking warnings should moreeffectively induce anti-smoking attitudes the more smoking is asource of self-esteem.

Method

Participants and design

Thirty-nine psychology students who indicated that they weresmokers took part in the study in exchange for course credit (31female, 8 male). Age ranged from 17 to 41 years (M = 22.46,SD = 4.603, Mdn = 21). They were randomly assigned to one of twoexperimental conditions (mortality salience vs. control).1 The twoconditions did not differ in the amount of smoking per day,t(37) = 1.223, p = .26.

Materials and procedure

After providing some demographic data, participants filled in aseries of questionnaires. The first questionnaire measured to whatdegree participants based their self-esteem on smoking with 12items that were adapted from Taubman Ben-Ari et al. (1999),and included the following examples: ‘‘Smoking brings out un-wanted aspects of my character” (reversed scored), ‘‘Smoking dam-

1 Furthermore, we varied whether the warning messages contained pictures thaadditionally emphasized the warning or not. However, this variation of thepresentation format had no effect on the attitudes, nor did it qualify the foundeffects. Therefore, it is not discussed further.

t

ages my positive self-image” (reversed scored), ‘‘Smoking allowsme to feel valued by others,” and ‘‘Smoking allows me to feel wor-thy.” For each statement, participants indicated their agreement ona scale ranging from 1 (do not agree at all) to 7 (agree completely).We calculated a mean smoking-based self-esteem index for eachparticipant (Cronbach’s a = .79). After this scale, participantsworked on a filler questionnaire.

Next, participants were randomly assigned to one of two condi-tions. In both conditions we presented illustrations of two cigarettepacks, each of which contained an anti-smoking warning message.In one condition, mortality was made salient by using warnings thatread, ‘‘Smokers die earlier” and ‘‘Smoking leads to deadly lung can-cer.” In the other version, the warnings were unrelated to death(i.e., ‘‘Smoking brings you and the people around you severe dam-age” and ‘‘Smoking makes you unattractive”). A pretest with an inde-pendent sample of 23 smokers had revealed that these two versionswere comparably threatening, t < 1, scary, t(21) = 1.843, p = .19, dis-turbing, t(21) = 1.902, p = .18, and self-relevant, t < 1, but differed inthe degree to which they remind perceivers of the death as intended,t(21) = 7.666, p = .01. In order to make sure that participants attendto the packages, they were asked to write down three thoughts thatcame to their mind when they saw the illustrations.

After this, participants filled in an unrelated questionnaire thatwas included to introduce a 15-min delay between exposure of thewarnings and the dependent measure. This was done because pre-vious research has shown that effects of mortality salience emergenot until death-related thoughts have been removed from con-scious awareness (Arndt, Greenberg, & Cook, 2002; Pyszczynski,Greenberg, & Solomon, 1999).

Subsequently, smoking attitudes were collected with five itemsthat were answered on respective 7-point scales (‘‘Do you enjoysmoking?” ‘‘How important is smoking for you?” ‘‘Do you intentto smoke more or less in the future?” ‘‘Do you intent to quit smok-ing in the future?” and ‘‘Are you going to smoke a cigarette directlyafter this study?”). Finally, participants were thanked, debriefed,and given credit.

Results

Preliminary analyses revealed that the mortality salience andthe control conditions did not differ significantly regardingsmoking-based self-esteem, (Mmortality salience = 2.25, SD = .84 vs.Mcontrol condition = 2.32, SD = .81), t(37) = .28, p = .78, and smokingattitudes (Mmortality salience = 4.24, SD = 1.06 vs. Mcontrol condition =3.93, SD = 1.00), t(37) = –.948, p = .349.

To test the hypothesis that smoking-based self-esteem moder-ates the effect of mortality salience on smoking attitudes andintentions, we regressed the attitude score on the experimentalcondition (0 = mortality salience condition, 1 = control condition),the z-standardized smoking-based self-esteem score and theirtwo-way interaction. The main effect of condition was not signifi-cant, b = .16, t(36) = .94, p = .35, indicating a similar overall smok-ing attitude in both conditions. Importantly, the interactionbetween the experimental condition and the smoking-based self-esteem was significant, b = .63, t(36) = 2.88, p < .01 (see Fig. 1). Ashypothesized, simple slope tests (Aiken & West, 1991) revealedthat the smoking-based self-esteem was negatively related tosmoking attitudes in the control condition, b = –.45, t(36) = –2.02,p = .05, but that it was positively related to smoking attitudeswhen mortality was salient, b = .42, t(36) = 2.05, p < .05.

Discussion

The present findings suggest that warning messages on ciga-rette packages can be effective in inducing anti-smoking attitudes.

Fig. 1. Attitudes towards smoking after anti-smoking warnings as a function ofmortality salience of the warnings and smoking-based self-esteem (±1 SD). Themean attitude score ranged from 1 to 7; higher values indicate a more positiveattitude towards smoking.

228 J. Hansen et al. / Journal of Experimental Social Psychology 46 (2010) 226–228

However, their effect depends on a combination of smoking-basedself-esteem and mortality salience of the message. On the onehand, death-related warnings were not effective and even ironi-cally caused more positive smoking attitudes among tobacco con-sumers who based their self-esteem on smoking. This findingsuggests that individuals with a high smoking self-esteem use po-sitive smoking attitudes as a strategy to buffer against existentialfears provoked by the death-related warning messages. For indi-viduals with a low smoking self-esteem, in contrast, a positive atti-tude towards smoking would not buffer against existential terror.Thus, relative to high smoking self-esteem participants, partici-pants with a low smoking self-esteem demonstrated lower smok-ing attitudes.2

On the other hand, warning messages that were unrelated todeath effectively reduced smoking attitudes the more recipientsbased their self-esteem on smoking. This finding can be explainedby the fact that warnings such as ‘‘Smoking brings you and the peo-ple around you severe damage” and ‘‘Smoking makes you unattrac-tive” may be particularly threatening to people who believe theopposite, namely that smoking allows them to feel valued by oth-ers or to boost their positive self-image. To the degree that warningmessages undermine the high smoking-based self-esteem, smok-ing may be devalued. Interestingly, this effect, too, only emergeswhen attitudes are assessed after a delay but not when attitudesare assessed directly after the warning (see Footnote 2). Possibly,when smokers are consciously aware of warnings that argueagainst the basis of their self-esteem, such warnings may be down-played. After a delay, however, the warnings are not in consciousawareness anymore and may unfold their impact.

In sum, consistent with the terror management theory (Green-berg et al., 1997; Solomon et al., 1991) and the terror managementhealth model (Goldenberg & Arndt, 2008), the impact of warningmessages on cigarette packs depended (1) on the degree to whichself-esteem was based on smoking, and (2) on the salience of deathin the warnings. Our finding is of high practical relevance, as it sug-gests that a differential strategy should be applied to warn smokersagainst negative consequences of smoking, depending on the de-gree to which they base their self-esteem on smoking. Death-re-lated warnings are not effective and even have unwanted effectswhen smokers have a high smoking-based self-esteem.

However, outside the laboratory, the degree to which smokersbase their self-esteem on smoking is unknown. Thus, it is difficult

2 Please note that this effect only emerged when attitudes had been assessed after adelay. In a different study in which attitudes were measured directly after themanipulation of mortality salience, we did not find any evidence for the influence ofmortality salience, smoking-based self-esteem, and their interaction on smokingattitudes, ts < 1. This finding is in accordance with the terror management healthmodel (Goldenberg & Arndt, 2008).

to predict whether a death-related or a death-unrelated warningmessage would be more effective. Yet, one could speculate thatcertain populations base their self-esteem on smoking to a higherdegree than others, for instance young smokers who want to im-press their peers. If this turns out to be true, a consequence ofour findings would be that such populations should be warnedagainst noxious consequences of smoking with death–neutral mes-sages that undermine their smoking-based self-esteem. Such mes-sages would probably not increase smoking attitudes as a strategyto buffer against existential fears, but instead change people’sminds after a delay.

In general, when smokers are faced with death-related anti-smoking messages on cigarette packs, they produce active copingattempts as reflected in their willingness to continue the riskysmoking behavior. Which coping attempt they use, depends ontheir smoking-based self-esteem. To succeed with anti-smokingmessages on cigarette packs one thus has to take into account thatconsidering their death may make people smoke.

Acknowledgment

We thank Malte Friese for helpful comments on an earlier ver-sion of this article.

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