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dissertation entitled

THE INFLUENCE OF SENSATION-SEEKING AND
MESSAGE CHOICE ON RESPONSES
TO FEAR APPEALS

presented by

Judith M. Berkowitz

has been accepted towards fulfillment
of the requirements for

 

 

 

 

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THE INFLUENCE OF SENSATION-SEEKING AND MESSAGE CHOICE ON
RESPONSES TO FEAR APPEALS

Judith M. Berkowitz

A DISSERTATION

Submitted to

Michigan State University

in partial fulfillment of the requirements

for the degree of

DOCTOR OF PI-HLOSOPHY

Department of Communication

1998

ABSTRACT

THE INFLUENCE OF SENSATION-SEEKING AND MESSAGE CHOICE ON
RESPONSES TO FEAR APPEALS

By

Judith M. Berkowitz

The purpose of this investigation is to examine the influence of sensation seeking
and message choice on responses to fear appeals. It is argued that sensation seeking will
be positively associated with an individual’s desire to view a high threat fear appeal and
that exposure to an optimal threat level will result in more positive attitudes and
intentions. A factorial design with an immediate post-test and two-week follow-up was
employed. There were two message threat level conditions (high or low) and two choice
conditions (received choice/did not receive choice). In addition, a forced exposure (high
threat/low threat) group was employed. Analyses indicate no relationship between
sensation seeking and message choice. Further, results indicate that exposure to a non-
desired message resulted in more positive behaviors than did exposure to a desired

message. The implications of these findings are discussed.

Dedication

To Robin, for courage and confidence;

To my family, for sustenance and faith;

To Brian and Evan, may you soar peacefully to new heights

iii

ACKNOWLEDGMENTS

There are many people to whom I offer my gratitude for their assistance in
completion of this project. I am especially grateful for the patience, suggestions, and
advice provide by members of my committee: Dr. Frank Boster who is credited with the
ideas contained within this project; Dr. Bradley Greenberg for insight into alternative
hypotheses; Dr. Jim Dearing (who missed the proposal defense just because Sam went into
labor with Spike) for his direction and encouragement; and to Dr. Kim Witte whose
pragmatic approach to the process made the project bearable.

This research was supported in part by an appointment to the Research
Participation Program at the Centers for Disease Control and Prevention, National
Institute for Occupational Safety and Health administered by the Oak Ridge Institute for
Science Education through an interagency agreement between the US. Department of
Energy and CDC. The author acknowledges Alan Janssen for access to the NIOSH
resources and this opportunity; Dick Tardif; and Susan Jacques for her artwork.

Thank you, Deb Tigner for the administrative support provided in “just doing your
job”. To Ann Wooten, Marge Barkman, and the rest of the administrative staff over the
course of my graduate career at MSU, a debt of gratitude is owed. In addition, I am
grateful for the wisdom and counsel of Sandi Smith, Chuck Atkin, Ron Tamborini,
Patrice Buzzanell, Steve Wilson and Leslie Snyder. It is reassuring to know that someone
can see the light at the end of the tunnel when you cannot. Finally, thanks to my family

for their support. And mice: look, I make it through the hoop!

TABLE OF CONTENTS

List of Tables ............................................................................................. vi
List of Figures ........................................................................................... viii
Chapter 1. Introduction ............................................................................. 1
Chapter 2. Literature Review .................................................................... 5
Chapter 3. Method .................................................................................... 33
Chapter 4. Results .................................................................................... 47
Chapter 5. Summary and Conclusions ....................................................... 61

List of References ...................................................................................... 73

LIST OF TABLES

Table 1. Items used to measure Sensation Seeking factors
based on F orrn V of Zuckerman’s Sensation Seeking Scale (1979) .............. 42

Table 2. Variables measured in the study ..................................................... 45

Table 3. List of independent and dependent variables for the
manipulation checks, hypotheses, and research questions ............................ 46

Table 4. Means, standard deviations, and cell counts for overall
sensation seeking and each sensation seeking factor by message choice ....... 51

Table 5. Adjusted means, standard deviations, and cell counts for
Attitude at Time 1 by message choice, message threat level, and
sensation seeking ........................................................................................ 57

Table 6. Adjusted means, standard deviations, and cell counts for
Intentions at Time 1 by message choice, message threat level, and
sensation seeking ...................................................................................... 57

Table 7. Adjusted means, standard deviations, and cell counts for
Behavior at Time 1 by message choice, message threat level, and
sensation seeking ........................................................................................ 58

Table 8. Adjusted means, standard deviations, and cell counts for
Attitudes at Time 2 by message choice, message threat level, and
sensation seeking ........................................................................................ 58

Table 9. Adjusted means, standard deviations, and cell counts for
Intentions at Time 2 by message choice, message threat level, and
sensation seeking ........................................................................................ 58

Table 10. Adjusted means, standard deviations, and cell counts for
Behaviors at Time 2 by message choice, message threat level,
and sensation seeking .................................................................................. 59

Table l 1. Adjusted means, standard deviations, and cell counts for
“Flossing more often” by message choice, message threat level, and
sensation seeking ........................................................................................ 59

Table 12. Adjusted means, standard deviations, and cell counts for
“Flossing more carefiilly” by message choice, message threat level,
and sensation seeking .................................................................................. 59

Table 13. Adjusted means, standard deviations, and cell counts for
“Flossing more regularly” by message choice, message threat level,
and sensation seeking .................................................................................. 6O

vii

LIST OF FIGURES

Figure 1. The Extended Parallel Process Model (EPPM) (Witte, 1992b) 7

Figure 2. Main effects predicted for Sensation Seeking and
Message Threat Level ................................................................................. 26

viii

CHAPTER 1

INTRODUCTION

In order to promote health protective behaviors, campaigners commonly attempt
to arouse fear in audiences. Indeed, Freimuth, Hammond, Edgar, and Monahan (1990)
found that 26 percent of all AIDS public service announcements utilized fear appeals to
promote health protective behavior. Fear appeals are messages designed to arouse fear in
the receiver by describing the terrible consequences associated with non-compliance with
the message recommendations (O’Keefe, 1990). It is presumed that these messages instill
fear in the audience and spur members to modify their behaviors and to undertake the
recommended beneficial health behaviors.

In general, fear appeals have been found to be an effective means of gaining
compliance with a message’s recommendations. Meta-analytic results indicate that a
positive relationship exists between fear level and attitudes, intentions, and behaviors, such
that strong fear appeals are more persuasive than weak fear appeals (Boster & Mongeau,
1984; Hale & Dillard, 1995; Sutton, 1982; Witte & Allen, 1996). Thus, we would expect
messages which instill greater fear arousal would result in more behavior change.

A number of models have arisen which suggest reasons why fear appeals are
successful in gaining compliance. One model in particular, the Extended Parallel Process
Model (EPPM) (W itte, 1992b), suggests the conditions under which risk messages are
likely to be accepted and result in health protective behaviors. The EPPM posits that when
individuals believe themselves to be at-risk for a serious health threat and believe that they

can easily and effectively avert the threat, they change their attitudes, intentions, and

behaviors to conform with the position advocated. However, if individuals do not believe
that the recommended response will be effective or they believe that they are unable to
perform it, then they are motivated to take action to reduce their fear.

Although the EPPM explains when a fear appeal message is likely to be accepted
or rejected, it has two shortcomings. One shortcoming of the model is the lack of
attention given to individual difference variables. Although the EPPM suggests that
individual differences indirectly influence the likelihood of engaging in health protective
action through perceptions of threat and efficacy, it does not specify the manner in which
it occurs. One variable in particular, sensation seeking, has been shown to influence
reactions to fear appeals in unexpected ways and is in need of further study. Second, the
fear appeal literature fails to take into account that people selectively expose themselves to
information. In reality, people seek out and pay attention to information which is
consistent with their beliefs and which does not exceed their desired arousal level;
however, the vast majority of fear appeal studies force exposure to high or low threat fear
appeal messages. These issues will be addressed in the study.

One health concern which has been the focus in persuasion research is dental
hygiene. Proper dental care has been used in tests of inoculation theory (e. g., McGuire,
1961; McGuire, 1962; McGuire & Papageorgis, 1961), theory of reasoned action and
theory of planned behavior (e.g., McCaul, O’Neill, & Glasgow, 1988; Mch1, Sandgren,
O’Neill, & Hinsz, 1993), and fear appeal research (e. g., Beck & Lund, 1981;
Dembrowski, Lasater, & Ramirez, 1978; Evans, Rozelle, Noblitt, & Williams, 1975; Janis

& Feshbach, 1953; Janis & Feshbach, 1954).

Proper dental hygiene (e.g., a diligent regimen of brushing and flossing) aids in the
prevention of periodontal (gum) disease. A proper regimen will remove the bacteria
which cause plaque and can lead to periodontal disease. Without proper removal,
bacteria-laden plaque builds up and may cause infections in the natural v-shaped gaps
(called the sulcus) between teeth and the gum line. Untreated, the depth of the sulcus
increases, allowing the gum line to recede from the teeth. Additional symptoms of early
stages of gum disease include redness, swelling and tenderness of the gums, and bleeding
when pressure is applied (Carranza, 1990; Cross, 1977). It is estimated that up to 75
percent of us have bacterial infections associated with periodontal disease (Schlosberg,
1996). When treated early, most cases of periodontal disease are reversible; however,
diligent dental hygiene is necessary to prevent the onset or recurrence of periodontal
disease (Carranza, 1990; Schlosberg, 1996).

Although most people know the importance of proper dental hygiene, many do not
floss on a regular basis (Camner, Sandell, Sarhed, 1994). The development and evaluation
of fear appeals intended to induce behavioral compliance with dental hygiene regimens will
benefit from the incorporation of knowledge based on current theoretical work and
research findings regarding fear appeals.

In sum, the purpose of this thesis is to extend the EPPM to incorporate the
influences of sensation seeking, selective exposure, and message choice in order to prevent
periodontal disease. Integrating these factors into the EPPM should increase the
predictive utility of the model and provide a stronger understanding of the influence of

sensation seeking on the desire to engage in health protective action. The next chapter

describes the EPPM, selective exposure, sensation seeking, and expectancy theory and
offers hypotheses. Chapter 3 presents the methodology for the experiment and describes
the health domain for the study. Chapter 4 presents results of the analyses. Finally,

Chapter 5 includes discussion and implications for the theory and for practitioners.

CHAPTER 2

LITERATURE REVIEW

Instilling fear in an audience in order to promote behavior change is a technique
which is commonly used (Atkin, 1994; Dillard, 1994; O’Keefe, 1990). The use of fear has
been the focus of numerous research projects in order to gain a greater understanding of
when and why fear appeals are effective in gaining attitude or behavior change (Boster &
Mongeau, 1984; Dillard, 1994; O’Keefe, 1990; Witte, 1992b). Fear appeals are
persuasive messages which are designed to fiighten the audience through the use of vivid,
gruesome language regarding the consequences of not performing the advocated
behaviors (Boster & Mongeau, 1984; O’Keefe, 1990; Witte, 1992b). Meta-analyses have
demonstrated that fear appeals have a small but consistent impact on behavior (Boster &
Mongeau, 1984; Mongeau, 1994; Witte & Allen, 1996).

In their meta-analysis, Witte and Allen (1996) found that stronger fear appeals
were consistently more persuasive than weaker fear appeals. Stronger fear appeals are
characterized by their ability to create greater perceptions of the severity of the threat and
one’s susceptibility to it. Boster and Mongeau (1984) noted that the size of the
correlation between fear manipulations and perceived fear was relatively small (r = .36),
suggesting that experimental inductions have been weak. This finding suggests that larger
discrepancies between high threat and low threat fear appeals would increase the
correlation between fear manipulations and perceived fear. The creation of a stronger fear

appeal, theoretically, would instill greater perceptions of severity and susceptibility.

6
In addition, Witte and Allen (1996) noted that the messages which were most

successful in promoting message acceptance were stronger fear appeals which contained
stronger efficacy messages. Thus, the success of a fear appeal is linked to its ability to
create perceptions that the individual may easily and effectively avert a severe threat
despite one’s susceptibility to it.

Recently, in an attempt to reconcile inconsistencies within the fear appeal
literature, Witte (1992b) proposed a model which attempted to explain when and why fear
appeals are likely to succeed in promoting attitude and behavior change. This chapter
begins with a discussion of a recent fear appeal theory, the Extended Parallel Process
Model (W itte, 1992b). Next, the EPPM’s shortcomings are presented and discussed.
These shortcomings are addressed in reviews of selective exposure and sensation seeking.
Finally, hypotheses are offered.

The Extended Pa_rall_el Process Model

Witte (1992b) developed the Extended Parallel Process Model (EPPM) in order to
detail more explicitly when and why fear appeals are effective in gaining attitude and
behavior change. As an extension of Leventhal’s (1970) parallel process model, the
EPPM differentiates between two responses to a fear appeal message: fear control and
danger control (see Figure 1). The EPPM suggests that individuals exposed to external
stimuli (e.g., a fear appeal message) will make judgments on the threat of the hazard and
the efficacy of the recommended response. Threat motivates action; therefore, if people do
not believe themselves to be at-risk to a severe threat, no further processing of the

message occurs. Thus, threat appraisal determines whether or not individuals will respond

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8
to the fear appeal message. If the individuals perceive low threat, the EPPM suggests that

the individuals will not respond to the fear appeal; they will merely ignore the message.
However, if the individuals perceive the threat to be high, the appraisal of efficacy will
determine the nature of their action. When individuals believe that they may easily and
effectively avert the threat, they engage in health protective action (i.e., danger control).
In contrast, when they believe that the recommended responses will be ineffective to avert
the threat or that they are unable to perform the response, they will engage in actions
designed to reduce their fear (i.e., fear control).

Fear appeals, by definition, are designed to arouse fear within the audience
members; performance of the fear appeals’ recommended course of action (i.e., the
recommended response) should lead to the reduction of fear level. This desire to reduce
the negative feelings associated with the fear are believed to result in behavioral
modification (O’Keefe, 1990). When individuals believe themselves to be at-risk for a
severe threat, fear is aroused and they are motivated to take any action which is capable of
reducing that arousal. However, there is no guarantee that the actions undertaken will
reduce the risk associated with the threat described in the fear appeal. Ifthe individuals
believe themselves capable of performing the recommended course of action, then they are
motivated to control the danger. This process, termed danger control, results in a
cognitive processing of the threat which leads to attitude, intention and behavior change
directed at averting the threat. However, when individuals believe that either the
recommended response will be ineffective in preventing harm or that they are unable to

perform that response, then they are motivated to take actions which will reduce their fear.

9
This process, termed fear control, results in processes designed to control the emotional

arousal caused by the threat. Individuals control their fear by rejecting the recommended
responses through defensive avoidance or denial of the threat (e. g., I’m just not going to
think about it) or through reactance.

In sum, appraisals of threat determine whether or not action will be taken while
appraisals of efficacy detemiine the nature of the responses. Danger control processes
dominate when individuals believe they may perform actions to avert the threat. In
contrast, fear control processes dominate when individuals believe they are unable to avert
the threat.

Empirical tests of the EPPM have garnered mixed results. Three studies are of
particular interest. First, Witte (1994) found partial support for the model. Specifically,
the results suggested separate fear control and danger control processes, such that
emotional arousal was associated with fear control and cognitive processes were
associated with danger control. She found that those engaged in defensive avoidance and
message minimization experienced less fear, suggesting that these processes enable
individuals to reduce the arousal produced by the fear appeal. Furthermore, the results
indicated that higher degrees of perceived efficacy lead to more positive attitude, intention
and behaviors (i.e., danger control outcomes).

In a difi‘erent study, Witte, Berkowitz, Cameron, and McKeon (1996) utilized a
modified Solomon four design to test the effectiveness of a fear appeal given existing
perceptions of efficacy. They found that respondents exposed to a high threat fear appeal

whose existing efficacy perceptions outweighed their threat perceptions had more positive

10
attitudes, stronger intentions to engage in the recommended response, and were more

likely to engage in the recommended behavior and undergo behavioral changes. For this
group, the fear appeal worked; they responded by controlling the danger. Conversely,
those people who saw the campaign but had low efficacy perceptions, were more likely to
engage in fear control responses such as issue derogation, defensive avoidance and
perceived manipulation.

Lastly, Rodriguez (1995) examined the interaction between perceived threat and
perceived efficacy and its influence on attitude change. He tested the EPPM across
several different health messages (e.g., bicycle helmets, alcohol consumption, and tetanus).
He did not find a significant amount of the variance in attitude change accounted for due
to perceptions of threat and efficacy, with eta squared no larger than .03 across the
various messages.l His analyses failed to find support for the EPPM or any other fear
appeal model tested (i.e., Protection Motivation Theory).

Overall, these research results suggest that the model’s predictive ability may be
improved. Respecification of the model and incorporation of specific individual difference
variables may lead to greater predictive utility. Moreover, understanding the interplay of
individual difference and message components will provide a basis fi'om which
practitioners may develop more effective campaigns. The next section addresses several

shortcomings of the model and provides suggestions as to additional factors to consider.

 

‘ These analyses were based on individual’s perceptions of threat and efficacy and not on
the traditional high versus low threat message groups.

1 l
Shortcomings of the EPPM

Researchers have found the EPPM to have various degrees of predictive utility
concerning when and why individuals engage in fear or danger control. However, results
indicate that the model is incomplete and that respecification may improve its predictive
abilities. This section will address several shortcomings of the model.

One shortcoming of the model surrounds the treatment of fear appeals as external
stimuli. As such, the audience members are viewed as passive recipients of the message.
However, individuals are much more active in seeking out information and exposing
themselves to messages. The EPPM does not account for this attribute of human
behavior. The EPPM’s treatment of a fear appeal as an external stimulus in combination
with experimental methods where exposure to the message is determined by the researcher
not by the participant create circumstances which may not adequately reflect non-
experimental conditions. Thus, consideration of how selective exposure influences
acceptance of a fear appeal’s recommendations would enhance the predictive utility of the
model.

Second, in her explication of the model, Witte suggests that individual differences
will indirectly affect the relationship among perceived threat, perceived efficacy, and fear
arousal and the likelihood of engaging in health protective action.

Several personality traits have been examined in terms of their influence on
reactions to fear appeals. Most of the studies examining individual differences have
yielded mixed findings. For example, research has found that greater levels of anxiety are

associated with less attitude change than are lower levels of anxiety (Boster & Mongeau,

12
1984; Witte & Allen, 1996). With regard to locus of control, Rosenstock, Strecher, and

Becker (1988) suggest that one’s locus of control coupled with perceptions of self-
efficacy will influence the likelihood of performing health protective behaviors.
Specifically, they suggest that individuals with high internal locus of control and high self-
efficacy are most likely to engage in the recommended response health protective action
while those with high external locus of control and low self-efficacy are least likely to
perform the recommended response. However, other research on locus of control has
found that those with external locus of control are more likely to engage in health
protective action (Beck & Lund, 1981; Burnett, 1981).

Casey (1995) found that a fatalistic mentality prevalent within a community of
low-socio-economic status African-American gay males diminished the relationship
between perceptions of threat and actual health protective behaviors as posited by the
EPPM. Despite the fact that members of this community believed that they could
effectively and easily use condoms to avert the threat of AIDS, they did not engage in
safer sex practices (i.e., use of a condom).

Thus, depending on the character of the population, individual differences can
affect greatly the predictive utility of the model. However, these individual differences do
not suggest why a person would selectively expose himself/herself to a fear appeal nor do
they consider the consequences of such exposure. One personality trait that has found to
be associated with willingness to view a fear appeal and acceptance of a fear appeal’s .
recommended response is sensation seeking. Indeed, researchers have found that high

sensation seekers are more likely to want to view a high threat fear appeal than are low

13
sensation seekers (Donohew, Lorch, & Palmgreen, 1991; Everett & Palmgreen, 1995;

Palmgreen, Donohew, Lorch, Rogus, Helm & Grant, 1991; Palmgreen, Lorch, Donohew,
Harrington, Dsilva, & Helm, 1995; Sheer & Cline, 1994; Zuckerrnan, 1988). Although
high sensation seekers may be prone to seek out a high threat fear appeal, the fear appeal
may have a limited impact on behavior. Several studies have found that low sensation
seekers are more likely to engage in the recommended responses than are high sensation
seekers (Clayton, Cattarello, & Walden, 1991; Harrington & Donohew, 1996; Horvath &
Zuckerman, 1993; Kalichman, Heckman, & Kelly, 1996; Sheer & Cline, 1994; Sheer &
Cline, 1995; Witte & Morrison, 1995). Whereas high sensation seekers, because of their
propensity to engage in high risk activities, may be at greater risk for the health threat,
exposure to a fear appeal may spur them to take additional risks regardless of their
perceptions of threat and efficacy (e.g., Witte & Morrison, 1995). Consequently, we
might expect that high threat, high efficacy messages would not produce danger control
responses for high sensation seekers; rather, they might increase the likelihood of high
sensation seekers to engage in the risky behavior. This contradicts the predictions of the
EPPM.

The EPPM treats fear appeals as external stimuli whose influences are limited to
their linguistic components (e. g., severity, susceptibility, response eflicacy, and self-
effrcacy). The EPPM suggests that high threat, high efficacy messages will always be the
most effective fear appeals. However, it ignores individuals’ propensity to seek out
information and their expectations about the level of threat a message might induce as they

afl‘ect message acceptance. Some people may be more inclined to view stronger fear

14
appeals. For instance, high sensation seekers are more likely to desire vivid, graphic

depictions contained within high threat messages (Everett & Palmgreen, 1995; Lorch,
Palmgreen, Donohew, Helm, Baer, & Dsilva, 1994). Yet, high sensation seekers are also
less likely to be persuaded by them (Witte & Morrison, 1995). While the EPPM suggests
that high threat, high efficacy messages lead to danger control, this may not be the case for
high sensation seekers. It is possible that high sensation seekers exposed to high threat,
high efficacy messages will engage in more risky activities (i.e., less danger control). To
this end, the EPPM may inadequately represent how the segment of the population most
likely to selectively expose themselves to high threat fear appeals are likely to respond to
them.

In sum, the characteristics of individual audience members and their tendency to
seek out information consistent with their predispositions is overlooked in the current
explication of the EPPM. Inclusion of these factors (selective exposure and sensation
seeking) into the EPPM might provide new insight into when and why fear appeals will be
successful in securing attitude and behavior change by mimicking more closely how
individuals act under real-life conditions.

_S_e_lective Exposure

In order for a campaign to be effective, individuals must first be exposed to the
message (Atkin & Freimuth, 1989; McGuire, 1989). McGuire (1989) believes that
attitude change occurs in stages which must occur in sequence. First, one must be
exposed to the message and pay attention to it. Even if one is exposed, no change may

take place if attention is not given. If one attends to the message, then it may be

15
processed. Processing the message, however, does not ensure that it will be

comprehended or interpreted in the manner intended by the researcher (Berkowitz,
Lapinski, Liu, Cameron, McKeon, & Witte, 1996; Covello, von Winterfeldt, & Slovic,
1987; McCallum, Hammond, & Covello, 1991). Unless it is processed, the individual may
not proceed to the next stage, learning. In this stage, individuals acquire the beliefs and
skills which are necessary for performing the advocated behaviors. Once learned, then
modification of beliefs and behaviors may ensue. At this stage, the individual yields to the
information contained within the message. Finally, the individual may be called upon to
utilize this newly acquired or redefined information at a later date (Fiske & Taylor, 1991;
McGuire, 1989; Olson, 1993; Smith, 1995).

Thus, as a precursor to any action, members of the target audience must be
exposed to a message. Typically, fear appeal studies utilize experimental methodology in
which participants are given a message to read (Boster & Mongeau, 1984; Mongeau,
1994; Witte & Allen, 1996). Under these conditions, exposure may be regarded as forced.
While these procedures provide necessary experimental control, they are not isomorphic
with the ways in which individuals are naturally exposed to messages. Finnegan (1994)
suggests that exposure has a variety of dimensions. Overall, these dimensions point to a
definition of exposure which encompasses the various “conditions and processes through
which individuals, groups, and populations come into contact with information in the
context of social systems and social relations” (p. 76). Exposure is typically manipulated
in terms of its amount (number of times a message is seen) or its duration (length of the

message) (O’Keefe, 1990). However, exposure to campaign materials does not

l6
necessarily ensure that the individual will be persuaded to engage in the recommended

health protective behaviors.

The reasons why individuals will expose themselves to different mass media
channels and context are varied. Some exposure is intentional; individuals actively seek
out information to fulfill certain needs (Atkin, 1985; Johnson & Meischke, 1993; Olson,
1993). One may seek information in order to find novel solutions to problems, obtain
background information about unknown events, or to help one cope with uncertainty.
Atkin (1985) suggests that intentional exposure depends on both receiver needs and
message attributes. When the receivers perceive that the benefits of acquiring and
processing information outweigh the effort needed to obtain and process it, they will seek
out the information. This search continues up until the point where economies of scale
associated with the search are insufficient to produce significant increases in desired
rewards. That is, one will halt the search once the effort required to continue exceeds the
perceived utility of acquiring additional information.

Aside from intentional exposure, one may be exposed to information
unintentionally. Olson (1993) terms this “accidental,” or non-intentional exposure. This
type of exposure occurs when an individual encounters stimuli or information but did not
seek it out actively. Examples of this type of exposure include: information on health
issues contained in entertainment programming; commercials viewed while channel
surfing; and advertisements in magazines, in newspapers, or on billboards. While
information is not sought actively and the individual may have no immediate use for it, it is

likely that the information may still be stored in memory for use at a later date. However,

17
because this information was not actively sought, the individual is unlikely to expend the

efl‘ort to evaluate the information critically prior to storing it in memory. Consequently,

subsequent use of the information may have serious ramifications for future behaviors if

that information was (a) misinterpreted; (b) inaccurate; or (c) utilized under unwarranted
conditions (see Chanowitz & Langer, 1981 for a description of the model).

It has been suggested that individuals naturally expose themselves to messages
which are consistent with their prior beliefs and which meet, but do not exceed, their
needs for emotional arousal (Donohew, Finn, & Christ, 1988; Donohew, Palmgreen &
Duncan, 1980; Donohew & Tipton, 1973; Lorch, Palmgreen, Donohew, Helm, Baer, &
Dsilva, 1994; Palmgreen, Donohew, Lorch, Rogus, Helm, & Grant, 1991). Donohew and
his colleagues (1973; 1980; 1988) have posited a model of information exposure in which
individuals seek pleasure through both variety and consistency in their experiences. When
information becomes monotonous, individuals seek change which will provide additional
stimulation. Likewise, when the information exceeds the threshold of stimulation (i.e., it
becomes too arousing or threatening), they seek change which will reduce the arousal or
avoid the perceived cause of the threat. Through this process, individuals strike a balance
point of stimulation. It must be noted that not all audience members desire the same
amount of emotional arousal. Fear appeals have the potential to create emotional arousal
in excess of that desired by some individual audience members (Donohew, Lorch, &
Palmgreen, 1991; Palmgreen, Donohew, Lorch, Rogus, Helm, & Grant, 1991). When
designing a campaign, it is important to understand the dynamic of audience members'

fear-level preferences and their reactions when the campaign message either exceeds or

18
does not meet their predispositions. Incorporating this factor may augment the predictive

utility of the EPPM.
W8

As mentioned above, one personality trait that researchers have found to be
associated with an individual's preference for high fear appeals is sensation-seeking. The
need for sensation refers to an individual's preferences for arousal related to novel,
ambiguous, and complex stimuli (Zuckerman, 1971; Zuckerrnan, Kolin, Price, & Zoob,
1964). High sensation seekers are more receptive to these types of stimuli and seek out
experiences which will provide high levels of arousal. Low sensation seekers, on the other
hand, prefer stimuli which do not provide such high levels of arousal. High sensation
seekers exposed to a fear appeal may be intrigued by the "thrill" associated with engaging
in the very activity the campaign is designed to prevent. Instead of promoting health
protective action, the fear appeal may serve to increase the likelihood of certain individuals
engaging in the discouraged activity. Sensation seeking, accordingly, may be at the root
of why a campaign fails to promote health behaviors effectively. An audience analysis
which considers this personality trait will provide a stronger base from which to gauge the
campaign's effectiveness (Atkin & Freimuth, 1989; Donohew, Lorch, & Palmgreen, 1991;
Lorch, Palmgreen, Donohew, Helm, Baer, & Dsilva, 1994; Palmgreen, Lorch, Donohew,
Harrington, Dsilva, & Helm, 1995; Sheer & Cline, 1994; Sheer & Cline, 1995). If, after
exposure to a message, an individual engages in the risky behavior, it may be due to the
propensity to engage in high risk behaviors as predicted by sensation seeking rather than

the campaign’s inability to deliver its message effectively. In other words, the message

19
may be crafied in a way which has been shown to work theoretically, but the campaign

may fail to promote health protective behavior because of the audience’s desire to engage
in risky activities. Moreover, this audience analysis may suggest that different approaches
to phrasing message contents be utilized in order to appeal to the varying needs of both
high and low sensation seekers.

The Sensation Seeking Scale was developed in an attempt to measure a personality
trait related to the optimal level of stimulation at which a person is comfortable
(Zuckerrnan, 1994). Zuckerrnan (1971, 1994) suggested that individuals, throughout the
course of a day, strive to find a balance point between overstirnulation and
understimulation. Beyond this optimal level, extreme anxiety may be felt; below this level,
the individual may experience boredom. This tolerance point is considered to be lower for
low sensation seekers than it is for high sensation seekers.

In addition, this personality trait is presumed to be related to an individual’s
propensity to engage in risky behavior. Risky behaviors are likely to induce anxiety and
arousal. This personality difference would be reflected in risk appraisals. Given the lower
tolerance level for low sensation seekers, they are presumed to be more likely to avoid
risky behaviors. High sensation seekers, on the other hand, are presumed to be more
likely to seek out such behaviors. Horvath and Zuckerrnan (1993) suggest that this
difi‘erence may be due to either (a) perceptions of rewards from having engaged in the
activity, or (b) an optimistic bias. It is possible that the value of the physiological arousal
derived from participating in risky activities (e.g., sky diving, gambling, drug use, etc.)

outweighs the perceived risks, and this serves as the impetus for high sensation seekers.

20
Alternatively, high sensation seekers may believe that they are less likely to be harmed by

engaging in a risky activity than are low sensation seekers. In either case, sensation
seeking would be predictive of one’s propensity to engage in risky behavior.

Since its original inception, Zuckerman’s sensation seeking scale has undergone
several revisions in order to update the phrasing of questionnaire items, to apply it to
diverse populations, and to address several measurement issues (Zuckerrnan, 1994).
However, through various versions and scale validation studies, four main subscales have
emerged: Thrill and Adventure Seeking; Experience Seeking; Disinhibition; and Boredom
Susceptibility. Zuckerrnan (1994) notes that these subscales have emerged with various
degrees of reliability in validation studies. (See Zuckerrnan, 1994, for a complete review of
the development of the scale). The first three factors tend to emerge more consistently
and with greater degrees of reliability than does the Boredom Susceptibility factor
(Zuckerrnan, 1971).

Thrill and Adventure Seeking refers to an individual’s desire to engage in risky and
unusual physical activities, such as sky diving, parasailing, mountain climbing, etc.
Second, Experience Seeking refers to the desire to encounter new sensations through
lifestyle choices. This may be accomplished through association with diverse groups of
unconventional individuals (e. g., hippies, artists, etc.) or through unconventional art,
music, or travel. The third subscale, Disinhibition, refers to unconventional social
activities and social stimulation. Included in this factor are activities such as wild parties,
drugs, alcohol consumption, and sex. The fourth subscale, Boredom Susceptibility, refers

to an intolerance of monotony in either the types of activities in which one engages or the

21
people with whom one associates. This intolerance leads to restlessness and a desire for

novel activity.

In general, males tend to exhibit higher levels of sensation than do females (Arnett,
1994; Newcomb & McGee, 1991; Sheer & Cline, 1995; Zuckerrnan, Eysenck, & Eysenck,
1978). Sensation seeking has also been found to be negatively related to age (Zuckerrnan,
1971; Zuckerrnan, Eysenck, & Eysenck, 1978); and negatively related to anxiety
(Zuckerrnan & Link, 1968). Sensation seeking is positively related to the likelihood of
engaging in illicit drug use, sexual behavior, criminal activity, and other delinquent
activities (Clayton, Cattarello, & Walden, 1991; Clayton, Leukefeld, Donohew, Bardo, &
Harrington, 1995; Kalichman, Heckman, & Kelly, 1996; Kalichman & Rompa, 1995;
Newcomb & McGee, 1991). In addition, sensation seeking has been found to be
negatively related to risk appraisal (Horvath & Zuckerrnan, 1993; Keinan, Meir, & Gome-
Nemirovsky, 1984). That is, individuals high in sensation seeking are more likely to
perceive a lower degree of risk involved with an activity than low sensation seekers.
However, Horvath and Zuckerrnan (1993) found that risk appraisal is a consequence,
rather than a mediator, of the relationship between sensation seeking and risky activities.
Moreover, this relationship is dependent upon the risky activity in question. Zuckerrnan,
Ball, & Black (1990) found that high and low sensation seekers had equivalent risk
perceptions of smoking. Thus, risk appraisals may be dependent upon the type of activity A
being appraised.

Overall, high sensation seekers are likely to desire greater levels of arousal, such as

those offered by a high threat fear appeal. As mentioned previously, high sensation

22
seekers are likely to desire to expose themselves to a message with high sensation value,

such as high threat fear appeals (Donohew, Lorch, & Palmgreen, 1991; Everett &
Palmgreen, 1995; Palmgreen, Donohew, Lorch, Rogus, Helm & Grant, 1991; Palmgreen,
Lorch, Donohew, Harrington, Dsilva, & Helm, 1995; Sheer & Cline, 1994; Zuckerrnan,
1988). Moreover, they are also more likely to volunteer for activities which produce such
arousal, especially those which offer novel and unique experiences (Zuckerrnan, 1994). If
given a choice between receiving a high threat and a low threat fear appeal, it is expected
that high sensation seekers will choose the high threat fear appeal more often than low
sensation seekers. Similarly, when given a choice of messages, low sensation seekers will
choose the low threat fear appeal more often than high sensation seekers. Thus,

H 1: The likelihood of choosing a high threat message will be positively related

to sensation seeking level.

Most investigations of the effect of sensation seeking on health behaviors and
reactions to messages has looked at sensation seeking as a composite of its four factors
rather than examining the effect due to each factor separately. Although most research
has examined sensation seeking as a general trait, this procedure is appropriate only when
the factors reflect the same underlying latent trait (Hunter & Gerbing, 1982). Ifthe
factors reflect the same underlying trait, then their relationships with other variables will
be identical (i.e., within sampling error). If the factors do not reflect the same underlying
trait, then it is possible that there will be different causal relationships between dependent
variables and the factors (i.e., Thrill and Adventure Seeking; Experience Seeking;

Disinhibition; and Boredom Susceptibility). Thus, we might expect one or more factors

23
may predict a behavior (e. g., desire to expose oneself to a high threat fear appeal) while

the other factors do not. Indeed, studies which have examined the four factors separately
have found differential relationships between each factor and different behaviors. For
example, disinhibition and boredom susceptibility to be predictive of the number of sexual
partners while the other factors are unrelated (N ewcomb & McGee, 1991; Sheer & Cline,
1995). Sheer (1995) found that different message appeals to get a sexual partner to use a
condom were more effective for different types of sensation seekers. Specifically, she
found that individuals high on disinhibition were more likely to intend to use pleasure or
threat appeals than were those low in disinhibition. Thus, we might expect one or more of
the sensation seeking factors to be stronger predictors of exposure to a high threat fear
appeal while the other factors are not predictors. The question is posed:

RQ 1: Which, if any, of the sensation seeking factors (Thrill and Adventure
Seeking; Experience Seeking; Disinhibition, and Boredom Susceptibility)
are related to choosing a high threat message?

In addition to its relationship with arousing stimuli, sensation seeking has also been
found to be related to an individual’s propensity to engage in health protective action after
exposure to a fear appeal. In a study examining the effectiveness of an intervention
campaign designed to curb the adolescents’ use of drugs, tobacco, and alcohol, Harrington
and Donohew (1996) found that low sensation seekers were more likely to abstain from
partaking in alcohol, drugs and tobacco. On the other hand, during the first year
immediately following the intervention campaign, high sensation seekers were more likely

to engage in the discouraged activities. However, at the follow-up interview two years

24
after the intervention campaign, the high sensation seeking students were less likely to

have engaged in the discouraged activities than were high sensation seekers who did not
participate in the intervention.

In a similar study, Clayton, Cattarello, and Walden (1991) examined the impact of
a drug prevention program on adolescents. They found that high sensation seekers would
engage in the discouraged activities within a short time period afier the intervention. After
this period, high sensation seekers exposed to the intervention would be less likely to
engage in the discouraged activities than would similar individuals within a control group.
Thus, it appears that high sensation seekers exposed to the fear appeal were more likely to
perform the discouraged activities in the time period immediately following their exposure
to the information. In the subsequent time period (two years later), however, they were
less likely to engage in the same activities. For high sensation seekers, the campaign’s
effectiveness was not immediate; rather, it precipitated experimentation with the
discouraged activity. Once the individuals had achieved the experience, they followed the
intervention campaign’s advice. However, this change in behavior may be attributable to
other factors besides the campaign. For example, it is possible that the high sensation
seekers had become bored with the activities and moved on to other novel and unique
activities which would produce the arousal levels desired.

Similar to these two studies, Witte and Morrison (1995) found that low sensation
seekers were more likely to be persuaded by the intervention than were high sensation
seekers. In addition, they found that the low threat fear appeal was more effective than

the high threat fear appeal regardless of the sensation seeking level. This finding is in stark

25
contrast to other fear appeal studies which, overall, have consistently found the high threat

message to induce greater attitude change than the low threat message (Boster &
Mongeau, 1984; Witte & Allen, 1996). They suggested these findings may be due to
several reasons, including (a) the use of extremely graphic pictures throughout the
presentation which may have proved distracting; (b) an optimistic bias on the part of the
adolescent participants; or (c) lack of adequate substitutable behaviors (e. g., other
activities which provide the desired stimulation without the risk of harm).

Given the research described above, we would expect that high sensation seekers
will have less positive attitudes and intentions to engage in the recommended response
than low sensation seekers and be less likely to perform the recommended response;
conversely, low sensation seekers will have more positive attitudes and intentions to
perform the recommended response than high sensation seekers and be more likely to
perform the recommended response. Thus, it is hypothesized that:

H 2: Sensation seeking level will be negatively related to attitudes, intentions,

and behaviors.

Further, main effects are expected for sensation seeking and message threat level,
such that:

H 3: The strong fear appeal will produce more positive attitudes, intentions, and

behaviors toward the recommended response than will the low fear appeal
regardless of sensation seeking level.

Graphically, the relationships are expected to resemble those depicted in Figure 2.

26

 

 

Attitude toward
recommended
response
Positive Low sensation seekers
¢ High sensation seekers
Negative

Low High Message Threat Level

Figure 2. Main effects predicted for sensation seeking and message threat level.

Again, we might expect that attitudes and intentions towards engaging in a particular
behavior may differ across the sensation seeking factors. Although research has examined
the relationship between sensation seeking factors and attitudes and intentions towards
religion, licit and illicit drug use, sexual experiences, and general deviance (e.g., Amett,
1994; Newcomb & McGee, 1991; Sheer, 1995), no research has focused on oral hygiene.
Therefore, the question is posed:

RQ 2: How are attitudes about, intentions to engage in the recommended
response of proper oral hygiene (i.e., flossing on a regular basis), and
actual behaviors related to each of the four sensation seeking factors?

Summgy. Incorporation of sensation seeking into the EPPM as an individual

difi‘erence has two benefits. First, it enables the message itself to be more than an external
stimulus whose influence is limited to its linguistic components (e. g., severity,

susceptibility, response efiicacy and self-efficacy). Sensation seeking provides an

27
explanation for when and why individuals will seek out a fear appeal. Second, sensation

seeking provides fitrther clarification for why individuals will have more positive attitudes
toward engaging in health protective action.
Choice a_nd Volunteerism in Fear Appeal Research

Although sensation seeking provides further conceptual explanation for when and
why a individuals may seek out a fear appeal, this only addresses intentional exposure. As
discussed above, exposure is not always intentional. At times, we are exposed to
information which we did not actively seek out. While sensation seeking provides an
explanation for intentional exposure, it alone is insufficient to explain the impact of non-
intentional exposure. Moreover, under real life conditions, one may seek out one type of
information (e. g., a low threat fear appeal) but be exposed to another (e. g., a high threat
fear appeal) during the search. Accordingly, research on volunteerism may aid in firrther
clarification of the EPPM.

As mention previously, high sensation seekers are predisposed to engage in
activities which offer heightened states of arousal (Zuckerrnan, 1994). Among these
activities are experiments which offer novel and unique experiences, such as hypnosis,
sensory deprivation, or the risk of physical harm (e. g., electric shock leaming
experiments). Coupled with a desire to view arousing stimuli, it would be expected that
high sensation seekers would be more likely to choose (i.e., “volunteer”) to see high threat
fear appeals (Donohew, Lorch, & Palmgreen, 1991; Everett & Palmgreen, 1995;
Palmgreen, Donohew, Lorch, Rogus, Helm & Grant, 1991; Palmgreen, Lorch, Donohew,

Harrington, Dsilva, & Helm, 1995; Sheer & Cline, 1994; Zuckerrnan, 1988). However,

28
most studies which suggest this tendency focused on how the “sensation value” of the

content attracts attention. As Witte and Morrison (1995) noted, attention does not
necessarily lead to attitude, intention or behavior change. Thus, firrther explication of the
relationship between exposure and sensation seeking must address research findings on
volunteerism. In the fear appeal literature, there are three notable experiments on the
impact of volunteerism on attitude change.

First, Horowitz (1969) randomly assigned volunteers and non-volunteers to read
either a high fear or low fear appeal message. He found that volunteers had more positive
attitudes and attitude change than did non-volunteers. In addition, for volunteers, the
relationship between fear and attitude change was positive. Conversely, for non-
volunteers, the relationship between fear and attitude change was negative. Analyses
revealed that non-volunteers felt more coerced than did volunteers.

In a similar experiment, Horowitz and Gumenik (1970) had volunteers and non-
volunteers choose the experiment in which they preferred to participate. They found that
volunteers who chose the experiment in which to participate exhibited the most positive
attitude. Overall, volunteers exhibited more positive attitudes than did non-volunteers.
Within each group, those who had a choice of experiments had more positive attitudes
than did those who did not. In addition, high fear messages promoted greater positive
attitudes under all conditions except for non-volunteers who did not have a choice of
experiments.

Third, Horowitz (1972) sought to detemrine how volunteerism affects attitude

change based on the level of arousal. Rather than rely on two levels of arousal (high or

29
low), Horowitz randomly assigned subjects to one of five arousal conditions. He found

that volunteers exhibited more positive attitudes than did non-volunteers. In addition, he
found that attitude change for non-volunteers peaks at intermediate levels of arousal while
for volunteers, it peaks at higher levels of arousal.

Thus, voluntary participation in an experiment has a positive efi‘ect on attitude
change. However, none of the three experiments reported above allowed the participants
to choose which message (high or low threat) they received; subjects only volunteered to
participate in the experiment itself. If allowed to choose between a high threat and a low
threat message, it is expected that:

H 4: Individuals who receive the message that they chose will have more
positive attitudes, intentions, and behaviors than those who receive the
message they rejected regardless of sensation seeking level.

We Choice. Sensation Seeking, and the EPPM

In order to improve the predictive utility of the EPPM, it was suggested that the
individual differences which indirectly affect the relationship between the threat and
efficacy perceptions and danger and fear control outcomes be specified explicitly.
Sensation seeking was identified as one factor to be incorporated as an individual
difference variable. Drawing on previous research, it was hypothesized that individuals
with high need for sensation would be more likely to choose a high threat fear appeal than
would those with low need for sensation. Furthermore, it was hypothesized that

individuals with lower needs for sensation would be more likely to engage in health

30
protective action while high sensation seekers would be more likely to engage in the

discouraged activities.

In addition to sensation seeking, volunteerism was considered as a means to
increase the predictive utility of the EPPM. However, it was noted that the explanation
surrounding sensation seeking as a predictor of exposure encompassed only intentional
exposure. In order to account for non-intentional exposure, consideration of volunteerism
was necessary. Drawing on previous research, it was hypothesized that volunteers (i.e.,
those receiving the message they chose) were more likely to exhibit more positive
attitudes and greater attitude change than were non-volunteers (i.e., those who do not
receive the message they chose).

Finally, it was noted that high threat fear appeals resulted in greater attitude,
intention, and behavior change under all circumstances except when an individual neither
volunteers to participate in an experiment nor receives a choice of which experimental
activity is undertaken. In addition, it was noted that high threat fear appeals are most
successfirl when efficacy is held constant at a high level.

Integrating these three streams of research (i.e., sensation seeking, message choice,
and message threat level in a fear appeal), the following relationships are expected for ~
attitudes, intentions, and behaviors when efficacy is held constant at a high level (where
the most positive attitudes, intentions, and behaviors are marked “A”, and the least

positive attitudes, intentions, and behaviors are marked “D”):

31

 

 

 

 

 

H 5: Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat A B B C
Message
Low Threat B C C D
Message

 

 

 

 

 

Thus, the condition in which the most positive attitudes, intentions, and behaviors
are expected is when low sensation seekers choose and receive a high threat message.
The conditions with the second most positive attitudes, intentions, and behaviors are
expected to be exhibited within the following three conditions: (a) low sensation seekers
who choose and receive the low threat message; (b) high sensation seekers who choose
and receive the high threat message; and (c) low sensation seekers who choose the low
threat message but receive the high threat message. The third most positive attitudes,
intentions, and behaviors are expected to be exhibited within the following three
conditions: (a) high sensation seekers who choose and receive the low threat message; (b)
high sensation seekers who choose the low threat message but receive the high threat
message; and (c) low sensation seekers who choose the high threat message but receive
the low threat message. The least positive attitudes, intentions, and behaviors are
expected when high sensation seekers choose the high threat message but receive the low
threat message.

In combination, integration of these three streams of research (i.e., sensation
seeking, message choice, and message threat level in a fear appeal) may improve the

EPPM by providing greater detail as to when and why fear appeals are likely to result in

 

32
danger control outcomes (i.e., attitude, intention, and behavior change). Moreover, the

treatment of fear appeals as more than simply external stimuli provides the fear appeal
research with a novel means to begin to explore how individuals might act under
conditions which more closely mimic non-experimental settings. While previous research
has addressed (a) how sensation seeking influences message choice; (b) how sensation
seeking impacts behavior; (c) how message choice impacts attitude change; and ((1) how
message threat level impacts the effectiveness of a fear appeal, this thesis attempts to

integrate these findings as a whole.

CHAPTER 3
METHOD
maize
The focus of the experiment is to examine the impact of message choice on
responses to a fear appeal. The experiment employed a factorial design with a control

group. The design is as follows:

 

 

 

High Threat Message Low Threat Message
Choice of Message - Received X 0 1 O 2 X 0 1 O 2
Choice of Message - Not Received X 0 1 O 2 X 0 1 O 2
No Choice Given X 0 1 O 2 X 0 1 O 2

 

 

 

 

where “X” represents the fear appeal message; “01” represents the immediate post-test;
and “02” represents the two-week follow-up. There were two choice conditions (choice
of a high threat or low threat message); and two received conditions (received choice
yes/no). A traditional forced exposure control group (randomly assigned a high threat or
low threat message) was also employed. Participants were randomly assigned to
conditions with the constraint that comparable numbers of participants be included in each
cell (p = 25). An immediate post-test in the form of fifteen minute questionnaire was

conducted. Participants completed a two-week follow-up questionnaire to assess behavior

changes.
Participants

Two-hundred sixty-one students enrolled in summer courses at several universities
participated in the research project. Thirty-eight percent of the participants were male;
62% were female. The majority (72%) were Caucasian; 15% were Afiican American;

6.5% were Asian, and 1.5% were Hispanic. Nearly all of the participants (87%) were

33

34

between the ages of 18 and 24 (x = 22). One quarter of the participants reported that they
currently smoke cigarettes; an additional 8% classified themselves as former smokers.
Almost half (45%) said they flossed their teeth at least once or twice per week (median =
once every two or three weeks) while 9% said they never floss their teeth. Fifty-four
percent said they go to the dentist twice a year; another 24% said they go once a year.
Although 93% had never been diagnosed with periodontal disease, 75% reported
experiencing at least one symptom of periodontal disease (e. g., bleeding gums; red, tender,
or swollen gums; or sensitivity to hot or cold foods). Participants received credit for their
participation in the study.

Prpcedure

Participants were told that the researchers were interested in “designing more
effective health communication campaigns.” Participants were assured that their answers
would be anonymous. Participants were randomly assigned to condition (forced exposure
or choice). Participants in the forced exposure condition were randomly assigned to read
either the high threat or the low threat message.

Prior to completing the questionnaire, individuals assigned to the choice conditions
were asked if they would prefer to see “an explicit and scary message or one designed to
arouse curiosity.” The wording was chosen such that both messages would seem equally
interesting and appealing to the participants. Half of the participants received the message
they chose (e. g., the explicit and scary message). The other half was told that “the
message you requested is not available”. Participants were then asked if they were willing

to read the other message (e. g., the message designed to arouse curiosity). Of the

35

participants assigned to receive the message they did not choose, only one refused to read
the message she had rejected (i.e., the explicit and scary message).

After participants read the message, they completed a fifteen minute questionnaire.
They were informed that they would be asked to complete an additional questionnaire in
two weeks. They were asked to write their name on an envelope which was attached to
the Time 1 questionnaire. The envelope was marked with a respondent identification
number so that Time 1 and Time 2 questionnaires could be matched while retaining
respondent anonymity.

Two hundred ten of the 261 participants completed the questionnaire two weeks
later resulting in a 20% attrition rate. Attrition appeared to be random across cells (X2 (5,
N = 261) = 7.32, p > .10).
Messa es

A single message was varied across levels for this study. Although multiple
message designs are preferred to increase generalizability, a single message design was
chosen because the main purpose of this study is to examine relations among theoretical
variables (e. g., sensation seeking, threat, and efficacy). A high threat and low threat
message were developed by compiling verbatim passages from several periodontal disease
textbooks, brochures, and other sources (Beck & Lund, 1981; Bhaskar, 1986; Carranza,
1990; Cross, 1977; Dembrowski, Lasater, & Ramirez, 1978; Lamey & Lewis, 1988;
Schlosberg, 1996; Wilson, 1989; Wilson, & Komman, 1996). The messages were
validated in a separate study described in the next section. Efficacy was held high at a

constant level (M = 5.78, sd = .70, N = 83 for response efficacy and M = 5.26, sd = .87, N

36

= 82 for self-efficacy on a 7-point Likert type scale). Following the format used by Beck
and Lund (1981) and Dembrowski, Lasater, and Ramirez (197 8), the messages stated the
cause of periodontal disease; the areas of the gum affected by it; the progression of the
disease; its eventual outcome; and a recommended response (brushing and flossing) to
avoid its onset. The high threat message was developed based on Witte’s (1993)
guidelines and focused on (a) individual’s susceptibility to periodontal disease and (b) the
severity of the disease. Additionally, the high threat message contained vivid,
personalistic, and graphic language. All of the information in the message was accurate.
Each message was accompanied by four pictures obtained from periodontal textbooks.
Pictures accompanying the low threat message depicted healthy gums, plaque build-up,
and a mild case of gingivitis (an early stage of periodontal disease). Pictures
accompanying the high threat message depicted plaque stained with blue food dye, chronic
inflammatory gingival enlargements, gingival recession, and soft-tissue swelling.
Message Validation Study

To ensure the messages differed in the degree of threat and fear they produce, the
fear appeal messages were subjected to pilot-testing and validation in accordance with
procedures found in the fear appeal literature. A separate study was undertaken to
validate the high threat message in fact acted as a fear appeal to produce stronger threat
perceptions and fear when compared to the low-threat message. Eighty-three students
were recruited from a mid-sized university in southern New England and were randomly
assigned to read versions of the high threat or low threat message. Participants were

asked to carefirlly read their message and then complete a 64 item questionnaire that

37

determined perceptions of threat (i.e., severity and susceptibility), efficacy (i.e., response
efficacy and self-efficacy) and fear. Specifically, 7-point Likert-type scales (ranging fi'om
“strongly disagree” to “strongly agree”) were used to assess: (a) sci/m (harmfirl; bad
for my health; have negative consequences; dangerous; serious; severe); (b) susceptibilig
(likely; possible; at-risk; probably); (c) response efficag (works; effective; adequately
prevents; reduce my chances; worthwhile); (d) self-efficacy (able to floss; easy to do;
convenient; does not take too much effort; not difficult; simple); and (e) fe_ar
(uncomfortable; frightens; scares; anxious; nervous; tense).

The validation study results indicated that the high threat message produced
significantly stronger severity and susceptibility perceptions and significantly greater fear
than the low threat message. After confirmatory factor analyses, items for each factor
were combined to form an index for that factor. The high threat message produced
significantly more severity perceptions (M = 6.22, sd = .73, N = 40 on a 7 point Likert-
type scale) than the low threat message (M = 4.79, sd = 1.06, N = 43 on a 7 point Likert-
type scale), t = -7.11, df= 81, p < .001 (g = .61, p < .001, N = 81). The high threat
message also produced significantly more susceptibility perceptions (M = 4.63, sd = 1.37,

1_\l_ = 40, on a 7 point Likert-type scale) than the low threat message (M = 3.02, sd = 1.10,

N = 43, on a 7 point Likert-type scale), t = -5.92, df= 81, p < .001 (g = .56, p < .001, N
81). Similarly, the high threat message aroused significantly greater levels of fear (M =
5.11, sd = 1.15, N = 39, on a 7 point Likert-type scale) than the low threat message (M =
4.07, sd = 1.38, N = 43, on a 7 point Likert-type scale), t = -3.69, df= 80, p < .001 (I =

.38, p < .001, N = 81).

38

Both high and low threat messages were compared to versions without the efficacy
component. No significant differences were revealed for perceptions of response efficacy
(E (3, 79) = .45, p = ns) or for self-efficacy (E (3, 78) = 1.26, p = ns). Overall, efficacy
perceptions were high (M = 5.78, sd = .70, 15 = 83 for response efficacy and M = 5.26, sd
= .87, N = 82 for self-efficacy on 7-point Likert type scales).

Measures

All scales were measured using 7 point Likert-type scales unless otherwise noted.
All measures were developed based on Ajzen and F ishbein’s (1977) guidelines for
measures to correspond in specificity. Scales were developed using the confirmatory
factor analysis subroutine of Hunter’s (1988) Package. Confirmatory factor analyses
(Hunter & Gerbing, 1982) were employed to test the dimensionality of the measures. At
the end of this section, two tables have been included. Table 2 summarizes the variables
measured in the study. Table 3 summarizes the independent and dependent variables for
the manipulation checks, hypotheses, and research questions.

Threat

The two components of threat, severity and susceptibility were measured with five
items each. Perceived severity of periodontal disease was assessed with such questions as:
(a) “I believe periodontal disease is bad for my health”; (b) “I believe periodontal disease
has negative consequences”; (c) “I believe that periodontal disease is dangerous”; ((1) “I
believe periodontal disease is serious”; and (e) “I believe periodontal disease is severe”.

After confirmatory factor analysis were performed, the scale items were summed and

39

averaged to create an overall index for perceived severity. Cronbach’s alpha for perceived
severity at Time 1 was .88 and at Time 2 was .94.

Perceived susceptibility was assessed with such questions as: (a) “I am likely to
get periodontal disease”; (b) “It is possible that I will get periodontal disease”; (c) “I am
at-risk for periodontal disease”; ((1) “I probably will get periodontal disease”; and (e)
Chances are I will get periodontal disease”. The scale items were summed averaged to
create an overall index for perceived susceptibility. Cronbach’s alpha for perceived
susceptibility at Time 1 was .91 and at Time 2 was .92.

M!

The two components of efficacy, response efficacy and self-efiicacy were assessed
with four and six items, respectively. Perceived response efficacy was assessed with such
questions as: (a) “I believe that flossing on a regular basis works in preventing periodontal
disease”; (1)) “I believe that flossing on a regular basis will be effective in preventing
periodontal disease”; (c) “I believe that flossing on a regular basis will adequately prevent
periodontal disease”; and (d) “I believe that flossing on a regular basis will reduce my
chances of getting periodontal disease”. The scale items were summed averaged to create
an overall index for perceived response efficacy. Cronbach’s alpha for perceived response
efficacy at Time 1 was .78 and at Time 2 was .87.

Perceived self-efficacy was assessed with such questions as: (a) “I am able to floss
on a regular basis to reduce my chances of getting periodontal disease”; (13) “Flossing on a
regular basis to prevent periodontal disease is easy to do”; (c) “Flossing on a regular basis

to prevent periodontal disease is convenient”; (d) “Flossing on a regular basis to prevent

4o

periodontal disease does mt take too much effort”; (e) “Flossing on a regular basis to
prevent periodontal disease is n_ot difficult”; and (f) “Flossing on a regular basis to prevent
periodontal disease is simple”. The scale items were summed and averaged to create an
overall index for perceived response efiicacy. Cronbach’s alpha for perceived self-efficacy
at Time 1 was .87 and at Time 2 was .90

Pia:

Fear arousal was measured by having participants rate the following mood
adjectives (“strongly disagree” to “strongly agree”): anxious; nervous; scares; fiightens;
and uncomfortable. The scale items were summed and averaged to create an overall index
for perceived fear. Cronbach’s alpha for fear at Time 1 was .87 and at Time 2 was .91.
Danger control outcomes

Attitude. Attitudes toward flossing on a regular basis were assessed with three
seven-point semantic differential scales (e. g., good/bad, beneficial/not beneficial, and
favorable/unfavorable). Cronbach’s alpha for these items at Time 1 was .68 and at Time 2
was .73.

Intentions. Intentions to floss on a regular basis were measured with seven
questions on a seven-point Likert type scale. These questions included:

(a) “I plan to floss on a regular basis to prevent periodontal disease”; (b) “I intend to floss
on a regular basis to prevent periodontal disease”; (c) “I am going to floss on a regular
basis to prevent periodontal disease”; (d) “I expect to floss on a regular basis to prevent

periodontal disease”; (e) “I intend to buy dental floss”; and (f) “I intend to use dental floss

41

on a regular basis”. Cronbach’s alpha for intentions at Time 1 was .97 and at Time 2 was
.96.

Behaviors. Current behavioral practices were assessed for everyone during the
initial interview. Participants were asked how often they flossed their teeth. In addition,
self-report measures of behavioral performance were asked. These questions included: (a)
“I currently floss on a regular basis”; (b) “I consistently floss on a regular basis”; and (c) “I
regularly floss”. Cronbach’s alpha for this index at Time 1 was .97 and at Time 2 was .98.
Fear control measures

Defenaive Avoidance. Participants will be asked to respond to the following
question in four ways, “When I first heard about periodontal disease, my first instinct was
to”: (a) “Want to think about/not want to think about my health risk”; (b) “Want/Not
want to protect myself from periodontal disease”; (c) “Think about it a lot/Put problem
out of my mind”; and ((1) “Think about the problem/Try to forget the problem”.
Cronbach’s alpha at Time 1 was .85 and at Time 2 was .88.

Perceived Manipulation. The perceived manipulation questions asked if the
participants felt that the message was: manipulative, misleading, or distorted. Cronbach’s
alpha at Time 1 was .82.

Issue Derogation. The issue derogation questions asked whether the participants
thought the reports of periodontal disease were: overblown, overstated, exaggerated, or
overestimated. Cronbach’s alpha at Time 1 was .97 and at Time 2 was .96.

Sensation seekipg

42

Sensation seeking was measured using Form V of Zuckerman’s Sensation Seeking
Scale Form V (1979). This instrument includes forty forced choice questions.
Zuckerman’s measurement scale was chosen based on its extensive validation and the
replication of its factors across a variety of topics with multiple populations.
Confirmatory factor analyses were performed in order to distinguish among the four
factors (i.e., Thrill and Adventure Seeking; Experience Seeking; Disinhibition; and
Boredom Susceptibility). Table 1 shows the items which met the criteria for internal
consistency and parallelism (Hunter & Gerbing, 1982). In addition, the four sub-factors
were analyzed in order to determine if they were second-order unidimensional according
to the procedures outlined by Hunter and Gerbing (1982). The four factors failed to meet
the criteria for second order unidimensionality; thus, analyses were conducted for the
factors only. In addition to correlational tests, subsequent analyses participants in the
upper tertile of each factor were classified as high sensation seekers for that dimension

while those in the lower tertile were classified as low sensation seekers for that dimension.

Table 1. Items used to measure Sensation Seeking factors based on Form V of
Zuckerman’s Sensation Seeking Scale (1979)

Factor No. Items mtg
Thrill and Adventure Seeking 10 3A 11B 16A 17A 20B
213 23A 28A 38B 408
Experience Seeking 5 48 6A 19B 22A 26B
Disinhibition 7 1A 13B 29B 303 33B 35B 36A
Boredom Susceptibility 6 5A 7B 8A 31B 34A 39A

 

Cronbach’s alpha for the four factors were as follows: Thrill and Adventure Seeking, a =

.81; Experience Seeking or = .36; Disinhibition or = .71; and Boredom Susceptibility or =

43

.54. Given the low reliabilities for experience seeking and boredom susceptibility, caution
should be used in interpreting the results from tests with those factors. The reduced
reliability indicates a potential lack of consistency and stability in the measures. It should
be noted however, that the reliability obtained for boredom susceptibility is approximately
that obtained in other studies which used this scale (e. g., Zuckennan, Eysenck, &
Eysenck, 1978; Zuckerrnan, 1971).
Theahold questions

Because it is possible for the high threat fear appeal to exceed the optimal level of
arousal of participants, five questions were asked to detemrine if the threshold was
exceeded. Questions using a seven point Likert-type scale included: (a) “This poster is
too scary; it should be milder”; (b) “This poster was too mild; it should be scarier”; (c)
“This poster was not as scary as I thought it would be”; ((1) “This poster was too extreme;
it should be toned down”; and (e) “This poster was too serious; it should be milder”.
Confound Checks

Participants’ beliefs about and their perceived comprehension of the message were
assessed. Participants responded to the question “This message was. . . on a seven
point Likert-type scale: boring, exciting, interesting, offensive, and easy to understand. In
addition, participants will be asked to evaluate how much they learned fi'om reading the
message (e. g., “I learned a lot from reading this message”). Finally, respondents will
evaluate the quality of the arguments presented on a seven-point semantic differential scale
(e.g., strong/weak; outstanding/poor; superior/inferior; great/lousy; marvelous/terrible;

impressive/unimpressive).

44

Demographic Variables

Sex, age, ethnicity, current flossing behavior, current brushing behavior, smoking,
family history of diabetes, and history of periodontal disease were assessed for use as

control variables when needed.

45

Table 2. Variables measured in the study

 

Extended Parallel Process Measures
Perceived threat: perceived severity and perceived susceptibility
Perceived efficacy: perceived response efficacy and perceived self-efiicacy
F ear
Danger control: attitudes, intentions, and behaviors
Fear control: defensive avoidance, issue derogation, perceived
manipulation

Sensation Seeking (Zuckerman’s Form V)
Thrill and adventure seeking
Experience seeking
Disinhibition
Boredom susceptibility

Message choice:

Choice: traditional “forced” exposure or allowed to choose (high threat or low
threat message)

For those allowed to choose, received choice or received the message they did not
choose

Threshold questions
Confound checks
Demographic variables

 

46

Table 3. List of independent and dependent variables for the manipulation checks,
hypotheses, and research questions.

 

 

Manipulation Check,

Hypothesis or Independent Dependent
Research Question Variable(s) Variable(s)
Manipulation check Message threat level Perceived severity,

(high or low) perceived
susceptibility,

Manipulation check

Hypothesis 1

Research Question 1

Hypothesis 2

Hypothesis 3

Research question 2

Hypothesis 4

Hypothesis 5

Message efficacy level

Sensation Seeking
(overall)

Sensation Seeking
(by factor)

Sensation seeking
(overall and by factor)

Message threat level
(high or low)

Sensation seeking
(by factor)

Message choice
(received choice versus
received message
rejected)
Message choice,
Sensation Seeking, and
Message threat level

perceived fear
Perceived response
efficacy, perceived
self-efficacy
Message choice
(high threat or low
threat)
Message choice
(high threat or low
threat)
Danger control
outcomes (attitudes,
intentions, behaviors)
Danger control
outcomes
(attitudes, intentions,
behaviors)
Danger control
outcomes
(attitudes, intentions,
and behaviors)
Danger control
outcomes
(attitudes, intentions,
and behaviors)
Danger control
outcomes
(attitudes, intentions,
and behaviors)

CHAPTER 4
RESULTS
9m

The purpose of this study was to examine the effect of sensation seeking and
message choice on responses to fear appeals. Results of the manipulation and confound
checks are presented followed by results for the hypotheses presented in Chapter 2. A
complete description of the message validation study procedures and results appear in
Chapter 3.

Manipulation Checks -- High versus Low Threat Message

Manipulation checks were conducted using one-tailed t-tests to determine if the
high threat message produced stronger perceptions of threat and fear than the low threat
message. In addition, two-tailed t-tests were employed to ensure that efiicacy was held
constant across both messages. To ensure that no self-selection features were factored
into the manipulation checks, the analyses were performed with the 75 individuals who
were randomly assigned to the forced exposure condition (i.e., they were not asked to
choose between the two fear appeal messages).

Perceived threat. The high threat message produced significantly more severity
perceptions (M = 6.05, sd = .78, N = 38, on a 7 point Likert-type scale) than the low
threat message (M = 5.48, sd = .85, N = 37, on a 7 point Likert-type scale), t = 3.04, df =
73, p < .05 (r = .34, p < .01, N = 75). The high threat message produced significantly
greater perceptions of susceptibility (.M. = 3.45, sd = 1.14, N = 38, on a 7 point Likert-type
scale) than the low threat message (M = 2.96, sd = 1.23, N = 37, on a 7 point Likert-type

scale), t = 1.83, df= 72, p < .05 (g = .21, p < .05, a = 74).

47

48

Fear. The high threat message produced significantly greater fear (M = 5.47, sd =
1.20, N = 38, on a 7 point Likert-type scale) than the low threat message M = 4.95, sd =
1.33, N = 37, on a 7 point Likert-type scale), t = 1.79, df= 73, p < .05 (g = .20, p < .05, N
= 7 5).

Perceived efficaey. No significant differences were revealed for perceptions of
response efficacy (t = -.87, df = 72, p = ns) or for self-efficacy (t = -l .25, df = 72 p = ns).
Overall, efficacy perceptions were high (M = 5.81, sd = .73, N = 74 for response efficacy
and M = 5.47, sd = .97, N = 74 for self-efficacy on 7-point Likert type scales).

Confound Chealas. No significant differences were found between the high and
low threat messages on their descriptive qualities (e. g., excitement, interest, etc.), the
amount of information learned from the message, or argument quality.

Manipulation Checks -- Choice Conditions

Additional analyses were conducted to rule out any effects choice versus no choice
might have had on threat perceptions for the high versus low threat messages. For
example, we were interested in assessing whether or not the high threat message produced
the same degree of severity, susceptibility and fear for those in the choice vs. no choice
conditions. No significant differences emerged between the two groups of individuals
who read the high threat message only (choice versus no choice) on perceived severity (t =
-. 12, df = 88, p = ns), perceived susceptibility (t = .69, (if = 88, p = ns), fear (t = .36, df =
87, p = ns), perceived response efficacy (t = -1.89, df = 88, p = us), or perceived self-
effrcacy (t = .96, df = 88, p = ns). Similarly, no significant differences emerged between

the two groups of individuals who read the low threat message only (choice versus no

49

choice) on perceived severity (t = .41, (if = 89, p = ns), perceived susceptibility (t = -l.87,
df = 89, p = ns), fear (t = -1.24, df = 89, p = ns), perceived response efficacy (t = -.79, df
= 89, p = ns), or perceived self-efficacy (t = -1.42, df = 89, p = ns).
Sensation Seeking and Message Choice

Hypothesis 1, that the likelihood of choosing a high threat message will be
positively related to sensation seeking level, was tested using correlational analyses. This
technique is appropriate when assessing the relationship between an intervally scaled
independent variable and a dichotomous dependent variable (Watt & van den Berg, 1995).
Similar to other sensation seeking studies, analyses using the upper and lower tertiles of
sensation seeking were also performed (e. g., Clayton, Cattarello, & Walden, 1991;
Palmgreen, Donohew, Lorch, Rogus, Helm & Grant, 1991; Witte & Morrison, 1995).
Hypothesis 1 was not supported. There was no relationship between sensation seeking
and message choice whether a total sensation seeking score was used (1; = -.09, N = 177, p
= ns) or if the efiect of all four factors was considered independently (R = .12, N = 177, p
= ns). In total, 34.5% of all subjects chose the high threat fear appeal while 64.5% chose
the low threat message. Analyses using only the upper and lower tertiles (X2 (l, N = 139)
= .15, p = ns) yielded similar results.2

Research Question I asked if there was any relationship between the individual
sensation seeking factors’ levels and the likelihood of choosing a high threat message.

Table 4 summarizes the mean, standard deviation, and cell counts by message choice (high

 

2The break point for sensation seeking tertiles were calculated using the entire sample,
regardless of condition. Respondents whose scores fell on the cut off point for the upper
and lower tertile were classified in that group.

50

or low threat). Individuals high in thrill and adventure seeking were not more likely to
choose the high threat fear appeal than were individuals low in thrill and adventure seeking
(g = -.04, N = 177, p = ns). Analyses using only the upper and lower tertiles (X2 (1, N =
106) = .03, p = ns) yielded similar results.

Individuals high in boredom susceptibility were not more likely to choose the high
threat fear appeal than were individuals low in boredom susceptibility. Although no
overall relationship was found, (r = -.07, N = 177, p = ns), analyses using only the upper
and lower tertiles revealed that those highest in the upper tertile for boredom susceptibility
were more likely to choose the message low threat message (“designed to arouse
curiosity”) than the high threat message (“explicit and scary”) (X2 (1, N = 141) = 4.70, p
< .05).

Experience seeking and disinhibition were also unrelated to a person’s likelihood
of choosing a high threat fear appeal was supported. No relationship was found between
experience seeking and message choice (r = .02, N = 177, p = ns) or disinhibition and
message choice (1 = -. l 1, N = 177, p = ns). Analyses using only the upper and lower
tertiles for experience seeking (X2 (1, N = 119) = .19, p = ns) and for disinhibition (X2 (1,

N = 136) = 2.19, p = ns) yielded similar results.

51

Table 4. Means, standard deviations, and cell counts for overall Sensation Seeking level
and each sensation seeking factor by Message Choice.
Chose High Threat Chose Low Threat

 

Message Message
Thrill and Adventure M = 6.78 out of 10* M = 6.94 out of 10* t = .38
Seeking sd = 2.93 sd = 2.55 df= 180"
N = 64 N = 118 p = ns
Experience Seeking M = 2.16 out of 5* M = 2.11 out of 5* t = -.21
sd= 1.00 sd= 1.20 df=179**
N = 64 N = 117 p = ns
Disinhibition M = 3.06 out of 7* M = 3.58 out of 7* t = 1.63
sd=2.12 sd=2.06 df=181**
N = 65 N = 118 p = ns
Boredom M = 1.74 out of 6* M = 2.03 out of 6* t = 1.29
Susceptibility sd = 1.44 sd = 1.49 df = 184"
N = 66 N = 120 p = ns
Overall Sensation M = 13.87 out of28* M = 14.76 out of28* t = 1.21
Seeking sd = 5.02 sd = 4.44 df= 175"
N = 62 N = 115 p = ns

*Number of items per scale
"Cell counts differ by factor due to missing data

Sensation Seeflag, Attitudes. Intentions, ml Behaviors

Hypothesis 2 posited that sensation seeking would be negatively related to
attitudes, intentions, and behaviors toward engaging in health protective action.
Specifically, high sensation seekers would have more positive attitudes, intentions, and
behaviors toward engaging in the risky behavior and, conversely, that low sensation
seekers would have more positive attitudes, intentions and behaviors towards performing
the recommended response of flossing. Research Question 2 sought to determine how
each of the sensation seeking factors were related to attitudes, intentions, and behaviors.
To test this hypothesis research question, correlation analyses were performed. Most
participants at the time of the initial interview had positive attitudes towards flossing (N =

6.28, sd = .83, N = 256). The overall sensation seeking factor was unrelated to attitudes

52

at the time of the initial interview or at the two week follow-up. None of the four
sensation seeking factors was related to attitudes at Time 1. Only individuals low in
boredom susceptibility had more positive attitudes toward engaging in the recommended
response at Time 2 (r = -. 14, N = 209, p < .05).

Intentions at Tirnel were negatively related to overall sensation seeking (r = -.10, N =

23 7, p < .05), though they were unrelated at Time 2. Individuals low in disinhibition and
individuals low in boredom susceptibility expressed greater intention to floss on a regular
basis initially (I = -. 13, N = 246, p < .05, and r = -. 16, N = 251, p < .05, respectively).

The overall sensation seeking factor was unrelated to behaviors at Time 1 and Time 2.
However, individuals low in sensation seeking reported brushing more regularly (r = -.14,
N = 201, p < .05), brushing more carefully (I = -. 18, N = 201, p < .01), brushing longer (1
= -.16, N = 201, p < .01), brushing more often (1 = -.19, N = 201, p < .01), as well as
talking with someone else about brushing one’s teeth (r; = -.14, N = 200, p < .05).
Individuals low in disinhibition also reported initially regular flossing (r = -.11, N = 247, p
< .05). Individuals low in boredom susceptibility also reported flossing more carefully (; =
- .14, N = 211, p < .05), brushing more often (_r_ = -.13, N = 210, p < .05), and talking with
someone else about brushing (I = -.16, N = 210, p < .05) at Time 2. In addition, those
low in thrill and adventure seeking reported that since participating in the study, they
brushed their teeth more regularly (r; = -.16, N = 206, p < .05), more carefully, (r; = -.23, N
= 205, p < .05), more often (r = -.21, N = 205, p < .05), and for longer periods of time (_r_
= -.19, N = 206, p < .05) as well as talking with someone else about brushing one’s teeth

(1* = -.13, N = 205, p < .05). Thus, Hypothesis 2 received partial support; though few

53

significant differences emerged, intentions and behaviors were negatively related to
sensation seeking level.
Message Threat Level. Attitudes. Intentions. a_nd Behaviors

Hypothesis 3 posited that the high threat message would produce more positive
attitudes, intentions, and behaviors regardless of sensation seeking level. This hypothesis
was assessed using an independent sample t-test. Although the high threat message did
not produce more positive attitudes and intentions either at the immediate post test or at
the two-week follow-up, behaviors were affected. Specifically, individuals who read the
high threat message reported flossing more often (t = -2.22, df = 210, p <05); flossing
more carefirlly (t = -3.10, df = 210, p <05); flossing more regularly (t = -2.S6, df = 209, p
<05); brushing more regularly (t = -2.52, df = 210, p <05); brushing more carefully (t = -
2.85, df= 210, p <05); brushing for longer periods of time (t = -3.59, df = 210, p <05);
and brushing more often (t = -2.58, df = 209, p <05). Thus, Hypothesis 3 was supported
for behaviors, but not for attitudes or intentions.
Choice. Attitudeafltentionwd Behaviors

Hypothesis 4, that individuals receiving the message they chose would have more
positive attitudes, intentions, and behaviors than those who received the message they
rejected regardless of sensation seeking level, was partially supported. Although no
differences emerged for attitudes or intentions, behaviors were affected. Individuals who
received the message they rejected reported flossing their teeth more often (t = -2.50, df =
146, p < .05); flossing more carefully (t = -2.03, df = 146, p <05); flossing more regularly

(t = -2.60, df= 145, p <05) and brushing longer (t = -1.94, df= 210, p <05). Moreover,

54

those individuals who chose the low threat but received the high threat message reported
flossing more often (t = -2.64, df = 74, p < .01) and flossing more regularly (t = -2.57, df
= 74, p < .01) than those who chose and received the high threat message.

C_ho_iea Post-hoc sub-analyses were conducted on the choice-only condition to
determine the perceptions of those who might choose the high threat message versus the
low threat message, as it was thought these perceptions might be related to attitudes,
intentions, and behaviors. Of the 186 participants given the choice of which message they
preferred to read, 66 chose the high threat message (35.5%) while 120 chose the low
threat message (64.5%). Interestingly, analyses revealed that individuals who chose the
high threat message, regardless of message received, had significantly greater perceived
susceptibility (M = 3.32, sd = 1.15, N = 66, on a 7 point Likert-type scale) than those who
chose the low threat message (M = 3.00, sd = 1.24, N = 120, on a 7 point Likert-type
scale), t = -1.75, df=179, p <05.

Choice, Message Threat Level. Swtion Seeking and Attitudes, Intentions and Behaa/iors

Hypothesis 5 predicted main effects for sensation seeking, message choice, and
message threat level for attitudes, intentions, and behaviors. Tables 5 to 13 show the
adjusted means, standard deviations, and cell sizes for attitudes, intentions, and behaviors
at Time 1 and Time 2 by message threat level, message choice, and sensation seeking
level. Only subjects who were not in the forced exposure conditions were included in the
following analyses.’ First, analysis of variance was performed in order to determine if

there were any interaction effects among the factors and attitudes, intentions, and flossing

 

3 Degrees of freedom differ due to missing data. No variable had more than five percent of
the data missing.

55

behaviors. No interactions were revealed. Thus, sensation seeking was treated as a
covariate and analysis of covariance was performed.

Analyses revealed no significant effects for the sensation seeking factors (E (4,
164) = .53, p = ns), message choice, (E (1, 164) = .51, p = ns), or message threat level (E
(1, 164) = .15, p = ns) on attitudes at the immediate post-test (E (7, 164) = .53, p = ns).
Similarly at the two-week follow-up, no significant effects on attitudes emerged (E (7,
132) = .94, p = ns). Analyses revealed no significant effects for the sensation seeking
factors (E (4, 132) = 1.29, p = ns), message choice, (E (1, 132) = .70, p = ns), or message
threat level (E (l, 132) = .18, p = ns). Thus, Hypothesis 5 was not supported for
attitudes.

With respect to intentions at the immediate post-test (E (7, 160) = 2.12, p < .05),
no effects for message choice (E (1, 160) = .58, p = ns) or message threat level (E (1, 160)
= .94, p = ns) emerged. Although none of the sensation seeking factors had a significant
effect on intentions individually, they did have a significant effect on intentions when
combined (E (4, 160) = 2.84, p < . 05). At the two-week follow-up, no significant effects
for the sensation seeking factors (E (4, 133) = 1.00, p = ns), message choice, (E (1, 133) =
1.25, p = ns), or message threat level (E (1, 133) = .21, p = ns) emerged. Overall, at the
two-week follow-up, there was no effect on intentions (E (7, 133) = .87, p = ns). Again,
Hypothesis 5 was not supported for intentions.

With respect to current behavioral practices at the immediate post-test, no
significant effects emerged for either message choice (E (1, 161) = .13, p = ns) or message

threat level (E (1, 161) = .22, p = ns). However, significant effects emerged for the

56

sensation seeking factor of disinhibition (E (1, 161) = 6.23, p < .05) and for the four
factors in combination (E (1, 161) = 2.81, p < .05). At the two-week follow-up, no
significant effects for the sensation seeking factors (E (4, 133) = 1.93, p = ns), message
choice, (E (1, 133) = .81, p = ns), or message threat level (E (1, 133) = .03, p = ns)
emerged. Overall, at the two-week follow-up, there was no effect on current behavioral
practices (E (7, 133) = .87, p = ns).

With respect to actual flossing behaviors at the two-week follow-up, although no
significant effects emerged overall (E (7, 134) = 1.51, p = ns), individuals who received
the message they rejected reported flossing more often than those individuals who
received the message they chose (E (1, 134) = 5.32, p < .05). Yet, no differences emerged
due to message threat level (E (1, 134) = .01, p = ns) or due to the sensation seeking
factors (E (4, 134) = .55, p = ns). Similarly, although no significant effects emerged
overall (E (7, 133) = 1.71, p = ns), individuals who received the message they rejected
reported flossing more regularly than those individuals who received the message they
chose (E (1, 133) = 5.16, p < .05). Again, no differences emerged due to message threat
level (E (1, 133) = .20, p = ns) or due to the sensation seeking factors (E (4, 133) = .75, p
= ns). However, individuals who received the message they rejected did not report
flossing more carefully than those individuals who received the message they chose (E (1,
134) = 2.30, p = ns). Again, no differences emerged due to message threat level (E (1,
134) = 2.54, p = ns) or due to the sensation seeking factors (E (4, 134) = 1.28, p = ns), or
for the model overall (E (7, 134) = 1.53, p = ns). Thus, Hypothesis 5 was not supported

for behaviors.

57

Overall, the best predictor of behavior at the two-week follow-up was an
individual’s flossing behavior at the immediate post-test ([ = .71, N = 206, p < .01).
Those who flossed more frequently at the beginning of the study had more positive
attitudes towards flossing (E = .22, N = 252, p < .01); more positive intentions to floss
both at Time 1 (g = .41, N = 248, p < .01) and Time 2 (a = .34, N = 206, p < .01); and
reported flossing more often (a = .17, N = 208, p < .05), more carefully (I = .19, N = 208,
p <01), and more regularly (I = .24, N = 207, p < .01).

Table 5. Means, standard deviations, and cell counts for Attitude at Time 1 by message
choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers

High Threat a = 6.39 a = 6.46 a = 6.14 a = 6.31

Message M = .88 M = .65 M = .83 M = .84
p =17 g = 16 p:20 a = 33

Low Threat a = 6.18 2; = 6.40 a = 6.27 a = 6.40

Message M= .72 M= .88 M= .51 M= .74
2:31 p=26 p=l4 __n=15

 

 

 

 

 

Table 6. Means, standard deviations, and cell counts for Intentions at Time 1 by message
choice, message threat level, and sensation seeking.

 

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat a = 5.55 a = 5.46 a = 5.34 a = 5.51
Message M = .94 M = 1.07 M = 1.63 M = .87
p=17 p=16 p=l9 p=30
Low Threat a = 5.55 2; = 4.56 a = 5.68 a = 5.49
Message M = .77 M = 1.53 M = .78 d = 1.03
g=3l p=26 g=14 p=15

 

 

 

 

 

 

58

Table 7. Means, standard deviations, and cell counts for Behavior at Time 1 by message
choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat a=4.38 a=401 _x=4.35 a=3.58
Message M= 1.70 M= 1.65 M= 1.91 M= 1.80
g=17 p=16 g=19 p=31
Low Threat a=4.41 a=306 a=4.4l a=3.64
Message M=1.98 M=201 M=1.77 M=1.95
g=31 p=26 p=14 p=15

 

 

 

 

 

Table 8. Means, standard deviations, and cell counts for Attitudes at Time 2 by message
choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat a = 5.64 a = 6.05 a = 5.85 a = 6.25
Message M = .93 M = 1.07 M = .76 M = .82
p=l4 p=12 g=17 p=30
Low Threat a= 5.93 a=6.12 a= 5.91 a=6.28
Message M = .67 a_ = .94 M = .74 M = 1.21
p=27 g=22 p=10 g=8

 

 

 

 

 

Table 9. Means, standard deviations, and cell counts for Intentions at Time 2 by message
choice, message threat level, and sensation seeking.

 

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat a = 5.07 a = 4.67 a = 5.13 2; = 4.80
Message d=l.26 M=1.05 M=1.35 M=1.11
g=14 p=12 p=l7 p=30
Low Threat a = 4.83 a = 4.47 a = 5.62 a = 4.76
Message M=l.34 M=1.61 M=1.10 M=1.35
g=27 g=22 p=11 g=8

 

 

 

 

 

 

 

59

Table 10. Means, standard deviations, and cell counts for Behaviors at Time 2 by
message choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat a=4.46 )_(=3.9l a=4.92 _x=3.81
Message M=2.10 M=1.80 M= 1.88 M=1.74
a=14 p=12 g=17 p=30
Low Threat a=4.39 a=3.42 a= 5.39 a=3.57
Message M=1.88 M= 1.82 M= 1.58 M=2.23
2:27 p = 22 p = 11 g = 8

 

 

 

 

 

Table 11. Means, standard deviations, and cell counts for “Flossing more oflen” by
message choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat x=3.32 a=301 x_=5.01 a=3.97
Message sd=2.11 M=1.53 M=1.83 M=1.88
p=14 a=12 p=17 p=30
Low Threat x=3.73 a: 3.32 a=4.43 _x=3.09
Message M =1.88 M = 2.02 M = 1.79 M =1.79
a: 27 p = 22 p = 11 a = 9

 

 

 

 

 

Table 12. Means, standard deviations, and cell counts for “Flossing more caretullz” by
message choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat x=3.47 a=3.57 _x=4.73 x=3.81
Message s_ = 2.17 M = 1.61 M = 1.90 M =1.83
p=l4 p= 2 _=17 g=30
Low Threat a=3.57 5= .02 a=4.10 a=3.10
Message M= 1.77 M= 1.75 M= 1.41 M= 1.45
pfi= 27 a: 22 p = 11 p = 9

 

 

 

 

 

 

 

 

60

Table 13. Means, standard deviations, and cell counts for “Flossing more regularly” by
message choice, message threat level, and sensation seeking.

 

 

 

 

 

Choice of Message No Choice of Message
Low Sensation High Sensation Low Sensation High Sensation
Seekers Seekers Seekers Seekers
High Threat x=3.65 a=2.67 )_r=4.93 5:381
Message sd=2.24 M= 1.51 M=1.80 M= 1.73
p=14 g=12 a=17 p=30
Low Threat a = 3.69 a = 2.97 a = 4.36 a = 2.76
Message M =1.77 M = 1.83 sd =1.70 M =1.58
p=26 g=22 n=11 g=9

 

 

 

 

 

 

CHAPTER 5

SUMMARY AND CONCLUSIONS

0_ve_rvi_evz

This study investigated the influence of sensation seeking and message choice on
responses to fear appeals. It was expected that (a) individuals who read a high threat
message; (b) who are low sensation seekers; and (c) who received a preferred message
would be more likely to have positive attitudes, to intend to engage in, and to perform a
recommended response advocated in a fear appeal.

Overall, the pattern of findings reveal that attitudes and intentions were seldom
affected by sensation seeking or message choice; however, behaviors were affected.

The lack of attitude change in this study may be due to the overall highly positive attitudes
held initially by the participants. Initial attitudes towards flossing as a preventive measure
were extremely positive and there was little variance in attitudes. Thus, the creation of
more positive attitudes would need to be measured on a more sensitive scale than was
utilized.

In addition, these highly positive attitudes may be attributable to a prevailing
understanding of the benefits associated with proper dental hygiene. The benefits of a
regimen of proper brushing and flossing may be considered a cultural truism; that is,
knowledge of these benefits is accepted and unquestioned by the vast majority of people
within society (McGuire, 1961, 1962; McGuire & Papageorgis, 1961). Under this
circumstance, strengthening already strong attitudes may be both diflicult to achieve and

unnecessary in order to produce behavior change.

61

62

The remainder of this chapter discusses the main findings for each of the
independent variables: message threat level, sensation seeking, and message choice.
Next, implications of these findings in addressing the EPPM’s shortcomings are discussed.
Finally, implications for health communicators based on the findings of this investigation
are presented.
Message Threat Level

Consistent with previous fear appeal research, the high threat fear appeal message
was more effective in producing the advocated behavior than the low threat message. The
message in this investigation was a high threat, high efficacy message which would
motivate people to control the danger posed by the health threat. This finding is in
contrast to the findings of an investigation of dental hygiene compliance by Janis and
Feshbach (1953). They found that the low threat fear appeal was more effective in
producing compliance than was the high threat message. One explanation for these
seemingly inconsistent results rest with the efficacy level conveyed by the message.
Whereas the messages used in this investigation contained high efficacy components, the
efficacy level conveyed by the messages in the Janis and Feshbach investigation is
unknown. As Witte and Allen (1996) point out, high threat fear appeals are most efl‘ective
when they are coupled with high efficacy components.

Although attitudes were unaffected (most likely due to a ceiling effect), individuals
who read the high threat message were more likely to engage in the recommended

response (i.e., floss their teeth) than were individuals who read the low threat message.

63

Again, this lack of attitude change may be due to the strong positive attitudes people held
initially and may be attributed to the reasons discussed in the previous section.

Although the high threat message did not produce attitude change, it did lead
individuals to follow proper dental hygiene suggestions more closely. The high threat
message may have been a stronger reminder than the low threat message and served as an
impetus to establish a efficacious habit or as an impetus to re-establish a lapsed habit.
mama—king

Sensation Seeking and Choice. Contrary to expectations, high sensation seekers
were no more likely to choose to view the high threat message than were low sensation
seekers. Thus, we may expect the majority of the population, regardless of sensation
seeking level, to prefer messages which are unlikely to arouse high levels of fear.
However, although individuals may not prefer high threat messages, these messages are
the ones which are more effective in promoting compliance with behavioral
recommendations.

Sensation seeking, as a general trait, was unrelated to choice of either a high threat
or a low threat message. However, analyses suggest that two of the four factors which
comprise sensation seeking -- boredom susceptibility and disinhibition - may be related to
message threat level preference. First, those individuals in the upper tertile of boredom
susceptibility were more likely to choose the low threat message. This may be due to the
options provided. The low threat message was described as a “message designed to
arouse curiosity”. This finding may indicate a tendency for those high in boredom

susceptibility to desire more mental stimulation associated with cognitive, rather than

64

emotional, arousal. When posed with a choice between explicit and scary material and
material designed to arouse curiosity, those high in boredom susceptibility may be
attracted to a message which may pique interest and stimulate thought rather than one
which invokes fear.

Similarly, those who may be more likely to choose a high threat message described
as “explicit and scary” may be those who are high in disinhibition. This group, aside from
describing individuals who seek unconventional social activities, and social stimulation
associated with drugs, alcohol, and sex, may also include those who are intrigued by
gruesome, graphic media depictions. They may also be more likely to desire to view
graphic horror films, pornographic material, or extreme violence. Although the
relationship between disinhibition and choice was not statistically significant, this may be
due to the weak reliability of the items measuring disinhibition.

Sensation Seeking. Attitudes. Intentions and Behaviors. Previous research has

 

shown that low sensation seekers have more positive attitudes and intentions and would
be more likely to engage in the recommended response than high sensation seekers
(Clayton, Cattarello, & Walden, 1991; Harrington & Donohew, 1996; Witte & Morrison,
1995). Although few significant differences emerged for attitudes and intentions across
the four sensation seeking factors, those that did were consistent with previous research
(i.e., individuals low in that sensation seeking factor had more positive attitudes and
intentions). It is important to note that, although attitudes were not related to sensation

seeking (except for boredom susceptibility at the two-week follow-up), behaviors were.

65

Sensation seeking may affect attitudes, intentions, and behaviors only when the
activity has high sensation value (i.e., able to elicit strong sensory, affective reactions).
The relationship between sensation seeking and engaging in an activity may depend upon
the type and general riskiness of the activity involved such that only those risk activities
with high perceived risk are likely to result in differential attitudes, intentions, and
behaviors across sensation seeking levels. Activities such as bungee jumping, sky diving,
drugs, travel to exotic places, unprotected sex, or other high risk activities may provide
the biologically based stimulation desired by the high sensation seekers. Activities such as
flossing one’s teeth, taking vitamins, and wearing sunscreen daily may be beneficial to
one’s health but not provide enough stimulation such that high sensation seekers might be
more likely to engage in the risky behavior. Moreover, different activities may not satisfy
different biologically driven needs as reflected in the four factors which comprise sensation
seeking. For example, a roller coaster ride may satisfy a need to engage in fiightening
experiences and be related to an individuals’ inclination toward thrill and adventure
seeking; however, it may not satisfy an inclination toward experience seeking and a desire
to engage in novel experiences.

Message Choice

Counter to what was expected, individuals who received the message they
preferred did not have more positive attitudes, intentions, and behaviors than those who
did not receive the message they preferred. To the contrary, those who received the
message they rejected had more positive behaviors. (As mentioned previously, attitudes

and intentions were unaffected.) This may be due to the effectiveness of the high threat

66

message producing more positive behaviors in general as compared to the low threat
message. In this study, participants received one of two messages: a high threat or low
threat message. Those who chose to view the low threat message, but did not receive it,
were exposed to the high threat message. As discussed above, the high threat message
produced more positive behaviors. Moreover, this group (which requested the low threat
but received the high threat message) reported flossing more often and more regularly
than the group which chose and received the high threat message. Thus, it appears that
individuals who desire low threat messages but are exposed to high threat messages are
still more likely to change their behaviors, even though their “choice” has, in effect, been
taken away. It appears that if individuals have a choice initially, even if that preference
cannot be satisfied, will lead to positive behaviors.

Interestingly, individuals who chose the high threat message reported greater
susceptibility to the health threat than did those who chose the low threat message. It may
be that those who believe themselves to be at greater risk to harm fiom a health threat
search for information which will be more likely to affirm this belief. To the extent that
high threat fear appeals, messages which are “explicit and scary,” are likely to confirm this
belief, individuals who believe themselves to be at greater risk will seek out health
messages, especially those which have the potential to confirm their beliefs about their
susceptibility to the threat. Because they already have high perceived susceptibility, we
might expect that this group to have more positive attitudes and intentions to engage in
health protective behaviors when exposed to high threat messages containing strong

efficacy messages.

67

MaaMge Threat Level. Sensation Seemgand Message Choice

The expected additive effects for choice, threat level, and sensation seeking were
not found; rather, more positive attitudes, intentions, and behaviors were found for those
individuals who chose the low threat but received the high threat message. Again, this
may be attributed to the greater effectiveness of a high threat, high efficacy fear appeal.

The influence of sensation seeking may have been absent due to the relatively low
degree of risk associated with not engaging in the recommended response to prevent
periodontal disease. However, if sensation seeking is truly a personality trait, then its
effects should be observed regardless of the health topic chosen. The results within this
study suggest that the utility of sensation seeking as an individual difference variable is
limited by the behavior under investigation. In addition, given the results of this
investigation, it is noted that the four factors which constitute sensation seeking (e. g.,
Thrill and Adventure Seeking; Experience Seeking; Disinhibition; and Boredom
Susceptibility) represent different aspects of personality and do not necessarily reflect the
same underlying latent personality trait. The analyses conducted suggest that, although
the four factors are related, each is conceptually distinct and may be indicative of difi‘erent
underlying biologically based needs. In other words, each factor reflects desires for
different types of stimulation and each factor may have a different relationship with the
outcome under investigation. This suggests that, in the firture, analyses by each factor
separately may be more illuminating and provide more insight about the relationship
among the theoretical constructs than would analysis by the sensation seeking factor as a

whole.

68

I_rr_ipl_thions for the Extended Pmllel Process Model

The EPPM served as the theoretical basis for this investigation. The EPPM
suggests that perceptions of threat determine if an individual will be motivated to take
health protective action while perceptions of efficacy determine the nature of that action.
According to the EPPM, high threat, high efficacy messages will be the most efi‘ective in
gaining compliance. Two shortcomings of the EPPM were identified: (a) the lack of
attention given to individual difference variables and their potential impact on message
acceptance; and (b) individuals’ propensity to selectively expose themselves to
information. Sensation seeking was examined because it has been found to influence
desire for high threat messages as well as to reduce the likelihood of engaging in health
protective action.

Results of this study suggest that, with efficacy held constant at a high level, high
threat messages are more effective in gaining behavioral compliance than are low threat
messages. These results are consistent with previous fear appeal studies. This study also
demonstrated that most people prefer to expose themselves to low threat messages. Thus,
although high threat messages will be more effective in promoting behavioral change,
there exists a need to address the role of selective exposure in the EPPM.

Sensation seeking was identified as an individual difference variable which might
explain selective exposure. Taken as a whole, sensation seeking does not appear to drive
people’s choice of messages. This may be due to the weak reliability of the scale items as
well as the evidence that the four factors which constitute sensation seeking (e. g., Thrill

and Adventure Seeking; Experience Seeking; Disinhibition; and Boredom Susceptibility)

69

represent different aspects of personality and do not necessarily represent the same
underlying personality trait. In addition, sensation seeking does not appear to be related
to engaging in health protective action for activities lacking high sensation value. Taken
together, these results suggest that it is possible certain sensation seeking factors to be
better predictors of selective exposure to high threat messages yet be unrelated to the
propensity to engage in risky activities. Again, the propensity to engage in health
protective action may rest on the type of activity being advocated.

Results also suggest that the people most likely to selectively expose themselves to
high threat messages are those who perceive themselves susceptible to the health risk. For
this group, it is expected that high threat, high efficacy messages will be effective. People
who feel susceptible and seek out information which affirrns this belief are likely to
encounter information about how they can change their behavior to protect themselves.
Active information seeking behavior may also indicate readiness and motivation to adopt
recommended courses of action. Yet, these results also raise the possibility that this group
will be more likely to engage in danger control responses (i.e., attitude, intention, and
behavior change) regardless of the level of efficacy contained within the message.

This investigation suggests that selective exposure to a high threat message may
play a pivotal role in determining the likelihood of acceptance of the message’s
recommendations. Although sensation seeking does not appear to provide a strong
explanation of selective exposure, perceived susceptibility does. The factors influencing

susceptibility perceptions may hold the key to understanding when and why individuals are

7O

likely to expose themselves to high threat messages and to engage in danger control
processes.
linpliflttions for Health Communicators

Health communicators who want to spur health protective action may want to
utilize high threat fear appeals with high efficacy components. It is these messages which
have consistently been found to be most effective (Rogers, 1983; Witte & Allen, 1996).
This investigation provides two reasons why high threat fear appeals with high efficacy
messages would be most effective. First, this study suggests that most people prefer to
expose themselves to low threat messages. However, these messages are likely to be less
effective in promoting attitude, intention, and behavior change in than would a high threat
message. Yet, when individuals who desire a low threat message receive a high threat
message, they have more positive attitudes, intentions and behaviors. Thus, use of a high
threat fear appeal should prove more effective for these individuals. Second, this study
also suggests that those individuals who desired to expose themselves to a high threat
message perceived themselves to be more susceptible to the health threat. Believing that
they are at risk for a health threat and that they are able to easily and effectively avert the
threat may motivate these individuals to engage in health protective action.

A caveat to this approach revolves around the augmenting of perceived
susceptibility for individuals who may not necessarily be at greater risk to a health threat.
The ramifications of increasing people’s perceived susceptibility to a threat for which they
are not truly at risk must be taken into account. First, this may cause an individual to

engage in a health protective action which is unnecessary. Second, it raises questions

71

about the ethics of using a high threat message regardless of the circumstances. Third, if
this approach is taken, the message must include messages which increase perceived
response efficacy and perceived self-efficacy to create conditions under which people will
be most likely to perform actions which would not prove detrimental to their health.

Although use of a high threat fear appeal is effective, it leaves the potential to
increase the desire of high sensation seekers to engage in the risky activity. Indeed,
previous research has shown that high sensation seekers are more likely to engage in the
discouraged activity (e. g., Clayton, Cattarello, & Walden, 1991; Harrington & Donohew,
1996; Witte & Morrison, 1995). As Witte and Morrison (1995) suggest, when using high
threat fear appeal messages the campaign needs to include a substitute behavior which will
provide the stimulation desired by high sensation seekers but will not lead to the negative
consequences. If a substitute behavior is not provided, the high sensation seeker is
unlikely to perform the recommended response and the high threat fear appeal may
provide an impetus to engage in the risky behavior.

Finally, health communicators must give consideration to the nature of the health
threat and the recommended responses. When advocating the creation, rather than the
cessation of habits, additional avenues to encourage maintenance must be provided.
Under most circumstances, the creation of a habit (like flossing one’s teeth) may involve
more effort than would the cessation of an activity because it requires the establishment of
patterns which may be viewed as not entirely within the realm of one’s control. Although
one may have a positive attitude, behavioral performance may not occur because one does

not believe that the performance of that behavior will be easy (Ajzen & Madden, 1986;

72

McCaul, Sandgren, O’Neill, & Hinsz, 1993). Not only would one message be insuflicient
to bring about attitude, intention, and behavior change, but strategies to encourage
behavior change as well as maintenance of the habit and long term performance would be
necessary for continued performance of the recommended response (McCaul, Glasgow &
O’Neill, 1992). Simply advising people what to do, without providing the knowledge of
how to perform the behavior as well as the means to support the creation of the habit may
leave motivated individuals otherwise unable to perform the desired actions. Health
communication campaigns which are limited solely to media messages may be insufficient
to spur health protective action. Utilization of peers and interpersonal communication
may prove fruitful in developing the advocated behaviors.
Summm

Fear appeals have been the subject of much investigation over the past forty years.
Results of these studies indicate that fear appeals are potent messages, especially when
they utilize both high threat and high efficacy components. This investigation provides
fiirther evidence for the effectiveness of high threat/high efiicacy messages regardless of
an individual difference variable (i.e., sensation seeking) and regardless of a person’s
desire to view a high threat message. In sum, campaigners must make audience members
feel at risk to a serious health threat and make them feel that they can easily and effectively

avert it.

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