HEALTH EDUCATION RESEARCH Theory & Practice Vol.12 no.2 1997 Pages 227-236 Provocative appeals in anti-smoking mass media campaigns targeting adolescents—the accumulated effect of multiple exposures A. Hafstad, L. E. Aar0', A. Engeland, Aa. Andersen, F. Langmark and B. Stray-Pedersen 2 Abstract This paper reports findings from a longitudinal study that evaluated the accumulated effect of three consecutive mass media campaigns using provocative and dissonance arousing appeals to prevent cigarette smoking by adolescents. In the spring of 1992, all eligible adolescents aged 14 and 15 in one intervention county (N = 4898) and one control county (N = 5439) in Norway were included in the study, and were followed until they were 17 and 18 years of age in 1995. Only students who completed questionnaires both in 1992 and 1995 were included in the analyses. Among the non-smokers at baseline, a significantly lower proportion of adolescents of both genders had started to smoke in the intervention county compared to the proportion in the control county. Among those who were smokers at baseline, significantly more girls in the intervention county had stopped smoking than in the control county, while no significant difference between the counties was detected among boys. Our findings suggest that provocat- ive and dissonance arousing appeals that create affective reactions and lead to interpersonal communication should be given more attention The Cancer Registry of Norway, Institute for Epidemiologies! Cancer Research, 0310 Oslo, 'Research Center for Health Promotion, University of Bergen, 5007 Bergen and ^The Norwegian Women's Public Health Association, 0260 Oslo, Norway. 3 Present address: Department of Health Promotion, National Institute of Public Health, 0403 Oslo, Norway in campaigns designed to influence adolescent smoking. However, such appeals may easily produce negative reactions and the normative context should be thoroughly considered when using such appeals in future interventions. Introduction Over the past decade, several studies have exam- ined the effects of mass media campaigns that have been combined with other efforts for delivering smoking preventive health messages (Ettema et al, 1983; Farquhar et al, 1990; Pierce et al, 1990; Korhonen et al, 1992). Most of these evaluations have shown significant effects and, for instance, Flynn et al. (1992, 1994) found an increased effect when adding a mass media campaign to a school- based intervention. Studies evaluating media alone campaigns, however, have reported somewhat discouraging results (Bauman et al, 1991; Murray et al, 1994). These discouraging results may indicate that mass media campaigns alone are not able to influence smoking behaviour. Problems in detecting effects may also be caused by method- ological problems in evaluating the effectiveness of such campaigns (Redman et al, 1990). Another reason can be that we have not learned how to utilize the potential of mass media in health educa- tion (Flay and Burton, 1990). Empirical studies on the use of different messages and appeals in anti- smoking mass media campaigns are rare, and it has been indicated that the nature of the persuasive appeals is the most critical factor for success (Flay and Burton, 1990) and consequently new approaches need to be tested. © Oxford University Press 227 Downloaded from https://academic.oup.com/her/article/12/2/227/619000 by guest on 03 May 2023