By Ifath Arwah, University of Sharjah
Fear can be used strategically in public health messaging to encourage people to quit smoking and avoid tobacco use, according to a joint study by researchers from the University of Sharjah and the University of Jordan. The study examines how the US-based public health agency,
Centers for Disease Control and Prevention (CDC), constructs fear-based messages in its long-running anti-smoking campaigns and identifies a set of persuasive strategies that drive behavioral change.
The findings highlight that fear, often criticized in health communication, can be highly effective when combined with credible information and practical guidance. This is particularly important given that tobacco use causes more than 8 million deaths globally each year,
according to the World Health Organization, underscoring the need for more effective public health messaging strategies.
The research is detailed in a study titled
Fear and persuasion in public health discourse: The case of CDC anti-smoking campaigns, published in
Language and Health.
“Fear is often criticized in health campaigns, but our study shows that when fear is used responsibly, it can save lives,” said lead author Ghaleb Rabab’ah, professor of linguistics at the University of Sharjah.
Analysing fear in public health messaging
The study employed a qualitative, descriptive content analysis of 27 press releases issued between 2012 and 2024 as part of the CDC’s Tips From Former Smokers campaign. Drawing on Aristotle’s theory of persuasion and the Extended Parallel Process Model, the researchers examined how fear-based messages are constructed and how they influence audience behavior.
The analysis reveals that these strategies “enhance the CDC’s message by amplifying fear appeals, thereby altering smokers’ current behaviors and attitudes.”
“Fear functions by highlighting the potential threat itself. Once people understand that certain careless behaviors can endanger their well-being or that of their loved ones, they become more inclined to stop and re-evaluate their behaviors,” Prof. Rabab’ah explained.
The study shows that fear-based messaging is used as a “persuasive strategy” to highlight the negative consequences of smoking and influence behavior.
“The fear elements present in CDC messages are not gratuitous, as the representation of fear is intentional and is systematically designed to nudge people to quit smoking or to choose not to start smoking,” he added.
Five strategies behind fear-based messaging
The researchers identified five core strategies that characterize how fear is used in CDC anti-smoking campaigns: fear-induced narratives, health-hazard emphasis, statistics, expert endorsement, and urgency.”
One of the most effective approaches is the use of real-life stories from former smokers who have experienced severe health consequences, making the risks of smoking more immediate and relatable.
“These are real people who, because of smoking, suffered from one or more smoking-related, life-threatening diseases. Some people lost portions of their lungs, whereas others suffered from heart failure or cancer, and many became dependent on their family members for routine daily care. This strategy is intentionally used to convince the audience and/or readers to either quit smoking or not start smoking, as it touches upon their emotions,” said Prof. Rabab’ah.
He added, “The CDC doesn’t just warn people that smoking is dangerous—it shows the human cost of smoking through real stories, real suffering, and real consequences.”
The campaigns also emphasize health hazards by clearly outlining serious smoking conditions such as cancer, heart disease, and premature death.
“The content … prominently highlights the negative consequences that will befall viewers if they do not quit smoking, and it suggests crucial conditions for the target recipient to quit smoking and change lifestyle habits,” the researchers noted.
The campaigns present statistical evidence to demonstrate the scale of harm caused by smoking, noting that such strategies strengthen the credibility of the message and reinforce its public health significance.
“The press releases state that hundreds of thousands of people die every year due to smoking, and billions of dollars are spent on smoking-related medical expenses and lost productivity. These statistics highlight the magnitude of the problem and show that it goes beyond individual issues and speaks to public health,” said Prof. Rabab’ah.
Another key strategy, according to the authors, is “expert endorsement,” which strengthens the persuasive power of these messages in authoritative medical voices.
Finally, the campaigns create a sense of urgency by encouraging immediate action, with messaging designed to prompt individuals to quit smoking or avoid starting.
“Statements like ‘Quit now' and ‘The sooner you quit, the better’ are commonplace. The press releases offer assistance, including quitlines and text message support services. This creates an immediacy that encourages the reader to take action rather than defer their plans to make a change. It suggests that assistance is on hand and that waiting could have negative consequences,” Prof. Rabab’ah said.
Implications for public health communication
The study demonstrates that fear-based messaging is most effective when it is combined with clear guidance and accessible support rather than used in isolation.
“Public health messages are strongest when emotion, evidence, and action work together,” explained Rabab’ah.
The findings offer practical implications for healthcare institutions by providing evidence of effective strategies.
“The use of fear in anti-smoking campaigns provides insight into why certain public health communications resonate more than others. Health organizations can use this study to create more focused, convincing messages that promote healthy behavioral changes,” he added.
Next steps
The researchers plan to extend their work by conducting a multimodal analysis of CDC interviews with former smokers to further explore how fear operates across different forms of public health communication.