Email updates

Keep up to date with the latest news and content from BMC Public Health and BioMed Central.

Open Access Highly Accessed Research article

Reactions to threatening health messages

Gill A ten Hoor1*, Gjalt-Jorn Y Peters2, Janice Kalagi1, Lianne de Groot1, Karlijne Grootjans1, Alexander Huschens1, Constanze Köhninger1, Lizan Kölgen1, Isabelle Pelssers1, Toby Schütt1, Sophia Thomas1, Robert AC Ruiter1 and Gerjo Kok1

Author Affiliations

1 Dept. of Work & Social Psychology, Faculty of Psychology & Neuroscience, Maastricht University, P.O. Box 616, 6200, MD, Maastricht, The Netherlands

2 Dept. of Research Methods & Statistics, Faculty of Psychology, Open University, P.O. Box 2960, 6401, DL, Heerlen, The Netherlands

For all author emails, please log on.

BMC Public Health 2012, 12:1011  doi:10.1186/1471-2458-12-1011

Published: 21 November 2012



Threatening health messages that focus on severity are popular, but frequently have no effect or even a counterproductive effect on behavior change. This paradox (i.e. wide application despite low effectiveness) may be partly explained by the intuitive appeal of threatening communication: it may be hard to predict the defensive reactions occurring in response to fear appeals. We examine this hypothesis by using two studies by Brown and colleagues, which provide evidence that threatening health messages in the form of distressing imagery in anti-smoking and anti-alcohol campaigns cause defensive reactions.


We simulated both Brown et al. experiments, asking participants to estimate the reactions of the original study subjects to the threatening health information (n = 93). Afterwards, we presented the actual original study outcomes. One week later, we assessed whether this knowledge of the actual study outcomes helped participants to more successfully estimate the effectiveness of the threatening health information (n = 72).


Results showed that participants were initially convinced of the effectiveness of threatening health messages and were unable to anticipate the defensive reactions that in fact occurred. Furthermore, these estimates did not improve after participants had been explained the dynamics of threatening communication as well as what the effects of the threatening communication had been in reality.


These findings are consistent with the hypothesis that the effectiveness of threatening health messages is intuitively appealing. What is more, providing empirical evidence against the use of threatening health messages has very little effect on this intuitive appeal.

Threatening health messages; Defensive reactions; Smokers; Drinkers