Controversies in tobacco control: the limitations of fear messages.

Anyone who doesn’t believe that fear messages can change behaviour should try going into a crowded theatre and shouting “FIRE!” Certainly, such messages have served tobacco control well over the last 50 years. Even a casual glance at prevalence trends demonstrates the impact of the major revelations about smoking and ill health. The power of warnings is enhanced with evocative creative executions, provided the resulting fear does not overwhelm the audience, and adequate support with quitting is offered. The recent Australian campaign demonstrates the potential of this approach. 2 However, in tobacco control we have to be especially sensitive to the all too successful tactics of the tobacco industry, and these, along with those of other commercial marketers, have undergone a paradigm shift in the last 20 years. The traditional fixation with transactions and sales has been replaced by a focus on customer relationships and satisfaction. In this piece we argue that we can learn from these developments. Specifically, they can tell us much about how advertising works, why people smoke, and how marketing exploits the resulting opportunities. All of this suggests that fear messages may be of limited value as we enter what has been dubbed the “second generation” of tobacco control (R Cameron, personal communication). Indeed it suggests that tobacco control is in need of its own paradigm shift. Our suggestions are contentious, but the aim is to stimulate what we feel is a crucial debate.