Scary tactics

The Kandiyohi County Drug-Free Communities Coalition is in the midst of surveying students about their perceptions and priorities, and a rather interesting preliminary finding has emerged: Many of the kids believe scare tactics are an important – perhaps even necessary – strategy for discouraging young people from tobacco and alcohol use.

But are tricks really better than treats? There’s in fact mixed evidence on whether scare tactics truly are successful at getting people to change their health-related behavior.

Look no further than the FDA’s new cigarette label warnings, which go into effect in September 2012. Unlike the current warnings, which are text only, the new ones are larger and more graphic – one of them features a photo of a corpse.

Will they be effective? There’s some international research suggesting that blunt, scary tobacco warnings can result in an increase in the number of smokers who want to quit. For other people, though, it’s likely to be a turn-off.

Repeated exposure to frightmeister messages often dulls the impact, Jonathan Whiteson, director of the Cardiac and Pulmonary Wellness and Rehabilitation Program at New York University’s Langone Medical Center told USA Today earlier this year. “We become immune to the negative warnings over time. The more graphic the image, the more likely the message will become marginalized.”

Another drawback to fear-mongering is that the effects often aren’t very long-lasting. After a health scare, for instance, people tend to have trouble sustaining their motivation to live better. When Truth on Call conducted a text message poll for on this issue, 47 percent of the 100 family physicians who were surveyed said their patients’ good intentions lasted for only a few weeks. A depressing 2 percent of the poll respondents said patients went back to their old ways within one day.

There seems to be some recognition in the health care world that browbeating patients with scare tactics has a way of backfiring. When the Clinical Diabetes journal published an overview in 2007 of best practices for encouraging patient adherence with diabetes management, it included a list of what not to do: “do not establish rapport; tell patients what to do; take control away from patients; misjudge patients’ sense of the importance of behavior change and their confidence in achieving change; overestimate their readiness to change; argue with patients; blame them for not taking better care of themselves; and use scare tactics.”

Unfortunately the dividing line isn’t always clear between what constitutes enough information and what’s too much. What’s the difference between scare tactics vs. fully informed consent? Are scare tactics more acceptable in public health campaigns than in the doctor-patient encounter? Do they work better among adolescents than among adults?

Ultimately, some of this seems to boil down to individual preferences and how the message is delivered.

When researchers interviewed obese African American patients for a study published two years ago in the Journal of General Internal Medicine, they uncovered some interesting nuances about how these patients perceived the use of weight-loss scare tactics. “I like to be scared. Scare me with all the bad things that can happen if I don’t lose weight,” one of the patients told the researchers. But others didn’t like it and even found it intimidating. “I look at it as a threat. The only thing the doctor should do is encourage,” was the response from one patient.

The upshot? Scare tactics seem to work sometimes, but they don’t work all the time and with many patients they’re counterproductive. Clinicians would do well to tailor their message, the researchers wrote. “Providers must be cautious when employing scare tactics as a means to promote lifestyle change to achieve weight reduction as not all patients respond well to this technique.”

West Central Tribune file photo

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