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In health promotion communications, fear appeals are widely used. The effectiveness of threatening health messages is intuitively appealing (Ten Hoor et al., 2012). Often, fear appeals focus on the severity of the negative consequences of the risky or unhealthy behavior, trying to promote negative emotions. The empirical evidence on the effectiveness of fear appeals is reported as being not very supportive and in the peer-reviewed literature fear appeals are often criticized (Peters, Ruiter, & Kok, 2013). Fear appeals would lead to defensive reactions on the targeted individuals and may have a negative impact on others. It is suggested that fear appeals might be applied more effectively with a focus on efficacy, but also that health promotion planners might use evidence-based alternatives to fear appeal interventions (Bartholomew et al., 2011). In this Special Section, invited experts will present theoretical and empirical evidence on fear appeals and draw conclusions about the use of fear appeals in health promotion.

Ruiter, Kessels, Peters, and Kok (2014) provided an overview of the use of threatening health messages in health education practice and the structure of effective fear appeals according to two main theoretical frameworks: protection motivation theory and the extended parallel process model. They summarize the findings of six meta-analytic studies into the effectiveness of fear appeals. They concluded that fear arousal is less important in motivating protective action than perceptions of response effectiveness and especially self-efficacy.

Peters, Ruiter & Kok (2014) described a study into the reasons for the persistent wide application of threatening health messages. They conducted qualitative interviews with 33 key actors in behavior change intervention development in the Netherlands. Main reasons for fear appeal use were to attract attention or prompt self-reflection, because target population members were assumed to like fear appeals and respond rationally to increased risk perceptions by changing their behavior, or simply because no alternatives for fear appeals seemed available.

Kessels, Ruiter, Wouters, and Jansma (2014) investigated whether reduced acceptance of self-relevant health risk information is already visible in early attention allocation processes, measured by recording event-related brain potentials and reaction times. Their findings provide further neuroscientific support for the hypothesis that threatening health information causes more avoidance responses among those for whom the health threat is self-relevant.

Brown & Whiting (2014) question whether distressing advertising can be ethically justified. While they warn that the laboratory and field evidence for distressing approaches is generally weak, they conclude that some advertising may be argued to be potentially effective on the basis of theory or precedent. Justification of these approaches is contingent on conditions of effectiveness, proportionality and least infringement being addressed. They propose a fourth, public accountability, which they see as a procedural condition whereby public views are to be solicited and taken into account. They explain how prospective advertising interventions can and should be evaluated against these four criteria.

Kok, Bartholomew, Parcel, Gottlieb, and Fernández (2014) suggested that instead of applying fear appeals, health promoters should carefully develop theory- and evidence-based programs. Their Intervention Mapping (IM) protocol helps program planners to optimize chances for effectiveness, such as finding effective alternatives for fear appeals. Authors who used IM indicated that it helped bringing the development of interventions to a higher level.

In conclusion, fear appeals that focus only on the emotional presentation of the negative consequences of risky or unhealthy behavior are seldom effective and often lead to defensive reactions. Health promotion planners could optimize the effects of fear appeals, among others by focusing more on relevance, response efficacy and self-efficacy. Planners should look for alternative behavior change approaches that are shown to be more effective. Behavior is determined by more than the traditional fear concepts, for example, by social and environmental influences. Health messages tailored to the relevant determinants of specific desirable behaviors are potentially more effective.

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