Can you scare people out of smoking? Since Janis and Feshbach’s influential research on the use of fear in dental hygiene education in the early 1950s,1 several generations of health educators have often uncritically accepted as near holy writ that you should not try to scare people into healthy practices, including smoking prevention and cessation.2 3 Given that survey evidence from ex-smokers has repeatedly affirmed that personalised concern about “scary” health consequences is the primary motivation ascribed to smoking cessation4-6 and is associated with predictors of cessation,7 interesting questions arise about whether this dogma is empirically grounded or whether it rather reflects a profession-wide neurosis intent on avoiding opprobrium from those who believe it is somehow not “nice” to deal in gory imagery in the name of persuasion.8

A mass media-led campaign launched in Australia in June 1997 has been seen by many as “the mother of all scare campaigns” (see the illustrations on the cover of this issue of Tobacco Control, the figure in this essay, the campaign-related material on the world wide web at <http://www.quitnow.au>, and the description of that web site on page 89). The television advertising campaign has been described repeatedly as “hard-hitting”, “gory”, and something smokers will “see once and never forget”. It has since been used by the state of Massachusetts tobacco control programme9 with dozens of other international enquiries also having been received.

To some, the campaign might be seen as something of a health promotion profanity in the wake of recent so-called “positive” practice—for example, campaigns using every manner of non-smoking role model; general proselytising about “healthy lifestyles”, freshness, and so on). However, to others it represents the culmination of a painstaking formative research process undertaken in the context of a stalled decline …