RESEARCH & PUBLICATION 1

Corporate Communication a critical factor in fostering CSR centricity:
A study of young adult Malaysian consumers’ attitude and purchase intentions of CSR supported grocery brands
Research Area: Communication Management

[ view in acrobat pdf ]

__________________________________________________________________________________

RESEARCH & PUBLICATION 2

Negative CR on China-made Brand

[ view in acrobat pdf ]

__________________________________________________________________________________

RESEARCH & PUBLICATION 3

Moral Panic And Migrant Deviance : Perceived Attitude And Intentions

[ view in acrobat pdf ]

_________________________________________________________________________

Testing the effectiveness of Health Risk Messages: Threat and Efficacy Processing
Thinavan P.

This is a micro study of an on-going macro study of the different categories of fear appeals used in the on-going national anti-smoking campaign. The print campaign used in the anti-smoking campaign was the focus of the study. Two types of advertisement was selected namely one which depicted social threat and the other a damaging health risk. Each type of advertisement was evaluated by two separate groups of participants. Evaluation was based on the extended parallel process model’s (EPPM) risk diagnosis scale. The social threat advertisement had low fear and efficacy message while the health threat advertisement had high fear and efficacy message. Findings showed that the social threat message (low fear/efficacy) was able to make the respondents of the study take a danger control position to avoid the negative consequences. In contrast the damaging health threat message (high fear/ efficacy) was found to move the participants to a fear control position that is to merely control the fear emotions. As per the EPPM model the efficacy construct determined how the fear appeal was processed (danger control or fear control).

Keywords: Extended Parallel Process Model, fear appeal, cognitive processing

     This study is fore-runner to a larger study on the usage of threat communication to dissuade individuals from risky behaviours such as smoking. According to a magazine report, tobacco is a legal product that can kill half its users (HT July 2009 pg 45). Does information like this, enough to dissuade the world’s 1.1 billion smokers to kick their habits indefinitely. An estimated one-in three adults now smoke and by 2025 this will add another half million to the existing statistics on smoking. The magazine report also emphasized that young people are taking up this habit in an alarming manner. An estimated 82,000 to 99,000 young people take up smoking every day worldwide and are at risk of contracting cancer, emphysema, chronic bronchitis, coronary artery diseases and other chronic ailments.

     The Malaysian tobacco scenario is equally alarming. The National Health and Morbidity Survey 2006 revealed that three million Malaysian were smokers and some 450,000 were aged between 13 and 18 years. The survey also showed that 46.4 per cent were adult males, 1.6 percent adult females and 26 percent adolescent boys and three per cent adolescent girls (Annie Freeda Cruez,Shuhada Elis, Aniza Damis & Sonia Ramachandran (2009). In a recent news report, Malaysian smokers smoke an average of 14 cigarettes per day and highlighted that there was a significant increase in young women smokers. It was forecasted that by 2025 adolescent female smokers will constitute 4% of the total number of women in the country (The Sun July 29, 2011). In another study of 2,900 students aged between 13 and 16 in the state of Selangor, one in 10 girls smoked and one in five students had started smoking by the age of 15 with an average age of initiation at 11.4 years(Annie Freeda Cruez,Shuhada Elis, Aniza Damis & Sonia Ramachandran (2009). In another study on the economic cost of tobacco smoking, smoking related health-care cost was 3 billion in 2004(UKM Medical Centre 2004). New Sunday times quoted the Health Ministry deputy-director general Datuk Dr. Ramlee Rahmat , “the number of deaths and economic losses due to tobacco use exceeds that of the combined total of most infectious diseases including influenza, dengue, malaria, tuberculosis and HIV./AIDS. About 10,000 people die in Malaysia each year due to tobacco attributed diseases” (NST, May31, 2009 – RM 3 Billion Medical Bill).

     Many studies in Malaysia and around the world tend to focus on either the teenagers or adults. There are very few studies done to gauge the seriousness of tobacco smoking at the college and undergraduate level. This is not only true in Malaysia but also in other parts of the world (Jie Xiu, 2008, Proquest Dissertations & Theses A & I). College and undergraduate students in Malaysia form a sizable group for tobacco marketing. Even in the United States College students comprise the single largest group of young Americans legally accessible to the marketing campaigns of the tobacco industry (Sax 1997). A considerable number of college and undergraduate students either begin to smoke in their college years or become regular smokers during the same time (Johnston Malley,Bachman, & Schenlenberg,2006). Lerman, Kaufmann,Neuner and Audrain-Mc Govern(2004) proposed that college years may have an influence in nurturing long term smoking habits. Compared to teenagers and adults, young adults aged 18- 25 were rarely considered in smoking cessation and prevention campaigns (Rigotti,Regan,Moran & Weschler 2003).

      In trying to establish new personal identities these youth tend to adopt behaviours which marked or symbolised adulthood status and smoking is the most accessible adult symbol that is adopted. According to Eadie D., Hastings G., Stead M., Mackintosh, Ann M. (1999), cigarettes play a vital social function for young people seeking peer endorsement and acceptance. Against this changing psychic of youths, nation-wide anti-smoking campaigns have been the main approach in most countries to curb this risky behaviour. Malaysia is not an exception in this global effort to reduce smoking among adolescents. On  February 2004, the former Prime Minister Dato’ Seri Abdullah Ahmad Badawi launched the nation-wide anti-smoking media campaign with a campaign signature “Tak Nak”! Setiap sedutan membawa padah ( Say No!. Every Puff you take damages your body).
                                             
The Tak Nak Campaign

       The Tak Nak was devised and implemented by the Malaysian Design Technology Centre (MTDC), a company appointed by the Ministry of Health. Tak Nak is a five year project with A total cost of approximately RM20 million and was financed by the Malaysian Government. According to the project concessionaire’s (MDTC) campaign document, the campaign aims was designed to galvanize

The entire nation against cigarette smoking using an identified focus to communicate the enormity of the problem. The magnitude could be gained from a wide reaching and integrated communication approach in targeting at children, youths, women as well as all smokers and the general public. Accurate effective information concerning health risks of smoking, disseminated through the Tak Nak campaign hoped to achieve the following:

1. discourage teenagers from starting to smoke
2. discourage women from smoking
3. discourage smokers from continuing their habit, and
4. encourage all to persuade their friends and loved ones from initiating or crease their smoking habit

       The concessionaires had emphasized on branding and claimed that through the use of a very simple expression and a very simple icon, the campaign could:

1. reach out to connect, especially with the young
2. appeal to all in an endearing way
3. create an impact that will be immediately felt nationwide
4. capture the imagination of the whole country
5. educate to discourage everyone from smoking

     The campaign brand and icon – Tak Nak was made widely visible to Malaysians through numerous medium. The concessionaires adopted strategic deployment of media channels to achieve effective reach and frequency of the target prospects electronic and outdoor media formed the main thrust of the campaign. Print and other media were used to extended coverage. The mass media used were television, newspapers, magazines, radio, cinema, billboards, school advertising panel, giant posters and community boards. Collaterals such as badge, car-stickers and T-shirts were also used. The high profile launch was meant to generate news and publicity for the campaign.

      This campaign began with two social risk series; the ‘Audition” and “The Home Coming”. These first sets of television advertising carried images of ‘bad teeth’ and messages on how smoking affects the physical appeal of young men and women. These visuals and messages were frequently aired in the initial months of the campaign. This was followed by the horror statement series adapted from the Australian National Tobacco Campaign. Materials carrying messages  and visuals of ‘Blood Clot’, ‘Cancer’,’ Rotting Lungs’ and ‘Tar’ appeared in newspapers and billboards.(refer Appendix B for the print and TV advertising). Also incorporated were the following slogans:

1. Cigarette smoking can cause brain damage
2. Cigarette smoking can cause cancer
3. Cigarette smoking rot the lungs
4. Cigarette smoking condenses in your lungs to form tar
5. Cigarette smoking can lead to drug addiction
6. Cigarette smoking can cause impotency
7. Cigarette smoking can affect children’s IQ
8. Cigarette smoking can wrinkle your skin
9. Cigarette smoking can causes bad teeth
10. Cigarette smoking kills more than 4 million people a year, 8000 a day, 6 a minute and 1 every 8 seconds.

           The Tak Nak anti smoking campaign is an effort to influence behaviour by scaring smokers and non-smokers into changing a dysfunctional attitude or behaviour. This media campaign was evaluated approximately one year after the launch by the Clearing house and Research Network for Tobacco Control, National Poison Centre of Malaysia, University Science Malaysia and findings indicated high levels of exposure amongst adult and adolescent smokers and Non-smokers and majority were able to recall particularly the horror themes and visuals. There was also expression of intentions to quit smoking or not likely to start it in both the adult and adolescent smoking and non-smoking groups. (Report: Evaluation of the National Anti-Smoking Campaign In Malaysia: Tak Nak Media Campaign 2004) May 2005, National Poison Centre (NPC), University Sains Malaysia). The evaluation study involved 2,007 adult smokers ( 18 years old) 1,011 adolescents ( 13-17 years old) irrespective of smoking status and 1,560 non-smokers ( 18 years and above) from four zones across Peninsular Malaysia and Sabah and Sarawak. Samples were drawn using a multistage cluster sampling design to ensure broad representation of the population under study.    

      Data was collected between January and March 2005. Face to face interview method was used and upon consent a self-administered questionnaire was given to be filled up. The questionnaire measured campaign awareness, likelihood of quit smoking / attitude, knowledge and beliefs of health effects of smoking and whether they had discussed this issue with others. Findings indicated that campaign exposure was high among both the adult (93%) and adolescent (94 %) groups. Television followed by billboard, newspapers and radio was selected as the main source of information regarding this campaign. The horror series were readily recalled and these include ‘Smoking can cause Cancer’, ‘Can Rot Lungs’ and ‘Clots Brains’. Generic messages such as ‘Smoking endangers health and say’ Tak Nak’ were commonly quoted in association with the campaign. The campaign had stimulated discussions among family members and friends. The survey revealed that non-smokers and adolescents were more likely to discuss about smoking and health impact with family and friends. Majority felt the campaign was relevant. Adult smokers who found the campaign relevant were more likely to quit smoking and similarly adolescents reported lower intention to smoke had acknowledged that the campaign made smoking less socially desirable. Two out of three adolescents perceived the campaign has encouraged their peers to quit smoking, while one in three believed it made smoking ‘less cool’. About 68% of the adolescents made then less likely to smoke in the future.

      In the context of fear two-thirds of adult smokers felt that the campaign made them fearful of smoking. There were no significant differences in response between gender and geographical location. In relation to fear 29% of adult smokers felt more likely to quit; 27% felt less likely to quit and another 27% said it did not make any difference. Overall results showed a positive association between likelihood to quit and fearfulness of smoking (p<0.001). Smokers who were very much fearful of smoking were more likely to quit. About 68% of adult non-smokers mentioned that the campaign had made them fearful of smoking.

      In the adolescents group both male and female were fearful of smoking after being exposed to the campaign. Female youths were significantly more fearful of smoking (p<0.001). Adolescents who did not smoke expressed more fear than those who smoke. There was a significant difference in fear expressed by non-smoking and smoking adolescents (p<0.001).A significant larger percentage (69.8%) of non smoking adolescent stated the campaign had made them less likely to smoke in the future compared to smokers (55.8%).

     
       In general the research results showed the campaign was successful in using fear to motivate thoughts of quitting or not taking-up smoking ( non-smokers) as well as initiating elaboration or discussions with family members and friends which implies that fear impacts affect and cognition which is vital in triggering deeper thoughts, views and possible behaviour response.

Study Rationale

     The Ministry of Health was quoted  in an editorial column, that it will  not only continue the current threatening health risk message but also step up to  provoke greater fear of the deadly consequences of tobacco smoking( Sun Friday July 29,2011 – Keep anti  smoking drive on track). It is therefore appropriate to study the efficacy of the fear component in the threatening health risk messages of the TAK Nak campaign.  Fear responses can be analysed in many approaches. One of the more popular approach used in current literature on fear communication is the use of the Risk Behaviour Diagnosis Scale (RBD) (Witte, Meyer and Martell 2001). This scale can be used for pre-testing or post-testing. Pre-testing to develop effective health risk message and post-testing to evaluate the impact of the risk message. This study which is part of a larger study proposes to measure the fear arousal based on the RBD which is part of the Extended Parallel Process Model (Wiite, 1992). The focus in this study is to evaluate how different types of health risk or threatening messages used in the TAK NAK campaign, which induces fear, is processed. Induced fear is expected to influence the affect construct of an individual which is expected to trigger cognitive activity influencing beliefs, values, attitude and behaviour (Perloff M. 2008).

Statement of Problem

       The TAK NAK CAMPAIGN evaluated by the Clearinghouse & Research Network for Tobacco Control, national Poison Centre (NPC) of Malaysia, University Sains Malaysia was conducted in 2005 to determine campaign awareness and to determine the receptivity of smokers and non- smokers to the anti-smoking threat messages disseminated via the mass media as well as to understand the psychosocial and behavioural effects on the targeted audience. Detailed study of the fear message components was not the focus of the NPC survey. It would be appropriate at this juncture to study the effectiveness of the two categories of physically and socially threatening fear appeals used in the TAK NAK anti smoking campaigns using established fear theories and models. Outcome of this study will be relevant in view of the fact that the Ministry of Health is planning to continue and increase the severity and susceptibility of future fear messages. The TAK NAK campaign study by NPC did not specifically target college students; as such this study will focus on this group. College students are at a critical stage of adulthood and independence from parental control and may find smoking a symbol of new found emancipation. This far there are no studies which specifically focus on impact of fear appeals on college students using fear appeal theories or models in Malaysia.
                                                        
  Theoretical Framework:  Fear Appeal Theories: Extended Parallel Processing Model

     According to Perloff (2008) fear appeals are persuasive communication that scare people into changing their attitudes by implying negative consequences if recommendation to avert the threat is not complied with. The Extended Parallel Process Model (EPPM) (Witte1992) is the most recent fear appeal theory that attempts to explain when and why fear is effective or ineffective (Wiite,1992,1994,1998;Witte &ALLEN,2000).

     The EPPM model as the name suggests amalgamates early fear theories which concentrated on how the threat (emotion) was perceived in terms of perceived severity and perceived susceptibility and the latter theories which considered cognitive processing of the recommended action to avert the dangerous health problems. The EPM model, which is essentially a message processing model, is based on the premise that fears messages are processed at both the emotional and cognitive level. The emotional message processing constructs of the theory namely perceived susceptibility and perceived severity come form the early drive theories or what is commonly known as the stimulus-response learning theories and  in particular  Janis (1967) Fear-As-Acquired Drive Model which explained  when and why fear appeals fail (fear control) . Leventhal’s (1970) Parallel Process Model introduced a cognitive dimension to fear processing. Individuals not only focused on how to cope with fear arousals, they also thought about strategies to overcome the threat. The earlier was described as fear control process and the latter the danger control process. The model was criticised for being imprecise and not able to explain when one process may dominate the other (Beck and Frankel 1981).

     Rogers (1975, 1983) Protection Motivation Theory focused on Leventhals (1970) cognitive aspect of the model. Cognitive or though-based reactions to fear appeals focused on danger control (when and why fear appeals work). The PMT did not clearly state how the two parallel processes of fear

And cognitive processing worked and at what point one process superseded the other and how this impacted the final behavioural response to the overall fear appeal.  The EPPM Model integrated insights from drive theories (when and why fear appeals fail) and the parallel response models (when and why fear appeals work)   to explain clearly how individuals process fear appeals and why people are persuaded (Boermans M.A. 2007  ).

Fig 1: EXTENDED PARALLEL PROCESS MODEL

Source: Putting the fear back in fear appeals: The extended parallel process model. Witte, K. (1992).Communication Monographs, 59, 329-349.   
    
      Based on the EPPM model outlined in Fig 1, an individual will appraise simultaneously the two components of a fear message that is the threat and the efficacy of the recommended response to avert the health danger (Witte, Meyer & Martell). Perloff (2008) describes this as problem (perceived threat) and solution (perceived efficacy information).  Threat appraisal comprise of two subjective perceptions known as perceived susceptibility and perceived severity.  An example of perceived susceptibility is when college students after considering the TAK Nak fear appeal may feel at risk of contracting the ill consequence. Perceived severity refers to one’s feelings about the seriousness of the tobacco related disease. The other appraisal is on the message efficacy which consists of two appraisals that is response efficacy and self efficacy. Response efficacy refers to beliefs about how effective the recommend response in averting the ill consequence of smoking (If a college student says NO to cigarettes than he is shielded from suffering the ill consequences).

     The Self efficacy construct introduced by Bandura (1977) is an introspective self-evaluation of one’s ability to perform the recommended behaviour  to avert from the suggested ill consequences (e.g. I can say No more smoking; I can say No to friends who wants me to smoke ).

     The EPPM model in figure 1 frames three behavioural outcomes from two cognitive fear appraisals. The outcome is largely dependent in individual differences that moderate the two cognitive appraisals. First a No Threat outcome is achieved when message recipients do not find the message threatening or relevant. This is a zero threat or negligible threat against a high or low efficacy. The second outcome is when the individual accepts the ill consequences of the threat and is motivated to take up affirmative action (protection motivation) and same time the individual has high levels of efficacy. This results in danger control or adaptive behaviours. Assuming the efficacy perceptions were low and threat perceptions high a maladaptive response will be exhibited. In this case, unable to contain the fear provocation, the individual will control the fear (fear control) to reduce the tension (defensive motivation) by denials, reactance or avoidance (Boerman MA 2007; Wiite 1992, 1994, 1998; Witte et.al. 2001). A campaign is successful when danger control behaviours are dominant and efficacy perceptions seems to be the critical determinant of the behavioural outcome.

     The EPPM has been extensively tested on a myriad of social and health issues using experimental, quantitative and qualitative research (Gore & Bracken 2009). Among them include college students and genital warts(Witte, Berkowitz,Cameron & Mc Keon 1998);Coal Mining and Hearing Loss(Lisa Murray Johnson et.al 2004); Texas farmers and Tractor Safety(Witte et.al 1993);Skin Cancer and Texas Young Adults(Stephenson & Witte,1998); Teen Mothers and Pregnancy(Witte );Breast Cancer (Kline 1995); HIV/AIDS Prevention(Casey 1995;Murray,Hubbell,Witte,Sampson & Morrison 1998).

 Research Hypotheses

Hypothesis 1:   After Exposure to a social (low threat/efficacy) heath risk message about cigarette smoking, participants will not be motivated towards danger control processes
Hypothesis 2:  After Exposure to a health (high threat/efficacy) risk message about cigarette smoking, participants will be motivated towards danger control processes.

 Method

     This study being a small part of a larger study aimed at testing the major tenets of the EPPM model namely the danger control and fear control outcomes of two print advertisements from the TAK NAK campaign. All xx anti smoking print advertisements used in the campaign fell under  two categories of fear appeal advertisements that is  Social Fear
Appeal(Low fear and efficacy information) and Health Fear Appeal( High fear with efficacy information). The categorisation was based on the on the visual and text content of all the print advertisements used in the first launch of the campaign. In a pre-test selection of advertisements for the research, twenty five college students
were asked to select one that represented the two extremes – low and high fear arousing advertisements. Based on the ratings the ‘stained teeth’ was voted as the low fear and the ‘brain with oozing blood’ as the highest in fear.

Quasi experimental Design

 A quasi experimental design was used to test the two pre-selected print advertisements. This is postest  only design.  Two groups of 63 students were randomly assigned . One group was given to view and read the low fear ad (stained teeth) while the other the high fear advertisement (brains with oozing blood). The groups were briefly informed about what they were expected to do. Both groups were told to view and read the printed ad distributed to them. Following this they were asked to fill-in the Risk Behaviour Diagnosis questionnaire to evaluate their fear and efficacy levels.                

 Instrument

The Risk behaviour diagnosis scale developed by Witte (1996) was used with minor modifications to tally with the advertisement that was being tested. RBD is a 12 item, 5 point Likert-type scale ranging from 1(strongly disagree) to 5 (strongly agree). Each of the four constructs of the EPPM that is Severity, Susceptibility, Response Efficacy and Self Efficacy had three statements each for the respondents to answer. For Example: Severity:  ‘Brain damage is a serious threat”, “Brain Damage is harmful” and “Brain damage is a severe threat”. The RBD analysis enables the researcher to gauge the respondent’s danger control or fear control processes after exposure to a health risk message. Three demographic questions were included that is sex and smoking status.
                                                         
Findings

     Research hypotheses 1  predicted that respondents exposed to the low threat / efficacy anti smoking health risk advertisement( stained teeth) would exhibit  low fear and may not be motivated to control the fear since it is not life threatening. On the contrary the susceptibility and severity perceptions were higher than severity: 460 > 177 which mean the respondents were in danger control position. Figure 2 provides both the total and means score comparisons between the four constructs. The Alpha Coronach for the constructs were at reliable level: response efficacy: 0 .835; Self efficacy: 0 .629; Susceptibility: 0.796; Severity: 0 .729.

R: response efficacy; S: self efficacy; Sus: Susceptibility and Sev; Severity

     Based on the frequency table male respondents made up 60.3% and 39.7% female and 57.1 % were social smokers and non-smokers 41.3% with only 1 smoker.  There was no significant differences in non-smoker and social smoker processing of the threat and efficacy constructs based on a t-test (p >0.05). There was also no differences in gender processing of the threat and efficacy constructs except susceptibility where there was a significant difference between male and female respondents; t = 5.391; p< 0.05.

     Research hypotheses 2  predicted that respondents exposed to the high threat / efficacy anti smoking health risk advertisement( brain damage) would exhibit  high fear and participants may be motivated to control the fear since it is life threatening. On the contrary the susceptibility and severity perceptions were higher than response efficacy and self efficacy: 501 > 447 which mean the respondents were in fear control position.

 Figure 3 provides both the total and means score comparisons between the four constructs. The Alpha Cronbach for the constructs were at reliable level: response efficacy: 0 .778; Self efficacy: 0 .754; Susceptibility: 0.776; Severity: 0 .669.

     Based on the frequency table male respondents made up 42.9% and 57.1 % female and out of this 38.1 % were social smokers, non-smokers 52%, 3% smokers and ex-smoker 3%.  There were no significant differences in non-smoker and social smoker processing of the threat and efficacy constructs based on a t-test.  There were also no differences in gender processing of the threat and efficacy constructs based on a t-test.

Discussion

     Several parallels can be drawn from the findings of this experimental study with the main constructs of the EPPM model. The main findings from several EPPM studies is that danger control status can be achieved with high levels of  threat(severity and susceptibility) and a higher level of efficacy(Witte 1992;Witte, Berkowitz, Mc Keon et.al  1998). The key finding in this research is that low threat was able to move respondents to danger control status.   Based on the perceived efficacy scores it can be inferred that respondents who were either social or non smokers were in control of handling the ‘stained teeth’ threat which has a greater propensity to occur in heavy smokers. Respondents in the high fear/efficacy message found it highly threatening and health risk like brain damage is hard to control. One may brush away the ‘ugly stains’ on the teeth but one will never know when their brains will get damaged and one cannot simply ‘fix it’. The efficacy perceptions were low and this resulted in fear control response. It can be inferred that the majority non-smokers and social smokers were probably overcome by the enormity of the risk (brain damage). It can also be interpreted that efficacy scores were lower because of the lack of confidence in the recommended response to avert the threat. Can a simple say NO can avert a serious brain damage? The efficacy message used in the tested advertisements as well as  in the other non-tested fear appeals advertisements were identical that is a brief explanation how smoke damages the brain or lungs  and one must say NO “because every puff you take damages your body”. This one size fits all efficacy message may not fit the varying levels of fear appeals presented in the advertisements.

     Based on the outcome of the low threat/efficacy and high threat/efficacy, the low fear/efficacy or the Social threat was found to be more effective than the Health Risk threat. Efficacy information must be varied according to the level of fear appeal in an advertisement since efficacy information as per the EPPM can make a major impact on the direction of the cognitive processing.

 Limitations

     This is a small scale study which is part of an ongoing study as such the findings may not be conclusive however it does demonstrate that the EPPM model  is an effective model to measure fear appeal  to ascertain the overall effectiveness of  a health campaign. Firmer conclusions can be drawn if all the advertisements were tested.

REFERENCES

Annie Freeda Cruez,Shuhada Elis, Aniza Damis & Sonia Ramachandran (2009, May 31). No More Gifts or Gimmick. New Straits Times, p.N6 & 7.
Bandura, A. (1977). Self-efficacy: Toward a unifying theory of behavioral change. Psychological
Review, 84, 191-215.

Beck,K.H., and Frankel, A. ( 1981). A conceptualization of threat communication and protective behaviour. The Journal of Social Psychology,107,239-251.
Boermans M.A. ( 2007). The communication process of persuation and fear appeals. Bachelors Theses, Virje Universiteit Amsterdam. 
Boster FJ, Mongeauw P(1984) Fear arousing persuasive messages. Communication Year Book, Beverley Hills CA: Sage.
Chan Li Jin(2011,June 14). Smoking Teens. The Sun pg 18.
Donovan R.J & Henley N. (1977) Negative outcomes, threats and threat appeals: widening the conceptual framework for the study of fear and other emotions in social marketing communications. Social Marketing Quarterly, 56-65.
Foong Kin, Maizuraj Omar, Razak Lajis, Rahmat Awang, et al. (2005) Evaluation of the national anti-smoking campaign in Malaysia: Tak nak media campaign. Research Report ; Clearinghouse and Research Network for Tobacco Control, National Poison Centre(NPC): Malaysia,Univeristi Sains Malaysia.
Gore T.D., Bracken C.C.(2005) Testing the theoretical design of a health risk message: Re-examining the major tenets of the extended parallel process model. Health Education & Behaviour, 32(10), 27- 41.
Janis.I.L., Feshbach S.(1953). Effects of Fear arousing communication. Journal of Abnormal Psychology, 48, 78-92.
Janis, I. L. (1967). Effects of fear arousal on attitude change: Recent developments in theory and
experimental research. In L. Berkowitz (Ed.), Advances in experimental social psychology
(Vol. 3, pp. 166-225). New York: Academic Press.

 Janis, I. L., & Feshbach, S. (1953). Effects of fear-arousing communication. Journal of Abnormal
and Social Psychology, 48, 78-92.

Jie Xiu. (2008). Influences of the sensation and cognition value of anti-smoking public service
announcements on college students message processing and self assessment.  Proquest Dissertations & Theses A & I
Keep anti smoking drive on track(2011.July 29). The Sun pg 12
Leventhal, H. (1970). Findings and theory in the study of fear communication. In L. Berkowitz
(Ed.), Advances in experimental social psychology (Vol. 5, pp. 119-186). NewYork: Academic
Press.

Morman Mark T. (2000) The influence of fear appeals, message Design, and Masculinity on Men’s motivation to perform the testicular self-exam. Journal of Applied Communication Research,28,91-116.
Patterson F. Lerman, Kaufmann, Neuner and Audrain-Mc Govern (2004). Cigarrette smoking practices among American College students: Review and Future directions. Journal of American College Health. 52,203- 210.
Perloff Richard M. (2008). The dynamics of persuasion: Communication and attitudes in the 21st century. 3rd ed.  New Jersey: Lawrence Erlbaum Assoc.
Regan A.R. Gurung(2010). Health psychology a cultural approach. Belmont: Wadsworth.
Robert A.C. Ruiter, Gerjo Kok, Bas Verplanken and Johannes Brug(2001). Evoked fear and effects of appeals on attitudes to performing breast self-examination: an information processing perspective. Health Education Research, 16, 307-319.
Rogers, R.W. (1975). A protection motivation theory of fear appeals and attitude change. Journal
of Psychology, 91, 93-114.

Rigotti, Regan, Moran & Weschler (2003). Student’s opinion for control policies recommended for US Colleges: A national survey . Tobacco control,12 251-256
Stephenson, M. T., & Witte, K. (1998). Fear, threat, and perceptions of efficacy from frightening
skin cancer messages. Public Health Reviews, 26, 147-174.
Witte, K. (1992). Putting the fear back in fear appeals: The extended parallel process model. Communication Monographs, 59, 329-349.  
Tobacco Facts (2009,July  ). Health Today pg 45.
Witte, K., P. & Allen, M. (2000). A Meta analysis of fear appeals: Implications for effective public health campaigns. Health and Education Behaviour, 27, 591-615.
Witte, K. (1997). Preventing teen pregnancy through persuasive communications: Realities, myths,
and the hard fact truths. Journal of Community Health, 22, 137-154.

Witte, K., Berkowitz, J., Cameron, K., & McKeon, J. K. (1998). Preventing the spread of genital
Warts: Using fear appeals to promote self-protective behaviors. Health Education & Behavior,
25, 571-585.

Witte, K., Cameron, K. A., Lapinski, M. K., Nzyuko, S. (1998).Theoretically based evaluation of
HIV/AIDS prevention campaigns along the trans-Africa highway in Kenya. Journal of Health
Communication, 3, 345-363.

Witte, K., Cameron, K. A., McKeon, J.,&Berkowitz, J. (1996). Predicting risk behaviors: Development
and validation of a diagnostic scale. Journal of Health Communication, 4(1), 317-341.
Witte, K., Meyer, G., & Martell, D. (2001). Effective health risk messages: A step-by step guide.
Thousand Oaks, CA: Sage.

Witte, K., &Morrison, K. (1995). The use of scare tactics in AIDS prevention: The case of juvenile
detention and high school youth. Journal of Applied Communication Research, 23, 128-142.

 Witte,K., Meyer, G.,Martell D. (2001). Effective health risk messages. A step-by-step guide.
California; Sage