1. Introduction
COVID-19 severely impacts public health, and smoking worsens COVID-19 severity. Awareness of this risk correlates with stronger quit intentions, making combined-risk messaging a promising tool for smoking cessation.
The EPPM explains fear-appeal health communication:
- High threat + high efficacy → danger control (adaptive protective actions)
- High threat + low efficacy → fear control (maladaptive coping, e.g., denial)
Most EPPM research focuses on single health threats, but smokers face two linked threats: smoking and COVID-19. This study fills the gap by testing how dual threat/efficacy perceptions shape protective intentions and emotional responses.
Hypotheses & Research Questions
- H1: Smoking threat, COVID-19 threat, their interaction, smoking efficacy, COVID-19 efficacy, and their interaction positively predict quit intentions.
- H2: The above variables positively predict COVID-protective intentions.
- H3: Smoking threat, COVID-19 threat, and their interaction positively predict fear.
- RQ1: How do dual efficacies predict fear?
- RQ2: How does fear relate to fatalism?
2. Materials and Methods
Participants & Design
- Sample: 747 U.S. adult smokers (recruited August 2020; excluded control group)
- Design: Online experiment with three risk-message conditions (COVID-19 risk, smoking risk, combined risk)
- Measures: Perceived threat (severity/susceptibility), perceived efficacy (self/response efficacy), fear, fatalism, quit intentions, COVID-protective intentions; covariates included demographics, smoking frequency, and pre-test variables.
- Analysis: Structural equation modeling (SEM) with mean-centered interaction terms.
3. Results
Quit Intentions (H1 Supported in Part)
- Positive predictors: COVID-19 threat, smoking efficacy, COVID-19 efficacy, efficacy interaction, fear.
- Smoking threat and threat interaction were not significant.
- Higher COVID-19 efficacy strengthened the link between smoking efficacy and quit intentions.
COVID-Protective Intentions (H2 Largely Unsupported)
- Positive predictor: COVID-19 efficacy.
- Negative predictors: COVID-19 threat, efficacy interaction.
- Smoking threat, threat interaction, and smoking efficacy were not significant.
Fear & Fatalism (H3 Supported in Part)
- Positive predictor of fear: COVID-19 threat; smoking efficacy also positively predicted fear.
- Fear was unrelated to fatalism.
- Positive predictors of fatalism: smoking threat, COVID-19 threat, threat interaction, smoking efficacy.
- Negative predictors of fatalism: COVID-19 efficacy, efficacy interaction.
Indirect Effect
Fear mediated the effects of COVID-19 threat and smoking efficacy on quit intentions.
4. Discussion
Key Findings
- Quit intentions: Dual-efficacy perceptions and COVID-19 threat drive adaptive responses, with fear as a positive mediator.
- COVID-protective intentions: Only COVID-19 efficacy matters; smoking efficacy may reduce precaution motivation.
- Emotional responses: Fear promotes (not hinders) cessation; fatalism links to heightened threat perceptions.
Practical Implications
- Combined-risk messages effectively motivate smoking cessation by highlighting dual efficacies (quitting + COVID-19 protection).
- Prioritize efficacy information in health campaigns; threat appeals work for cessation but may backfire for COVID-19 precautions.
Limitations
- Cross-sectional data (no causal claims).
- Conducted pre-vaccine; context may shift with variants/misinformation.
- Convenience sample limits generalizability.
5. Conclusions
This study extends the Extended Parallel Process Model (EPPM) by examining how dual threats of smoking and COVID-19 shape protective responses among smokers. Results confirm that combining these two linked risks in health messages is an effective strategy to boost smoking cessation intentions, with perceived efficacy for both quitting smoking and COVID-19 protection serving as key drivers. Fear plays a constructive role in promoting cessation rather than triggering fatalistic responses. These findings support public health campaigns that integrate dual-risk information and clear efficacy messages, offering a practical approach to reduce tobacco use during public health crises. Despite cross-sectional design and pre-vaccine data limitations, this work provides meaningful insights for multi-risk health communication and future research on interconnected health threats.
