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Introduction

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The terror management theory suggests that peoples’ behavior is dependent upon fear; thus, support for the theory can be seen by examining peoples' reactions to death and their fear of death. Research not only shows peoples’ reactions to the fear of death, but to suffering as well. Death was welcomed in some cases, by patients and hospice volunteers, if it meant an end to suffering.[1]

The reasons behind peoples' decisions regarding their own health can be explored through a terror management health model. Goldenberg & Arndt (2008) propose three different angles for approaching this topic. In their first proposition Goldenberg & Arndt (2008) examine how one's consciousness to death can lead them to make decisions, in regards to their health, that will attempt to remove the death thoughts from their consciousness. Additionally, the researchers suggest in their second proposition that unconscious death thoughts can in fact direct individuals towards decisions having to do with their self-esteem, as opposed to their health. Moreover, Goldenberg & Arndt (2008) final proposition explores how peoples' worry about their physical bodies can hinder their decision-making process when they are engaging in health promotion decisions and activities.[2]

Self-Esteem as Anxiety Buffer

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Furthermore, individuals’ levels of self-consciousness not only impact their views on life, but more specifically, their views on death. Research has demonstrated that in some instances, individuals with higher levels of self-consciousness have increased death cognitions, and a generally more negative outlook on life.[3]


Conversely, self-esteem can work in the opposite manner. Research has confirmed that individuals’ with higher self-esteem, particularly in regards to their behavior, have a more positive attitude towards their life. Specifically, death cognitions in the form of anti-smoking warnings were effective for smokers and in fact, increased their positive smoking attitudes.[4] The reasons behind individuals optimistic attitudes towards smoking after morality was made salient are that: people use their positivity as a buffer to hide behind their fears, individuals find it easier to cope with the fear this way, and death cognitions might make people engage in the behavior (smoking) more. [5]

TMT and Self-Esteem

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In terms of health, self-esteem plays an important role. In some cases, people may be so concerned with their physical appearance and boosting their self-esteem that they ignore problems or concerns with their own physical health.[6] Arndt et al. (2009) conducted three studies to examine how peer perceptions and social acceptance of smokers contributes to their quitting, as well as if, and why these people continue smoking for outside reasons, even when faced with thoughts of death and anti-smoking prompts. Tanning and exercising were also looked at in the researchers' studies. The studies found that people are influenced by the situations around them. Specifically, Arndt et al. (2009) found in terms of their self-esteem and health, that participants who saw someone exercising were more likely to increase exercise. In addition, the researchers found in study two that how participants reacted to an anti-smoking commercial was affected by their motivation for smoking and the situation. For instance, people who smoked for extrinsic reasons and were previously prompted with death reminders were more likely to be compelled by the anti-smoking message.[7]

Morality Salience

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In addition, morality salience has an influence on individuals and their decisions regarding their health. Cox et al. (2009) discuss morality salience in terms of suntanning. Specifically, the researchers found that participants who were prompted with the idea that pale was more socially attractive along with morality reminders, tended to lean towards decisions that resulted in more protective measures from the sun.[8] In their study they gave one group of participants an article on relating to the fear of death, while the control group received an unrelated to death article dealing with the fear of public speaking. Additionally, they gave one group an article pertaining to the message that "bronze is beautiful," one relating to the idea that "pale is pretty," and one neutral article that did not speak of tan or pale skin tones. Finally, after introducing a delay activity, the researchers gave the participants a five-item questionnaire asking them about their future sun-tanning behaviors. The study illustrated that when tan skinned was associated with attractiveness, morality salience positively affected peoples' intentions to suntan; however, when pale skin was associated with attractiveness peoples' intentions to tan decreased.[9]

Morality and Self-Esteem on Health Risks

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Morality and self-esteem both have an impact on health-related risks. Both of these factors are important aspects of the terror management theory. Jessop et al. (2008) study this relationship in their 4 studies that examine how people react when they are given information on risks, in terms of morality, of driving.[10] More specifically, the researchers hypothesized that when participants acted for self-esteem, the impact of this morality-related health-risk information would be affected.[11] Overall, Jessop et al. (2008) found that even when morality is prominent, people who engage in certain behaviors to improve their self-esteem have a greater chance of continuing with these activities, thus supporting their hypothesis.[12] Morality and self-esteem are both factors that influence peoples' behaviors and decision-making regarding their health. Furthermore, individuals who are involved in behaviors and possess motivation to enhance their self-worth are less likely to be affected by the importance placed on health risks, in terms of morality.


Self-esteem is important when morality is made salient, because it can allow people a coping mechanism, one that can cushion individuals' fears; thus, impacting one’s attitudes towards a given behavior.[13] Individuals who have higher levels of self-esteem regarding their behavior(s) are less likely to have their attitudes, and thus their behaviors changed regardless of morality salient or death messages. People will use their self-esteem to hide behind their fears of dying. In terms of smoking behaviors, people with higher smoking-based self-esteem are less susceptible to anti-smoking messages that relate to death; therefore, morality salience and death warnings afford them with an even more positive outlook on their behavior, or in this instance their smoking.[14]


In the Hansen et al. experiment the researchers manipulated morality salience. The dependent variable in the experiment was smokers’ attitudes towards smoking. The interesting thing about the Hansen et al. experiment is that they used actual warning labels to create morality salience. The researchers first gave participants a questionnaire to measure their smoking-based self-esteem. Followed by, randomly assigning participants to two different conditions; the first were given anti-smoking warning labels about death and the second, control group were exposed to anti-smoking warning labels not dealing with death. Before the participants’ attitudes towards smoking were taken the researchers introduced an unrelated question to provide a delay. Further research has demonstrated that delays allow morality salience to emerge because thoughts of death become non-conscious.[15] Finally, participants were asked questions regarding their intended future smoking behavior.[16] One weakness in their conduction is that the final questionnaire addresses opinion and behavior questions, not how persuaded the individuals’ were by the different anti-smoking warning labels.


Additionally, many people are more motivated by social pressures, rather than health risks. Specifically for younger people, morality salience is stronger in eliciting changes of ones behavior when it brings awareness to the immediate loss of social status or position, rather than a loss, such as death that they can not imagine and feels far off.[17] However, there are many different factors to take into consideration, such as how strongly an individual feels toward a decision, their level of self-esteem, and the situation around them. Particularly with peoples’ smoking behaviors, self-esteem and morality salience have different effects on individuals’ decisions. In terms of the length of their smoking decisions, it has been seen that individuals’ smoking habits are affected, in the short-term sense, when they are exposed to morality salience that interrelates with their self-esteem. Moreover, people who viewed social exclusion prompts were more likely to quit smoking in the long run than those who were simply shown health-effects of smoking. [18] More specifically, when people had high levels of self-esteem, that is when they are more likely to quit smoking from the social pressure messages, rather than the health risk messages. [19]

Terror Management Health Model

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Death and thoughts of death can serve as a way of empowering the self. Researchers, Cooper et al. (2011) explored the TMHM in terms of empowerment, specifically using breast self-exams (BSEs) under two conditions; when death thoughts were prompted, and the control, thoughts of death were non-conscious.[20] Cooper et al. (2011) found that when morality and death thoughts were primed, women reported more empowerment feelings than those who were not prompted before preforming a BSE. [21] Additionally, the TMHM suggests that morality awareness and self-esteem are important factors in individuals' decision-making and behaviors relating to their health. The TMHM explores how people will engage in behaviors, whether positive or negative, even with the heightened awareness of morality, in the attempt to conform to societies expectations and improve their self-esteem.[22] The TMHM is useful in understanding what motivates individuals regarding their health decisions and behaviors.

In terms of smoking behaviors and attitudes, the impact of warnings with death messages depends on:

1). The individuals’ level of smoking-based self-esteem

2). The warnings actual degree of death information[23]

Death Anxiety on Health Promotion

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Due to a change in peoples’ lifestyles, in the direction of more unhealthy behaviors, the leading causes of death now, being cancer and heart disease, most definitely are related to individuals’ unhealthy behaviors[24] Age and death anxiety both are factors that should be considered in the terror management theory, in relation to health-promoting behaviors. Age undoubtedly plays some kind of role in peoples’ health-promoting behaviors; however, if there is an actual age related effect on death anxiety and health-promoting behaviors has yet to be seen. Although, research has demonstrated that for young adults only, when they were prompted with death related scenarios, they yielded more health-promoting behaviors, compared to those participants in their sixties. In addition, death anxiety has been found to have an effect for young adults, on their behaviors of health promotion.[25]

References

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  1. ^ Planalp, S., & Trost, M. R. (2008). Communication issues at the end of life: Reports from hospice volunteers. Health Communication, 23(3), 222-233. doi:10.1080/10410230802055331
  2. ^ Goldenberg, J. L., & Arndt, J. (2008). The Implications of death for health: A terror management health model for behavioral health promotion. Psychological Review, 115, 1032-1053.
  3. ^ Taubman-Ben-Ari, O., & Noy, A. (2010). Self-consciousness and death cognitions from a terror management perspective. Death Studies, 34(10), 871-892. doi:10.1080/07481187.2010.496685
  4. ^ Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  5. ^ > Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  6. ^ Arndt, J., Cox, C. R., Goldenberg, J. L., Vess, M., Routledge, C., Cooper, D. P., & Cohen, F. (2009). Blowing in the (social) wind: Implications of extrinsic esteem contingencies for terror management and health. Journal Of Personality And Social Psychology, 96(6), 1191-1205. doi:10.1037/a0015182
  7. ^ Arndt, J., Cox, C. R., Goldenberg, J. L., Vess, M., Routledge, C., Cooper, D. P., & Cohen, F. (2009). Blowing in the (social) wind: Implications of extrinsic esteem contingencies for terror management and health. Journal Of Personality And Social Psychology, 96(6), 1191-1205. doi:10.1037/a0015182
  8. ^ Cox, C. R., Cooper, D. P., Vess, M., Arndt, J., Goldenberg, J. L., & Routledge, C. (2009). Bronze is beautiful but pale can be pretty: The effects of appearance standards and mortality salience on sun-tanning outcomes. Health Psychology, 28(6), 746-752. doi:10.1037/a0016388
  9. ^ Cox, C. R., Cooper, D. P., Vess, M., Arndt, J., Goldenberg, J. L., & Routledge, C. (2009). Bronze is beautiful but pale can be pretty: The effects of appearance standards and mortality salience on sun-tanning outcomes. Health Psychology, 28(6), 746-752. doi:10.1037/a0016388
  10. ^ Jessop, D. C., Albery, I. P., Rutter, J., & Garrod, H. (2008). Understanding the impact of mortality-related health-risk information: A terror management theory perspective. Personality And Social Psychology Bulletin,34(7), 951-964. doi:10.1177/0146167208316790
  11. ^ Jessop, D. C., Albery, I. P., Rutter, J., & Garrod, H. (2008). Understanding the impact of mortality-related health-risk information: A terror management theory perspective. Personality And Social Psychology Bulletin,34(7), 951-964. doi:10.1177/0146167208316790
  12. ^ Jessop, D. C., Albery, I. P., Rutter, J., & Garrod, H. (2008). Understanding the impact of mortality-related health-risk information: A terror management theory perspective. Personality And Social Psychology Bulletin,34(7), 951-964. doi:10.1177/0146167208316790
  13. ^ Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  14. ^ Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  15. ^ Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  16. ^ Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  17. ^ Martin, I. M., & Kamins, M. A. (2010). An application of terror management theory in the design of social and health-related anti-smoking appeals. Journal Of Consumer Behaviour, 9(3), 172-190. doi:10.1002/cb.293
  18. ^ Martin, I. M., & Kamins, M. A. (2010). An application of terror management theory in the design of social and health-related anti-smoking appeals. Journal Of Consumer Behaviour, 9(3), 172-190. doi:10.1002/cb.293
  19. ^ Martin, I. M., & Kamins, M. A. (2010). An application of terror management theory in the design of social and health-related anti-smoking appeals. Journal Of Consumer Behaviour, 9(3), 172-190. doi:10.1002/cb.293
  20. ^ Cooper, D. P., Goldenberg, J. L., & Arndt, J. (2011). Empowering the self: Using the terror management health model to promote breast self-examination. Self And Identity, 10(3), 315-325. doi:10.1080/15298868.2010.52749
  21. ^ Cooper, D. P., Goldenberg, J. L., & Arndt, J. (2011). Empowering the self: Using the terror management health model to promote breast self-examination. Self And Identity, 10(3), 315-325. doi:10.1080/15298868.2010.52749
  22. ^ Cox, C. R., Cooper, D. P., Vess, M., Arndt, J., Goldenberg, J. L., & Routledge, C. (2009). Bronze is beautiful but pale can be pretty: The effects of appearance standards and mortality salience on sun-tanning outcomes. Health Psychology, 28(6), 746-752. doi:10.1037/a0016388
  23. ^ Hansen, J., Winzeler, S., & Topolinski, S. (2010). When the death makes you smoke: A terror management perspective on the effectiveness of cigarette on-pack warnings. Journal Of Experimental Social Psychology,46(1), 226-228. doi:10.1016/j.jesp.2009.09.007
  24. ^ Bozo, Ö., Tunca, A., & Şİmşek, Y. (2009). The effect of death anxiety and age on health- promoting behaviors: A terror-management theory perspective. Journal Of Psychology: Interdisciplinary And Applied, 143(4), 377-389. doi:10.3200/JRLP.143.4.377-389
  25. ^ Bozo, Ö., Tunca, A., & Şİmşek, Y. (2009). The effect of death anxiety and age on health- promoting behaviors: A terror-management theory perspective. Journal Of Psychology: Interdisciplinary And Applied, 143(4), 377-389. doi:10.3200/JRLP.143.4.377-389