Tarred lungs of a cigarette smoker from the exhibition Body Worlds Vital in Melbourne, Australia (photo by David Jackmanson via Flickr)

One dramatic turn in my efforts to break a 12-year smoking habit was a work-related field trip to Bodies: The Exhibition, when it was first installed at the South Street Seaport in NYC (c. 2006). While the origins of the real human bodies on display are probably the true horror, I vividly remember a piece of the exhibition that showed a smoker’s lungs. Though disgusting, the point was made, and I quit smoking permanently in 2008, after a couple of false starts over the course of the intervening years.

This experience mirrors analysis done by Woo-Kyoung Ahn, a professor of psychology at Yale University, regarding the impact of graphic imagery on public health behavior.

“A vivid image is much more powerful than just abstract numbers,” Ahn told Wired in June. “Disgust is a powerful emotion rooted as an evolutionary adaptation that helps us expel and avoid harmful substances.”

While such approaches have been used in the past to influence behaviors like cigarette smoking and STD transmission, Ahn became interested in the subject with respect to public engagement with vaccines for COVID-19. While some of the effects, such as prolonged fatigue or shortness of breath, are hard to envision, there are a few that provide startling visuals, like swollen toes and damaged lungs. So Ahn and her co-author Kellen Mermin-Bunnell decided to show people such images, and see what kind of impact it had on their willingness to be vaccinated.

“Current public health messaging used in the US could be improved to better combat mistrust about COVID-19 and its mitigation measures, especially vaccines,” states the abstract of their study, published in May on PLOS ONE. “We propose that a disgust-inducing public health campaign will be more effective than current approaches, primarily among conservatives, who are both sensitive to moralized disgust and are less compliant with US public health guidelines.”

The researchers showed participants chest x-ray images of a COVID-19 patient who went through lung transplant; the images also show the damaged and scarred original lungs. Definitely not a pleasant sight. (courtesy The Lancet)

It is interesting to note that the study not only reinforces the impact of exposing subjects to the graphic outcomes of neglecting their own health, but also reaffirms other studies that indicate that people who identify as politically conservative have a higher propensity for disgust. This is certainly reflected in the broad conservative tendency to become outraged about social behaviors that don’t necessarily affect them, like homosexuality or abortion, but Ahn’s findings indicate that this offers potential inroads in vaccine compliance for a population segment that is ideologically intolerant and suspicious of them.

Ahn and Mermin-Bunnell, drew their test subjects through online questionnaires in late February 2021, at a time when the US had just begun vaccine rollout primarily to older people, the immunocompromised, and essential workers. Out of 400 people, who ranked themselves from strongly liberal to strongly conservative, some were randomly chosen to see five pairs of disgusting images and headlines related to COVID. The rest saw a much more ordinary set of COVID-related photos, including things like doctors in masks.

Then the researchers asked the participants to rate their likelihood of following COVID guidelines from the US Center for Disease Control and Prevention — like wearing masks, social distancing, and getting vaccinated — yielding an overall “compliance score.” For the group that identified as conservative, this average score was about 72 for those who saw gross images and about 60 for those who saw tame ones — a fairly large gap. For those who identified as liberals, the scores were around 85 and 88, respectively. This wasn’t a big difference. In fact, you might have noticed that the score was actually slightly lower for people who saw the gross images, but Ahn says it’s not enough to be statistically meaningful. Following the battery of images, participants were asked specifically about willingness to comply with CDC guidelines for COVID prevention, including social distancing and wearing masks — and this is where results skewed, at almost an inverse to the vaccination rates in red versus blue counties. For conservatives, the average “compliance score” was about 72 for those who saw gross images and about 60 for those who saw tame ones.

When pressed on the subject of getting vaccinated, specifically, the average score among conservative participants was 63 for those who saw disgusting images and about 53 for those who saw ordinary ones — a sizeable difference that suggests their disgust pushed a greater desire for disease-prevention measures. Among the liberals, the averages were about 83 and 87, respectively (again indicating a slight drop-off in compliance in response to graphic imagery). A second phase of the study was conducted in April of 2021, when vaccines were widely available, comparing the effects of disgusting imagery to incentive campaigns offering money, donuts, and even drugs — and still found disgust campaigns to be more effective in moving the needle for conservative participants (drawn from a pool of 1,500 subjects in this round).

The study lacks information about follow-through, so whether or not the effect of disgust promotes immediate results or an actual call-to-action remains unclear, but perhaps we should look forward to pictures of swollen toes coming to signs everywhere. The main thing that has been conclusively proven, yet again, is that for all their “liberal snowflake” rhetoric, it is conservatives are the political affiliation with the weaker stomachs.

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Sarah Rose Sharp

Sarah Rose Sharp is a Detroit-based writer, activist, and multimedia artist. She has shown work in New York, Seattle, Columbus and Toledo, OH, and Detroit —...

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1 Comment

  1. This is quite interesting. It makes me wonder what might happen if images were ever published of children killed by AR-15 rifles. Might there be a groundswell to outlaw them again? Thanks for your writing.

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