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date: 25 July 2017

Celebrity-Based Appeals in Health and Risk Messaging

Summary and Keywords

Celebrities are famous individuals, well known by many members of the public, who appear frequently in media content. When celebrities appear in the media alongside another cause, be it selling soap or promoting public health, the message becomes a celebrity appeal. Celebrity appeals are messages where a celebrity advocates for or is implicitly associated with a target behavior. In the context of health and risk-related messages, celebrity appeals can take the form of public service announcements, advertisements for health and risk-related products, or even news coverage of a celebrity’s personal struggles with a health issue or risky behavior.

Research on celebrity appeals overlaps with the marketing literature investigating the effects of celebrity endorsements on product preferences and purchasing behavior. This work on the persuasiveness of celebrity endorsements demonstrates that celebrities can draw attention to a product or idea, but also that many other factors, like involvement, familiarity, source credibility, and endorser gender can moderate how persuasive a celebrity-based appeal is. Additionally, research on celebrity disclosures of illnesses reveal that these de facto awareness campaigns can elicit emotions in audiences and motivate behavior change. However, media coverage of celebrities has also been associated with harmful effects on lay individuals’ wellbeing, suggesting important caveats for message designers who rely on celebrities to garner attention for a cause or to motivate lay individuals to change their own health and risk-related behaviors. The existing empirical evidence on celebrity appeals and additional theoretical perspectives for understanding their potential persuasiveness provides many insights for message designers.

Keywords: celebrity appeals, celebrity endorsement, source effects, strategic communication, persuasion, social influence, emotion

Celebrities are a staple of modern culture and make frequent appearances in media coverage as well as in conversations between lay individuals who are mutually interested in those celebrities. Members of the public may be enamored with a famous celebrity because of her artistic talents, athletic feats, aesthetic appeal, intriguing personal life, public service, or charitable activities, to name just a few factors that attract audiences to these public figures. In fact, research has suggested that interest in news about celebrities (i.e., “celebrity gossip”) may be part of our evolved desire to acquire survival-relevant information as well as our desire for friendships with respected others, even if those friendships are parasocial and one-directional (De Backer, Nelissen, Vyncke, Braeckman, & McAndrew, 2007).

Given this hardwired public interest in and growing fascination with media coverage of celebrities, it is not surprising that there is a long history of including celebrities in health and risk messages in hopes of gaining public attention and motivating the public to action. From paid endorsement deals and participation in public service announcements to news coverage of a serious diagnosis, celebrities frequently appear in media messages related to health and risk behaviors. These types of messages featuring celebrities that also include an impetus to some type of behavior change (be it an explicit call to action or an implicit link to the target behavior) can be broadly defined as celebrity appeals.

The pre-existing interest in, knowledge of, and affection for celebrities can encourage individuals to pay attention to any health or risk-related messages associated with these likable, intriguing, and/or talented message sources. Beyond garnering our attention, celebrity appeals may impact message consumers in multiple ways, including knowledge gain, attitude change, information seeking behavior, message-sharing behavior, and changes in the target behavior. A meta-analysis of celebrity endorsement effects suggests that advertisements featuring celebrities (including not-for-profit public service announcements) can change audience attitudes but are less likely to change target behavior (Knoll & Matthes, 2016). This finding is not surprising giving that attitudes toward a target behavior, while strong predictors of that behavior, do not necessarily guarantee the behavior will occur (Ajzen, 2011). However, research on news coverage of celebrity illnesses has repeatedly found increased prevention and early detection behaviors amongst the public after individuals learn that celebrities are facing an illness (Brown & Basil, 2010; Noar, Willoughby, Myrick, & Brown, 2014). As these findings demonstrate, additional research is needed in the area of celebrity appeals to help clarify when and why these types of messages change attitudes and behaviors. However, a strong base of existing work and theory points to many potential mechanisms and moderators of celebrity appeal effects.

Celebrities, Media, and Society

Before examining the effects of celebrity appeals on audiences, it is helpful to first consider the role of celebrities in society more generally. Given that media products typically reflect a society’s values and desires, the overarching stature of celebrities in a society is likely an important factor in determining the prominence and effectiveness of celebrity appeals. Many researchers have noted that the public interest in celebrities continues to grow as media use increases (Beck, Chapman, Simmons, & Tenzek, 2015), which suggests a strong positive relationship between public consumption of messages and the influence of celebrities on individual attitudes and behaviors.

Famous individuals, known across society for their exploits, have garnered public attention and shaped culture since the ages of Alexander the Great and Julius Caesar, and likely before them, too (Braudy, 1997). Notably, though, fame and celebrity are not quite the same; while fame involves being widely known across time points, celebrity is dependent on media production and, as a term, came into common usage during the 20th century (Giles, 2000). The growth of television in the mid-20th century helped establish an era where celebrities visually entered our private homes on a daily basis and viewers easily developed psychological relationships with their favorite characters and stars (Beck et al., 2015). In the 21st century, social media have revolutionized how close individuals can be to celebrities—social media users can see every day what their favorite celebrities eat, where they vacation, which brand of clothes they wear, which television shows they watch, and more (Marwick & boyd, 2011). This increasing exposure to celebrities in daily life may foster a closer sense of parasocial relationship, or virtual friendship, with these public figures as well as encourage lay individuals to aspire to fame and fortune of their own (Caulfield, 2015).

When issues of health and risk are involved, celebrities may come across as even more similar to the average lay individual, who also has to deal with such issues (Beck et al., 2015). The public also uses social media to mourn and find meaning when celebrities succumb to an illness or accident (Cohen & Hoffner, 2016). Social media provide an immediate and interactive platform for users to converse about the health and risk-related issues associated with the celebrities who have touched their lives in some way (Noar et al., 2014). As new and different types of media continue to evolve, messages about and by celebrities will likely follow and permeate these new platforms, too.

Types of Celebrity Appeals

There are multiple types of celebrity appeals related to health and risk messaging contexts. For instance, celebrities may be spokespeople for a foundation or for government agency campaigns. In these situations, the celebrities may be directly impacted by the topic at hand, such as Katie Couric advocating colon cancer early detection prevention by televising her own colonoscopy after her husband died from colon cancer (Cram, Fendrick, Inadomi, Cowen, Carpenter, & Vijan, 2003). Another example of this type of celebrity appeal would be Mary Tyler Moore’s own diabetes diagnosis and associated public activism, which included testifying before the U.S. Congress about the condition and the need for more research funding (Beck et al., 2015). Even without a direct personal connection to a health or risk-related issue, celebrities may be interested in assisting a campaign because they think it is important or that it may improve their own reputations to be involved in something benefiting the public good. For example, celebrities may be featured in environmental conservation public service announcements even though they have not been directly impacted by the environmental issue at hand (Myrick & Evans, 2014).

Besides volunteering to be the public face of an illness or other risk-related cause, celebrities are often hired by commercial entities to endorse health- or risk-related products, services, or organizations. Indeed, celebrities have a long history of working for pharmaceutical companies and promoting prescription products. Typically, those celebrities pitching a pharmaceutical product do, in fact, have direct experience with the condition that product addresses, and often offer their own testimonials as evidence of the drug’s effectiveness (Gerald, 2010). In the 1800s, drug companies placed images of presidents next to their advertisements in order to imply these public figures used the products themselves, and in the early 1900s, some companies paid athletes to tout their use of a particular supplement as being central to their success in sports (Gerald, 2010). However, with the advent and spread of broadcast media as well as changes in government regulations allowing direct-to-consumer advertising for prescription pharmaceutical products, the use of celebrities as paid drug spokespeople grew throughout the 20th century and continues to be a common practice. In addition to appearing in advertisements, some celebrities have been paid by pharmaceutical companies to do interviews with news media outlets where they share their illness narratives and discuss how a particular pharmaceutical product has helped them (Ta & Frosch, 2008).

Celebrities may also inadvertently become associated with an illness or risky behavior when news breaks of their diagnosis or death. Even if they do not choose to speak openly about their situations, news coverage of these instances can draw public attention to an illness or related behavior and start a dialogue. One example of this situation would be Apple CEO and famous technology innovator Steve Jobs’ diagnosis of and eventual death from pancreatic cancer—he was notoriously quiet about the condition, yet the media reported on his physical appearance or any other cancer-related tidbits they could uncover from other sources (Noar et al., 2014). Another example would be actor Robin William’s suicide and previously unannounced diagnosis of Parkinson’s Disease, which was later determined to be a misdiagnosis of Lew body dementia (Cohen & Hoffner, 2016). Copious media coverage as well as information sharing about William’s death, suicide awareness, and these neurological conditions spread across traditional and digital media platforms in the wake of the initial report of his passing.

Besides these different types of celebrity appeals, the type of celebrity may also shape public thoughts, feelings, and behaviors regarding these outcomes. To date, though, there is scant research comparing different types of celebrities and their effectiveness as endorsers for either consumer or non-profit causes. However, a meta-analysis that included multiple studies testing the effectiveness of both commercial and non-profit celebrity appeals found that persuasive messages featuring actors were associated with more favorable attitudes than those featuring athletes, models, musicians, or TV hosts (Knoll & Matthes, 2016). Athletes had the second-strongest effect on attitudes behind actors in this meta-analysis. This persuasive advantage for actors and athletes may be due to the particular athletes featured in the cases in this meta-analysis, the particular product causes involved, or possibly to audiences having greater exposure to sports stars than to other types of celebrities who make less frequent appearances in the media, among other possibilities. Additional work is needed to directly compare types of celebrity endorsers in the same study, which would likewise afford the opportunity to control for other potentially confounding variables to ensure that differences are actually due to celebrity type and/or previous exposure to that famous individual.

Exposure to Celebrity Appeals

Although designing health or risk messages that include a celebrity is a common persuasion tactic, the use of celebrities does not automatically guarantee the public will actually be exposed to the message. Exposure to celebrity appeals is a crucial factor in determining their potential effects on audiences. As with any message, the increasingly crowded media environment insures there are multiple other sources of information and entertainment vying for an individual’s attention alongside any celebrity-backed health or risk messages.

To begin, different areas of the world with different cultures and media systems vary in their use of celebrity appeals, which would likely result in corresponding differences in exposure to these types of messages. A review of the literature on the prevalence of celebrity endorsers in television advertisements found that viewers in the United States and Europe see fewer celebrity endorsements (less than 15% of television advertisements) than in Asian countries, such as China (25%) and Korea (60–61% in South Korea) (Bergkvist & Zhou, 2016). However, this work did not assess what portion of the celebrity endorsements were for health or risk-specific contexts, leaving a gap in our knowledge of the prominence of this particular type of celebrity appeal across countries.

However, the campaign evaluation literature also provides some insight about exposure to celebrity appeals. In a survey measuring public awareness of a 2012 U.S.-based colorectal cancer screening campaign, featuring actor Terrence Howard telling the story of his mother’s death from the disease, researchers found that 8.3% of the target audience (in this case, women ages 50–75 with no history of colorectal cancer or polyps) reported actually seeing the campaign’s television, radio, or print advertisements (Cooper, Gelb, & Lobb, 2014). This particular campaign, called “Screen for Life” and funded by the Centers for Disease Control and Prevention, relied solely on donated placements for their public service announcements, suggesting that paid placements in more targeted outlets could result in greater exposure to celebrity health or risk appeals.

Additionally, little work to date has focused on selective exposure to celebrity appeals; that is, when individuals actively chose to consume these types of media messages. However, this area is ripe for additional research. We do know, for instance, that online search queries related to cancer spike after news breaks of a celebrity cancer diagnosis or death, signifying that there are at least some specific moments when the public actively and purposefully looks for health or risk information in conjunction with a celebrity-related media event (Noar et al., 2014). In addition to investigating which factors determine the persuasiveness of health and risk messages featuring celebrities, future work could investigate the demographic and psychosocial factors that increase the likelihood an individual will purposefully seek out and pay attention to celebrity appeals and news of celebrity health or risk-related issues.

The above discussion of celebrity appeals has focused on direct exposure; that is, an individual directly consuming a message containing a celebrity. However, it is important to note that indirect exposure to celebrity messages is likewise highly probable and could influence health and risk-related attitudes and behaviors. As soon as an individual who was directly exposed to a celebrity appeal mentions the topic of the appeal to another, indirect exposure has occurred. The literature on media effects, interpersonal communication, and social sharing has found that our social networks and community ties can influence our understanding of health and science topics (Southwell, 2013; Southwell & Yzer, 2007). It would follow that how we talk about celebrity appeals could subsequently influence others in our networks, and future research in this area could assess both direct and indirect exposure to celebrity-based messages.

Mechanisms of Celebrity Appeal Effects

Once an individual is exposed to a celebrity appeal, the question becomes how, exactly, the appeal affects the message consumer. The literature on the effects of celebrity endorsements in an advertising context finds these strategic messages, on the whole, to be effective marketing tools (Erdogan, 1999). While not all celebrity health or risk-related appeals involve paid endorsements, this body of work provides helpful insights into the factors that make celebrity appeals more or less persuasive advocates for a behavior, be it buying a product or eating more fresh vegetables. Given this premise, that the work on advertising and consumer behavior can inform similar health and risk-related research, multiple theoretical perspectives as to how and why celebrity endorsements are persuasive are reviewed below.

One conceptual framework suggested in the consumer endorsement literature is the affective-cognitive framework. The affective-cognitive framework argues that the celebrities present in media messages can facilitate three psychological processes in audience members (Eisend & Langner, 2010). The first psychological process is the immediate and automatic emotional responses to the message, known as lower-order emotions, which can have a strong impact on behavior given the motivational properties of emotions. Typically, audience members have positive automatic associations with celebrities. The second psychological process includes higher-order cognitions, which require more deliberate information processing and can include evaluations of the celebrity’s expertise or consideration of the celebrity’s motives for selling the product. The third psychological process in this affective-cognitive framework is the additional high-order emotions fostered by the high-ordered cognitions.

To exemplify this mixed affective-cognitive process, consider the example of the aforementioned “Screen for Life” colon cancer awareness advertisements featuring actor Terrence Howard (Cooper et al., 2014). Howard told a moving story of his mother’s struggle with the disease, and the presentation of this narrative message alongside the emotions displayed on Howard’s face likely evoked automatic emotional responses of sadness and empathy in those who viewed the television PSA. Next, viewers may have considered that Howard, having witnessed his mother’s scenario, is probably knowledgeable about the condition and motivated to do something about it to bring meaning to his own family’s suffering (these evaluation’s of source knowledge and motivation being higher-order cognitions). Finally, thinking about Howard’s situation and his past experiences may engender subsequent higher-order emotions, like compassion and hope, that taking the advocated action (preventative screening via colonoscopy) will help prevent future suffering.

This affective-cognitive framework could be quite helpful for predicting the behavioral effects of celebrity appeals, an area where previous research on celebrity endorsers has struggled to find consistent findings or theoretical explanations for them. Moreover, a meta-analysis of celebrity endorsement studies found that the notion that celebrities impact affective outcomes was supported by the body of literature in this area, but across studies there was not support for significantly stronger cognitive or behavioral effects generated by celebrity over non-celebrity endorsements (Knoll & Matthes, 2016). As such, it may be the initial automatic affective impulses alongside subsequent cognition-driven emotions that most impact behavior in this particular messaging context, but further research applying this framework and investigating a wide range of affective and cognitive responses to celebrity appeals is strongly needed before making any definitive claims in this area.

In addition to the affective-cognitive framework, another theoretical explanation for celebrity appeal effects is that the inclusion of a celebrity in an advertisement results in meaning transfer from the celebrity to the product and brand featured in the message (McCracken, 1989). While not many studies have empirically tested the meaning-transfer model, it is oft-cited in consumer behavior research and is conceptually helpful to think about the ways in which the audience may transfer both the evaluative and non-evaluative properties of the celebrity to the product or cause (Bergkvist & Zhou, 2016).

Notably, the meaning transfer approach does not necessarily contradict the aforementioned affective-cognitive framework. In particular, meaning transfer could explain the ability for a celebrity appeal to evoke emotions in viewers. For example, recent brain imaging research suggests that the parts of the brain that process emotional stimuli become more active when individuals see appeals featuring celebrities than when they see appeals featuring equally-attractive non-famous individuals (Stallen, Smidts, Rijpkema, Smit, Klucharev, & Fernández, 2010). Moreover, these researchers found that the neurological processes associated with implicit memory and attention were not central to explaining the persuasive advantage of celebrity appeals, suggesting that the positive emotion the public associates with celebrities can transfer to the target of a persuasive message. To extrapolate further, the power of meaning transfer as an explanation for celebrity appeal effects may rest on the transfer of the emotion associated with the celebrity to the persuasive message context and less on the additional attention a celebrity brings to the message context.

Another conceptual perspective for studying how celebrity appeals affect audiences is to analyze the source characteristics (e.g., the perceived credibility and attractiveness of the celebrity) that may influence information processing. This line of work relies heavily on the elaboration likelihood model, which proposes that message factors like perceived source credibility and attractiveness help determine if the audience will process a message peripherally or centrally (Petty, Cacioppo, & Schumann, 1983). Peripheral processing takes place when an individual lacks the ability or motivation to spend effort thinking about a message and typically results in a reliance on cues like source attractiveness or expertise, while central processing requires the audience member to have both ability and motivation to process, which results in closer scrutiny of the quality of message arguments and less reliance on peripheral cues. Additionally, when individuals perceive a situation as personally relevant, they are more likely to have the motivation to process a celebrity appeal centrally and carefully consider the persuasive arguments before establishing an opinion or forming an intention to take an action.

In a study testing the elaboration likelihood model in a celebrity endorsement context, researchers found that, when individuals were not highly involved in the message context (that is, they didn’t find it personally relevant), they were more persuaded by the celebrity endorsers (athletes, in this case) than by the average person featured in the non-celebrity advertisement condition (Petty et al., 1983). However, when participant involvement was high—participants were motivated to pay attention to the advertisement and carefully consider the arguments made in it—there was no persuasive advantage for the celebrity message. In short, celebrity endorsements may be particularly persuasive when individuals are not paying a lot of attention to a message or are initially unmotivated or unable to engage deeply with the nuances of the message. In these low-involvement situations, when audience members are peripherally processing a message, celebrity attractiveness and/or perceived expertise may be particularly important for shaping audience attitudes.

These two source cues—attractiveness and expertise—have received a great deal of attention in the celebrity endorsement literature, with mixed results on how they impact persuasion (Erdogan, 1999; McCracken, 1989). Perhaps it is because they are sub-components of the broader umbrella concept of source credibility. Ohanian (1990) conceptualized perceived source credibility in the context of a celebrity product endorser as being composed of evaluations of the celebrity’s expertise, trustworthiness, and attractiveness. Notably, though, a majority of the studies analyzing celebrity endorser credibility in general, or expertise and attractiveness more specifically, used print messages and focused on explicit strategic appeals. One might consider the newer social media context where messages—be they explicitly advertising or more subtle forms of product placement or issue advocacy—are often short or limited by space restrictions. On these types of platforms where there is not a lot of room to make several strong arguments for a product or cause, attractive or topically credible celebrities may be even more influential in cueing individuals to consider the persuasive message’s proposition.

Moderators of Celebrity Appeal Effects

The aforementioned literature points to a number of causes of celebrity appeal effects, including the interplay of emotional and cognitive responses, meaning transfer, and source cues alongside information processing levels. Additionally, there are other potential factors that can shape or moderate how persuasive celebrity appeals are for various types of audiences.

The first is the perceived match, or fit, of the celebrity with the product or activity being endorsed, also known as the match-up or congruency hypothesis. This is the idea that audiences are most likely to be persuaded by a celebrity endorser when they perceive the celebrity to somehow match or align with the product/topic featured in the message (Erdogan, 1999). For example, a swimmer might endorse a particular treatment for swimmer’s ear or a musician might advocate for a type of musical instruction that prevents overuse or posture-related injuries. However, an attractive and thin celebrity featured in an advertisement for a fast food chain may not be perceived by audiences as a good fit, given that eating at a fast food chain is not typically associated with thinness. A meta-analysis of celebrity endorsement studies found that congruency between the endorser and the endorsed object/behavior was positively associated with improved attitudes toward the endorsed object/behavior and stronger behavioral intentions, thereby providing empirical backing for this hypothesis (Knoll & Matthes, 2016).

The findings supporting the match-up hypothesis could be due to the fact that companies typically (but, not always) choose endorsers who are at least somewhat connected to their brands or products (Erdogan, 1999). For instance, even if a famous golfer endorsing an automotive brand does not seem like a strong match to some, if the automotive brand is seen as elite and powerful, and golf is a sport associated with elites and with powerful drives off the tee, then there could be a certain degree of psychological congruence in the audience members’ minds. As with all messaging contexts, it is the audience perception and not any standard of seemingly objective reality that will determine responses to the message. A longitudinal messaging plan featuring a celebrity appeal about health or risk-related behaviors could start with initial messages meant to first establish a psychological connection between a celebrity and the particular group, cause, or action before later in the campaign, after the congruency between celebrity and outcome has been established, having the celebrity ask the audience to change their own personal behavior, donate, or support a particular policy change.

Another important moderator of celebrity appeal effects to consider is the time since exposure to the appeal. Some research suggests that the initial persuasiveness of a celebrity endorsement may be driven by affective processes (e.g., liking or perceived attractiveness of the celebrity), whereas a cognitive factor like perceived source expertise may be more important in later considerations of the message (Eisend & Langner, 2010). An experiment testing immediate versus delayed assessment of message persuasiveness found that the attractiveness of a celebrity endorser was most important in determining immediate responses to the message, but that source expertise was a better predictor of delayed measures of persuasion (Eisend & Langner, 2010). Alongside considerations of how a longitudinal course of multiple exposures to a celebrity appeal might influence persuasiveness, additional work on delayed measures of persuasion would help advance this area of the literature and determine the status of time as a moderator of effects in the celebrity appeal context.

Audience familiarity with the product or target behavior is another factor that can influence celebrity appeal persuasiveness. A meta-analysis revealed that audience familiarity with an endorsed product moderated persuasiveness, with celebrities being more persuasive endorsers of unfamiliar as opposed to familiar products (Knoll & Matthes, 2016). Therefore, rare diseases or new environmental threats may benefit more from a celebrity spokesperson than do well-known or deeply partisan causes.

The same aforementioned meta-analysis found that implicit celebrity endorsements (i.e., where a celebrity merely uses an object but does not outright announce an endorsement) tend to be more persuasive than explicit ones. As such, product placement or even news coverage of a celebrity’s health or risk-related behaviors may potentially be more influential in shaping public behavior than paid advertisements or public service announcements. Additional research is needed to test this possibility across multiple celebrity appeal contexts.

Finally, demographic differences in gender and race can also influence how different groups respond to celebrity appeals. A meta-analysis revealed that male celebrities tend to be more persuasive overall than female celebrities (Knoll & Matthes, 2016). As for race, some research has found different recall of exposure to a celebrity health campaign message, with recall highest amongst the group of the same race as the featured celebrity (Cooper et al., 2014); however, much additional work is needed to see if this race-congruency carries over from recall to persuasion, and if it applies in other messaging contexts. Notably, though, little work has directly compared celebrity endorsement effects of different celebrity genders or races in the same study. Additionally, future work based on the congruency hypothesis may consider how the match or mismatch between endorser and audience member gender/race shapes persuasion.

Where to Place Celebrities in Persuasive Messages

While considering celebrity appeal effects, additional message details may not be addressed by the aforementioned theories or moderating factors. For instance, what should the celebrity do or say in the message to best encourage audience behavior change? Other questions may concern when exactly a celebrity should appear in a message or which types of celebrities to use for promoting different types of health or risk behaviors. Below, three possible conceptual frameworks for addressing these challenges are offered.

First, when celebrities model the target health or risk-prevention behavior, then individuals can learn and build efficacy for the behavior without having to try it first (Bandura, 2004; Brown & Basil, 2010). Therefore, having the public figure model the actual target behavior in this type of appeal (as opposed to focusing solely on the threat or risk) may give audience members more confidence they understand what they are supposed to do and that they can do it effectively on their own.

Second, the emotional flow perspective on narrative message design (Nabi & Green, 2015) points out that messages evoke multiple emotions in sequence as the message unfolds. Therefore, when designing a celebrity appeal, message creators should be cognizant of which parts of the message might evoke which types of emotion in the target population. The crux of the emotional flow framework is that the message consumer’s shift from one emotional state to the next is a critical consideration when trying to understand persuasive outcomes. As such, it may not be the average amount of fear evoked by a public service announcement about sexually transmitted infections that motivates viewers to considering changing their behavior; rather, it may be the shift from the initial fear a viewer felt when a celebrity detailed the threat of acquiring an infection to the feeling of subsequent relief experienced when the celebrity discussed the effectiveness of condoms for preventing infections that motivates subsequent behavior change. Message designers can pre-test different combinations of threat and efficacy components in their celebrity appeals to see if shifting the emotional state of the viewer at specific points in their appeal (e.g., when presenting the target behavior) increases motivation and intention to perform the target behavior.

Another consideration brought about by the emotional flow framework is how to juxtapose a celebrity whom audiences typically associate with positive emotions with the discussion of an important health or risk-related issue that would be more likely to evoke negative emotions. Perhaps to generate the type of emotional shift that gains consumer’s attention and helps motivate them to take action, the positive-emotion inducing celebrity could be introduced at the beginning to gain the attention of audiences, then text could appear on screen to detail the negative health threat or other type of risk, then the celebrity could reappear to introduce the efficacy information that sparks hope or relief in audiences, motivating them to approach their goals and take action. These emotional shifts generated by different temporal placement of the celebrity in an appeal may also impact message processing and memory for message content. Additional work is needed to test the emotional flow perspective in empirical studies of celebrity appeal effects, but it is a conceptually promising perspective to consider in this message design context.

Another conceptual perspective that might inform the nuances of celebrity appeal message design is that of excitation transfer, which is the finding that individuals in a state of high arousal do not immediately calm down after the highly arousing stimulus is removed, and therefore, that arousal also becomes associated with the next stimulus (Zillmann, 1971). An example of excitation transfer would be if theatergoers watched an extremely frightening horror movie, they would likely still feel on edge as they walked out of the theater, even though the movie had been over for five minutes. When the movie viewers got home and heard an unexpected noise, the continued high arousal state might prompt them to scream and jump up in the air upon hearing the noise.

Excitation transfer is important to consider in designing celebrity appeals because celebrities as well as the health or risk context could both potentially lead to high or low arousal in audiences. Some celebrities have carefully cultivated images of excitement, high energy, and unpredictability, leaving audiences to wait in suspense whenever they appear in any message. Additionally, highly attractive and beautiful celebrities could automatically increase arousal levels in audiences, particularly in opposite-sex audience members. However, other celebrities have calmer, more predictable personas and/or are less physically attractive, and these celebrities would likely be less arousing for message consumers.

Moreover, while many health and risk-related areas are quite serious and attention-grabbing—for example, Ebola, flesh-eating bacteria, cancer, apocalyptic forecasts of climate change effects, etc.—other issues are very mundane despite taking larger tolls on public well-being, such as influenza, carbon monoxide poisoning, or even poor posture resulting in chronic neck and back pain.

In the situations where the health or risk context is not inherently exciting (e.g., influenza), pairing a high-energy celebrity with the appeal may help garner public attention by transferring the arousal associated with the celebrity to the next stimulus: the presentation of the threat. However, if the message context is already highly arousing (e.g., Ebola or cancer), then audience members may need to be calmed down in order to make better decisions or have the motivation to seek out additional information on a difficult topic. In that situation, a lower-energy, less ebullient celebrity may be the ideal spokesperson.

The general theories of media effects and the placement possibilities mentioned above assume a traditional persuasive appeal, such as an advertisement or public service announcement, and involve the specifics of message production in that context. Another placement consideration may be to place celebrities in non-persuasive messages as a way to change audience attitudes and behaviors. For many decades, researchers and message designers have subtly placed health and risk-prevention messages into entertainment media in attempts to change health behaviors in a genre referred to as entertainment education (Singhal & Rogers, 1999). An example of an entertainment education message would be including a storyline about cancer detection and treatment in a popular fictional television drama (Murphy, Frank, Moran, & Patnoe-Woodley, 2011).

While not all entertainment education messages include celebrities, some do and their effects on audiences can be explained by general theories of social influence as well as by entertainment-specific theories such as the extended-elaboration likelihood model (E-ELM; Slater & Rouner, 2002). The E-ELM notes that entertainment messages can be particularly influential because the audience tends to be less critical while they are immersed in a narrative, thereby making them more likely to shift their attitudes than if they were consuming non-entertainment media. The entertainment overcoming resistance model (EORM) has also been proposed as an additional theoretical framework for understanding how entertainment messages, including those with celebrities, may shape attitudes and behavioral outcomes (Moyer-Gusé, 2008). The EORM integrates multiple theoretical perspectives on audience involvement (including the E-ELM, social cognitive theory, and others) to provide a comprehensive explanation as to why entertainment messages can shift behaviors. Both frameworks (E-ELM and EORM) may likewise help advance work on celebrity appeals when integrated with the aforementioned research and theory in this area.

News Coverage of Celebrity Health or Illness as De Facto Celebrity Appeal

In addition to strategic celebrity appeals, news coverage of celebrity illness or death can constitute a de facto awareness campaign for health and risk-related behaviors. While the mechanisms shaping audience reactions to news coverage of celebrities may not differ greatly from those involved in strategic message effects, these two contexts are different, and audiences come to them with different expectations. That is, when one sees an advertisement or public service announcement, there is the expectation that the source is trying to persuade the media consumer to take action (Friestad & Wright, 1994), whereas news consumption is associated with the goal of being more informed about (i.e., surveillance) and engaging with events going on in the world (Vincent & Basil, 1997). The seemingly constant flow of celebrity-related media also makes celebrities’ personal health narratives important spaces for public dialogue about health and risk (Beck et al., 2015). Indeed, media coverage of celebrity illnesses has repeatedly been shown to influence public attitudes and behaviors (Beck et al., 2015; Brown & Basil, 2010).

Parasocial relationships and identification are two of the theoretical mechanisms credited for the effects of mediated celebrity illness disclosures on public behavior. Parasocial relationships are feelings of quasi-friendship with mediated personas, while identification is the process of identifying with or looking up to a celebrity (Brown & Basil, 2010). Together, these processes of social influence can be thought of as audience involvement with a mediated other, such as a celebrity whom the public has never met in person but feels deeply connected to thanks to media. From news about the health struggles of White House inhabitants to singers, actors, and athletes, many studies have found that individuals who experience higher levels of audience involvement with a celebrity are more likely to shift their own attitudes and/or behaviors after learning of a celebrity illness or death (Brown & Basil, 2010; Noar et al., 2014). Audiences often become so psychologically involved in the health narratives of their favorite celebrities, as when fans rallied around actor Michael J. Fox after he announced his Parkinson’s Disease diagnosis, that they feel as if they are co-owners of the story and want to be kept in the loop with frequent updates on the celebrity’s health status (Beck et al., 2015).

Based in this context of celebrity announcements of cancer, Noar et al. (2014) reviewed the literature and proposed a conceptual model of celebrity illness disclosure effects. Their main argument is that, although audience involvement is clearly a central mechanism of celebrity illness disclosure effects on audiences, not every celebrity disclosure will have the same effect on all audiences. Celebrities vary in their level of fame, popularity, health history, gender, and age, any or all of which could influence how members of the general public respond to their announcements. Once an illness is announced, different scenarios may result in more or less media coverage and different emphasis on prevention versus detection within media reports on the celebrity’s illness, with the nature of the media coverage likely shaping how audiences respond to it. And finally, audience factors like age, gender, socioeconomic status, perceived similarity with the celebrity, health history, health literacy, and degree/type of media use may each influence audience involvement with the celebrity, which in turn impacts attitudes and behavioral responses, too.

Additional research suggests that news of a celebrity illness or death can impact not just individual attitudes and behaviors but also disease-related stigma and intentions to perform prosocial actions regarding a disease and those who have to deal with it. An experiment tested audience reactions to celebrity obituaries and found that feeling anxious after reading about the celebrity death increased the stigmatizing perception that the disease (in this case, cancer) was the fault of the individual (Myrick, 2016). However, feeling compassion after reading a celebrity obituary dampened the belief that the individual was at fault and increased the belief in the contributions of societal causes to cancer rates. Moreover, compassion was associated with an increase in both individual behavior change and pro-social behavioral intentions to donate or volunteer for a related cause, while anxiety after reading the obituary was not significantly associated with either type of behavioral intention. This study also found that identification with the deceased celebrity was positively and directly predictive of prosocial behaviors, while it indirectly motivated individual behavior change via its positive influence on compassion.

Additional work is needed to examine these relationships between audience involvement, compassion, anxiety, and both prosocial and individual behaviors across multiple celebrity and disease contexts. However, these findings suggest strategic message designers may want to try to generate compassion toward a deceased celebrity in coordinated messaging that takes place in the wake of a celebrity death. Be it in editorial pieces, social media posts, guest blogs, television interviews, or other forums for discussing the cause of the celebrity’s death, health advocates who are able to generate compassion for that individual may see subsequent benefits in fighting stigma, raising monetary resources and political capital, as well as changing individual behavior.

As the implications of the study on celebrity obituaries demonstrated, understanding the effects of news coverage of a celebrity illness, risk-related behavior, or death may not be considered a typical celebrity appeal but can still benefit strategic message designers. By taking advantage of the rush of attention a particular illness or behavior receives in the wake of a celebrity illness disclosure or death, organizations could launch coordinating campaigns to increase awareness and raise money. Additionally, if campaigns recognized which types of audiences are most likely to be impacted by a celebrity illness disclosure or death, they could target their messages toward those sub-populations to more effectively utilize their resources. Given the power of big data to allow for online advertisements to reach very specific audiences, this tailoring strategy may be particularly apt for placing messages in front of social media users who already “liked” or “followed” a celebrity’s social media pages prior to the illness or death.

The Downside of Celebrity Appeals

Some celebrity appeals have the adverse effects of actually harming public health or impinging on simultaneous public campaigns to improve public wellbeing. Particularly in the realm of beauty and diet products, many celebrities support and are even paid spokespeople for fads with zero scientific support (Caulfield, 2015). For instance, actress January Jones advocates using dried placenta pills after childbirth, while fellow actress Gwyneth Paltrow uses her popular website and lifestyle brand, Goop, to promote unproven low calorie diets. Many celebrities endorse cleanse diets that supposedly help them lose weight and gain energy, while the medical community cautions that such cleanses can actually damage health and rarely lead to any sustained weight loss (Caulfield, 2015).

Another health and risk-related area where celebrity narratives have run counter to the findings from medical science is the vaccine-autism connection. Actress Jenny McCarthy, whose son has autism, was very vocal about her belief that the condition was caused by vaccination even though the main study arguing for a link between vaccines and autism has been entirely debunked (Larson, Cooper, Eskola, Katz, & Ratzan, 2011). By retelling the emotional story of her own family’s struggles with autism, McCarthy served as a prominent exemplar of this supposed risk of vaccination, thereby amplifying the credence given to the anti-vaccine movement far above and beyond the scientific evidence that there is no autism-vaccine link.

Even when a celebrity’s health advocacy or personal experience with a medical condition is actually informed by medical experts, it may still have some potentially harmful effects on individuals. For example, genetic testing received a copious amount of news coverage in 2012 after actress, director, and human rights advocate Angelina Jolie wrote an opinion piece in The New York Times to announce her preventative bilateral mastectomy, which she chose to undertake as she was a carrier of a gene that greatly increased her cancer risk. A content analysis of the ensuing media coverage found that it portrayed genetic testing in a very positive light and often omitted important medical information or potential negative consequences of undergoing genetic testing (Kamenova, Reshef, & Caulfield, 2013). Additionally, these researchers found that most news coverage of Jolie’s situation ignored how rare her situation actually was, leading them to argue that this coverage could encourage many women to undergo unnecessary and expensive genetic testing without full awareness of the downsides of the procedure.

Also in the context of breast cancer, multiple researchers documented a rise in media coverage of the disease and in screening behavior after Australian-British singer-songwriter Kylie Minogue was diagnosed with breast cancer (Noar et al., 2014). However, while there was a spike in breast cancer screening after her illness announcement, particularly among women under age 40 (like Minogue, herself) who normally would not be screened, there was not a concomitant rise in breast cancer surgeries. This finding suggests that much of the increased breast cancer screening that occurred after media coverage of Minogue’s breast cancer was actually unnecessary. Since breast cancer screening involves radiation, then the risks of unnecessary screening are important to consider, too. Health journalism experts encourage reporters to always discuss both the risks and benefits of any medical procedure, as well as the strength of the evidence for those possible benefits or risks (Myrick, 2014; Schwitzer, 2014). The implementation of this advice when reporting on celebrity illnesses may likewise help alleviate some of the potential negative effects of this coverage, but more research is needed to test how the specific information included in reports on celebrity illnesses impacts audiences.

In addition to coverage of celebrity announcements of illness, exposure to messages featuring celebrities—even when the celebrities are not directly advocating for awareness or behavior change—has the potential to generate negative effects for some specific audiences. For instance, exposure to images of pregnant female celebrities in celebrity gossip magazines—even if the image was only a headshot without showing a body, predicted greater self-objectification amongst pregnant magazine readers (Hopper & Aubrey, 2013). While many celebrities can attract public attention to media messages thanks to their beauty, this study and others make the point that, once audiences start comparing their own looks to a celebrity’s, negative feelings may ensue, potentially negating the effectiveness of using a celebrity in a health or risk-related appeal.

There is additional research that points to the potential harm celebrity endorsers can cause in a persuasive context. In a study of the effects of celebrity endorsers in alcohol advertisements, researchers found that celebrity endorsers were able to significantly increase underage (13–17 years old) individuals’ positive image of the alcoholic product and their intentions to consume it compared to non-celebrity endorsers (e.g., Atkin & Block, 1983). However, this same study found little difference in the persuasiveness of alcohol advertisements featuring a celebrity versus a non-celebrity for older audience members, suggesting that the negative impact of celebrity endorsements of potentially harmful substances are most likely to affect younger cohorts—a serious concern for public health advocates. Overall, because celebrities can bring attention to a cause or a product, it is important to remember that the questionable quality of any particular cause or product can potentially facilitate adverse consequences. Furthermore, strategic message designers may need to work hard to counter celebrity-generated misinformation or advocacy for harmful substances with their own strategic campaigns, perhaps likewise using popular celebrities in their efforts to reeducate and/or change public behavior.

Conclusion

Celebrity appeals are messages where famous and typically well-liked individuals are featured alongside a target behavioral outcome, be it buying a product or visiting a healthcare provider. In addition to strategic messages, news coverage of celebrities associated in any way with health or risk-related behaviors can also serve as a de facto celebrity appeal, raising awareness and directing public attention. The marketing literature about the effects of celebrity endorsements demonstrates that they are generally effective at changing attitudes, but there is less of a connection between these types of strategic messages and behavior change. This literature also reveals a number of important considerations for the design of celebrity appeals, from the fit between the celebrity and the product/target behavior to the endorser type, endorser gender, and product familiarity. Additionally, theories regarding information processing, the interplay of affect and cognition, physiological arousal, and motivation can inform future work in the domain of celebrity appeals. Given the prominent role of celebrities in modern society and their near omnipresence in the media, this area of research is an important one for understanding and shaping public perceptions of health and risk-related behaviors.

Discussion of the Literature/Historiography

The literature on celebrity appeals is interdisciplinary and crosses a number of theoretical and applied contexts. Research in social psychology about information processing also served as early tests of celebrity appeal effects. In establishing involvement as a key moderator of information processing in their piece published in Journal of Consumer Research, Petty et al. (1983) also provided evidence that the characteristics of a celebrity used in an endorsement (e.g., credibility or attractiveness) could influence persuasion-related outcomes.

McCracken (1989) also published an influential conceptual article in Journal of Consumer Research. This piece argued that more than celebrity attractiveness or expertise, the meaning a celebrity brought to the endorsement context, be it evaluative or non-evaluative, was what influenced persuasiveness. Later, Erdogan (1999) published an oft-cited narrative review of the celebrity endorsement effects literature in Journal of Marketing Management. While he concluded that celebrity endorsements are often influential, he pointed out numerous gaps in empirical evidence, particularly the lack of evidence supporting McCracken’s meaning-transfer hypothesis as well as a general lack of nuanced theory in this area of research.

More recently, a quantitative meta-analysis of celebrity endorsement effects was published by Knoll and Matthes (2016) in Journal of the Academy of Marketing Science. While there had been previous narrative reviews of this area of work and one previous quantitative meta-analysis that focused solely on source effects of celebrity endorsements, this meta-analysis was the first to take a broader and quantitative approach. The authors found 46 studies with 10,357 participants that met their inclusion criteria. Their analyses revealed that, under certain conditions, celebrity endorsements are quite effective, while under other conditions they may not sway attitude or behavior.

In the context of celebrity illness announcements, the review piece by Brown and Basil (2010) and published in Health Communication provides an extremely useful review of findings on audience involvement with celebrities in a health context. The reference list from their piece provides a very helpful list of their specific studies on the role of media coverage and audience involvement in shaping public reactions to celebrity illness announcements. A few years later, Noar et al. (2014) published a journal article titled “Public Figure Announcements About Cancer and Opportunities for Cancer Communication: A Review and Research Agenda” in the same journal, Health Communication. This manuscript offered a conceptual model for investigating moderators and boundary conditions of celebrity illness disclosure effects, and may provide helpful guidance for researchers interested in examining the many nuances of celebrity-related media effects. While this particular review focused on celebrity announcements of cancer, its findings and proposed model could potentially inform work across a number of celebrity-related health and risk contexts.

The book Celebrity Health Narratives and Public Health by Beck et al. (2015) provides helpful background on the role of celebrities and stories about them in shaping public responses to health. Eleven of the chapters deal with different case studies of celebrity’s whose health narratives were made public, providing readers with helpful examples as well the opportunity to make comparisons between different types of celebrities (e.g., actors versus athletes) and illnesses contexts (e.g., mental illnesses versus physical injuries versus cancer, etc.). Whereas much of the aforementioned literature on celebrity endorsement effects or on audience involvement takes a quantitative approach, Celebrity Health Narratives and Public Health provides a nuanced and rich qualitative take on the role of celebrities in shaping audience perceptions of health and illness.

Along these lines, while not focused on health or risk, the journal article “To See and Be Seen: Celebrity Practice on Twitter,” published by Marwick and boyd (2011) in the journal Convergence: The International Journal of Research into New Media Technologies, takes a very insightful qualitative approach to analyzing how celebrities use social media and the accompanying power dynamics between celebrities and their social media followers. Their work addresses issues of intimacy, sincerity, and authenticity, among others, across three case studies of celebrity Twitter use, and the findings and discussion could very well help inspire future research projects regarding celebrity appeals related to health and risk.

Primary Sources

Someone searching for literature regarding celebrity appeals may find a number of books, journal articles, encyclopedia entries, essays, and even insightful news articles to examine. The resources listed below are helpful places to start exploring the role of celebrities in shaping public opinion as well as individual behavior regarding health and risk-related outcomes.

Scholarly articles published in consumer research and marketing journals are a good place to start looking for research related to celebrity appeals, celebrity endorsements, and persuasion. Reputable journals that have published important work in this area include Journal of Consumer Research, Journal of Marketing Management, and Journal of the Academy of Marketing Sciences. With regards to celebrities included in health-related messages, health communication journals such as Health Communication and Journal of Health Communication are also high-quality sources of scholarship about this topic. The journal Science Communication has also published work relevant to using celebrities in conservation and environmental risk-related messages.

Libraries are also a helpful place to look for books and book chapters regarding celebrity appeals. Searching library databases using queries such as “celebrity appeals,” “celebrities and health,” “celebrity cause advocacy,” “celebrities and public service announcements,” and other related terms will help researchers to find these resources.

Further Reading

Beck, C. S., Chapman, S. M. A., Simmons, N., & Tenzek, K. E. (2015). Celebrity health narratives and the public health. Jefferson, NC: McFarland.Find this resource:

Bergkvist, L., & Zhou, K. Q. (2016). Celebrity endorsements: A literature review and research agenda. International Journal of Advertising, 35(4), 642–663.Find this resource:

Brown, W. J., & Basil, M. D. (2010). Parasocial interaction and identification: Social change processes for effective health interventions. Health Communication, 25(6/7), 601–602.Find this resource:

Cram, P., Fendrick, A., Inadomi, J., Cowen, M. E., Carpenter, D., & Vijan, S. (2003). The impact of a celebrity promotional campaign on the use of colon cancer screening: The Katie Couric effect. Archives of Internal Medicine, 163(13), 1601–1605.Find this resource:

Erdogan, B. Z. (1999). Celebrity endorsement: A literature review. Journal of Marketing Management, 15(4), 291–314.Find this resource:

Giles, D. (2000). Illusions of immortality: A psychology of fame and celebrity. New York: St. Martin’s Press.Find this resource:

Knoll, J., & Matthes, J. (2016). The effectiveness of celebrity endorsements: A meta-analysis. Journal of the Academy of Marketing Science, 45(1), 55–75.Find this resource:

Marwick, A., & boyd, d. (2011). To see and be seen: Celebrity practice on Twitter. Convergence: The International Journal of Research into New Media Technologies, 17(2), 139–158.Find this resource:

McCracken, G. (1989). Who is the celebrity endorser? Cultural foundations of the endorsement process. Journal of Consumer Research, 16(3), 310–321.Find this resource:

Noar, S. M., Willoughby, J. F., Myrick, J. G., & Brown, J. (2014). Public figure announcements about cancer and opportunities for cancer communication: A review and research agenda. Health Communication, 29(5), 445–461.Find this resource:

Petty, R. E., Cacioppo, J. T., & Schumann, D. (1983). Central and peripheral routes to advertising effectiveness: The moderating role of involvement. Journal of Consumer Research, 10(2), 135–146.Find this resource:

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