Introduction: Smoking cessation is critical in reducing global mortality caused by tobacco use. Fear appeal messages based on the Extended Parallel Process Model (EPPM) have played an important role in promoting smoking cessation, but their effectiveness is limited by psychological reactance and a ceiling effect from relying on internal message optimization.


Purpose: The present study aimed to investigate how death reflection enhances the effectiveness of fear appeal messages by mitigating psychological reactance, and its interaction with self-oriented vs. other-oriented message framing.


Method: A web-based experiment using a 2 (death reflection: absent vs. present) × 2 (message orientation: self-oriented vs. other-oriented) factorial design was conducted (N=300).


Results: First, death reflection significantly increased smoking cessation intentions through a serial mediation of enhanced posttraumatic growth and reduced psychological reactance, compared to fear appeal messages without death reflection component. Second, death reflection interacted with message framing, specifically, in the death reflection group, the intention was significantly higher in other-oriented condition than self-oriented condition. In the control group, the intention for both self-oriented and other-oriented conditions did not have significant differences, and psychological reactance mediated the interaction effect. Third, other-oriented messages were more effective than self-oriented messages.


Conclusions: These findings explore new pathways of research to contribute to EPPM by integrating external psychological mechanisms and providing practical strategies for optimizing anti-smoking messages.