1. The effects of MORTALITY SALIENCE ON SELF-REPORTED Health practices
Charles E Sepers Jr
University of Nebraska-Kearney
Faculty Mentors: Richard L Miller & William J Wozniak

2. Introduction
I would like to start by asking, how many of you think about death? How many of you think about death when you are waiting in line at the drive thru of your favorite fast food restaurant?

3. Introduction Mortality Salience Terror Management Theory
Existential anxiety
Defense mechanism needed
Terror Management Theory
Proximal defense
Suppression
Distal defense
Cultural worldview
Americans make health-related choices every day that will ultimately lead to an untimely death; many times with at least a basic understanding that those choices are unhealthy at best. While modern medicine allows individuals to live longer than ever before, behavior-related diseases now account for a majority of all deaths in the United States. If individuals fear nonexistence, how is this fear suppressed long enough to knowingly make poor health choices? As a function of survival, a defense mechanism is needed to mediate thoughts associated with the inevitability of death.
In 1991, Solomon, Greenberg, and Pyszczynski proposed the Terror Management Theory in an effort to explain the mechanisms behind the defense against mortality salience. This theory suggests that an anxiety buffer rooted in a robust, cultural worldview successfully shields individuals from the anxiety of death by engaging in activities that increase self-esteem or allow for a literal or figurative immortality. The concept of the death defense is organized between conscience (or proximal defense) when mortality is salient which acts to suppress thoughts of death, and the unconscious (or distal defense) when the thought of death is active, but not present, that support the cultural worldview.
As an illustrative example of cultural worldview as a function of mortality salience, consider Rosenbladtt, et al., an investigation involving municipal court judges reviewing cases of prostitution. Judges in the treatment condition were given an open-ended mortality salience essay survey, followed by an affect checklist, a hypothetical case brief, and finally, a bond assessment form. Those in the control condition received identical materials with the exception of the mortality salience survey. Those in the treatment condition were significantly harsher in assigning bond amounts, $455 compared to $50, in hypothetical cases. Moral principles play a vital role in the formation of the cultural worldview anxiety buffer. When it becomes challenged, it is defended by exerting the threatened belief system upon the source of the opposing threat. This is the typical format and result of Terror Management Theory based investigations.

4. introduction Terror Management Theory & Health Hypothesis
Health and death associations concerning health behavior
Lack of empirical psychological investigation
Hypothesis
Self-report health practice differences
Proximal condition
Distal condition
Control condition
Despite the obvious relationship between health and death, there has been little research performed within health psychology to explain health outcomes from the perspective of terror management. A strong body of evidence is needed to determine the applicability of Terror Management Theory. It is this rationale that is the basis for this investigation.
The purpose of this study is to examine the differences in self-report health practices as a function of mortality salience. It is hypothesized that those in the proximal condition will score significantly higher on a self-report health questionnaire than those in the control and distal conditions.

5. Method Participants Design Groups
College-aged men (n = 16) and women (n = 66)
Control: n = 30
Proximal: n = 27
Distal: n = 25
Design
One-way ANOVA
Groups
Random
Participants in this investigation included 82 college-aged men and women over the age of 19 recruited from the University of Nebraska-Kearney Psychology Department Human Subjects Pool. Extra credit for was awarded for participation. All procedures were approved by the Institutional Review Board.
The current study featured a one-way analysis of variance to measure self-report health behavior.
Questionnaires were arranged using a random number generator and administered to participants indiscriminately.

6. method Questionnaires Primes Treatment/Control
15-item true/false
Treatment/Control
2-item essay
Delay (distal condition only)
Word search delay task
Dependent variable
Calculated from health survey
Questionnaire packets contained a format similar to those used in traditional Terror Management Theory studies as described during the introduction. Those in the proximal condition were given a 15-item true/false primer survey on death, a 2-item mortality salience essay, and a health behavior survey. The distal condition was identical except for the addition of a television-themed distraction task after the mortality salience essay survey. The television-themed control condition was set-up identical to the proximal condition.
Sample questions from the true/false survey in the mortality salience condition included “I am very much afraid to die,” and, “I often think about how short life really is.” The essay survey asked, “Please briefly describe the emotions that the thought of your own death arouses in you,” and, “Jot down, as specifically as you can, what you think will happen to you physically as you die and once you are physically dead.”

7. Method Health Questionnaire Three health categories
Nutrition, physical activity, and well-being
Perceived ideal health behavior
“Indicate the ideal number of hours of sleep that should be received each night.”
Actual health behavior
“Indicate the number of hours of sleep that you receive each night.”
The health questionnaire contained two versions of a 15-item health behavior survey designed by the investigator to measure three categories of health; nutrition, physical activity, and over-all well being. One version asked individuals to indicate their perceived ideal amount of given health behaviors and the other version asked for the amount of actual behavior carried out for the same behaviors. As an example, in the ideal version, instructions had asked participants to indicate the ideal amount of the following sample health behaviors, “The number of times per week breakfast should be eaten. The number of days a week spent walking to work, school, or to run errands instead of driving,” and “The number of times that should be spent each week engaged in activities designed to combat stress.” Then, the second version had participants indicate their actual behavior for each item. The health questionnaire survey was tested for reliability, resulting in a Chronbach’s alpha of .71, deeming it a reliable measure.

8. Method Procedure Proximal/Control Delay Mortality/Television salience
Health questionnaire
Delay
Mortality salience
Word search (3 min)
Those in the control and proximal conditions were instructed to complete each survey in sequence without pause beginning with the mortality or television primes and ending with the health questionnaire. However, individuals in the distal group were instructed to pause after completing the 2-item essay survey. Those in this condition were then administered the television word search delay task for which they were given 3 minutes to carry out. After the allotted time, participants were then instructed to complete the health questionnaire.

9. Results Ideal/Actual/Difference Health Behavior Means
Difference Score ANOVA
F(2,79) = 0.49, p = .62, 2partial = .01,  = .13
Per item post hoc analysis
p > .05
Proximal (n = 27)
Distal (n = 25)
Control (n = 30)
Ideal
73.93
71.38
72.92
Actual
58.06
56.82
59.73
Difference
15.87
14.56
13.83
Descriptive statistics were calculated for the perceived ideal health behavior and actual health behavior surveys in each of the three conditions. An analysis of variance was conducted on the summary scores for both surveys and resulted in no significant difference between groups. A difference score was computed by subtracting the sum of self-report health practices from the sum of perceived ideal health behavior, the dependent variable of interest.
An analysis of variance was conducted upon this summary variable. These results indicate no differences occurred between each of the three conditions.
Furthermore, change scores were computed for each question and analyzed using a Dunnett’s post hoc comparison. No significant difference between any of the items was detected between groups.

10. Discussion Hypothesis Refuted Terror Management Health Model
Differences do not exist between groups
Terror Management Health Model
Goldenberg & Arndt, 2008
Attempts to explain health behavior
These data refute the hypothesis that a difference exists for increased self-reported health behavior by those in the mortality salient proximal condition compared to those in the delay and control conditions. Recent work adds insight into these results.
In 2008, Goldenberg and Arndt proposed the Terror Management Health Model in an attempt to explain health behavior within the setting of Terror Management Theory. Consisting of three proposals, the model identifies motives within the proximal and distal conditions when considering the prediction of health behavior.

11. Discussion Terror Management Health Model Operative health motivations
Conscious mortality
Self-oriented motivations
Activated but unconscious mortality
Three Proposals
Explain different motivations
The Terror Management Health Model seeks to explain health-based defenses within the context of the Terror Management Theory. If mortality is salient, health-oriented motivations are in play, similar to the proximal defense of Terror Management Theory. In this condition, individuals will be most likely to intend to increase health-related behavior in an attempt to remove the threat. In addition, increased health behavior serves to enforce the logical association between health and longevity.
Similarly, when death-thought activation is present, but unconscious, individualistic values are recruited in an attempt to prevent the conscious thought of death from immerging. This too parallels Terror Management Theory, but in the distal condition.
Within the model, Goldenberg and Arndt make three proposals to explain health-related motivations.

12. Discussion Proposal 1 Proposal 2 Proposal 3 Proximal defense
Health-oriented variables moderate behavior
Proposal 2
Distal defense
Self-oriented methods
Proposal 3
Body-oriented health behavior
In the first proposal, Goldenberg and Arndt state that when mortality is salient, predicted health behavior is moderated by health-oriented variables in an attempt to remove death thought from consciousness by logical means, for example, those recently diagnosed with lung cancer would indicate intention to reduce cigarette smoking as a suppression of death thought. It is believed that those in the state of conscious vulnerability towards death, the intention to increase health behavior will become more prevalent. Furthermore, Proposal 1 dictates that the more proximal the threat, the greater the intent to increase associated health behavior.
The second proposal states that in the distal condition, health behavior is moderated within the context of the individual’s cultural worldview. For those that are religious, transcendence of permanent death is often overcome with the concept of either physical or symbolic immortality as a function of faith. Within health promotion, worldview-based defenses could be utilized if an individual believed that the health outcome would further promote self-esteem and social value.
Similar to Proposal 2, Proposal 3 predicts health behavior in the mortality distal condition, however, this proposal suggests that physical health behaviors, for example, health screenings, are more likely to be avoided when an individual is reminded of their creatureliness. This proposal suggests that when symbolic value is stripped of the body, individuals are less likely to engage in body-oriented health behavior.

13. Discussion Implications for Health Behavior Future Research
Increased health promoting behavior in the proximal condition
Behavior is contextual in the distal condition
Future Research
Specific primes
Sensitive measures
Control for belief systems
The Terror Management Health Model provides sufficient theoretical pathways in which to predict health behavior under a variety of scenarios. Increased health behavior is predicted in the mortality salient condition as a proximal defense. Increasing health behavior is a viable strategy for death thought suppression when increased health promoting behavior is believed to directly remove mortality salience. When death-thought activation is in the subconscious, appeals to an individual’s self-esteem or belief system are the most useful for the purposes of health promotion. Appeals to an individual to engage in activities that increase self-esteem will be successful when death thoughts are present, but not active, regardless whether they are health promoting or not, for example, as a function of their religious beliefs, the Amish stifle the use of technology, and as a result, must often engage in vigorous physical activity for survival which ultimately improves their overall physical health.
Future research should include primes associated with disease apparent to death and dependent manipulations aimed specifically at preventing death to detect changes in the proximal condition. While examining the effects of mortality salience in the distal condition was not the primary focus of this investigation, the results indicate there was no difference between the control and the proximal conditions. Future research must control for individual belief systems and cultural world view when seeking to detect moderated effects of mortality salience within the context of health in the delay condition.

14. References
Arndt, J., Cook, A., Goldenberg, J. L., & Cox, C. (2007). Cancer and the threat of death: The cognitive dynamics of death thought suppression and its impact on behavioral health intentions. Journal of Personality and Social Psychology, 92,
Arndt, J., & Greenberg, J. (2002). Mortality salience and the spreading activation of worldview- relevant constructs: Exploring the cognitive architecture of terror management. Journal of Experimental Psychology: General, 131, doi: //
Arndt, J., Schimel, J., & Goldenberg, J. L. (2003). Death can be good for your health: fitness intentions as a proximal and distal defense against mortality salience. Journal of Applied Social Psychology, 33,
Goldenberg, J. L., & Arndt, J. (2008). Implications for health: A terror management health model for behavior health promotion. Psychological Review, 115, doi: /a
Greenberg, J., Arndt, J., Simon, L., Pyszczynski, T., & Solomon, S. (2000). Proximal and distal defenses in response to reminders of one’s mortality: Evidence of a temporal sequence. Personality and Social Psychology Bulletin, 26,

15. References
Rosenblatt, A., Greenberg, J., Solomon, S., Pyszczynski, T., & Lyon, D. (1989). Evidence for Terror Management Theory: I. The effects of mortality salience on reactions to those who violate or uphold cultural values. Journal of Personality and Social Psychology, 57,
Solomon, S., Greenberg, J., & Pyszczski, T. (1991). A terror management theory of social behavior: The psychological functions of self esteem and cultural worldviews. In M. P. Zanna (Ed.), Advances in experimental social psychology (Vol. 24, pp ). New York: Academic Press.