The Effect of Anti-Tobacco Warning Messages on Psychological Reactance and Smoking Behaviour

Abstract

According to the theory of Psychological Reactance, an-ti-tobacco warning messages are perceived as a threat to individual's freedom to choose among behavioral alternatives which may elicit resistance to desirable beha-vioural change. Similar to the previous studies, we have investigated the psychological effects of text-only; graphic and text together warning messages; and to take a step further we also examined anti-smoking public service announcements which are official government interventions that combine information with fear appeals. The findings show that smokers who were exposed to those public service announcements experienced significantly more reactance than the other participants.

Full text

107
Abstract
According to the theory of Psychological Reactance, an-
ti-tobacco warning messages are perceived as a threat
to individual’s freedom to choose among behavioral al-
ternatives which may elicit resistance to desirable beha-
vioural change. Similar to the previous studies, we have
investigated the psychological eects of text-only; grap-
hic and text together warning messages; and to take a
step further we also examined anti-smoking public ser-
vice announcements which are oicial government in-
terventions that combine information with fear appe-
als. e findings show that smokers who were exposed
to those public service announcements experienced sig-
nificantly more reactance than the other participants.
Keywords: Smoking Behavior, Psychological
Reactance eory, Public Health, Warning Messages
Smoking Behavior
Tobacco use has been identified by the World He-
alth Organization as the leading cause of death and
disability (Murray & Lopez, 1997). e Center for
Disease Control and Prevention reports that cigaret-
te smoking is responsible for approximately 443,000
premature deaths annually. In all its parts, smoking
is one of the biggest public health problems. Since
the discovery of the hazardous eects of smoking on
health, several methods have been tried to struggle
with this addiction. Restrictive measures, smoking
cessation programs, health education for the com-
munity and other methods are all conducted almost
all over the world. e common point of all these
eorts is ‘the right to know’. e WHO Framework
Convention on Tobacco Control’s guiding principle
is that “every person should be informed of the he-
alth consequences, addictive nature and mortal threat
posed by tobacco consumption and exposure to to-
bacco smoke’’ (WHO, 2003). Indeed previous studies
revealed that smokers who are more aware of these
risks are more motivated to quit (Romer & Jamieson,
2001).erefore, to reduce the smoking rate, in many
countries it is required that cigarette packs must con-
tain text-only or graphic health warnings that inform
consumers about the dangers of smoking. Warning
labels are good for communicating with smokers
directly, and in addition, when compared to the ot-
her smoking control policies, warning labels can be
an extremely cost-eective educational intervention
(rasher, Hammond, Fong & Santillan, 2007). Text-
only warnings are more informative than the grap-
hics, but, compared to text-only warnings, graphic
warnings are more likely to be noticed by smokers,
are rated as more eective, elicit greater negative tho-
ughts and feelings about smoking, and are more likely
to be cited as a source of motivation to quit (Ham-
mond, Fong, McDonald, Brown, & Cameron, 2004a,
2004b; Hammond, Fong, McDonald, Cameron, &
Brown, 2003; Kees, Burton, Andrews, & Kozup, 2006;
White, Webster, & Wakefield, 2008). Besides giving
information to the target audience about the main
The Eect of Anti-Tobacco Warning Messages on Psychological
Reactance and Smoking Behaviour
Nihan Tomris Küçün1 - B. Zafer Erdoğan2 - Müjdat Özmen3
1 Teknoloji Transfer Ofisi Uygulama ve Araştirma Merkezi, Tur k e y
2 Department of Marketing, Anadolu University, Tu r ke y, bzerdogan@anadolu.edu.tr
3 Eskişehir Osmangazi University, Turkey, mujdat26@yahoo.com (Contact Person)
2nd INT’L SOCIAL BUSINESS @ ANADOLU CONFERENCE
Anadolu University - Eskişehir

108
The Eect of Anti-Tobacco Warning Messages on Psychological Reactance and Smoking Behaviour
issue, fear can help to change the undesired behavio-
ur too. Literature suggests a positive linear relations-
hip between message acceptance and fear-arousing
conditions (Leventhal, 1971). Another government-
conducted smoking control attempt is public service
announcements about harms of smoking. ese an-
nouncements are generally a mix of fear and infor-
mation. So, according to literature inputs, public ser-
vice announcements must be more eective than the
other smoking control policies on smoker’s intention
to quit smoking. Despite the use of all types of mes-
sages for anti-smoking, there is a large gap between
the intended and the reached amount of the change
in behaviour. Recently, this gap has been explained
with a psychological process labeled Brehm’s (1966)
psychological reactance (Shoham, Trost, & Rohrba-
ugh, 2004).
Psychological Reactance Theory & To-
bacco Control Policies
Psychological reactance theory explains human be-
havior in response to the perceived loss of freedom
in an environment. A freedom is defined, briey, as
a belief that one can engage in a particular behavior.
Freedoms include what one does, how one does it, or
when one does it (Brehm & Brehm, 1981). Psycho-
logical reactance, as a motivational state, is aroused
by a threat to a particular freedom. It is not just any
freedom, but particularly the freedom which is thre-
atened in an environment or a situation. Examples
may be to buy House A rather than House B from real
estate agents or to read Magazine A rather than Ma-
gazine B. In other words, reactance theory deals with
specific, discrete behavioral and attitudinal freedoms
that people act upon in everyday life. reats can be
defined as any kind of attempted social inuence, any
kind of impersonal event, and any behavior on the
part of the individual holding the freedom (including
his or her preferences) that work against exercising
the freedom (Brehm & Brehm, 1981). reats to free-
dom may be social inuence attempts such as various
sales pressures from real estate agents or impersonal
barriers such as the high probability of the sale of a
particular house among alternatives to another party.
ere are two mediators of the reactance process,
which are presence or absence of freedom, and im-
portance of freedom (Clee & Wicklund, 1980). For
reactance to be aroused either by social inuence at-
tempts or barriers there must first be an expectation
of free choice; presence or absence of freedom in ot-
her words. Besides the presence of freedom, the more
important the freedom, the more reactance is genera-
ted due to personal or impersonal threats. e theory
advocates that if an individual’s freedom is threate-
ned, he or she will become motivationally aroused to
restore it. (Brehm & Cole, 1966; Brehm, 1989; Clee
& Wicklund, 1980). Reactance theory is applicable to
any situation as long as one expects a measure of free-
dom to act in a given situation and some threat arises
that infringes upon that freedom. Primarily, psycho-
logical reactance theory is a social psychological app-
roach and at the beginning applications of the theory
were in this area. Since, the theory has become a re-
ference point for many other disciplines which aim
to shed light on human behavior. Particularly some
studies on public health, such as smoking (Grandpre,
Alvaro, Burgoon, Miler & Hall 2003), family sun sa-
fety (Buller, Borland & Burgoon 1998) and drunken
driving (Dillard & Shen 2005), have come to take the
theory to be applicable to make the results of their
practices closer to the expected. Public health experts
had focused on attitudinal and behavioral change for
years before they understood that these theoretical
approaches are restricted, consequently reactance
mechanism became an appropriate way out. Due to
the failure of health campaigns which aim to make
behavioral change, significance of understanding the
reactance at individual level becomes apparent. And
recently for many researchers, exposure to cigarette
health warnings may elicit a defensive, maladaptive
psychological response in some smokers, known as
reactance. is reactance may negatively impact smo-
king attitudes and behavior (Wiium, Aarø, Hetland
2009; Erceg-Hurn & Steed 2011).
Reactance as a psychological tendency may dier
in individuals’ characteristic potential for reactance.
Hong & Page’s (1989) reactance scale is developed
for this kind of trait (dispositional) reactance. Reac-
tance is also generated by situational factors so that
Shen and Dillard (2005) have developed a scale for
‘state reactance’ which is the combination of anger
and negative cognitions. According to the theoretical
framework of reactance studies the degree of nicoti-
ne dependence is eective on state reactance (Miller,
Burgoon, Grandpre, & Alvaro, 2006). Obviously both
dimensions of reactance can negatively aect tobacco
control policies’ eiciency.

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2nd Int’l Social Business@Anadolu Conference, 10-13 June 2015
Reviewing the literature, despite the fact that researc-
hers have a general agreement on the helpfulness of
graphic warning messages and public service anno-
uncements, the expected consequence of decreasing
rate of tobacco addiction does not occur. ere are
merely a few studies which argue that the psycholo-
gical reactance may be the reason between the expec-
ted and the actual situation. Our aim is to determine
whether the aforementioned gap could be explained
by psychological reactance. Accordingly, we have pre-
pared five research questions.
R1: Is there a relationship between trait reactance
and state reactance? If yes, how does trait reac-
tance aect state reactance?
R2: Is there a relationship between the individual’s
nicotine dependence degree and state reactan-
ce? If yes, how does the individual’s nicotine
dependence degree aect state reactance?
R3: Is there a dierence among the degree of state
reactance elicited by public service announce-
ment video, graphic and text together warning
label, and text-only warning label?
R4: Is there a relationship between the individual’s
state reactance and thinking of quitting smo-
king aer seeing the warning messages?
R5: Is there a dierence between the eect of war-
ning messages on the first person’s (self) in-
tention to quit smoking and the believed eect
on the third person’s (others) intentions to
quit smoking?
Method
is study is exploratory and descriptive in nature as
not much has been done previously in the topic espe-
cially in Turkey.
Participants
Data collected from three state universities in Tur-
key (Anadolu University, Osmangazi University and
Trakya University). e sample on which analyses
were performed consisted of 520 students. Similar
numbers of men (N = 301; 57.9%) and women (N =
219; 42.1%) participated in the study, ranging in age
from 16 to 38 years (M= 23 years; 17.3%).
Table 1. Age of Participants

AgeGroupsFrequency(%)
Below205811.2
20‐2539475.8
26andabove6813.1
All participants are smokers. As the sample is taken
from university students, duration of smoking in ye-
ars is gathered between 2 and 10 years.
Apparatus and Measures
ree kinds of warning messages (public service an-
nouncement, graphic warning labels, text-only war-
ning labels) are used randomly in the surveys. All
warning messages were selected with the same con-
tent. e message was “smoking cessation reduces the
risk of fatal heart and lung diseases”. e message was
only designed to inform participants and did not inc-
lude emotional components.
Table 2. Smoking Duration of Participants
DurationofSmokingFrequency(%)
1yearorbelow356.7
2‐5years27853.5
6–10years17834.2
Above10years295.6


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The Eect of Anti-Tobacco Warning Messages on Psychological Reactance and Smoking Behaviour
Trait reactance: Trait reactance was measured using
the 14-item version of the Hong Psychological Re-
actance Scale (HPRS; Hong, 1992; Hong & Faedda,
1996; Hong & Page, 1989), which includes items such
as “I resist the attempts of others to inuence me,”
and “When someone forces me to do something, I
feel like doing the opposite.” e scale was internally
consistent (Cronbach’s Alpha = 0.78). All questions
related to trait reactance were measured by a scale 1
=totally disagree to 5 =totally agree.
State reactance: State reactance was assessed by
adapting Dillard and Shen’s (2005) self-report anger
scale. Participants were asked to rate how irritated,
angry, annoyed, and aggravated the warnings made
them on 5-point Likert-type scales. e scale was
internally consistent (Cronbach’s Alpha = 0.77). All
questions related to state were measured by a scale 1
=totally disagree to 5 =totally agree.
Nicotine dependence: Nicotine dependence was me-
asured by a slightly revised version of Fagerstörm’s
nicotine dependence scale (1990). (0-4 points=Low
nicotine dependence, 5-8 points=Medium nicotine
dependence, 9-12 points=High nicotine dependen-
ce). e scale was internally consistent (Cronbach’s
Alpha = 0.70).
Results
As can be seen in Table 4, participants have mostly
emphasized the importance of freedom which lets
them act of their own will and how they feel when
the freedom of choice is restricted by others. Accor-
dingly, out of fourteen statements, “I become angry
when my freedom of choice is restricted” has recei-
ved the highest mean score of 4.32 out of a five point
Likert scale. Nevertheless, resistance against the rules
and advices are slightly low when they are compared
with the other expressions. ough, ‘I consider advi-
ce from others to be an intrusion’ has the lowest rate
with 2.34. ese results show that our sample is sensi-
tive about the phenomenon of freedom but it is more
about the characteristics they have, not so much abo-
ut the other people or other social forces. It seems like
deciding and acting on their own choices are impor-
tant and desirable for them but the resistance degree
against the rules, advice or any other interventions is
weaker than expected. Especially, their aim to break
the rules is relatively weak in the statement ‘When so-
mething is prohibited, I usually think “that’s exactly
what I’m going to do’’ as shown by the mean score of
2.99. Due to the given data, it is acceptable that the
participants have moderate levels of reactance.
e scale was subjected to exploratory factor analy-
sis. Results indicated two factor structure, namely in-
dependent decision making (variance exp. 31.74) and
rules and restrictions (variance exp. 14.34), explaining
just over 46 per cent of the variance in the construct.
State reactance phenomenon, which is known as a
complement of the reactance theory, is hard to mea-
sure. Brehm, who is the founder of the psychological
reactance theory (1981), claimed that the theory can-
not be measured at all. In our study, state reactance
degree was measured by anger aspect only. Based on
the psychological reactance theory; statements had
been listed from bottom to top to represent the in-
tensity of anger. Table 5 shows that warning messages
elicit a noticeable reactance on our sample.
Table 3. Message Type Frequency
WarningMessageTypeFrequency %
Text‐only16030.8
Graphic18836.2
PublicServiceAnnouncement
Video
17233.1
Total520100.0


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2nd Int’l Social Business@Anadolu Conference, 10-13 June 2015
Table 4. Hong Psychological Reactance Scale (Hong, S. M., & Faedda, S. 1996).
StatementsMeanStd.Dev.
Regulationstriggerasenseofresistanceinme. 3.37 1.38
Ifindcontradictingothersstimulating. 3.20 1.29
Whensomethingis prohibited,Iusuallythink“that’sexactlywhatI’m
goingtodo”.
2.99 2.68
Thethoughtofbeingdependentonothersaggravatesme. 4.02 1.19
Iconsideradvicefromotherstobeanintrusion. 2.34 1.36
Ibecome frustratedwhenIam unable to makefreeand independent
decisions.
4.02 1.17
Itirritates me when someone points out thingswhichareobviousto
me.
4.24 1.05
Ibecomeangrywhenmyfreedomofchoiceisrestricted 4.32 1.01
Advicesandrecommendationsinducemetodojusttheopposite. 3.00 1.35
IamcontentonlywhenIamactingofmyownfreewill. 4.29 1.01
Iresisttheattemptsofotherstoinfluenceme. 3.98 1.11
Itmakesmeangrywhenanotherpersonisheldupasamodelforme
tofollow.
3.95 1.19
When someone forces me to do something, I feel like doing the
opposite.
3.62 1.82
Itdisappoints me to seeotherssubmittingto society’s standardsand
rules
3.51 1.38
*Scale:1=totallydisagreeto5=totallyagree.

Table 5. State Reactance - Measurement of Anger (Dillard & Shen, 2005)
StatementsMeanStd.Dev.
Whileviewing/readingthismessage,Ifeltirritated. 3.20 1.38
Whileviewing/readingthismessage,Ifeltangry. 3.57 2.64
Whileviewing/readingthismessage,Ifeltannoyed. 3.85 1.25
Whileviewing/readingthismessage,Ifeltaggravated. 3.34 1.39
*Scale:1=totallydisagreeto5=totallyagree.

Table 6. Respondents Level of Nicotine Dependence (Heatherton, Todd F. et al. 1991)
LevelofnicotinedependenceFrequency %
Low24046.0
Medium19738.0
High8316.0
Total520100.0
*DetailsofcalculationofnicotinedependencelevelcanbefoundinAppendix


112
The Eect of Anti-Tobacco Warning Messages on Psychological Reactance and Smoking Behaviour
e scale was also subjected to the exploratory factor
analysis. Reliability analysis indicated that “I felt irri-
tated” item was distorting the factor structure. It was
eliminated from the structure and reliability score
Cronbach’s Alpha jumped from 0.77 to 0.88. Results
showed one factor structure that explained over 80
per cent of the variance in the construct.
Good news from the results is that only 16 per cent
of the respondent’s level of nicotine dependence is
calculated to be high (Table 6). However, results also
indicate that 70 per cent of the respondents smoke
more than a half of pack a day.
Exploring Research Questions
e first research question explored the relationship
between trait reactance and state reactance. Corre-
lation analysis indicated that there is a statistically
strong positive relationship between the rules and
restrictions component of the trait reactance (r=0.475,
p<0.001) and a statistically weak positive relationship
between the independent decision making component
of the trait reactance (r=0,083, p<0.05) and state reac-
tance. In order to delve further into the relationship,
a multiple linear regression analysis was calculated
to predict state reactance based on rules and restric-
tions and independent decision making components
of trait reactance. Results showed a significant reg-
ression equation (F=78.3, p<0.001 with a R2=0.232).
e analysis showed that both components of trait
reactance significantly predicted state reactance (ru-
les and restrictions: Beta = 0.48, t= 12.3, p<0.001),
(independent decision making: Beta = 0,083, t= 2.16,
p < 0.05). According to these results it is safe to ar-
gue that the rules and restrictions component explains
more variations in the level of state reactance than the
independent decision making component.
e second research question investigated the relati-
onship between the individual’s nicotine dependence
degree and state reactance. Correlation analysis in-
dicated a statistically significant, but weak positive
relationship (r=0.174, p<0.001). In order to explore
this relationship further, a linear regression analysis
was calculated to predict state reactance based on
the individual’s nicotine dependence degree. Results
indicated a significant regression equation (F=16.1,
p<0.001 with a R2=0.03), but the eect is very small.
e third research question compared the degree of
state reactance elicited by public service announce-
ment video; graphic and text together warning label;
and text-only warning label. e results of a one way
ANOVA test reveal that there are statistically signi-
ficant dierences among elicited state reactance by
dierent mediums (Table 7).
e fourth research question investigated the relati-
onship between the individual’s state reactance and
thinking of quitting smoking aer seeing the warning
messages. Correlation analysis indicated that a statis-
tically significant and moderate negative relationship
(r=-0.314, p<0.001). is results indicates that at the
stages of choosing message content and medium, ma-
nagers and authorities need to beware of not eliciting
reactance among audience.
Table 7. Mean Elicited State Reactance by Medium
MediumN MeanStd.Dev.F Sig.
Textonly160 3.46 1.1812.34 0.001
GraphicandText1883.32 1.19 
PSA‐Video1723.92* 1.16 
*Publicserviceannouncementvideoelicitedmorestatereactance(p<0.001).

* Public service announcement video elicited more state reactance (p<0.001).
e last research question was aimed to see whether
the eect of warning messages diers on the first per-
son (self) and the third person (others). As can be
seen in Table 8, the mean score of warning messages’
eect on the participant’s intention to quit smoking
is substantially weak (1.78). However, respondents
indicated that warning messages’ eect on third per-
son is high. ese scores are compared by repeated
measures t-test. Test result is statistically significant
(t=23.12, p<0.001).

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2nd Int’l Social Business@Anadolu Conference, 10-13 June 2015
is result can be explained by the argument which
claims that ‘individuals may find the warning messa-
ges useful, moreover they may strongly support the
use of these kind of messages in tobacco control po-
licies or prevention studies, but when it gets to the
point to quit smoking (especially the eect on them-
selves) they will describe them almost non-eective’
(Önsüz, 2009).
Discussion
Previous studies are inconclusive as to whether ciga-
rette warnings elicit psychological reactance in smo-
kers or not. Our study shows that it is possible for
cigarette warnings to elicit state reactance. Further-
more, we have found that public service announce-
ments elicit far greater state reactance than the other
warning messages. It is important to consider what
impact this reactance has on smoking behavior and
beliefs about smoking.
e theory of psychological reactance predicts that
if smokers believe their freedom to smoke is being
impinged by warnings and reactance is elicited, they
will be motivated to restore their freedom (Brehm
& Brehm, 1981). We realized that our participants
did not experience state reactance in extreme levels,
but only that they have qualified them as ‘annoying’
(3.50/5.00). We believe that this is due to the sample’s
low-nicotine dependence level. (Most of our partici-
pants’ level of nicotine dependence was low (46%),
only 16% of them were qualified as highly addicted).
ere are numerous ways in which reactant smokers
could restore their freedom. One can be “digging in
their heels” and becoming less motivated to quit smo-
king (Erceg- Hurn, Steed, 2011). Another would be
to smoke more than they did previously. However,
our sample did not act in this way. at result may
be caused by the limitations of our study. Reactance
has been conceptualized in the literature as a com-
posite of negative cognitions and anger (Dillard &
Shen, 2005), but only anger was measured in the cur-
rent study. Another limitation is that participants in
our study viewed warnings via survey and PC, rather
than on actual cigarette packs or TV. is may have
inuenced the results.
Consistent with recent studies indicating that grap-
hic anti-smoking warnings can elicit maladaptive
psychological responses (Leshner, Bolls & omas,
2009), results confirmed that ‘Warning messages are
non-eective’ on the first person. However, the eect
on the third person is much more. We believe that
utilizing a third person perception framework to as-
sess eectiveness of anti-smoking warnings can be a
fruitful further research avenue.
ese findings highlight the importance of rigorously
testing and improving public health interventions
using experimental methods prior to disseminating
the interventions to the public. Cigarette health war-
nings may yield substantial public-health benefits,
but the reactance elicited by the warnings may jeo-
pardize their eectiveness among some smokers.
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Table 8. Eect of Warnings on Intention to Quit Smoking for the 1st and 3rd Person
StatementsMeanStd.Dev.
Warningmessagesmademethinkquittingsmoking. 1.78 1.10
Warningmessagescanmakeothersthinkquittingsmoking. 3.57 1.34
*Scale:1=totallydisagreeto5=totallyagree.


114
The Eect of Anti-Tobacco Warning Messages on Psychological Reactance and Smoking Behaviour
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115


INSTRUCTIONS:Foreachquestion,circleyouranswer.Keeptrackofyourpointsasyougo.
1.Howsoonafteryouwakeupdoyousmokeyourfirstcigarette?
a.Within5minutes(3points)
b.Within6‐30minutes(2points)
c.Within31‐60minutes(1point)
d.After60minutes(0points)
2.Doyoufinditdifficulttorefrainfromsmokinginplaceswhereitisforbidden(e.g.,in
church,atthelibrary,incinema,etc)?
Revised(Used)    Original
a.Notatalldifficult(0Points)  a.Yes(1point)
b.Notdifficult(1Points)  b.No(0points)
c.Difficult(2Points)
d.VeryDifficult(3Points)
3.Whichcigarettewouldyouhatemosttogiveup?
a.Thefirstoneinthemorning(1point)
b.Anyother(0points)
4.Howmanycigarettesperdaydoyousmoke?
a.10orless(0points)
b.11‐20(1point)
c.21‐30(2points)
d.31ormore(3points)
5.Doyousmokemoreduringthefirsthoursafterwakingthanduringtherestoftheday?
a.Yes(1point)
b.No(0points)
6.Doyousmokeevenwhenyouareillenoughtobeinbedmostoftheday?
a.Yes(1point)
b.No(0points)
Nowaddupyourpoints.Howdidyouscore?_______
*Heatherton,Todd F.etal. (1991). TheFagerström Test forNicotineDependence: ARevisionof the
FagerströmToleranceQuestionnaire.BritishJournalofAddiction,86,1119‐1127.

OriginalScoringKey:Ascore of 5 ormoreindicates a significantdependence,while a scoreof4 or
lessshowsalowtomoderatedependence.
‐‐‐
OurRevisedScoringKey:
0‐4=Lowdependence
5‐8=Moderatedependence
9‐12=Highdependence
2nd Int’l Social Business@Anadolu Conference, 10-13 June 2015
White, V., Webster, B., & Wakefield, M. (2008). Do
graphic health warning labels have an impact on
adolescents’ smoking‐related beliefs and behavio-
urs?. Addiction, 103(9), 1562-1571.
Wiium, N., Aarø, L. E., & Hetland, J. (2009). Subjective
attractiveness and perceived trendiness in smoking
and snus use: a study among young Norwegians.
Health education research, 24(1), 162-172.
APPENDIX Fagerström Nicotine Dependence Scale*