Does Reactance against Cigarette Warning Labels Matter? Warning Label Responses and Downstream Smoking Cessation amongst Adult Smokers in Australia, Canada, Mexico and the United States

Abstract

ObjectiveSome researchers have raised concerns that pictorial health warning labels (HWLs) on cigarette packages may lead to message rejection and reduced effectiveness of HWL messages. This study aimed to determine how state reactance (i.e., negative affect due to perceived manipulation) in response to both pictorial and text-only HWLs is associated with other types of HWL responses and with subsequent cessation attempts.MethodsSurvey data were collected every 4 months between September 2013 and 2014 from online panels of adult smokers in Australia, Canada, Mexico, and the US were analyzed. Participants with at least one wave of follow-up were included in the analysis (n = 4,072 smokers; 7,459 observations). Surveys assessed psychological and behavioral responses to HWLs (i.e., attention to HWLs, cognitive elaboration of risks due to HWLs, avoiding HWLs, and forgoing cigarettes because of HWLs) and cessation attempts. Participants then viewed specific HWLs from their countries and were queried about affective state reactance. Logistic and linear Generalized Estimating Equation (GEE) models regressed each of the psychological and behavioral HWL responses on reactance, while controlling for socio-demographic and smoking-related variables. Logistic GEE models also regressed having attempted to quit by the subsequent survey on reactance, each of the psychological and behavioral HWL responses (analyzed separately), adjustment variables. Data from all countries were initially pooled, with interactions between country and reactance assessed; when interactions were statistically significant, country-stratified models were estimated.ResultsInteractions between country and reactance were found in all models that regressed psychological and behavioral HWL responses on study variables. In the US, stronger reactance was associated with more frequent reading of HWLs and thinking about health risks. Smokers from all four countries with stronger reactance reported greater likelihood of avoiding warnings and forgoing cigarettes due to warnings, although the association appeared stronger in the US. Both stronger HWLs responses and reactance were positively associated with subsequent cessation attempts, with no significant interaction between country and reactance.ConclusionsReactance towards HWLs does not appear to interfere with quitting, which is consistent with its being an indicator of concern, not a systematic effort to avoid HWL message engagement.

Attitudinal and behavioural responses to increasing tobacco control regulation among high smoking prevalence groups: A qualitative study

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The role of negative affect and message credibility in perceived effectiveness of smokeless tobacco health warning labels in Navi Mumbai, India and Dhaka, Bangladesh: A moderated-mediation analysis

“…The findings on the desirable effects of negative emotional responses to warnings are also in line with recent experimental field studies (Evans et al 2015) and observational research (Cho et al 2016), including research based on nationally representative longitudinal data from four high-income countries (Yong et al, 2014). Yong and colleagues (2014) used mediational analyses to identify factors that explained the impact of warnings on key indicators of cessation among adult smokers.…”

A brief measure of reactance to health warnings

“…A widely-used measure, developed by Dillard and Shen (2005), assesses anger toward and counterarguments against a message, using four close-ended questions assessing anger and an open-ended thought-listing task to assess counterarguments about the warning (Dillard & Shen, 2005; Gollust & Cappella, 2014; Quick, 2012; Rains, 2013; Rains & Turner, 2007). Some prior studies on pictorial warnings have often focused on the emotional element of reactance (Cho et al, 2016; Erceg-Hurn & Steed, 2011). Other researchers testing Extended Parallel Process Model have measured reactance as a combination of perceived manipulation, message minimization, and message derogation (Witte, 1994).…”