609669

research-article2015
CRXXXX10.1177/0093650215609669Communication ResearchLaVoie et al.

Article
Communication Research
121
Are Graphic Cigarette The Author(s) 2015
Reprints and permissions:
Warning Labels an Effective sagepub.com/journalsPermissions.nav
DOI: 10.1177/0093650215609669
Message Strategy? A Test crx.sagepub.com

of Psychological Reactance
Theory and Source Appraisal

Nicole R. LaVoie1, Brian L. Quick1, Julius M. Riles1,

and Natalie J. Lambert1

Abstract
The purpose of this study is to examine psychological reactance in response to graphic
cigarette warning labels and to strengthen and expand on the current literature
by using validated measures. Young adults (N = 435) were randomly assigned to a
cigarette package featuring a graphic image or a package featuring no image. Utilizing
both structural equation modeling and multivariate analyses, the results indicate
that graphic warning labels are associated with freedom threat perceptions directly
and reactance indirectly. In addition, exposure to graphic cigarette warning labels
resulted in higher freedom threat perceptions, negative cognitions, and source
domineeringness. Our results are considered with an emphasis on the theoretical
and practical implications for policy makers.

Keywords
psychological reactance, graphic images, tobacco, fear appeals

Tobacco smoking is a costly health behavior, both for individuals who smoke and for
the broader community who pay for tobacco-related diseases. According to the World
Health Organization (WHO; 2013b), smoking is the number one contributor to pre-
ventable death in the world. Furthermore, for the United States alone, the financial
cost associated with these preventable diseases is estimated at US$193 billion per year

1University of Illinois at Urbana-Champaign, IL, USA

Corresponding Author:
Nicole R. LaVoie, University of Illinois at Urbana-Champaign, 169 Lincoln Hall, Urbana, IL 61801, USA.
Email: lavoie1@illinois.edu

Downloaded from crx.sagepub.com at University College London on February 22, 2016

2 Communication Research

(Centers for Disease Control and Prevention [CDC], 2013a). Despite the financial and
health costs, 19% of U.S. adults above the age of 18 smoke. This statistic, however,
may be conservative, considering it is measured as adults who have smoked more than
100 cigarettes in their lifetime and who report smoking every day or most days (CDC,
2013a). This means that there are likely far more adults who smoke, but who consider
themselves occasional smokers or social smokers. To reduce smoking prevalence,
many countries have implemented new policies and laws for tobacco control including
public smoking bans, increased taxes on tobacco products, and text warnings on ciga-
rette packaging, which are often accompanied by graphic images (for the remainder of
the article, whenever the term image is used, what is meant is a graphic image). This
last measure has received a great deal of attention in international scholarly research
in the past several years and is the focus of the current investigation.
Thus far, 168 countries have ratified the WHOs Framework Convention on
Tobacco Control, which requires large health warnings to be prominently placed on
cigarette packaging (WHO, 2013a). Following the lead of other countries, the United
States passed a law requiring the display of graphic images and warnings on all ciga-
rette packaging by September of 2012 (Pelofsky & Yukhananov, 2011). The U.S. Food
and Drug Administration (FDA) selected the images, which include pictures of dis-
eased lungs, a diseased mouth, a person dying of lung cancer, and a corpse, among
others (Salahi, 2010). However, even after a federal court ruled that these images reach
beyond the bounds of legal government involvement in private commerce, the case
was heard by, and upheld by, an appellate court. According to U.S. District Judge
Richard J. Leon, these labels are designed to intentionally elicit emotional responses,
which goes beyond the governments role in imparting factual information (R. J.
Reynolds Tobacco Company, Lorillard Tobacco Company, Commonwealth Brands,
Inc., Liggett Group, LLC, & Santa Fe Natural Tobacco Company, Inc. v. FDA,
Hamburg, & Sebelius, 2012). The fate of this law may be tied up in litigation for some
time (Pelofsky & Yukhananov, 2011), but in the interim, the tobacco industry and its
supporters continue to fight the implementation of the law while antitobacco advocacy
groups continue to cite the laws effectiveness in other nations.
Numerous studies evaluating the results of graphic packaging claim that these
images are effective in reducing smoking behaviors (Hammond etal., 2007; Hammond,
Fong, McDonald, Brown, & Cameron, 2004; Hammond, Fong, McDonald, Cameron,
& Brown, 2003; Hammond, McDonald, Fong, Brown, & Cameron, 2004; OHegarty
etal., 2006; Peters etal., 2007; Willemsen, 2005). However, some scholars have ques-
tioned the legitimacy of these claims because the implementation of these warning
labels has, in many cases, coincided with other tobacco control measures such as tax
increases and smoking bans, thereby raising questions about the cause of declining
smoking rates (Ruiter & Kok, 2005). Furthermore, research that espouses the success
of these graphic labels also reports a percentage of the smoking population for which
these warnings and images seem to have no effect or negative effects (Hammond etal.,
2007; Hammond, Fong, etal., 2004; Hammond etal., 2003; Hammond, McDonald,
etal., 2004; OHegarty etal., 2006; Peters etal., 2007; Willemsen, 2005). One possi-
ble explanation for these varying outcomes may be found in psychological reactance

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 3

theory (PRT; J. W. Brehm, 1966). PRT predicts that these graphic warning images may
help some people but inadvertently harm others by causing reactance and correspond-
ing maladaptive responses.
To isolate the effects of graphic warning images and investigate whether these
labels contribute to negative outcomes, Erceg-Hurn and Steed (2011) examined expo-
sure to graphic cigarette warnings and its possible arousal of psychological reactance.
Their study found that smokers exposed to graphic warning images were more likely
to experience anger than smokers who were exposed to text-only warnings. Although
their findings supported the case against graphic tobacco packaging, there were sev-
eral shortcomings in their study. First, although the study claimed to measure psycho-
logical reactance, the researchers failed to assess freedom threat perceptions and
negative cognitions. In response to this limitation, the current study will reexamine
freedom threat perceptions and psychological reactance following exposure to text
warnings and graphic imagery on cigarette packaging. Specifically, this project will
examine psychological reactanceas conceptualized by J. W. Brehm (1966) and
operationalized by Dillard and Shen (2005) as an amalgamation of anger and negative
cognitionsin response to a freedom threat initiated by graphic warning images.
Furthermore, this study will examine three understudied endogenous variables associ-
ated with reactance: source domineeringness, expertise, and trustworthiness.

PRT
PRT posits that people value freedom, choice, and autonomy. Thus, perceived threats
to or the elimination of a freedom may result in attempts to restore that threatened or
lost freedom. J. W. Brehm (1966) theorized that a persons reactance to a freedom
threat is based on the strength of the threat and the amount of personal value attributed
to that freedom. As reactance increases, peoples drive to restore their threatened or
lost freedom subsequently increases, resulting in a variety of potentially negative out-
comes. Messages perceived as threatening may be avoided, rejected, or result in boo-
merang effects, which restore freedom through the engagement in a threatened or
proxy behavior (see J. W. Brehm, 1966). In addition, reactance may lead to derogation
of the source (e.g., Quick & Bates, 2010; Miller, Lane, Deatrick, Young, & Potts,
2007), which is of particular interest in this study.
In the realm of health communication, PRT has enjoyed a wide variety of applica-
tions in recent years. The theory has been studied in the context of binge drinking
(Dillard & Shen, 2005; Quick & Bates, 2010), condom use (Quick & Stephenson,
2007), drunk driving (Shen, 2010), exercise (Miller etal., 2007; Quick & Considine,
2008), organ donation (Reinhart, Marshall, Feeley, & Tutzauer, 2007), recycling
(Bessarabova, Fink, & Turner, 2013), smoking (Grandpre, Alvaro, Burgoon, Miller, &
Hall, 2003; Shen, 2010), and sunscreen use (Quick & Stephenson, 2008), as well as in
political contexts such as gun control (Miller etal., 2013) and the legalization of mari-
juana (Miller etal., 2013). In addition, and most germane to this study, research apply-
ing PRT to tobacco use has shown that reactance proneness, or the ease with which a
person experiences reactance when confronted with a freedom threat (Quick, Shen, &

Downloaded from crx.sagepub.com at University College London on February 22, 2016

4 Communication Research

Dillard, 2013), is a positive predictor of tobacco use, as well as a moderator of per-

ceived effectiveness of antismoking messages (Miller & Quick, 2010). That is, reac-
tant prone individuals are less likely to perceive antismoking messages as effective
compared with their nonsmoking counterparts. Even more concerning is that reactance
may lead to an increase in smoking in response to strong antismoking messages
(Grandpre etal., 2003; Henriksen, Dauphinee, Wang, & Fortmann, 2006; Miller,
Burgoon, Grandpre, & Alvaro, 2006).
PRT research reveals that message features play an important role in the arousal
of reactance (for a review, see Quick etal., 2013). Dogmatic, explicit, or forceful
language in messages arouse more reactance than messages featuring nonopinion-
ated, implicit, or nonforceful language (e.g., see Buller, Borland, & Burgoon, 1998;
Miller etal., 2007; Quick & Considine, 2008), and controlling language arouses a
greater freedom threat and elicits more negative cognitions and anger than noncon-
trolling language (Miller etal., 2007). In a related study, dogmatic and vivid lan-
guage was perceived as more freedom threatening following exposure to exercise
and sunscreen messages than nondogmatic and pallid language (Quick & Stephenson,
2008).
Because the literature has established that strong language choices have the ability to
increase reactance, it seems reasonable that graphic and explicit message imagery would
increase reactance as well. Wohlburg (2009) found partial evidence for this claim by
examining college students responses to antismoking messages. Specifically, students
reported that antismoking messages with imagery often made them angry, defensive, or
defiant and, in some cases, served as cues to light up (Wohlburg, 2009). As cited ear-
lier, Erceg-Hurn and Steed (2011) confirmed that graphic cigarette images also arouse
anger. More specifically, they found that graphic imagery led to increased anger beyond
text warnings. However, because their study did not measure freedom threat perceptions,
the mechanism through which this anger occurred was theoretically unclear. J. W.
Brehms (1966) conceptualization of PRT requires the audience to perceive a freedom
threat. It is this freedom threat that mediates the relationship between the message and
reactance, and freedom threat has been shown to be significant by a number of scholars
(for a recent discussion, see Quick etal., 2013). The connection between these graphic
tobacco warning images and psychological reactance remains unknown. However, con-
sidering previous findings on graphic message features and freedom threat perceptions
(Quick & Stephenson, 2008), the first hypothesis is advanced:

Hypothesis 1 (H1): Cigarette warning labels with an image increase freedom threat
perceptions compared with cigarette warning labels without an image.

Although S. S. Brehm and Brehm (1981) originally posited that psychological reac-
tance could not be measured, Dillard and Shen (2005) provided a tenable measurement
of the theorys central construct by operationalizing reactance as the combination of
negative cognitions and anger. The measurement properties of reactance were recently
bolstered by research demonstrating the superiority of Dillard and Shens operational-
ization as compared with others methods, such as Lindseys (2005) measurement,

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 5

with respect to the constructs reliability and validity (Quick, 2012), as well as through
a meta-analysis (Rains, 2013). Thus, to measure psychological reactance, researchers
should assess freedom threat perceptions as well as anger and negative cognitions fol-
lowing message exposure. Erceg-Hurn and Steed (2011) acknowledged the impor-
tance of measuring reactance as a latent construct consisting of anger and negative
cognitions, but they assessed only anger in their study. Therefore, the current research
utilizes assessments of both anger and negative cognitions in order to draw conclu-
sions that adhere more closely to PRT. Consistent with previous research, a positive
association is hypothesized between freedom threat perceptions and psychological
reactance.

Hypothesis 2 (H2): Freedom threat perceptions are positively associated with psy-
chological reactance.
Hypothesis 3 (H3): Freedom threat perceptions mediate the relationship between
warning labels (whether text or image) and psychological reactance.

Source Appraisal
A number of studies demonstrate that graphic, explicit, and/or overtly threatening lan-
guage enhance freedom threat perceptions and, therefore, psychological reactance.
What is missing from this literature, however, is how reactance affects source appraisal.
Research has generally found a negative association between reactance and perceived
source expertise, sociability, and trustworthiness within the contexts of exercise
(Miller etal., 2007) and responsible drinking (Quick & Bates, 2010). To our knowl-
edge, no study has examined how reactance is connected with the aforementioned
source dimensions within the context of graphic cigarette imagery on labeling. In addi-
tion, no study has examined the relationship between reactance and the additional
source dimension of source domineeringness. Dillard, Palmer, and Kinney (1995)
conceptualized domineeringness as indicating interpersonal control. The authors con-
trasted interpersonal domineeringness as a forceful assertion compared with a respect-
ful request. As noted earlier, previous PRT research demonstrates that forceful
language is associated with freedom threat perceptions and reactance (Dillard & Shen,
2005). To be consistent with earlier work, it therefore seems plausible to hypothesize
the following:

Hypothesis 4a (H4a): Reactance is negatively associated with perceived source

expertise and trustworthiness.
Hypothesis 4b (H4b): Reactance is positively associated with perceived source
domineeringness.

In addition to testing the hypothesized paths of the reactance process, examining

mean differences among variables is also explored. Specifically, this study will iden-
tify mean differences between image conditions on freedom threat perceptions, on
psychological reactance directly, and on source appraisal. In this spirit,

Downloaded from crx.sagepub.com at University College London on February 22, 2016

6 Communication Research

Hypothesis 5 (H5): Compared with warning labels without an image, exposure to

cigarette warning labels with a graphic image results in (a) greater freedom threat
perceptions, (b) greater reactance, and (c) less favorable source appraisal

Trait Reactance
Although the majority of PRT research conceptualizes reactance as a psychological
state, a related literature perceives reactance as an individual difference variable (see
S. S. Brehm & Brehm, 1981; Wicklund, 1974). Although such conceptualizations are
not consistent with J. W. Brehms (1966) original depiction of reactance, he later pos-
ited that certain individuals are more reactant prone than others (see S. S. Brehm &
Brehm, 1981). Trait-reactant individuals are characterized as independent, autono-
mous, rebellious, mistrustful, and self-sufficient (for a review, see Quick etal., 2013).
Research has found that reactance-prone individuals have a greater proclivity to con-
sume tobacco products (Miller etal., 2006) and engage in illicit drug use and risky sex
(Miller & Quick, 2010). Not surprisingly, given the characteristics of trait-reactant
individuals, health communication researchers consider segmenting audiences based
on this personality profile a fruitful endeavor (Miller etal., 2006; Miller & Quick,
2010; Quick, Bates, & Quinlan, 2009). With these studies in mind, the final hypothesis
is advanced:

Hypothesis 6 (H6): High trait-reactant individuals experience (a) greater freedom

threat perceptions and psychological reactance and (b) less favorable source
appraisal compared with low trait-reactant individuals.

Method
Participants and Procedure
Participants were undergraduate students attending a large Midwestern university
(N = 435), with an average ranged between 18 and 25 years, an average age of 19.88
years (SD = 1.44), and a median age of 20. The sample was ethnically diverse; 62.3%
identified as Caucasian, 8.3% as African American, 7.6% as Latino, 17.0% as Asian, and
5.5% as other (including Multiracial, Native American, Pacific Islander and Other).1 The
sample was 34% male and 66% female. Regarding smoking status, we divided the sam-
ple by those who reported smoking at least once during the last month (smokers) and
those who reported no smoking during the last month (nonsmokers). Within the sample,
82.5% reported being nonsmokers, whereas 17.5% reported smoking behaviors.
Participants were recruited through communication courses and offered extra credit
for their participation. Participants were randomly assigned to either the graphic image
or no-image condition. The stimulus consisted of a text warning alone (on a regular
pack of cigarettes) or a text warning and graphic image together (on the governments
proposed new packaging). The text warning only, in this case, served as a control
because it is the legal status quo. After proper consent was acquired, students were

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 7

given envelopes and instructed not to open them until the researcher told them to do
so. Students completed initial baseline surveys on demographics and smoking behav-
iors and then were given a short written paragraph explaining the researchers interest
in their perceptions and opinions about antismoking messages. They were then
instructed to open their envelopes and carefully examine the cigarette packages, after
which they completed a thought-listing exercise and the remainder of the survey.

Stimulus Materials
Erceg-Hurn and Steeds (2011) study used online computer-generated images to pres-
ent the stimuli to participants. However, as noted in their limitations section, viewing
a flat image may not have the same effect as holding an actual cigarette package. For
this reason, participants in the current study were provided with real cigarette pack-
ages and were able to hold and examine them. Half of the cigarette packages bore
graphic images on the labels, and all packages of cigarettes were identical in every
way with the exception of the presence or absence of the image. Seven different images
were rotated equally but randomly among participants in the image condition. These
images were chosen because they are some of the actual images that the FDA approved
to appear on cigarette packages.
Marlboro Golds were the cigarette brand used for the stimuli. Marlboro is the most
popular cigarette brand in the United States, making up 40% of the American market
share (CDC, 2013b). This is more of the market share than five of Marlboros main
competitors combined (CDC, 2013b). In addition, cigarettes labeled light or ultra-
light (defined as 15g of tar or less) made up 94.7% of the cigarettes smoked in 2011
(Federal Trade Commission [FTC], 2013). Legislation introduced in 2010 prohibits
referring to cigarettes as light or ultra-light on packaging, and Marlboro Gold
was the name that replaced Marlboro Lights after this change (CDC, 2013b).

Measures
Smoking status. Smoking status was assessed using an item from the CDCs (2010)
National Adult Tobacco Survey Questionnaire. Specifically, the item asked partici-
pants how many days during the past month they had smoked. Participants reporting
that they had smoked at least 1 day during the past month were coded as smokers
(n = 76) and individuals reporting they had not smoked within the past month were
coded as nonsmokers (n = 359).

Freedom threat. Freedom threat perceptions were measured using a four-item scale
from Dillard and Shen (2005) on a 1 = strongly disagree to 7 = strongly agree scale.
This measure has been validated and had respectable reliability in our analysis
(M = 3.33, SD = 1.64, = .83).

Reactance. Reactance was measured as a latent variable consisting of anger and nega-
tive cognitions. Two recent tests of Dillard and Shens (2005) operationalization

Downloaded from crx.sagepub.com at University College London on February 22, 2016

8 Communication Research

support its continued use (Quick, 2012; Rains, 2013). Consistent with earlier work,
anger was assessed on a 1 = not at all to 7 = a great deal of this feeling scale using the
four-item scale created by Dillard and Shen (2005). Previous reliabilities have been
consistently good with this scale, as was ours (M = 2.51, SD = 1.60, = .93). Negative
cognitions were assessed using the participant-as-coder technique. More specifically,
participants were given 90 seconds to write out each thought that passed through their
minds while holding and viewing the cigarette package. Next, participants coded each
thought as relevant (pertaining to the cigarette package) or irrelevant (not pertaining to
the cigarette package). Then, participants coded each of their thoughts as favorable,
unfavorable, or neutral. Consistent with earlier research, only relevant negative thoughts
were included in the analysis (M = 2.46, SD = 1.96; Quick, 2012; Rains, 2013).

Trait reactance. Trait reactance was measured using Hong and Faeddas (1996) 14-item
reactance proneness scale with participants indicating their reactance proneness on a
1 = strongly disagree to 7 = strongly agree scale (M = 3.87, SD = 0.80, = .82).2

Source appraisal. Source appraisal (domineeringness, expertise, and trustworthiness)

was measured using items adapted from Miller and colleagues (2007) and earlier con-
ceptualizations regarding source domineeringness (Dillard etal., 1995). The items
pertaining to source expertise and trustworthiness came from Miller and colleagues
(2007) were originally adapted from McCroskeys (1966) scale. The questions asked
participants to rate the message source using a 7-point scale with dichotomous descrip-
tors anchoring each end of the scale for domineeringness (e.g., domineering/not domi-
neering; M = 3.72, SD = 1.36, = .80), expertise (e.g., knowledgeable/unknowledgeable;
M = 4.71, SD = 1.32, = .86), and trustworthiness (e.g., trustworthy/untrustworthy; M
= 5.10, SD = 1.27, = .86).

Data Analytic Strategy

In testing H1, H2, H3, and H4, structural equation modeling was employed using EQS
6.1. In doing so, a covariance matrix was computed and analyzed using full informa-
tion maximum likelihood estimators. Specifically, the two-step approach (Kline, 2005)
was performed by first examining the measurement properties of each variable to
determine whether the measured items are consistent with the hypothesized latent
variables followed by assessing the hypothesized paths using a structural model. A
single item observed variable was used to assess the experimental message feature and
negative cognitions. In addition, five latent composite variables were used including
freedom threat, anger, source domineeringness, expertise, and trustworthiness. Each
latent composite variable was identified with one indicator by setting the error term by
subtracting the scales alpha reliability from 1 with the difference being multiplied by
the measures variance (Holbert & Stephenson, 2002).
Prior to assessing model fit, the distribution of the data was examined. The data were
not heavily skewed as indicated by a Mardias normalized estimate of 2.32. That said,
the assumption that the sample data are drawn from a nonnormal population cannot be

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 9

Table 1. Means, Standard Deviations, and Correlation Matrix Among Measured Variables.

M SD 1 2 3 4 5 6 7
1. Image 1.0
2. Freedom threat 3.33 1.64 .52*** 1.0
3. Negative cognitions 2.46 1.96 .27*** .22*** 1.0
4. Anger 2.51 1.6 .04 .23*** .14** 1.0
5. Domineering 3.72 1.36 .16** .23*** .02 .09 1.0
6. Expert 4.71 1.32 .08 .02 .06 .06 .28*** 1.0
7. Trustworthiness 5.1 1.27 .03 .03 .01 .02 .10* .67*** 1.0

Note. Image was coded with 0 = no image, 1 = image. All results were two-tailed.
*p < .05. **p < .01. ***p < .001.

rejected. In evaluating each model, the chi-square distributed goodness-of-fit statistic

(2), the comparative fit index (CFI), and the standardized root mean square residual
(SRMR; see Bentler, 2007) were employed. We controlled for smoking status for both
the measurement and structural models. In doing so, smoking status was used to create
residualized scores for the variables in the model, thus controlling for smoking status.
With respect to controlling for smoking status, we partitioned out the variance from
smoking status prior to entering the variables into the model. All reported probabilities
are one-tailed. The means, standard deviations, and correlations among the measured
variables are shown in Table 1.

Results
We found acceptable fit indices for the measurement and structural models. The mea-
surement model demonstrated good model fit, 2(4, N = 435) = 25.33, p < .001, SRMR
= .03, and CFI = 1.0. However, we also ran a confirmatory factor analysis to ascertain
that all the items loaded on their respective latent variables. The results of this analysis
support their unidimensionality, CFI = .96, SRMR = .05, root mean square error of
approximation (RMSEA) = .06 (90% confidence interval [CI] = [.05, .07]), 2(109, N
= 435) = 271.17, p < .001. In addition, the hypothesized structural model featuring the
latent composite variables demonstrated good fit, 2(10, N = 435) = 31.09, p < .001,
SRMR = .04, and CFI = 1.0. The unstandardized regression coefficients are presented
in Figure 1.

H1: Cigarette Warning Labels and Freedom Threat Perceptions

As evidenced by the structural model presented in Figure 1, in support of H1, ciga-
rette packages containing a graphic image were positively associated with freedom
threat perceptions. In other words, cigarette packages containing a graphic image
resulted in stronger freedom threat perceptions than cigarette packages without an
image.

Downloaded from crx.sagepub.com at University College London on February 22, 2016

10 Communication Research

Figure 1. Unstandardized regression coefficients for hypothesized structural model.

Note. For the image construct, cigarette packages featuring a graphic image were coded as 1 and
packages without graphic images were coded as 0.

H2: Freedom Threat and Psychological Reactance

The second hypothesis, as shown in Figure 1, predicted that freedom threat perceptions
are positively associated with psychological reactance. H2 was supported. A significant
positive association between freedom threat perceptions and reactance emerged.

H3: Mediating Role of Freedom Threat Perceptions

The third hypothesis predicted that freedom threat perceptions mediate the cigarette
warning label (both with and without images) to reactance relationship. In testing this
association, PRODCLIN was employed to obtain the asymmetric 95% CIs
(MacKinnon, Fritz, Williams, & Lockwood, 2007). Results revealed that freedom
threat perceptions mediated the image to reactance relationship, 95% CI = [0.342,
1.027]. Therefore, the third hypothesis was supported. It should be noted that a main
effect between graphic cigarette warning labels and reactance was not significant.

H4: Psychological Reactance and Source Appraisal

It was hypothesized that reactance is significantly associated with source appraisal.
Specifically, it was hypothesized that reactance is negatively associated with source
expertise and trustworthiness but positively associated with source domineeringness. The
results revealed that reactance was not significantly associated with source expertise or
trustworthiness but was significantly associated with source domineeringness in the
hypothesized direction. Thus, H4b received support, although H4a did not.

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 11

Overall, the model accounted for moderate variance in the measured variables.
Specifically, the model accounted for variance in a freedom threat (R2 = .41), psycho-
logical reactance (R2 = .75), and source domineeringness (R2 = .10).

H5: Mean Differences Among Measured Variables by Warning Images

H5 predicted that exposure to cigarette warning labels featuring a graphic image would
arouse greater freedom threat perceptions and reactance and less favorable source
appraisal compared with labels without a graphic image. Smoking status was not a
significant covariate and therefore was removed from the analysis. A multivariate
main effect was found for image, Wilkss lambda = .69, F(6, 417) = 19.81, p < .001,
2 = .31. Univariate differences revealed that individuals exposed to warning labels
with an image (M = 4.16, SD = 1.45) reported greater freedom threat perceptions than
those exposed to labels without an image (M = 2.46, SD = 1.32), F(1, 422) = 158.80,
p < .001, 2 = .27. Similarly, participants exposed to warning labels featuring a graphic
image (M = 3.00, SD = 2.24) had more negative cognitions than those receiving labels
without an image (M = 1.90, SD = 1.46), F(1, 422) = 35.74, p < .001, 2 = .08. In addi-
tion to these differences, exposure to warning labels with a graphic image (M = 3.92,
SD = 1.44) aroused stronger perceptions of source domineeringness than labels with-
out an image (M = 3.51, SD = 1.23), F(1, 422) = 9.97, p < .05, 2 = .02.

H6: Mean Differences Among Measured Variables by Trait Reactance

The sixth and final hypothesis predicted that high trait-reactant (HTR) individuals would
experience greater freedom threat perceptions, psychological reactance, and maintain
less favorable source appraisal compared with low trait-reactant (LTR) individuals. We
performed a median split to determine high (n = 221, M = 4.50, SD = 0.45) versus low
(n = 214, M = 3.22, SD = 0.52) trait-reactant individuals. Once again smoking status was
not a significant covariate and as a result was removed from the analysis. A multivariate
main effect was found for trait reactance, Wilkss lambda = .94, F(6, 417) = 4.14, p <
.001, 2 = .06. Univariate differences were found for freedom threat perceptions with
HTR individuals (M = 3.56, SD = 1.64) reporting greater freedom threat perceptions than
LTR persons (M = 3.08, SD = 1.59), F(1, 422) = 9.14, p = .01, 2 = .02. Similarly, HTR
(M = 2.75, SD = 1.63) individuals experienced more anger than their LTR counterparts
(M = 2.23, SD = 1.53), F(1, 422) = 11.85, p = .001, 2 = .03. A similar difference appeared
for source domineeringness, F(1, 422) = 5.20, p < .05, 2 = .01, with HTR (M = 3.87,
SD = 1.31) individuals perceiving the source as more domineering than LTR (M = 3.57,
SD = 1.39) individuals. No other differences were discovered.

Discussion
The intention of the pending federal law requiring graphic images on warning labels
on cigarette packaging is clearly designed to deter citizens from the dangers of smok-
ing. Although previous studies have hailed these efforts as successes in other countries
(e.g., Hammond etal., 2007; OHegarty etal., 2006; Peters etal., 2007), results from

Downloaded from crx.sagepub.com at University College London on February 22, 2016

12 Communication Research

the current study indicate using graphic imagery could result in unintended effects that
potentially do more harm than good. Specifically, we found that freedom threat per-
ceptions occurred to a greater degree in response to the graphic image packaging than
to warning labels without an image. This, in turn, was associated with heightened
psychological reactance and the perception that the source was domineering. In addi-
tion, we found mean differences for both high and low trait-reactant individuals across
the measured variables, with HTR individuals experiencing stronger freedom threat
perceptions, anger, and source domineeringness than LTR individuals.
Our study points to several important theoretical and practical considerations. First,
as hypothesized, graphic images led to freedom threat perceptions and psychological
reactance. This study lends credence to the notion that reactance can be triggered via
an assortment of message types. Previous research has largely focused on, and manip-
ulated, language in testing reactance (see Quick etal., 2013). However, moving beyond
verbal or textual accounts, the current study shows that primarily visual messages can
invoke strong freedom threat perceptions and corresponding reactance above and
beyond text alone. Our confidence in this finding is strengthened given that 75% of the
variance explained in reactance was accounted for by the image and freedom threat
perceptions. In addition, our finding that graphic imagery leads to reactance, which
has an emotional component (anger), may provide some support to one of the Supreme
and Appellate Courts reasons for rejecting this bill (R. J. Reynolds Tobacco Company,
Lorillard Tobacco Company, Commonwealth Brands, Inc., Liggett Group, LLC, &
Santa Fe Natural Tobacco Company, Inc. v. FDA, Hamburg, & Sebelius, 2012). That
is, these graphic images may galvanize strong emotional reactions more than inform
the public of factual information.
Although there is no surprise in the finding that freedom threat perceptions led to
reactance, the resulting source appraisal deserves further attention. Trustworthiness
and expertise were unaffected by reactance to these images; however, negative evalu-
ations of source domineeringness were heightened. Participants not only viewed the
source of these warnings to be knowledgeable and trustworthy but also perceived the
source as domineering. It is possible that people interpreted these messages as credible
but found the way in which the messages were delivered to be problematic. It is also
possible that participants did not dispute the claims on these cigarette packages, but
that the tone in which these claims were presented was not well received. Taken
together, these findings illustrate how an image can indirectly influence source percep-
tions. The finding that participants derogate the source as a response to reactance has
been supported in other recent PRT studies as well (e.g., Bessarabova etal., 2013). In
their study, they discovered that freedom threat perceptions led to reductions in source
credibility and increases in source derogation. The reasons for discrepancies in the
different dimensions of source appraisal as outcomes (i.e., credibility) are deserving of
greater attention in future research. However, perhaps source attribution or attitudes
toward the source before message exposure may be variables to consider in the future.
With specificity to our findings, Dillard and Shen (2005) stated, Roughly parallel
to forcefulness or authoritarianism, dominance captures the extent to which a message
reveals that the source believes he or she can control the message recipient (p. 163).

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 13

Furthermore, research has established that negative source appraisals lead to a reduc-
tion in message persuasiveness (Grandpre etal., 2003; Quick & Considine, 2008).
Thus, experiencing reactance toward a message and, therefore, perceiving the source
as more domineering, could potentially create more negative attitudes toward the mes-
sage or the source. Negative attitudes toward the source may reduce behavioral inten-
tions, an operationalization of persuasiveness, of graphic image warning labels as an
antitobacco strategy.
Two other dimensions, trustworthiness and expertise, were not affected to the same
degree; individuals still viewed the source (presumably the government) as an expert
and rated the source as credible. There is little explanation for why these results would
emerge; however, observing reactances effect on only the source appraisal of dimen-
sion leaves questions as to the relationship between these variables. Therefore, future
research should consider whether manipulating source changes the source appraisal as
an outcome of reactance or whether reactance is consistently only associated with
domineeringness.
Our project also considered the potential moderating effect of trait reactance. The
high and low trait-reactance models were very similar. In both HTR and LTR models,
a freedom threat was positively associated with reactance, and reactance was posi-
tively associated with source domineeringness. Although we collapsed these models
due to no statistical differences, the similarity of these two models indicates that the
hypothesized relationships were not unique to individuals based on their reactance
proneness. In fact, these findings indicate that the reactance process is experienced
similarly in response to these cigarette graphic images regardless of this individual
difference. Put differently, images too graphic or shocking may create freedom threat
perceptions to a much broader audience, not just among individuals with a proclivity
to resist freedom-threatening messages. This is important information for the FDA and
lawmakers who are debating the future of this persuasive strategy because reactance to
these messages may lead to unintended consequences and a variety of maladaptive
freedom restoration behaviors among different audience segments. Furthermore,
highly freedom-threatening messages, whether textual or visual, may reduce the per-
suasiveness of the intended message (Bessarabova etal., 2013), thereby thwarting the
primary goal of this tobacco control measure.
Although the unstandardized regression coefficients were the same for both HTR
and LTR individuals, our analyses did reveal significant mean differences. Specifically,
HTR individuals experienced greater freedom threat perceptions, anger, and source
domineeringness compared with their LTR counterparts. Thus, although the associa-
tions among the measured variables were experienced similarly across the entire sam-
ple, the magnitude of these variables was heightened among individuals with a
tendency to experience reactance. That said, caution should be used when interpreting
these findings given the relatively small effect sizes observed. Smokers are the audi-
ence most targeted by graphic image cigarette packaging, and previous research indi-
cates that trait reactance is more prevalent in smokers (Miller etal., 2006). However,
if the smoking population is more trait-reactant, the freedom threat and the resulting
reactance may be magnified for this group. This highlights the potential unintended

Downloaded from crx.sagepub.com at University College London on February 22, 2016

14 Communication Research

consequences this antitobacco message strategy may have on smokers and those most
at risk to initiate smoking in the first place. It may be the case that the group that needs
the most help would be the least likely to find support through these graphic image
messages.
Research has begun to consider the role of genetics in addiction to nicotine, and
there is evidence that for many smokers no message, by itself, can overcome a genetic
or physical dependence (e.g., Hoft etal., 2009; Weiss etal., 2008). Many graphic image
campaigns have been successful in reaching many smokers who can quit easily (e.g.,
Hammond etal., 2007; Hammond, Fong, etal., 2004; Hammond etal., 2003; Hammond,
McDonald, etal., 2004; OHegarty etal., 2006; Peters etal., 2007; Willemsen, 2005),
but for hard-core smokers, there may be something else going on (Marcus, 2011,
p. 1). In addition, medication and addiction counseling are likely to be more helpful to
addicted smokers than campaigns and graphic imagery (Marcus, 2011).
Between the two variables composing psychological reactance (anger and negative
cognitions), only anger was of greater magnitude for highly trait-reactant individuals.
In contrast, only negative cognitions were heightened across the entire sample in
response to the graphic image condition. Future studies should assess whether trait-
reactant individuals are more prone to anger as a reaction to freedom threat. If this
were the case, it would underscore the need for addressing trait reactance when design-
ing persuasive messages. Furthermore, how might anger, for HTR individuals, or
negative cognitions, for the overall population, wax or wane when exposed to these
graphic images on cigarette packaging? In other words, future research should inves-
tigate if anger and negative thoughts would increase in intensity and number with each
subsequent exposure or would they diminish as suggested in theories of desensitiza-
tion (Salahi, 2010).
In the current study, we also looked at the differences between exposure to the
graphic image and no-image conditions. Participants exposed to a graphic image expe-
rienced significantly greater freedom threat perceptions, negative cognitions, and per-
ceived source domineeringness. Interestingly, anger was not significantly different
across message conditions. Miller and colleagues (2013) recently argued that negative
cognitions might be longer lasting than anger, which is short-lived following exposure
to a message. Additional research should investigate why anger arousal did not differ
between image conditions. This may be useful information for scholars looking to
advance PRT, whether in harnessing the motivational power of reactance or in looking
to minimize it.
Despite gaining greater insight into the role of reactance within the context of ciga-
rette warning labels, we are aware of the limitations of this research project. First, this
study was cross-sectional. Although it may illuminate some interesting processes and
important variables within the context of graphic smoking warning labels, the results
cannot speak to any lasting positive or negative effects on smoking behaviors, specifi-
cally behavioral outcomes.
Although we are sympathetic to the perception that including attitudes and behav-
ioral intentions in studies is an accepted standard or proxy, we see not including these
measures in the current study as a limitation of studying this particular health behavior,

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 15

not a weakness of our study. We did not measure these outcomes toward smoking
because research has shown that these measures are not that helpful in discriminating
smokers from nonsmokers (Huijding, de Jong, Wiers, & Verkooijen, 2005). Further
addressing this particular health behavior, affective reactions to (attitudes toward) smok-
ing have little effectiveness in providing explanation for smoking behavior (Svanson,
Rudman, & Greenwald, 2001). Behavioral intentions can be equally problematic with
this topic; studies have shown that the effects between intentions and behaviors are not
as strong as once thought, especially when behaviors are risky, lack perceived control-
lability, or are habitual (Webb & Sheeran, 2006; Wood, Quinn, & Kashy, 2002).
Furthermore, because 80% of our sample were nonsmokers, asking whether they
intend to smoke is an odd question, because most people do not anticipate trying ciga-
rettes as adults. Research shows that more than 80 percent of all adult smokers begin
smoking before the age of 18; and more than 90% do so by age 20 (National Survey
on Drug Use and Health, 2012). Although our college-student sample is only slightly
older, it is unlikely that they would feel like they intended to start smoking. In our case,
asking nonsmokers if they have a positive attitude toward smoking as well as an inten-
tion to smoke would be better evaluated with a younger sample, because smoking
initiation happens much earlier on average, and asking smokers if they intend to quit
or smoke would very likely be misleading. Overall, a longitudinal study with a younger
sample would be needed to determine the lasting psychological, attitudinal, and behav-
ioral effects of these images.
Another possible limitation was the use of a college-student sample. Although there
are good reasons supported by the literature that this population was more than ade-
quate (see Arnett, 2000), generalizability is still restricted. Young adults are no longer
adolescents but may not have reached the maturity of adulthood (Arnett, 2000), mak-
ing them a sample that has characteristics of both younger and older adults.
Correspondingly, the emergent adult population has been determined to be a good
segment to examine in reactance studies. According to Cho and Salmon (2006), per-
ceived threats to freedom may be amplified among college-age individualswho tend
to be more defiant to persuasion regarding behavior change than older adults (p. 97).
Second, one limitation of the Erceg-Hurn and Steed (2011) study was that they only
sampled smokers. However, college students may have engaged in a wider variety of
smoking behaviors. After all, college is a time in which, as Arnett (2007) argued, the
emerging adult population is at the peak age period for many behaviors most societies
try to discourage (p. 72). Furthermore, student status and drinking alcohol have both
been related to the frequencies of smoking behaviors as well as identification as a
smoker (Berg etal., 2009). Thus, a college-student population offered the opportunity
to attain a sample of both smokers and nonsmokers to test our hypotheses.
Despite the rationale for using a college sample, however, a sample more represen-
tative of the general population may illuminate important moderators such as sex,
education, race, and socioeconomic status. A more general sample may also capture
more variation in smoking behaviors or yield greater numbers of smokers than a rela-
tively homogeneous college sample. Our sample did not yield a sufficient number of
smokers to adequately divide the sample by smoking status. We did run MANOVAs to

Downloaded from crx.sagepub.com at University College London on February 22, 2016

16 Communication Research

determine if smokers experienced any of the measured variables in question to a

greater degree than nonsmokers; however, there were no significant differences. The
proportion of smokers in our sample was consistent with the current population-wide
smoking rates; 18.9% of the general U.S. population between the ages of 18 and 24
currently smoke (CDC, 2013b). However, we would need a larger sample to yield a
sufficient number of smokers for the division of the sample by smoking status. We did
run MANOVAs to determine if smokers and nonsmokers differed across the measured
variables; however, there were no significant differences.
What our study may have overlooked, though, is that previous research has shown
that smoking behaviors do not necessarily predict identification as a smoker, and iden-
tification may be an important predictor in a number of outcomes related to smoking
behaviors, including psychological reactance (Berg etal., 2009; van den Putte, Yzer,
Willemsen, & de Bruijn, 2009). We defined smoker as anyone who had smoked in the
previous month, thus grouping social smokers with daily smokers, two groups that
may have different identities with respect to their smoking behavior. Identification has
not been examined in the context of cigarette warning labels or reactance to antismok-
ing messages, although future research should aim to determine whether smoking fre-
quency correlates with smoking identity. Furthermore, addressing how frequency and
identity may affect reactions to and outcomes from graphic antismoking warning
labels would be a worthy undertaking because of the role identification performs in
PRT (Berg etal., 2009; van den Putte etal., 2009). In essence, including more smokers
in the sample would allow for a more finessed analyses of smoker identity based on
overtime measures of smoking behaviors.
Finally, our study establishes a pattern of psychological reactance to warning labels
with graphic images, but its scope did not exhaust the variety of outcomes linked to
reactance. We acknowledge that ideally we would have measured attitudes, intentions,
and behaviors had we recruited a different sample. When individuals attempt to restore
a threatened freedom, they may be more likely to engage in the threatened behavior
but are also believed to be more likely to engage in proxy behaviors that can fulfill this
goal (J. W. Brehm, 1966; Quick etal., 2013). Future research should explore the
behaviors triggered by reactance in response to graphic warning labels and images
more specifically.

Summary and Conclusion

This study reexamines the conclusions of Erceg-Hurn and Steed (2011), correcting
weaknesses and expanding the scope of their study in several important ways. First,
we employed complete and validated measures of psychological reactance and
explored our results using both tests of association (structural equation modeling) and
tests of difference (MANOVA). Second, we increased external validity by using real
cigarette packages with the actual FDA-approved images as our stimuli. Third, our
study investigated how this tobacco control strategy and reactance may affect source
appraisal. Finally, we examined the mean differences between high and low trait-reac-
tance individuals across the measured variables.

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 17

Overall, our results suggest that using graphic imagery on cigarette packaging
enhances freedom threat perceptions, reactance, and perceived source domineering-
ness. This finding was found among HTR and LTR persons, although to varying mag-
nitudes. These results indicate that utilizing graphic images on tobacco packaging
might not be as effective as some practitioners had initially hoped. In fact, the mes-
sages designed to deter smoking behaviors ignite freedom threat appraisal, which pre-
cedes reactance and, in turn, elevates source domineeringness. Each of these outcomes
is counterproductive to this antitobacco strategy. In other words, the good intentions of
this tobacco control measure may be for naught; in light of this studys findings, using
graphic warning images on tobacco packaging should be carefully considered before
its implementation.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

Funding
The authors received no financial support for the research, authorship, and/or publication of this
article.

Notes
1. The Census states that Latinos can be African American, Asian, or Caucasian, so the cat-
egories used in this article are not mutually exclusive. Furthermore, we cannot ascertain if
Asian means Asian American or Asian non-American or both in the current article.
2. Initially, an objective of the current study was to evaluate the moderating role of trait reactance
in the hypothesized structural model. In doing so, the multigroup method of testing different
models encompassing the moderating variable of interest (e.g., trait reactance) was employed.
A median split was used to segment the participant pool into either the high or low trait-
reactance model. No differences were observed among these individuals across the path coef-
ficients. As a result, we collapsed the high and low trait-reactant models into a single model.

References
Arnett, J. J. (2000). Emerging adulthood: A theory of development from the late teens through
the twenties. American Psychologist, 55, 469-480. doi:10.1037/0003-066X.55.5.469
Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Childhood
Development Perspectives, 1, 68-73. doi:10.1111/j.1750-8606.2007.00016.x
Bentler, P. M. (2007). On tests and indices for evaluating structural models. Personality and
Individual Differences, 42, 825-829. doi:10.1016/j.paid.2006.09.024
Berg, C. J., Lust, K., Sanem, J. R., Kirch, M. A., Rudie, M., Ehlinger, E., . . . An, L. C. (2009).
Smoker self-identification versus recent smoking among college students. American
Journal of Preventative Medicine, 36, 333-336. doi:10.1016/j.amepre.2008.11.010
Bessarabova, E., Fink, E. L., & Turner, E. M. (2013). Reactance, restoration, and cognitive struc-
ture: Comparative statistics. Human Communication Research, 39, 339-364. doi:10.1111/
hcre.12007

Downloaded from crx.sagepub.com at University College London on February 22, 2016

18 Communication Research

Brehm, J. W. (1966). A theory of psychological reactance. New York, NY: Academic Press.
Brehm, S. S., & Brehm, J. W. (1981). Psychological reactance: A theory of freedom and con-
trol. San Diego, CA: Academic Press.
Buller, D. B., Borland, R., & Burgoon, M. (1998). Impact of behavioral intention on effectiveness
of message features: Evidence from the family sun safety project. Human Communication
Research, 24, 433-453. doi:10.1111/j.1468-2958.1998.tb00424.x
Centers for Disease Control and Prevention. (2010). National Adult Tobacco Survey (NATS).
Retrieved from http://www.cdc.gov/tobacco/data_statistics/surveys/nats/
Centers for Disease Control and Prevention. (2013a). Economic facts about U.S. tobacco pro-
duction and use. Retrieved from http://www.cdc.gov/tobacco/data_statistics/fact_sheets/
economics/econ_facts/index.htm
Centers for Disease Control and Prevention. (2013b). Smoking and tobacco use. Retrieved from
http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm
Cho, H., & Salmon, C. T. (2006). Fear appeals for individuals in different stages of change:
Intended and unintended effects and implications on public health campaigns. Health
Communication, 20, 91-99. doi:10.1207/s15327027hc2001_9
Dillard, J. P., Palmer, M. T., & Kinney, T. A. (1995). Relational judgments in an influence
context. Human Communication Research, 21, 331-353. doi:10.1111/j.1468-2958. 1995.
tb00350.x
Dillard, J. P., & Shen, L. (2005). On the nature of reactance and its role in persuasive health com-
munication. Communication Monographs, 72, 144-168. doi:10.1080/03637750500111815
Erceg-Hurn, D. M., & Steed, L. G. (2011). Does exposure to cigarette health warnings elicit
psychological reactance in smokers? Journal of Applied Social Psychology, 41, 219-237.
doi:10.1111/j.1559-1816.2010.00710.x
Federal Trade Commission. (2013). Federal trade commission cigarette report for 2011.
Retrieved from http://www.ftc.gov/reports/federal-trade-commission-cigarette-report-2011
Grandpre, J. R., Alvaro, E. M., Burgoon, M., Miller, C. H., & Hall, J. R. (2003). Adolescent
reactance and antismoking campaigns: A theoretical approach. Health Communication, 15,
349-366. doi:10.1207/S15327027HC1503_6
Hammond, D., Fong, G. T., Borland, R., Cummings, K. M., McNeill, A., & Driezen, P.
(2007). Text and graphic warnings on cigarette packages: Findings from the International
Control Four Country Study. American Journal of Preventative Medicine, 32, 202-209.
doi:10.1016/j.amepre.2006.11.011
Hammond, D., Fong, G. T., McDonald, P. W., Brown, K. S., & Cameron, R. (2004). Graphic
Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smok-
ers. American Journal of Public Health, 94, 1142-1445. doi:10.2105/AJPH.94.8.1442
Hammond, D., Fong, G. T., McDonald, P. W., Cameron, R., & Brown, K. S. (2003). Impact
of the graphic Canadian warning labels on adult smoking behavior. Tobacco Control, 12,
391-395. doi:10.1136/tc.12.4.391
Hammond, D., McDonald, P. W., Fong, G. T., Brown, K. S., & Cameron, R. (2004). The impact
of cigarette warning labels and smoke-free bylaws on smoking cessation: Evidence from
former smokers. Canadian Journal of Public Health, 95, 201-204.
Henriksen, L., Dauphinee, A. L., Wang, Y., & Fortmann, S. P. (2006). Industry sponsored anti-
smoking ads and adolescent reactance: Test of a boomerang effect. Tobacco Control, 15,
13-18. doi:10.1136/tc.2003.006361
Hoft, N. R., Corley, R. P., McQueen, M. B., Schlaepfer, I. R., Huizinga, D., & Ehringer, M.
A. (2009). Genetic association of the CHRNA6 and CHRNB3 genes with tobacco depen-

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 19

dence in a nationally representative sample. Neuropsychopharmacology, 34, 698-706.

doi:10.1038/npp.2008.122
Holbert, R. L., & Stephenson, M. T. (2002). Structural equation modeling in the com-
munication sciences, 1995-2000. Human Communication Research, 28, 531-551.
doi:10.1111/j.1468-2958.2002.tb00822.x
Hong, S., & Faedda, S. (1996). Refinement of the Hong psychological reactance scale. Educational
and Psychology Measurement, 56, 173-182. doi:10.1177/0013164496056001014
Huijding, J., de Jong, P. J., Wiers, R. W., & Verkooijen, K. (2005). Implicit and explicit atti-
tudes toward smoking in a smoking and a nonsmoking setting. Addictive Behaviors, 30,
949-961. doi:10.1016/j.addbeh.2004.09.014
Kline, R. B. (2005). Principles and practice of structural equation modeling (2nd ed.). New
York, NY: Guilford Press.
Lindsey, L. L. M. (2005). Anticipated guilt as behavioral motivation: An examination of appeals
to help unknown others through bone marrow donation. Human Communication Research,
31, 453-481. doi:10.1111/j.1468-2958.2005.tb00879.x
MacKinnon, D. P., Fritz, M. S., Williams, J., & Lockwood, C. M. (2007). Distribution of the
product confidence limits for the indirect effect: Program PRODCLIN. Behavior Research
Methods, 39, 384-389. doi:10.3758/BF03193007
Marcus, M. B. (2011). Genes may make quitting tougher for smokers. Retrieved from http://con-
sumer.healthday.com/public-health-information-30/centers-for-disease-control-news-120/
genes-may-make-quitting-tougher-for-smokers-659214.html
McCroskey, J. C. (1966). Scales for the measurement of ethos. Speech Communication, 33, 65-
72. doi:10.1080/03637756609375482
Miller, C. H., Burgoon, M., Grandpre, J. R., & Alvaro, E. M. (2006). Identifying principal risk
factors for the initiation of adolescent smoking behaviors: The significance of psychologi-
cal reactance. Health Communication, 19, 241-252. doi:10.1207/s15327027hc1903_6
Miller, C. H., Ivanov, B., Sims, J., Compton, J., Harrison, K. J., Parker, K. A., . . . Averbeck,
J. M. (2013). Boosting the potency of resistance: Combining the motivational forces of
inoculation and psychological reactance. Human Communication Research, 39, 127-155.
doi:10.1111/j.1468-2958.2012.01438.x
Miller, C. H., Lane, L. T., Deatrick, L. M., Young, A. M., & Potts, K. A. (2007). Psychological
reactance and promotional health messages: The effects of controlling language, lexical
concreteness, and the restoration of freedom. Human Communication Research, 33, 219-
240. doi:10.1111/j.1468-2958.2007.00297.x
Miller, C. H., & Quick, B. L. (2010). Sensation seeking and psychological reactance as health
risk predictors for an emerging adult population. Health Communication, 26, 266-275.
doi:10.1080/10410231003698945
National Survey on Drug Use and Health. (2012). Substance Abuse and Mental Health Services
Administration. Available from http://www.samhsa.gov
OHegarty, M., Pederson, L. L., Nelson, D. E., Mowery, P., Gable, J. M., & Wortley, P. (2006).
Reactions of young adult smokers to warning labels on cigarette packages. American
Journal of Preventative Medicine, 30, 467-473. doi:10.1016/j.amepre.2006.01.018
Pelofsky, J., & Yukhananov, A. (2011, November 29). Obama admin appeals cigarette warn-
ing ruling. Reuters. Retrieved from http://www.reuters.com/article/2011/11/29/us-fda-
tobacco-idUSTRE7AS2GT20111129
Peters, E., Romer, D., Slovic, P., Hall Jamieson, K., Wharfield, L., Mertz, C. K., &
Carpenter, S. M. (2007). The impact and acceptability of Canadian-style cigarette warn-

Downloaded from crx.sagepub.com at University College London on February 22, 2016

20 Communication Research

ings among U.S. smokers and nonsmokers. Nicotine & Tobacco Research, 9, 473-481.
doi:10.1080/14622200701239639
Quick, B. L. (2012). What is the best measure of psychological reactance? An empirical test of
two measures. Health Communication, 27, 1-9. doi:10.1080/10410236.2011.567446
Quick, B. L., & Bates, B. R. (2010). The use of gain- or loss-frame messages and efficacy
appeals to dissuade excessive alcohol consumption among college students: A test of psy-
chological reactance theory. Journal of Health Communication, 15, 603-628. doi:10.1080
/10810730.2010.499593
Quick, B. L., Bates, B. R., & Quinlan, M. R. (2009). The utility of anger in promoting clean
indoor air policies. Health Communication, 24, 548-561. doi:10.1080/10410230903104939
Quick, B. L., & Considine, J. R. (2008). Examining the use of forceful language when designing
exercise persuasive messages for adults: A test of conceptualizing reactance arousal as a
two-step process. Health Communication, 23, 483-491. doi:10.1080/10410230802342150
Quick, B. L., Shen, L. J., & Dillard, J. P. (2013). Reactance theory and persuasion. In J. P.
Dillard & L. J. Shen (Eds.), The persuasion handbook: Developments in theory and prac-
tice (2nd ed., pp. 167-183). Los Angeles, CA: Sage.
Quick, B. L., & Stephenson, M. T. (2007). Further evidence that psychological reactance can be
modeled as a combination of anger and negative cognitions. Communication Research, 34,
255-276. doi:10.1177/0093650207300427
Quick, B. L., & Stephenson, M. T. (2008). Examining the role of trait reactance and sensa-
tion seeking on perceived threat, state reactance, and reactance restoration. Human
Communication Research, 34, 448-476. doi:10.1111/j.1468-2958.2008.00328.x
Rains, S. A. (2013). The nature of psychological reactance revisited: A meta-analytic review.
Human Communication Research, 39, 47-73. doi:10.1111/j.1468-2958.2012.01443.x
Reinhart, A. M., Marshall, H. M., Feeley, T. H., & Tutzauer, F. (2007). The persuasive effects
of message framing in organ donation: The mediating role of psychological reactance.
Communication Monographs, 74, 229-255. doi:10.1080/03637750701397098
R. J. Reynolds Tobacco Company, Lorillard Tobacco Company, Commonwealth Brands,
Inc., Liggett Group, LLC, and Santa Fe Natural Tobacco Company, Inc. v. U.S. Food and
Drug Administration, Hamburg, and Sebelius. 11-1482 RJL 19. (US District Court 2012).
Retrieved from https://ecf.dcd.uscourts.gov/cgi-bin/show_public_doc?2011cv1482-58
Ruiter, R. A. C., & Kok, G. (2005). Saying is not (always) doing: Cigarette warning labels are
useless. European Journal of Public Health, 15, 329-330. doi:10.1093/eurpub/cki095
Salahi, L. (2010, November 10). FDA wants cigarette packs to include images of corpses, dis-
eased lungs. Retrieved from http://abcnews.go.com/Health/Wellness/cigarette-packaging-
graphic/story?id=12109439#.Ttwmv4PT-fE.email
Shen, L. (2010). Mitigating psychological reactance: The role of message-induced empa-
thy in persuasion. Human Communication Research, 36, 297-422. doi:10.1111/j.1468-
2958.2010.01381.x
Svanson, J. E., Rudman, L. A., & Greenwald, A. G. (2001). Using the Implicit Association
Test to investigate attitude-behavior consistency for stigmatised behaviour. Cognition and
Emotion, 15, 207-230.
van den Putte, B., Yzer, M., Willemsen, M. C., & de Bruijn, G. (2009). The effects of smoking
self-identity and quitting self-identity on attempts to quit smoking. Health Psychology, 28,
535-544. doi:10.1037/a0015199
Webb, T. L., & Sheeran, P. (2006). Does changing behavioral intentions engender behav-
ior change? A meta-analysis of the experimental evidence. Psychological Bulletin, 132,
249-268.

Downloaded from crx.sagepub.com at University College London on February 22, 2016

LaVoie et al. 21

Weiss, R. B., Baker, T. B., Cannon, D. S., von Niederhausern, A., Dunn, D. M., Matsunami, N.,
. . . Leppert, M. F. (2008). A candidate gene approach identifies the CHRNA5-A3-B4 region
as a risk factor for age-dependent nicotine addiction. PLoS Genetics, 4(7): e1000125.
doi:10.1371/journal.pgen.1000125
Wicklund, R. A. (1974). Freedom and reactance. Potomac, MD: Lawrence Erlbaum.
Willemsen, M. C. (2005). The new EU cigarette health warnings benefit smokers who want
to quit the habit: Results from the Dutch continuous survey of smoking habits. European
Journal of Public Health, 15, 389-392. doi:10.1093/eurpub/cki061
Wohlburg, J. M. (2009). College students response to antismoking messages: Denial, defi-
ance, and other boomerang effects. Journal of Consumer Affairs, 40, 294-323. doi:10.1111/
j.1745-6606.2006.00059.x
Wood, W., Quinn, J. M., & Kashy, D. (2002). Habits in everyday life: The thought and feel of
action. Journal of Personality and Social Psychology, 83, 1281-1297. doi:10.1037//0022-
3514.83.6.1281
World Health Organization. (2013a). Full list of signatories and parties to the WHO framework
convention on tobacco control. Retrieved from http://www.who.int/fctc/signatories_par-
ties/en/index.html
World Health Organization. (2013b). WHO report on the global tobacco epidemic. Retrieved
from http://www.who.int/tobacco/global_report/2011/en/

Author Biographies
Nicole R. LaVoie (MA, University of Illinois at Urbana-Champaign, 2010) is a PhD candidate
at the University of Illinois Urbana-Champaign. Her primary interests are in unintended conse-
quences of health messages. Currently, she is working on the examination of message cues that
affect the cognitive, affective, and behavioral processes of underlying uninteded effects such as
stigma.
Brian L. Quick (PhD, Texas A & M University, 2005) is a Professor in the Department of
Communication and in the College of Medicine at the University of Illinois at Urbana-
Champaign. His primary research interests examine how individuals process persuasive mes-
sages across a host of health contexts.
Julius M. Riles (MA, University of Illinois at Urbana-Champaign, 2010) is a PhD candidate at
the University of Illinois at Urbana-Champaign. His primary research interests pertain to the
effects of media messages on stigma and other social perceptions.
Natalie J. Lambert (MA, University of Illinois at Urbana-Champaign, 2012) is a PhD student
at the University of Illinois at Urbana-Champaign. She conducts organizational and health
research using computational and traditional methods in order to develop communication theory
that is informed by large-scale empirical data.

Downloaded from crx.sagepub.com at University College London on February 22, 2016