Reactance to Health Warnings Scale: Development and Validation

Abstract

Background Health warnings may be less effective if they elicit reactance, a motivation to resist a threat to freedom, yet we lack a standard measure of reactance. Purpose We sought to validate a new health warning reactance scale in the context of pictorial cigarette pack warnings. Methods A national sample of adults (n=1,413) responded to reactance survey questions while viewing randomly assigned pictorial or text warnings on images of cigarette packs. A separate longitudinal sample of adult smokers received the warnings on their own cigarette packs (n=46). Results Factor analyses identified a reliable and valid 27-item Reactance to Health Warnings Scale. In our experimental study, smokers rated pictorial warnings as being able to motivate quitting more than text warnings. However, five reactance scale factors weakened the warnings’ impact (anger, exaggeration, government, manipulation, and personal attack; all p<.05). Conclusions The Reactance to Health Warnings Scale had good psychometric properties. Reactance weakened the impact of pictorial warnings on smokers’ evaluation of the warning’s ability to motivate quitting.

Adolescents' Responses to Pictorial Warnings on Their Parents' Cigarette Packs

“…However, with the exception of willingness to smoke, each of the observed differences was in the expected direction. Contrary to previous research demonstrating that pictorial warnings elicit reactance among adults [21,36,37], we did not find that reactance among adolescents differed between study arms. As reactance derives from a perceived threat to one's freedom [38], adolescents could have experienced greater reactance due to a newfound need for independence and autonomy [39].…”

“…Survey items assessed unaided recall and list-aided recognition of the warning to which the adolescent's parent was assigned, reactions to the warning [18–20], reactance to the warning [21], perceived effectiveness of the warning, social interactions about the warning, attitudes toward smoking [14,22], smoking risk appraisals [22–24], smoking susceptibility [25], smoking behavior [22,25], and demographics. We cognitively tested [26] new and modified items with 10 adolescents ages 13–17.…”

A brief measure of reactance to health warnings

“…We assessed message reactance using the 27-item RHWS (Hall et al, 2016) at the immediate post-test survey, the week 1 follow-up survey, and the week 4 follow-up survey. The outcome variables used to assess predictive validity were obtained at the week 4 follow-up survey, and comprised perceived effectiveness of the warning (six items, α = .90, “How much did having this warning on your cigarette packs make you want to quit smoking?…”

“…Drawing on the rich body of empirical and conceptual work on reactance (Dillard and Shen, 2005; LaVail et al, 2010; Quick, 2012; Quick & Stephenson, 2007; Rains, 2013; Witte, 1992, 1994), we define reactance as an emotional and cognitive resistance to a message, characterized by (1) perceived threat to freedom, (2) anger toward the message, and (3) counterarguments against the message, such as denial or derogation. Based on this definition, we developed and evaluated the validity of a 9-factor, 27-item Reactance to Health Warnings Scale (RHWS; Hall et al, 2016) in the context of pictorial cigarette pack warnings. We found that the RHWS had high reliability and good construct validity (Hall et al, 2016).…”

“…Based on this definition, we developed and evaluated the validity of a 9-factor, 27-item Reactance to Health Warnings Scale (RHWS; Hall et al, 2016) in the context of pictorial cigarette pack warnings. We found that the RHWS had high reliability and good construct validity (Hall et al, 2016). As expected, reactance factors were positively correlated with trait reactance (i.e., a personality characteristic reflecting a predisposition to reactance), being a smoker, and exposure to pictorial cigarette pack warnings (vs. a text-only warning control).…”