1. THE EFFECT OF ANTI-TOBACCO WARNING MESSAGES ON PSYCHOLOGICAL REACTANCE AND SMOKING BEHAVIOUR NIHAN TOMRIS KÜÇÜN ESKIŞEHIR OSMANGAZI UNIVERSITY TECHNOLOGY TRANSFER OFFICE ESKISEHIR –TURKEY BAYRAM ZAFER ERDOĞAN ANADOLU UNIVERSITY ESKISEHIR- TURKEY MÜJDAT ÖZMEN ESKIŞEHIR OSMANGAZI UNIVERSITY ESKISEHIR- TURKEY

2. Tobacco Use Tobacco use has been identified by the World Health Organization as the leading cause of death and disability. Center for Disease Control and Prevention reports that cigarette 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 mortal influences of smoking on health, several methods were tried to struggle with this addiction. Restrictive measures, smoking cessation programs, health education for the community and some others are all conducted almost all over the world.

3. Tobacco Control Efforts Tobacco Control’s guiding principle is that ‘every person should be informed of the health consequences, addictive nature and mortal threat posed by tobacco consumption and exposure to tobacco smoke’. Indeed, previous studies revealed that smokers who are more aware of these risks are more motivated to quit. As a result; the common point of most studies is ‘the right to know’. Therefore, to reduce the smoking rate, in many countries it requires that cigarette packs must contain text-only or graphic health warnings that inform consumers about the dangers of smoking.

4. Warning Labels Literature suggests a relationship between warning messages’ content and message acceptence. ‘Warning labels are good to communicate smokers directly, additionally when compared to the other smoking control policies, warning labels can be extremely cost-effective educational intervention’ ‘Text-only warnings are more informative than the graphics but compared to them, graphics are more likely to be noticed and more effective on the desired motivation to quit’

5. Government-conducted Public Service Announcements Another smoking control attempt is public service announcements about harms of smoking. These announcements are generally mixed of fear and information. Despite the use of all messages for anti-smoking, there still 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. This theory is a social psychological approach and at the beginning applications of the theory were only in this area. Afterwards, the theory has become a reference point for many other disciplines which aim to shed light on human behavior.

6. Psychological Reactance Theory The theory basically explains human behavior in response to the perceived loss of freedom in an environment. A freedom is defined, briefly, 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. Psychological reactance is aroused by a threat to a particular freedom. Threats can be defined as any kind of attempted social influence, any kind of impersonal event, and any behavior that work against exercising the freedom

7. Psychological Reactance Theory There are two mediators of the reactance process which are presence or absence of freedom and importance of freedom. For reactance; there must first be an expectation of free choice. Then, the importance attributed to freedom determines the degree of generated reactance. Finally; the theory advocates that if an individual’s freedom is threatened, he or she will become motivationally aroused to restore it in various ways.

8. Types Of Reactance Reactance may differ in individual’s characteristics. Hong & Page’s (1989) scale is developed for this kind of trait reactance. Reactance 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. ‘Recently for some researchers, exposure to cigarette health warnings may elicit a defensive, maladaptive psychological response in some smokers, known as reactance. This reactance may negatively impact smoking attitudes and behavior’ (Wiium, Aarø, Hetland 2009; Erceg-Hurn & Steed 2011).

9. Despite the fact that researchers have a general agreement on the helpfulness of graphic warning messages and public service announcements, expected consequence as decreasing rate of tobacco addiction does not occur. There are merely a few studies argue that reactance may be the reason between the expected and the actual situation. Our aim is to determine whether the mentioned gap could be explained by psychological reactance. Reactance & Tobacco Control Policies

10. Methodology Age of Participants Age GroupsFrequency(%) Below 205811.2 20-2539475.8 26 and above6813.1 Smoking Duration of Participants Duration of SmokingFrequency(%) 1 year or below356.7 2 - 5 years27853.5 6 – 10 years17834.2 Above 10 years295.6

11. Apparatus and Measures Message Type Frequency Trait reactance: Trait reactance was measured by using the 14-item version of the Hong Psychological Reactance Scale (1992). The scale was internally consistent (Cronbach’s Alpha = 0.78). Warning Message TypeFrequency% Text-only16030,8 Graphic18836,2 Public Service Announcement Video17233,1 Total520100,0

12. Apparatus and Measures 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. The scale was internally consistent (Cronbach’s Alpha = 0.77). Nicotine dependence: Nicotine dependence was measured by Fagerstörm’s nicotine dependence scale (1990). (0-4 points=Low nicotine dependence, 5-8 points=Medium nicotine dependence, 9-12 points=High nicotine dependence). The scale was internally consistent (Cronbach’s Alpha = 0.70).

13. Results

15. Exploring Research Questions TOBACCO CONTROL POLICIES Text-only – Graphic - Video INTENTION TO QUIT SMOKING NICOTINE DEPENDENCE DEGREE STATE REACTANCE TRAIT REACTANCE (r=0.475, p<0.001) (r=0,083, p<0.05) (F=78.3, p<0.001 with a R 2 =0.232) (r=0.174, p<0.001) (F=16.1, p<0.001 with a R 2 =0.03) (r=-0.314, p<0.001).

16. DISCUSSION 1.Our study shows that; it is possible for cigarette warnings to elicit state reactance. 2.Furthermore, video messages elicit far greater state reactance than the other warnings. 3.Our participants did not experience state reactance in extreme levels, but only they have qualified them as ‘annoying’. 4.Research limitations may have influenced the ‘restoring freedom’ statement. 5.Results confirmed that ‘Warning messages are noneffective’ on the first person. However, the effect on the third person is much more.

17. THANK YOU…