The Role of Narrative and Other-Referencing in Attenuating Psychological Reactance to Diabetes Self-Care Messages

This study charts pathways through message resistance to enhance the persuasiveness of diabetes self-care messages. A 2 (narrative) × 2 (other-referencing) × 2 (message) × 4 (order) experiment with adult diabetics (N = 58) tested whether packaging overt recommendations as a story rather than an informational argument (i.e., narrative structure) and highlighting the impact of health decisions on family and friends rather than the individual (i.e., other-referencing) can effectively attenuate psychological reactance to messages encouraging healthy diet and physical activity. Narrative and other-referencing each led to lower perceived threat to choice, less state anger and counterarguing, less negative cognitive responses, more positive attitudes toward the ad and the behaviors promoted, and greater intended compliance with message recommendations. Findings illustrate two strategies that communicators may employ in order to benefit from clear, direct health messages while avoiding the reactance they may provoke. Moreover, findings inform message design for diabetes self-care education.     

Social Marketing in Malaysia: Cognitive,Affective, and Normative Mediators of the TAK NAK Antismoking Advertising Campaign

Antismoking mass media campaigns are known to be effective as part of comprehensive tobacco control programs in high-income countries, but such campaigns are relatively new in low- and middle-income countries and there is a need for strong evaluation studies from these regions. This study examines Malaysia's first national antismoking campaign, TAK NAK. The data are from the International Tobacco Control Malaysia Survey, which is an ongoing cohort survey of a nationally representative sample of adult smokers (18 years and older; N = 2,006). The outcome variable was quit intentions of adult smokers, and the authors assessed the extent to which quit intentions may have been strengthened by exposure to the antismoking campaign. The authors also tested whether the impact of the campaign on quit intentions was related to cognitive mechanisms (increasing thoughts about the harm of smoking), affective mechanisms (increasing fear from the campaign), and perceived social norms (increasing perceived social disapproval about smoking). Mediational regression analyses revealed that thoughts about the harm of smoking, fear arousal, and social norms against smoking mediated the relation between TAK NAK impact and quit intentions. Effective campaigns should prompt smokers to engage in both cognitive and affective processes and encourage consideration of social norms about smoking in their society.     

The Effectiveness of Empathy- Versus Fear-Arousing Antismoking PSAs

Building on a previous study (Shen, 2010), this paper investigates the effectiveness of fear- versus empathy-arousing antismoking PSAs and examines the roles of message-induced fear and state empathy in persuasion. Twelve professionally produced antismoking PSAs were used as stimuli messages in a 3 (message type: empathy, fear vs. control)?×?4 (messages) mixed design study. The 260 participants were randomly assigned to each message type and watched four PSAs presented in a random sequence. Results from multilevel modeling analyses showed that empathy-arousing messages are potentially more effective than fear-arousing ones. Both fear and state empathy were found to have a positive direct effect on persuasion. However, fear also had a negative indirect impact on persuasion by activating psychological reactance, while state empathy also had a positive indirect effect by inhibiting psychological reactance. Implications for persuasion, health communication campaigns, and future research were discussed.     

Source Credibility and E-Cigarette Attitudes: Implications for Tobacco Communication

As there are many conflicting sources of e-cigarette information, research is needed to determine the impact of these sources on e-cigarette attitudes to inform future communication campaigns. Source credibility is important in shaping attitudes toward other health topics; however, no study has examined its role in influencing e-cigarette attitudes. Data from the 2015 Health Information National Trends Survey-FDA (HINTS-FDA) were utilized to assess differences in trust in different sources by e-cigarette user status and to investigate the associations between trust in sources and e-cigarette attitudes (n = 3,738). Differences in trust in sources were examined using weighted linear regression. Associations between trust in sources of e-cigarette health effects and attitudes toward e-cigarettes were assessed using weighted logistic regression. Overall, e-cigarette ever users reported significantly lower trust in governmental agencies as compared to never users. Trust in e-cigarette companies was negatively associated with perceived addictiveness of e-cigarettes (AOR = 0.76, 95% CI = 0.58, 1.00), while trust in doctors/pharmacists/healthcare providers was negatively associated with harm perceptions of e-cigarettes relative to conventional cigarettes (AOR = 0.72, 95% CI = 0.55, 0.95). Trust in tobacco companies and trust in e-cigarette companies were negatively associated with absolute perceived harm of e-cigarettes (AOR = 0.70, 95% CI = 0.51, 0.95; AOR = 0.60, 95% CI = 0.46, 0.79, respectively). Results from this study indicate that the associations between trust in sources of e-cigarette health effects and e-cigarette attitudes differ both by source and specific attitude assessed. Ultimately, future campaigns should incorporate messaging to discredit industry sources of information and utilize non-governmental sources to effectively influence e-cigarette attitudes.     

Restrictive Mediation and Unintended Effects: Serial Multiple Mediation Analysis Explaining the Role of Reactance in US Adolescents

Extant research indicates that restrictive parental mediation, parents enforcing rules limiting children’s media use, produces unintended effects in adolescents. Speculation exists that these suboptimal effects are due to psychological reactance following a restrictive mediation interaction leading the adolescent toward defiant behavior. A survey of undergraduate students (N = 483) was conducted to investigate the process of psychological reactance as a mediating factor in the relationship between restrictive parental mediation and three unintended effects: negative attitude toward parents, positive attitude toward restricted content, and increased viewing of restricted content with friends. Results revealed a direct effect of restrictive mediation on attitude toward parent, but not attitude toward restricted content or viewing restricted content with friends. Moreover, the reactance process fully mediated restrictive mediation’s effect on attitude toward restricted content and viewing restricted content with friends, and partially mediated the effect on attitude toward parents.     

The effectiveness of empathy- versus fear-arousing antismoking PSAs

Building on a previous study (Shen, 2010), this paper investigates the effectiveness of fear- versus empathy-arousing antismoking PSAs and examines the roles of message-induced fear and state empathy in persuasion. Twelve professionally produced antismoking PSAs were used as stimuli messages in a 3 (message type: empathy, fear vs. control) × 4 (messages) mixed design study. The 260 participants were randomly assigned to each message type and watched four PSAs presented in a random sequence. Results from multilevel modeling analyses showed that empathy-arousing messages are potentially more effective than fear-arousing ones. Both fear and state empathy were found to have a positive direct effect on persuasion. However, fear also had a negative indirect impact on persuasion by activating psychological reactance, while state empathy also had a positive indirect effect by inhibiting psychological reactance. Implications for persuasion, health communication campaigns, and future research were discussed.     

Ideal self-image congruency as a motivator for smoking: the moderating effects of personality traits

A content analysis showed that cigarette advertising in Taiwan from June 2001 to May 2003 portrayed smokers as masculine, adventurous, pleasure-loving, and sociable. A survey of 1,490 high school students further indicated that smokers and nonsmokers differ in the congruency between their ideal self-images and the perceived smoker image on these 4 image dimensions. The self-smoker image congruency was greater for smokers than for nonsmokers and was positively associated with attitudes toward cigarette advertising Most important, this study demonstrated that participants' personality traits moderated self-smoker image congruency effects on smoking attitudes. Implications and suggestions for antismoking campaigns are discussed.     

Anti-Sugar-Sweetened Beverage Messages Elicit Reactance: Effects on Attitudes and Policy Preferences

Messages that convey the dangers associated with consumption of sugar-sweetened beverages (SSBs) may be the most effective means of changing attitudes toward consumption and policy preferences. However, there is a risk that this message type also stimulates reactance, a form of resistance to persuasion. A study (N = 618) using messages from the 2012 New York City anti-SSB campaign and a sample of New York City residents showed just such effects. Reactance was heightened by prior message exposure, conservative political orientation and prior consumption of SSBs. The net message effect was still persuasive overall for attitudes, but could be improved by 17% if reactance were eliminated. In contrast, the net message effect on policy preferences was counterpersuasive, due to processes other than reactance. Anti-SSB threat appeals can change attitudes toward one’s own behavior in a more healthful direction, while simultaneously eroding support for more restrictive SSB policies.     

Book Review

News coverage of obesity has increased dramatically in recent years, and research shows that media content may contribute to negative public attitudes toward obese people. However, no work has assessed whether photographic portrayals of obese people that accompany news stories affect attitudes. In the present study, the authors used a randomized experimental design to test whether viewing photographic portrayals of an obese person in a stereotypical or unflattering way (versus a nonstereotypical or flattering portrayal) could increase negative attitudes about obesity, even when the content of an accompanying news story is neutral. The authors randomly assigned 188 adult participants to read a neutral news story about the prevalence of obesity that was paired with 1 of 4 photographic portrayals of an obese adult (or no photograph). The authors subsequently assessed attitudes toward obese people using the Fat Phobia Scale. Participants in all conditions expressed a moderate level of fat phobia (M = 3.83, SD = 0.58). Results indicated that participants who viewed the negative photographs expressed more negative attitudes toward obese people than did those who viewed the positive photographs. Implications of these findings for the media are discussed, with emphasis on increasing awareness of weight bias in health communication and journalistic news reporting.     

Inoculating Against Reactance to Persuasive Health Messages

This investigation examined the possibility of decreasing psychological reactance to health campaigns through the use of inoculation messages. It was hypothesized that an inoculation message, which forewarned of the potential of subsequent reactance, would decrease participants’ likelihood of reacting negatively to a freedom-threatening message aimed to reduce excessive alcohol consumption. Participants (N = 275) who were inoculated against potential reactance felt less threatened and experienced less reactance compared to those who did not read an inoculation message. Structural equation modeling showed that inoculation indirectly predicted lower intention to drink alcohol via the theorized mediated reactance process. This research suggests that it is possible to inoculate against self-generated cognitions that might otherwise lead toward negative health behaviors.     

Communication,Reasoning, and Planned Behaviors: Unveiling the Effect of Interactive Communication in an Anti-Smoking Social Media Campaign

This study examines direct and indirect effects of interactive communication in an antismoking social media campaign. To that end, we pose a multitheoretical framework that integrates communication mediation models and the Theory of Planned Behavior. To test the theorized model, we conducted an experiment using a two-group pretest–posttest design. Participants (N = 201) were randomly assigned into two experimental conditions: “campaign message reception only” as a control group and “message reception and social interaction” as a treatment group, in which the participants contributed to the antismoking campaign by posting their own campaign ideas and information they found through mediated and interpersonal communication. The findings show that interactive communication catalyzes the participants’ information searching behaviors through diverse communication channels. In turn, increased media use plays a crucial role in changing their attitudes and perceived social norms about smoking behaviors, and eventually reducing smoking intention. This study affirms that the theory of planned behavior is effective in predicting behavioral intention and demonstrates the usefulness of a multitheoretical approach in interactive campaign research on social media.     

Examining the Relationship between Message Variables,Affective Reactions,and Parents’ Instrumental Attitudes toward Their Child’s Physical Activity: The “Mr. Lonely” Public Service Announcement

This study examined the relationship between message variables and affective reactions with parents’ attitudes after seeing a physical activity mass media public service announcement (PSA). It was hypothesized that there would be a positive relationship between message variables (i.e., personal relevance, novelty of information, and feelings toward sponsoring organization) and parents’ attitudes toward their child/children’s physical activity after viewing the PSA. Furthermore, we explored whether discrete affective reactions were related to attitudes, beyond the effect of message variables. A secondary data analysis was conducted with parental responses to an online campaign evaluation survey (n = 267). Hierarchical regression analyses showed an overall positive relationship between all three message variables and attitudes. Furthermore, two discrete affective reactions were positively related to attitudes. Parents who endorsed feeling motivated or guilty after viewing the advertisement had more positive attitudes toward their children’s physical activity levels. This study represents an ecologically valid assessment of how message variables and affective reactions are related to attitudes within the context of a physical activity mass media campaign. The results provide guidance for the effective design of mass media physical activity campaigns.     

Friends Don’t Let Friends Smoke: How Storytelling and Social Distance Influence Nonsmokers’ Responses to Antismoking Messages

This study examines nonsmokers’ responses to antismoking messages. Informed by construal-level theory (CLT), it investigates whether and how evidence type (narrative vs. non-narrative) and social distance might interact to influence nonsmokers’ attitudes toward others’ quitting smoking and intentions to persuade others to quit smoking. Results of a controlled experiment (N = 281) revealed an approximately significant two-way interaction pertaining to attitudes. Simple effects analyses revealed that narratives produced less-favorable attitudes toward others’ quitting smoking than nonnarratives when participants thought about their best friend. Yet, there was no difference in attitudes between narratives and nonnarratives when participants thought about socially distant others. The results also indicated that nonnarratives overpowered narratives to influence participants’ attitudes toward others’ quitting smoking. Moreover, social distance had a consistent impact on their risk beliefs, such that they perceive fewer health risks of their close friends than an average college student. Theoretical and practical implications of the results are discussed.     

Emotional Expressions in Antismoking Television Advertisements: Consequences of Anger and Sadness Framing on Pathways to Persuasion

The authors conducted an experiment among U.S. college students (N = 115) to assess the effects of anger- and sadness-framed television antismoking advertisements on viewers' emotional response, impressions of the speaker, source likability, and empathy toward the speaker. The study was based on the fundamental assumptions of discrete emotions and was operationalized using the principles of universal facial expressions. The authors also constructed a path model to investigate how these variables predicted one's attitude toward smoking, attitude toward the tobacco industry, and intentions to smoke. Supporting study hypotheses, the anger-framed message increased the perceived dominance of the speaker relative to the other conditions. Perceived dominance, in turn, was negatively associated with smoking attitudes and, indirectly, smoking intentions. Contrary to study hypotheses, the sadness-framed message did not increase sad emotional responses, source likability, or empathy relative to the no emotion-framed message. The anger-framed message unexpectedly appeared to decrease these outcomes. Empathy and source likability were associated with positive attitudes toward the tobacco industry, but these attitudes did not predict intentions to smoke. The authors discuss the implications of these findings.     

State Psychological Reactance to Depression Public Service Announcements Among People With Varying Levels of Depressive Symptomatology

Campaigns seeking to help people with depression can be effective, but they can also backfire. Psychological reactance is proposed as a partial explanation. Two experimental studies examined the effect of two depression messages (i.e., autonomy-supportive language, controlling language) for participants (n = 2027, n = 777) with varying levels of depressive symptomatology. For Study 1, two versions of a print public service announcement about seeking help for depression served as the experimental stimulus. Study 2 used an existing video public service announcement about seeking help for depression, but the text was altered to create the two conditions. In both studies, increased depressive symptomatology was associated with reduced help-seeking attitudes and intentions, as well as greater state reactance to a public service announcement about depression. Increased state reactance mediated the relationship between increased depressive symptomology and unfavorable help-seeking outcomes. Further, across the two studies, participants with high levels of depressive symptomatology who were exposed to the autonomy-supportive language ad reported either as much, or more, state reactance than participants with high levels of depressive symptomatology who were in the control condition. These results warn that language perceived as autonomy-supportive by people without depression might be perceived as controlling among people with depression.     

Identifying principal risk factors for the initiation of adolescent smoking behaviors: the significance of psychological reactance

An in-school youth survey for a major state anti-tobacco media campaign was conducted with 1,831 students (Grades 6-12) from 70 randomly selected classrooms throughout the state. Tobacco users accounted for nearly 25% of the sample. Pretest questionnaires assessed demographic variables, tobacco use, and various other risk factors. Several predictors of adolescents' susceptibility to tobacco use, including prior experimentation with tobacco, school performance, parental smoking status, parents' level of education, parental communication, parental relationship satisfaction, best friend's smoking status, prevalence of smokers in social environment, self-perceived potential to smoke related to peer pressure, and psychological reactance, were examined using discriminant analysis and logistic regression to identify the factors most useful in classifying adolescents as either high-risk or low-risk for smoking uptake. Results corroborate findings in the prevention literature indicating that age, prior experimentation, and having friends who smoke are among the principal predictors of smoking risk. New evidence is presented indicating that psychological reactance also should be considered as an important predictor of adolescent smoking initiation. The utility of producing antismoking messages informed by an awareness of the key risk factors-particularly psychological reactance-is discussed both in terms of the targeting and design of anti-tobacco campaigns.     

More on Inoculating Against Reactance to Persuasive Health Messages: The Paradox of Threat

This research examined the efficacy of inoculation as a strategy to mitigate psychological reactance based on the level of threat communicated in the forewarning and subsequent persuasive health appeal. Two 2 (inoculation) × 2 (freedom-threatening language) experiments were conducted. The first (N = 181) used elaborated inoculation designed to enhance the threat of impending reactance to a message advocating for responsible alcohol consumption. The second (N = 159) used limited inoculation designed to minimize the threat of impending reactance to a message advocating for responsible soft drink consumption. Results showed that elaborated inoculation increased reactance, whereas limited inoculation decreased reactance but only when the subsequent appeal used less freedom-threatening language. These findings suggest that inoculation has the potential to facilitate or buffer reactance depending on the level of threat communicated in inoculation forewarnings and in subsequent persuasive health appeals.     

Locating Relationship and Communication Issues Among Stressors Associated With Breast Cancer

This investigation examined antecedents associated with support for clean indoor air policies. Participants (N = 550) living in a Midwestern county (population = 62,223) were randomly sampled. Results suggest that beliefs in the health risks associated with secondhand smoke are positively associated with favorable attitudes toward clean indoor air policies, whereas trait reactance is negatively associated with these attitudes. Findings also indicate that risks and trait reactance are indirectly associated with support for clean indoor air policies, mediated through anger arousal toward exposure to secondhand smoke. In addition, regression analyses revealed that health risks, trait reactance, and smoking status explained a significant amount of variance regarding anger toward exposure to secondhand smoke, but only health risks and smoking status accounted for a significant amount of variance toward clean indoor air attitudes. Finally, the Smoking Status × Health Risks interaction was supported for anger toward exposure to secondhand smoke and favorable attitudes toward clean indoor air policies. Our findings suggest the incorporation of anger appeals when promoting clean indoor air policies.     

Effects of Temporal Framing on Response to Antismoking Messages: The Mediating Role of Perceived Relevance

This study tested the effect of temporal framing on young adult smokers’ response to antismoking communication messages. In two studies using largely identical designs, young adult smokers recruited from a large university (n = 52) and Amazon Mechanical Turk (n = 210) were exposed to either no messages or messages featuring different temporal frames. Analysis of the combined data (N = 262) showed that framing the health consequences of smoking in a proximal (vs. distal) time frame led to greater perceived message relevance, less use of heuristic processing, greater use of systematic processing, greater positive affect, and more intense fear. Mediation analysis showed that perceived relevance was a significant mediator of the effect of temporal framing on message processing and emotional responses. In separate analysis of the Amazon Mechanical Turk data, the proximal frame also showed a consistent pattern of stronger impact on behavioral intentions compared to the distal frame, but the difference was only significant on the measure of intending to try to quit. Overall, findings of this study suggest that using proximal (vs. distal) frames may enhance receptivity to antismoking messages among young adult smokers, although the behavioral impact of this framing strategy still awaits further research.     

Why Do Smokers Talk About Antismoking Campaigns? Predictors of the Occurrence and Content of Campaign-Generated Conversations

Smokers often talk about antismoking campaigns, and these conversations can contribute to campaign effectiveness. However, little is known about the predictors and content of naturally occurring campaign-generated conversations. In two studies (Study 1, N = 480; Study 2, N = 232), we systematically examined whether the occurrence and content of smokers’ conversations after exposure to one of eight antismoking television advertisements were predicted by characteristics of (a) the message, (b) intrapersonal responses to the message, (c) the individual, and (d) the social context in which exposure occurred. In multivariable models, we found that conversations were more likely to occur when advertisement exposure occurred in the presence of others, and as the amount of anxiety elicited by the advertisement increased. Conversations were more likely to contain a favorable appraisal of the advertisement when the message elicited higher levels of sadness, and less likely to contain favorable appraisals when the respondent had finished secondary education (vs. lower levels of education). Stronger feelings of guilt reduced the likelihood that conversations contained unfavorable appraisals, and increased the likelihood that they contained quitting talk. These findings suggest several promising avenues for future investigations into why smokers talk and talk in particular ways.