Running head: ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE

Anti-smoking Warnings and Extraversion: Influence on Reactance Chelsea Micheals and Carl Pearson University of Minnesota Duluth

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE Abstract The theory of psychological reactance would predict that smokers experience more reactance to a graphic (as opposed to text-only) anti-smoking warning, as the threat to personal freedom is

more explicit. Extraversion is also correlated with higher rates of smoking. This study explored whether or not smokers experience more reactance to graphic warnings, and if extraverts experience more reactance to one or both types of warnings, compared to introverts. We found 10 subjects to participate in the 2 x 2 mixed design. They self-reported their reactance level after being presented with each warning type. They also took a questionnaire to determine extraversion. We hypothesized that graphic anti-smoking warnings would elicit higher reactance in general, and extraverted individuals would experience higher reactance than introverts. The difference in reactance to graphic and text-only warnings was marginally significantly different. There was no significant effect between introversion and extraversion on reactance. Many antismoking campaigns use graphic warnings, so these conclusions could be used to help antismoking campaigns be more effective. Also, approximately half of the American population is extraverted so this could influence anti-smoking campaigns in that regard. Keywords: smoking, reactance, warnings, extraversion, anti-smoking

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE Anti-smoking Warnings and Extraversion: Influence on Reactance Smoking tobacco kills millions of people every year and, worldwide, is the number one

cause of avoidable death (Erceg-Hurn & Steed, 2011). With billions of dollars spent each year on smoking prevention, it is important to consider the effectiveness of anti-smoking advertisements and the personality characteristics that contribute to engaging in smoking behaviors. In this study, we will analyze the effect of anti-smoking warnings and extraversion on reactance. When an individual perceives a limit or imposition on his or her freedom, he or she will act in order to restore that freedom (Dauphinee, Fortmann, Henriksen, & Wang, 2006). This phenomenon may influence ones decision to begin or continue to smoke, if he or she feels the decision to smoke is restricted and his or her personal freedom is limited (Erceg-Hurn & Steed, 2011). It is important to know the relationship between psychological reactance and smoking behavior to develop and implement successful smoking cessation programs, educational programs to deter smoking behavior, and parental guidance techniques that can effectively teach their children not to smoke without causing psychological reactance. Extraverted behavior is characterized by stimulationand attention-seeking behavior (Sato, 2005). Discovering the relationship between smoking behavior and extraversion will shed light on the personality characteristics that are associated with smoking behavior to allow higher levels of prediction and control. Reactance Psychological reactance is important to consider in anti-tobacco advertisement effectiveness. Industry sponsored anti-smoking advertisements were found to have the opposite effect than intended on adolescents, ages 14-17 (Dauphinee, et al., 2006). This effect was due to the subtle promotion of their product over deterring adolescents from using the product. Psychological reactance may be involved because the advertisements could be perceived as

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE restricting their freedom from a desirable substance. Reactance is likely to cause individuals to resist tobacco control measures if they feel their personal freedom is restricted (Aar, Hetland, &Wiium, 2009). When this occurs, smoking control measures may actually promote smoking behaviors. This could be a common occurrence as evinced by the conclusions of Chen et al.

(1999): anti-tobacco rules and regulations are noticed the most and supported the least by current smokers. Smoking control measures and anti-smoking ads must be created carefully to avoid psychological reactance. More specifically, the type of content contained in anti-tobacco warnings that were presented influence psychological reactance levels at varying levels of intensity. Anti-tobacco warnings written in text alone in the absence of graphics resulted in relatively low levels of reactance for smokers. Conversely, graphic warnings elicited high levels of reactance in the vast majority of smokers and may cause more harm than good (Erceg-Hurn & Steed, 2011). Psychological reactance has also been found to be an important predictor for the onset of smoking tobacco (Alvaro, Burgoon, Grandpre, & Miller, 2006). Subjects that exhibited psychological reactance were found to perceive the pleasure of smoking more than the negative side effects from usage (Fisher, Govindan, Larsen, Walker, & Zona, 2004). High levels of psychological reactance are associated with tobacco smoking initiation, continuation, ad perception, and resistance to quitting. Other research has demonstrated that psychological reactance and extraversion are related to tobacco smoking use. Extraversion In a longitudinal analysis over 53 years, Munaf and Black (2007) found that high levels of extraversion were correlated with a higher probability of being a current smoker. Another cross-sectional study with a large sample size of 11,967 men and women showed that

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE extraversion is related to smoking initiation and continuation, providing strong support for the claim that extraversion and smoking behavior are related (Ormel, J., Surtees, P. G., Tijhuis, M.,

& Van Loon, A. J., 2005). Other than the likelihood of being a current smoker, there is evidence to say extraversion is associated with smoking initiation and using at higher levels (de Leeuw, Scholte, Sargent, Vermulst, & Engels, 2010). Another study found similar results, that extraverted personality traits are correlated with smoking tobacco and continuing to do so longer than introverted personalities (Helgason, Fredrikson, Dyba, & Steineck, 1995). This study found that while introverted individuals may be equally like to start smoking, they are more likely to quit than extraverted individuals. Because extraversion is characterized by being more social, outgoing, and gregarious than introverted individuals, it may contribute to beginning and continuing to smoke tobacco more than introverted individuals. Perhaps because of this clear affinity for high emotional expression, extraverts could elicit a more reactant response to reactance-inducing stimuli than introverts. This study will measure the level of state reactance experienced based on extraversion and the type of anti-smoking warning presented. We hypothesize that graphic warnings will elicit more reactance as they will make individuals perceive a greater, more explicit threat to their freedom. Extraverted individuals should experience more reactance because of their affinity for high emotional stimulation. Method Participants In this study, we found 10 participants using the SONA system through the University of Minnesota Duluth campus and a convenience sample of acquaintances, due to difficulty finding candidates for participation with the specific smoking habit requirements. All

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE participants were students and between the ages of 18 and 23. All were Caucasian except for

two, one of whom was Asian and the other was Latino/Hispanic. Every subject spoke English as a first language. The gender ratio was approximately 1:1. The socio-economic background and education level was higher than average because of the university setting. This study measured the effectiveness of smoking warning labels in smokers. Therefore, to be considered smokers, participants had to have smoked at least 100 cigarettes throughout their lives and at least once in the past 30 days. Participants in the SONA system were compensated by receiving academic credit in their psychology lectures, for which their psychology instructors will provide extra credit in the course. Other participants agreed to be in the study as volunteers. Participants were treated according to the ethical standards of the American Psychological Association. Materials There will be two different types of warning labels. The graphic type will be a depiction of cancer in someones mouth or lungs with the text, Warning: Cigarettes cause cancer. (Cigarette Health Warnings, 2012). The Food and Drug Administration is currently proposing to the United States Congress the mandatory use of these labels on tobacco products. We will use one of the five designs per each subject; therefore, the design is incomplete. The other warning type will be text-only, which will simply display in a readable font with a plain background, Warning: Cigarettes cause cancer or, Warning: Cigarettes shorten life-expectancy. The state reactance questionnaire that will be used is adapted from Kaczkurkin (2008). It was modified from having 27 questions to 16 questions. The participants will be prompted with the question, How does this warning make you feel? Then, there will be eight different emotional words that characterize reactance (resistant, angry, stubborn, aggressive, and bitter)

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE and eight emotional words not characterized with reactance (happy, calm, stable, reserved, and sympathetic.). For each word the subject will report feeling the emotion between four amounts (not at all, a little bit, quite a bit, or very much), with a number value attached to the word (1, 2, 3, 4, and 5, respectively). With the non-reactant emotions reverse coded, we will find each participants average score to measure reactance on an interval scale (1 corresponding to not experiencing reactance and 4 corresponding to experiencing high reactance). Extraversion will be measured by an Eysenck personality questionnaire. It was taken

from a study showing it has valid internal consistency and test-retest reliability (Sato, 2005). The questions testing for neuroticism were removed, so only extraversion will be measured. There are eleven items, answered by yes or no. An example of a normally coded question will be, Do you like plenty of action and excitement around you? An example of a reverse-coded question will be, Are you mostly quiet when you are with other people? By choosing an odd number of questions participants will be clearly partitioned between extraversion and introversion, without some participants directly in the middle. Those participants who answer 7 or more responses coded as extraverted will be considered extraverts; the remaining participants will be considered introverted. Thus, extraversion and introversion will be measured on a nominal scale. A video clip from the BBC nature show, Planet Earth will also be used as an emotionally neutral stimulus to allow reactant responses to disperse between warning type conditions. Procedure After being screened for smoking habits that meet those of a moderate smoker (having smoked at least 100 cigarettes throughout their lives and at least once in the past 30 days), the participants will consent to being in this study. Then, they will fill out some basic demographic information before the experiment begins.

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE This study will use a 2 x 2 mixed design. The first independent variable uses repeated measures, with the two levels being the graphic warning and the text-only warning. In order to counterbalance for effects due to the order of presentation, half of the subjects will experience the graphic warning first (N=5) and the other half of the subjects will experience the text-only

warning first (N=5). The participants will view each graphic warning for 45 seconds. After each exposure to either level, the subjects will complete a self-report state reactance questionnaire. Between viewing the initial condition and the following condition, subjects will watch a five minute, an emotionally neutral video clip from the television show Planet Earth. This will help mitigate emotional carryover effects. The second independent variable is the subject variable of extraversion and uses independent groups. This will be measured nominally between two categories: predominantly extraverted and predominantly introverted. In order to measure this personality trait, the participants will fill out the self-report questionnaire from Sato (2005). In order to counterbalance possible prompts for the reactant responses or carryover effects from previously experienced reactance, half of the subjects will take the questionnaire before viewing the warnings (N=5) and the other half of the subjects will take the questionnaire after viewing the warnings (N=5). The dependent variable is state reactance, which is measured by the reactance questionnaire that is filled out after each warning type condition (Kaczkurkin, 2008). A score of 4 for each item indicates the highest reactance, and a score of 1 indicates the lowest reactance. Summing the scores for a total out of 64 indicates the overall reactance elicited by the respective warning.

Results

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE Figure 1 displays the mean scores for both graphic and text-only conditions, as well as the different scores between extraverts and introverts. In the text-only warning condition for extraverts, scores ranged from 32 to 38 (SD=2.45); the mean score for this condition was 35.0. In the text-only warning condition for introverts, scores ranged from 20 to 49 (SD=10.41); the mean score for this condition was 33.4. In the graphic warning condition for extraverts, scores ranged from 35 to 41 (SD=3.36); the mean score for this condition was 38.6. In the graphic

warning condition for introverts, scores ranged from 35 to 50 (SD=6.83); the mean score for this condition was 40.8. Both introverts and extraverts scored higher on the self-report reactance questionnaire when shown the graphic warning, as opposed to the text-only warning. Introverts had a far higher variability in scores across graphic and text-only conditions. Introverts scored lower on reactance with text-only warnings than extraverts. Also, introverts scored higher than extraverts on reactance with the graphic warning condition. We ran a 2 x 2 mixed ANOVA to obtain our results. The dependent variable was the amount of reactance experienced and was measured using a self-report reactance questionnaire scored from 0 to 64 (64 signifying the highest reactance level). The first independent variable (within-subjects) was the warning label type and was either a graphic or text-only. The second independent variable (between-subjects) came from natural groups: predominantly extraverted and predominantly introverted. Introverts and extraverts scored higher when exposed to the graphic warning, as opposed to text-only warning. However, this difference did not produce a significant main effect or interaction. There was a marginally significant main effect for warning type (F(1,8)=4.71, p=.062). There was no significant main effect for the extraversion/introversion natural groups variable

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE (F(1,8) =.01, p=.930). Lastly, there was no significant interaction effect for warning type by extraversion/introversion (F(1,8)=.56, p=.475). Our analyses marginally supported our hypothesis that graphic warnings elicit significantly more reactance than text-only warnings. Our analyses did not support our second

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hypothesis that extraverted individuals experience more reactance than introverted individuals in graphic and text-only warning conditions. Discussion Our hypothesis that graphic anti-smoking advertisements would cause more psychological reactance in smokers than text only advertisements was supported by our results. However, the results were only marginally significant for the main effect of warning type. Our second hypothesis predicted that extraverted individuals would experience more reactance than introverted individuals. This was not supported by our results because there was no significant main effect for the extraversion/introversion natural groups variable. Additionally, our results did not find a significant interaction for warning type by extraversion/introversion. The results of this study further the understanding of the relationship among extraversion/introversion, psychological reactance, and the type of anti-smoking advertisement viewed by current smokers. Graphic warnings can elicit more reactance than text-only warnings to smokers. While extraversion does play a role in smoking behavior according to past research, we found that extraverted personality traits to not affect how a person experiences reactance compared to how introverted personalities traits do. Our results suggest that the graphic, more explicit warning type may elicit higher levels of psychological reactance in smokers than text-only warnings. Previous studies have discovered that attitudes toward anti-tobacco policies are an important factor in determining smoking

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE behavior (Chen et al., 1999). This study also found that smokers were the most aware of antismoking policies and showed the least amount of support for them when compared to non-

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smokers. The results of this study implicate that graphic warnings may make an individual more likely to smoke in an effort to restore their personal freedom when they feel it is threatened. In agreement with our results and predictions, previous research has found that smokers have less positive attitudes toward strong tobacco control measures than non-smokers and elicit higher levels of reactance to graphic versus text-only anti-smoking warnings (Erceg-Hurn & Steed, 2011). Psychological reactance may cause graphic warning to have the opposite of the intended effect in current smokers. There was little research relating extraversion to reactance levels, but many previous research studies found significant correlations between extraversion and smoking behavior. Although, our results did not find that the extraversion/introversion natural group variable was significantly related to the level of elicited reactance, it is an important variable to consider for the onset and continuation of smoking. A previous study found that extraverted individuals were more likely to engage in smoking behavior (de Leeuw, et al., 2010). Also, extraverted individuals were found to be less likely to quit smoking than introverts (Helgason, et al., 1995). Since our results did not indicate any significant relationship between extraversion/introversion and elicited reactance, it suggests that other factors associated with extraversion increase an individuals likelihood to begin and continue smoking. These factors may include social influences, seeking more exciting behaviors, and being more open to new experiences. Extraverted behavior is characterized by stimulation- and attention-seeking behavior (Sato, 2005); cigarettes are a stimulant and smoking is a very social behavior. These factors likely contribute to the higher rates of smoking among extroverted individuals than introverts. Further

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE research could provide more insight on the relationship between extraversion and smoking behavior. Our results did not find a significant interaction for warning type by

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extraversion/introversion, because the data indicate that extraverted characteristics do not cause a person to experience reactance differently than one with introverted characteristics. Additional research could be conducted to find personality variables related to psychological reactance that would provide a more in depth understanding between personality variables, reactance, and smoking behavior. Identifying personality characteristics that make individuals likely to experience reactance would be useful in implementing successful anti-smoking policies for effective anti-smoking advertising and cessation programs. This study is not without limitations. Our results suggest that graphic anti-smoking advertisements may elicit higher level of reactance than text only warnings, but the results were only marginally significant. Another analysis with a larger sample size should be conducted to obtain a higher level of power. Additionally, while some members of our sample were obtained using the SONA system through the University of Minnesota Duluth campus, the remainder were obtained via a convenience sample due to difficulties in finding participant that were current smokers through the SONA system. It was most challenging to find current introverted smokers to include on our sample. A larger and more representative sample, obtained via random selection, would provide more accurate and powerful results that could be generalized to a larger and more diverse population. Finally, while multiple different graphic warnings were used, all of them were taken from the U.S. FDA. This set of warnings could be more or less intense than different warnings from the U.S. or around the world, which could be an alternative explanation to the levels of reactance that the warnings elicited.

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE Billions of dollars and millions of lives are at stake regarding anti-smoking control measures. Anti-smoking policies and advertising are increasingly limiting the perceived and

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actual freedom of current smokers in many ways, including limiting the places they can smoke, exposing them to anti-smoking advertising, and restriction of sales. Psychological reactance theory predicts that when an individual perceives that his or her freedom is being restricted that the individual will act in order to restore that freedom (Dauphinee, et al., 2006). These limitations may even cause smokers to experience reactance and engage in smoking to restore their personal autonomy if they feel their personal freedom is being threatened (Aar, et al., 2009). Future implementation of anti-smoking advertisements should take psychological reactance into consideration because graphic or explicit advertisements may produce the opposite of the intended effect in smokers if these advertisements elicit high levels of psychological reactance. Although extraversion/introversion was not found to significantly affect the amount psychological reactance experienced, it has been shown by previous research to be an important factor in determining smoking behavior. Future research should be conducted examining personality variables associated with smoking behavior and attitudes toward anti-smoking advertisements. The results could be useful for developing effective anti-tobacco policies and advertising. Another useful study to broaden the understanding of the level of reactance elicited from anti-smoking warnings could measure reactance levels using the independent variable of explicitness. This study could incorporate more types of graphic and visual anti-smoking warnings to provide useful results that may be beneficial for creating more effective antismoking advertisements. Although extraversion may not directly affect reactance responses, many governments have used or are considering the use of graphic anti-smoking warnings so it

ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE is important to gather a robust corpus of data to determine whether or not the use of such warnings will achieve the intended effect of smoking deterrence.

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ANTI-SMOKING WARNINGS, EXTRAVERSION, AND REACTANCE 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(1), 219-237. doi:10.1111/j.1559-1816.2010.00710.x Fisher, E.B., Govindan, R., Larsen, R. J., Walker, M.S., & Zona, D. M. (2004). Smoking urges and relapse among lung cancer patients: Findings from a preliminary retrospective study. Preventative Medicine, 39, 449-457. doi:2048/10.1016/j.ypmed.2004.04.035 Helgason, . R., Fredrikson, M., Dyba, T., & Steineck, G. (1995). Introverts give up smoking

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more often than extraverts. Personality and Individual Differences, 18(4), 559560. doi:10.1016/0191-8869(94)00189-Y Kaczkurkin, A. (2008). Developing a measure of psychological reactance. Munaf, M. R., & Black, S. (2007). Personality and smoking status: A longitudinal analysis. Nicotine & Tobacco Research, 9(3), 397-404. Doi:10.1080/14622200701188869 Ormel, J., Surtees, P. G., Tijhuis, M., & van Loon, A. J. (2005). Determinants of smoking status: Cross-sectional data on smoking initiation and cessation. European Journal of Public Health, 15(3), 256-261. doi:10.1093/eurpub/cki077 Sato, T. (2005). The Eysenck Personality Questionnaire Brief Version: Factor structure and reliability. The Journal of Psychology, 139, 545552.

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Text-only warning

Graphic warning

Figure 1. Self-report reactance questionnaire scores. Graphic shows that introverts scored lower in the text-only warning than extraverts, and introverts scored higher than extraverts in graphic warning. The text-only warning elicited lower reactance overall and the graphic warning elicited higher reactance overall.