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Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. Spring 2017 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. Spring 2017 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. Spring 2017 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017-05 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation Health Behavior Noel T. Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes; labels; reactance; smoking; tobacco; warnings eng Doctor of Philosophy Dissertation Health Behavior Noel T. Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 University of North Carolina at Chapel Hill Degree granting institution Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Understanding the Role of Reactance to Pictorial Warnings on Cigarette Packs Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes, labels, reactance, smoking, tobacco, warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Health Behavior Noel T. Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 Marissa Hall Creator Department of Health Behavior Gillings School of Global Public Health Background. Pictorial cigarette pack warnings may be less effective if they elicit reactance, a motivation to resist a perceived threat to freedom. This dissertation developed and validated a brief version of the Reactance to Health Warnings Scale (RHWS). The dissertation also sought to determine the mechanisms by which pictorial warnings elicit stronger quit intentions and subsequent quit attempts, and whether reactance weakened the effect of the warnings. Methods. To develop the Brief RHWS and to test mediation, I used data from a trial that randomly assigned 2,149 adult US smokers in 2014 and 2015 to receive pictorial warnings or text-only warnings on their cigarette packs for four weeks. To further evaluate the brief RHWS, I randomly assigned US adults (n=1,413) to view pictorial or text warnings on digital images of cigarette packs. Results. The three-item Brief RHWS had good internal consistency and test-retest reliability. The scale correlated with higher trait reactance (β=.32, p<.001) and exposure to pictorial warnings (β=.21, p<.001), supporting its convergent validity. With respect to predictive validity, the Brief RHWS was associated with lower perceived message effectiveness, lower quit intentions, greater avoidance of the warnings, and more cigarettes smoked per day (all p<.05). Pictorial warnings produced stronger quit intentions (p<.05) which were associated with a greater likelihood of making a quit attempt (p<.001). Negative affect toward the warnings mediated the effect of pictorial warnings on quit intentions (mediated effect=.25, p<.001), whereas message reactance suppressed the effect (mediated effect=-.06, p<.001). Negative affect was associated with greater perceived likelihood of harm from smoking and anticipated regret of continuing to smoke, which were in turn associated with stronger quit intentions (all p<.05). Conclusion. The Brief RHWS can aid in the development of persuasive messages. Pictorial warnings elicited greater quit intentions, an effect that was stronger after accounting for message reactance. Negative affect appears to be a key mechanism by which pictorial cigarette pack warnings exert their effect on smoking-related cognitions and behaviors. Moreover, pictorial warnings changed risk appraisals and quit intentions indirectly through negative affect. 2017 Public health Communication Public policy cigarettes; labels; reactance; smoking; tobacco; warnings eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Noel T. Brewer Thesis advisor Seth Noar Thesis advisor Marcella Boynton Thesis advisor Paschal Sheeran Thesis advisor Kurt Ribisl Thesis advisor text 2017-05 Hall_unc_0153D_16794.pdf uuid:05310319-8098-436b-a6df-70d3ab0fa58e 2017-04-10T17:41:00Z 2019-07-05T00:00:00 proquest application/pdf 2551825 yes