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 = 1413) 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.
Keywords: Health communication; Pictorial warnings; Reactance; Scale development; Tobacco control.