Self-affirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels

Effects of self-affirmation on university students' processing of health risk messages related to sedentary behavior

OBJECTIVE

Examine effects of self-affirmation on university students' processing of health risk messages related to sedentary behavior.

PARTICIPANTS

Eighty-eight students from a Canadian university (females = 53; males = 35; Mage = 21.74, SD = 5.36) participated during the 2018-2019 academic year.

METHODS

Participants were randomized to a self-affirmation (n = 43) or control group (n = 45), watched a video conveying sedentary behavior risk messages, and completed measures of acceptance, derogation, risk perceptions, negative affect, and intentions. A one-way between-groups multivariate analysis of variance (MANOVA) examined effects of condition on the combined set of outcome variables.

RESULTS

Self-affirmation had no observable effect on any outcome variables.

CONCLUSION

Self-affirmation did not appear to impact students' reactions to sedentary behavior risk messages. Given the lack of a manipulation check, however, this finding must be interpreted with caution. The Trigger and Channel framework offers a useful account of factors that influence self-affirmation effects. Implications and future research directions are discussed.

Effectiveness of Self-Affirmation Interventions in Educational Settings: A Meta-Analysis

School and university can be stressful contexts that can become an important source of identity threats when social prejudices or stereotypes come into play. Self-affirmation interventions are key strategies for mitigating the negative consequences of identity threat. This meta-analysis aims to provide an overview of the effectiveness of self-affirmation interventions in educational settings. A peer-reviewed article search was conducted in January 2023. A total of 144 experimental studies that tested the effect of self-affirmation interventions in educational contexts among high school and university students from different social and cultural backgrounds were considered. The average effect of self-affirmation interventions was of low magnitude (dIG+ = 0.41, z = 16.01, p < 0.00), with a 95% confidence interval whose values tended to lie between 0.36 and 0.45 (SE = 0.0253). In addition, moderators such as identity threat, participants' age, and intervention procedure were found. Through a meta-analysis of the impact of self-affirmation interventions in educational contexts, this study suggests that interventions are effective, resulting in a small mean effect size. Thus, self-affirmation interventions can be considered useful, brief, and inexpensive strategies to improve general well-being and performance in educational settings.

Information Avoidance: Past Perspectives and Future Directions

In the present age of unprecedented access to information, it is important to understand how and why people avoid information. Multiple definitions of "information avoidance" exist, and key aspects of these definitions deserve attention, such as distinguishing information avoidance from (lack of) information seeking, considering the intentionality and temporal nature of information avoidance, and considering the personal relevance of the information. In this review, we provide a cross-disciplinary historical account of theories and empirical research on information avoidance and seeking, drawing from research in multiple fields. We provide a framework of antecedents of information avoidance, categorized into beliefs about the information (e.g., risk perceptions), beliefs about oneself (e.g., coping resources), and social and situational factors (e.g., social norms), noting that constructs across categories overlap and are intertwined. We suggest that research is needed on both positive and negative consequences of information avoidance and on interventions to reduce information avoidance (when appropriate). Research is also needed to better understand temporal dynamics of information avoidance and how it manifests in everyday life. Finally, comprehensive theoretical models are needed that differentiate avoidance from seeking. Research on information avoidance is quickly expanding, and the topic will only grow in importance.

Self-Affirmation and Image/Performance Enhancing Drug Use in Recreational Exercise

Objectives: The use of image and performance enhancement drugs (IPEDs) in recreational sport represents an emerging public health and societal problem. The present study investigated whether self-affirmation changed exercisers' intentions to use IPEDs, via the effects of mental construal and message acceptance. Method: Sixty-eight exercisers who self-reported IPEDs use participated in the study and were randomly assigned to either a self-affirmation or a control group. All participants read a health-related message about the 10 consequences of IPEDs and subsequently completed a survey measuring message acceptance, mental construal, doping intentions and IPEDs-related social cognitive variables. Results: There were no significant differences between the self-affirmed and the control groups. Hierarchical linear regression analysis further showed that message acceptance, subjective norms, and situational temptation were significantly associated with intentions to use IPEDs. Conclusion: Our findings raise the possibility that for recreational exercisers IPED's use is seen mostly as a health-related matter than a socio-moral transgression.

The effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery. A randomized controlled trial

BACKGROUND

Self-affirmations help one focus on positive outcomes and adapt to new situations both psychologically and physiologically by the repetition of positive affirmation sentences. This method, which has promising results in symptom management, is predicted to have effective results in the management of pain and discomfort in patients undergoing open-heart surgery.

AIM

To investigate the effect of self-affirmation on anxiety and perceived discomfort in patients who have undergone open-heart surgery.

METHODS

This study adopted a randomized controlled pretest-posttest follow-up research design. The study was conducted at a public training and research hospital (Istanbul, Turkey) specialized in thoracic and cardiovascular surgery. The sample consisted of 61 patients randomized into two groups: intervention (n = 34) and control (n = 27). The participants of the intervention group listened to a self-affirmation audio recording for three days after surgery. Anxiety levels and perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured daily. The State Trait Anxiety Inventory (STAI) was used to measure the level of anxiety, meanwhile perceived discomfort regarding pain, dyspnoea, palpitations, fatigue and nausea were measured by a 0 to 10 Numeric Rating Scale (NRS).

RESULTS

The control group had significantly higher anxiety than the intervention group three days after surgery (P < 0.001). The intervention group had less pain (P < 0.01), dyspnoea (P < 0.01), palpitations (P < 0.01), fatigue (P < 0.001) and nausea (P < 0.01) than the control group.

CONCLUSIONS

Positive self-affirmation helped reduce anxiety and perceived discomfort in patients who underwent open-heart surgery.

CLINICALTRIALS

gov Identifier: NCT05487430.

Impact of Self-Affirmation on Responses to Health Warning Messages: Does Consideration of Future Consequences Matter?

Self-affirmation theory has inspired numerous studies that have tried to understand the effects of self-affirmation on defensive processing of threatening health messages and subsequent behavior. Despite the overall positive effects of self-affirmation, psychological processes through which self-affirmation exerts such impact remain unclear. We examined Consideration of Future Consequences (CFC) as a potential moderator of the effects of self-affirmation on responses to graphic cigarette warning warnings, in an attempt to shed light on the psychological processes. We conducted an experimental study in which 925 African American smokers were instructed to self-affirm (or not) prior to viewing graphic cigarette warning labels. We found that smokers with stronger present time orientation (PTO) experienced higher defensive responses as measured by anger, perceived message manipulation, and message derogation, after viewing graphic cigarette warning labels; whereas smokers with stronger future time orientation (FTO) reported less message derogation. PTO interacted with self-affirmation in predicting defensive processing measures, such that self-affirmation reduced message derogation at lower levels of PTO and increased message derogation and perceived message manipulation at higher levels of PTO. Self-affirmation also had a conditional indirect effect on smoking intentions and intention to quit smoking through measures of defensive processing. We discuss implications of our study.

Taking advantage of multiple identities to reduce defensiveness to personally threatening health messages

A host of studies have shown that self-relevant health messages may result in increased defensiveness and rejection of protective recommendations. Drawing on research showing that multiple identities offer psychological resources to deal with identity threats, we sought to examine whether the salience of an alternative identity before people are exposed to a personally relevant health message may buffer the threat and reduce defensive responses. Two studies were conducted on samples of daily smokers asked to read an antismoking message before completing a range of measures of defensiveness. Half of the participants had an alternative identity made salient beforehand (vs. no salience condition). Consistent with our hypotheses, Study 1 (N = 90) showed that this manipulation significantly reduced defensiveness to the message. Study 2 (N = 95) additionally showed that such effects only occurred when the alternative identity overlapped highly with the threatened identity. The theoretical implications of these findings are discussed.

Lowering Red Meat and Processed Meat Consumption With Environmental, Animal Welfare, and Health Arguments in Italy: An Online Experiment

Introduction

In addition to being a source of valuable nutrients, meat consumption has several negative consequences; for the environment, for animal welfare, and for human health. To persuade people to lower their meat consumption, it is assumed that the personal relevance of the topic of lowering meat consumption is important as it determines how people perceive the quality of the arguments.

Method

In an experimental exploratory field study (n = 139), participants recruited from the general Italian population were randomized to one of the four conditions with a text with pictures on the environmental, animal welfare, or health consequences of meat consumption, or a text on mustard (the control condition). The dependent variables were self-reported consumption of red meat and processed meat after 2 weeks. Personal relevance was assessed in the pre-test with self-reported meat consumption and intention.

Results

The interaction between pre-test meat consumption and condition was significant: In participants who scored high on pre-test meat consumption, the self-reported red meat consumption after 2 weeks in the health argument condition was significantly lower compared to the control condition and the environmental argument condition. The effects of pre-test intention as a moderator were less certain.

Discussion

The persuasive effects of the different arguments made a difference only in people who ate a relatively high level of meat in pre-test, and the type of arguments made a difference. Although the present outcomes are caused by the specific formulations of the arguments in this study, the results do show that it is relevant to choose the arguments carefully to ensure effectiveness.

Increasing Receptivity to COVID-19 Public Health Messages with Self-Affirmation and Self vs. Other Framing

There remains an urgent need for effective communication about the importance of widespread adherence to behavioral recommendations to control the COVID-19 pandemic that will also reduce resistance to such guidance. We examined two strategies for COVID-19 communication- (1) self-affirmation (reflecting on a personal value in order to boost self-integrity and reduce defensiveness to potentially threatening information); and (2) manipulating self/other message framing - and moderation of these strategies by COVID-19 risk. 600 participants (M_age = 32.55, 51% female) were recruited for an online study and, after assessment of risk factors for severe COVID-19 infection, were exposed to the experimental manipulations. Three classes of defensive responses were considered as outcomes of interest: reactance, attitudinal responses, and behavioral responses. We found that participants derogated the self-focused message more than the other-focused message. Further, other-focused messaging and/or self-affirmation were more likely to elicit positive responses among individuals at higher risk for COVID-19 complications. Our findings suggest having individuals affirm values prior to viewing COVID-19 messages, and framing messages in terms of the importance of protecting others, may be beneficial strategies for encouraging responsiveness - particularly if the targets of such messages are at risk of COVID-19 complications themselves.

Self-affirmation increases acceptance of information on COVID-19 vaccines and promotes vaccination intention

Previous studies have shown that self-affirmation increases acceptance of a message and motivates health behavior change. The present study investigated whether self-affirmation increases the acceptance of persuasive messages on COVID-19 vaccines and promotes vaccination intention. A total of 144 participants were randomly assigned to the self-affirmation (n = 72) or control (n = 72) groups before reading a persuasive message on COVID-19 vaccines. The results revealed that the self-affirmation group showed significantly higher acceptance of persuasive information on COVID-19 vaccines than the control group. Additionally, the self-affirmation group also showed significantly higher post-experiment vaccination intention than the control group. Mediation analysis indicated that increased acceptance of persuasive information significantly mediated the beneficial effects of self-affirmation on post-experiment vaccination intention. The present study demonstrated that self-affirmation could be an effective strategy for increasing the acceptance of persuasive messages on COVID-19 vaccines and promoting vaccination intention.

The Effects of Self vs. Group Affirmation and Message Framing on College Students' Vape-Free Campus Policy Support

A growing number of American colleges and universities have become vape-free campuses in response to the high e-cigarette use prevalence among young adults. However, little is known about communication or social-psychological factors associated with campus members' support for a tobacco policy prohibiting e-cigarette use on the campus (vape-free policy support). The present study explores the main and interaction effects of affirmation and message framing on the vape-free policy support among college students who vary in their vaping status. We conducted a computer-based experiment with a two (affirmation: self vs. group) by two (message framing: gain vs. loss) by two (vaping status: vapers vs. non-vapers) between-subjects design. Our analysis indicated that self-affirmation is associated with a higher level of vape-free policy support than group-affirmation. The main effects of message framing as well as two-way interactions between framing and affirmation were not statistically significant. A notable finding was the three-way interaction effect among affirmation, framing, and vaping status. For vapers, the level of policy support was the highest when they were self-affirmed and exposed to a gain-framed message. For non-vapers, the level of policy support was the highest when they were self-affirmed and exposed to a loss-framed message. Our findings suggest that colleges may use varied approaches in communicating a vape-free campus policy based on the target students' vaping status, and the group-pride or collective identity appeals may not be effective in promoting such policy.

Testing a Self-Affirmation Intervention for Improving the Psychosocial Health of Black and White Medical Students in the US

Self-affirmation interventions have been shown to mitigate the negative psychological effects of stereotype threat on Black students in secondary and undergraduate education. However, there is currently limited research testing whether Black students in medical schools may also experience the negative influences of stereotype threat. Until now, it has been unclear whether Black (vs. White) students experience a lower sense of belonging in medical school and whether they can benefit from self-affirmation interventions during medical training. With a longitudinal field experiment, we tested (a) whether Black (vs. White) medical students in the US experience decrements in psychological well-being (i.e., fatigue, depression, anxiety), sense of belonging, perceived residency competitiveness, and residency goal stability; and (b) the extent to which a self-affirmation intervention would ameliorate any observed disparities in these outcomes for Black students. With a sample of 234 Black and 182 White medical students across 50 schools in the US, we found that Black students tended to report more fatigue and less belonging than White students; however, the self-affirmation intervention did not significantly influence students' fatigue, depression, anxiety, or belonging. Unexpectedly, Black students in the self-affirmation (vs. control) condition reported lower perceived competitiveness for residency. White students' perceived competitiveness for residency was unaffected by the intervention. Exploratory analyses revealed that Black (vs. White) students were less likely to indicate stable residency goals over time, which may be an indication of threat; however, this racial gap was eliminated with the intervention. We discuss the plausible reasons for these findings and provide recommendations for future work in this area.

Proscriptive Injunctions Can Elicit Greater Reactance and Lower Legitimacy Perceptions Than Prescriptive Injunctions

Based on previous research investigating proscriptive injunctions (requesting that one should not do something) versus prescriptive injunctions (requesting that one should do something), we propose that proscription leads to greater reactance than does prescription for a range of actions, and that this effect is associated with lower perceived legitimacy of the injunction. Across five experimental studies, our student and general population samples received proscriptions or prescriptions and reported their reactance. Proscription led to greater reactance than did prescription in all five studies. This effect was accentuated by an authoritative source (Study 2), was mediated by the perceived legitimacy of the request (Study 3 and Study 4), and was attenuated by a self-affirmation intervention (Study 5). We suggest that proscriptions are viewed as more obligatory than prescriptions, limit the scope of behavioral alternatives, restrict perceived autonomy, and elicit greater reactance. The findings have implications for the design of effective persuasive communications.

Sustaining the integrity of the threatened self: A cluster-randomised trial among social assistance applicants in the Netherlands

Stereotypes and stigma associated with living on welfare or a low income can be a psychological threat that hampers performance and undermines aspirations. Our paper explores the potential of a novel self-affirmation intervention to mitigate such adverse impacts. The intervention comprises a verbal self-affirmation exercise for applicants during their first meeting with a caseworker. We conduct a cluster-randomised trial among a sample of 174 applicants for social assistance benefits in a Social Services office in Maastricht, the Netherlands. We measure outcomes on feelings of self-worth, stress, societal belonging, job search behaviour self-efficacy and cognitive performance immediately after the meeting. In our full sample, the intervention has a negative impact on feelings of societal belonging, but no effect on other outcomes. Effects, however, vary by subgroups. Our treatment increases negative feelings of self-worth and negatively affects societal belonging, but also improves cognitive performance among the group that had paid work in the previous two years. By contrast, self-affirmation positively impacts job search behaviour self-efficacy and cognitive performance for individuals who face increased challenges to (re)integrate into the labour market, proxied by lower levels of education or social assistance receipt in the previous two years. Since our intervention gives rise to testing more than one null hypothesis, we control the false discovery rate using the Benjamini-Hochberg approach. Our findings are sobering. Effects only remain significant for negative feelings of self-worth and improved cognitive performance for one particular subgroup: individuals with paid work in the past two years. This suggests self-affirmation may have reminded them of the time they still had a job, hence creating a backlash effect on feelings of self-worth. At the same time, they may have felt a need to distinguish themselves from others on social assistance benefits resulting in better cognitive performance. These interpretations are consistent with theory and empirical evidence on social identity and self-categorisation. We discuss the implications of our results and outline avenues for future work.

What if I Tell You E-Cigarette Users are Inferior? An Investigation of Social Identity Threat in Health Messaging

Drawing on the literature on social identity threat, this study examined how threatening ecigarette users' identities in a narrative impacts their perceived behavioral control regarding ecigarette use, and how this effect can be moderated by de-emphasizing the story character's user identity. In an experiment, current e-cigarette users (N = 395) read a conversation between the main character (an e-cigarette user) and their friend. Identity threat was manipulated using negative descriptions of e-cigarette users, and identity emphasis was manipulated through the main character's self-description. Results showed identity threat in a message could influence perceived behavioral control to reduce e-cigarette use through two routes. First, attacking ecigarette users' identity led to perceived threat, which predicted lower perceived behavioral control. Furthermore, character identity emphasis moderated the effect of identity threat: For a character with low identity emphasis, attacking (vs. not attacking) e-cigarette users' identity led to stronger perceived behavioral control; for a character with high identity emphasis, attacking (vs. not attacking) users' identity led to weaker perceived behavioral control. The findings extend the social identity perspective and contribute to health communication research by examining a health behavior-specific social identity and demonstrating the utility of social identity threat as a persuasion strategy.

Self-affirmation and responses to cigarette warning labels: The moderating role of message strength

The present research investigated whether message strength moderates the effect of self-affirmation on reactions given to cigarette warning labels. Three hundred eighty-four female (Study 1) and 383 male (Study 2) smokers completed a self-affirmation manipulation and then evaluated either strong or weak warning labels in terms of message derogation. Next, they reported their intentions to quit smoking. Only for the male sample, message strength moderated the effect of self-affirmation on message derogation. However, message strength did not have a moderating role on both message derogation and quit intentions for the female sample and on quit intentions for the male sample.

Smoking self-concept moderates the effects of self-affirmation on smoking-related beliefs and behavioral intentions

OBJECTIVE

Smoking stigmatization has been shown to hinder cigarette smoking cessation, especially among individuals with a strong smoker identity. Self-affirmation, a psychological threat-management coping strategy, can promote smoking cessation, and may mitigate the adverse consequences of stigmatization.

DESIGN

Data from an online sample of 1,020 U.S. adult smokers were analyzed using multiple linear regression.

MAIN OUTCOME MEASURES

Participants completed a self-affirmation (or no-affirmation control) writing task before viewing a smoking stigma (or non-stigma control) anti-smoking public service announcement video. Participants then reported smoking-related cognitions and behavioral intentions.

RESULTS

Among participants with strong-but not weak-ties to a smoker identity (smoking self-concept), self-affirming led to higher quit intentions compared to the control condition. Among participants with weak-but not strong-smoking self-concepts, those who self-affirmed had lower intentions to switch completely to e-cigarettes relative to the control condition. Exposure to stigmatization reduced intentions to seek cessation counseling, particularly among those with weak smoking self-concepts.

CONCLUSION

Findings demonstrate the critical role that smoking identity centrality plays in moderating reactions to both affirming and stigmatizing stimuli. Additional research is needed to better understand how self-affirmation and stigma-reduction interventions can be tailored and implemented in natural contexts.

Effects of self-affirmation on emotion and cardiovascular responses

Self-affirmation is the act of focusing on important aspects of the self, such as personal values and characteristics. We used a within-participants design (N = 125) to examine cardiovascular reactivity and self-reported affective responses to the practice of self-affirmation. In the self-affirmation condition, we asked participants to write about their top-ranked personal value for 5 min and used a writing exercise unrelated to personal values in the control condition. The International Affective Picture System was used to induce positive and negative emotion. Results showed that participants had greater high frequency heart rate variability and respiratory sinus arrhythmia (RSA) when practicing self-affirmation. During negative emotion induction, self-affirmation also led to lower maximum heart rate, higher RSA, and lower ratings of negative affect. Our findings suggest that the act of focusing on an important aspect of self has beneficial effects on psychological and physiological well-being.

Association of Spontaneous and Induced Self-Affirmation With Smoking Cessation in Users of a Mobile App: Randomized Controlled Trial

Background

Most smokers attempt to stop using cigarettes numerous times before successfully quitting. Cigarette cravings may undermine perceived competence to quit and thus constitute psychological threats to the individual’s self-concept. Self-affirmation may promote smoking cessation by offsetting these threats.

Objective

This study examines whether self-affirmation is associated with smoking cessation in the context of a cessation app. Two types of self-affirmation are examined: tendency to spontaneously self-affirm, and self-affirmation inductions added to a publicly available smoking cessation app (Smoke-Free Quit Smoking Now). In addition, this study explores whether optimism and emotional states (happiness, anger, anxiousness, hopefulness, sadness) predict smoking cessation.

Methods

All users who met the inclusion criteria, provided consent to participate, and completed a baseline assessment, including all individual difference measures, were randomized to 1 of 4 conditions. Half of the participants were randomly assigned to complete a self-affirmation induction upon study entry. Orthogonally, half of the participants were randomly assigned to receive self-affirming text notifications during their quit attempt or to receive conventional notifications. The induction and the text notifications were fully automated, and all data were collected through self-assessments in the app. Self-reported smoking cessation was assessed 1 month and 3 months following study entry.

Results

The study enrolled 7899 participants; 647 completed the 1-month follow-up. Using an intent-to-treat analysis at the 1-month follow-up, 7.2% (569/7899) of participants self-reported not smoking in the previous week and 6.4% (503/7899) self-reported not smoking in the previous month. Greater tendency to spontaneously self-affirm predicted a greater likelihood of cessation (P<.001) at 1 month after controlling for smoking-related variables. Neither self-affirmation induction influenced cessation. In addition, spontaneous self-affirmation did not moderate the relationship between self-affirmation inductions and cessation. Greater baseline sadness was associated with a lower likelihood of reporting successful cessation. Optimism predicted past-week cessation at the 1-month follow-up, and both happiness and anger predicted past-month cessation at the 1-month follow-up; however, none of these potential predictors moderated the relationship between self-affirmation conditions and successful cessation.

Conclusions

Spontaneous self-affirmation may be an important psychological resource for managing threats to self-concept during the smoking cessation process. Sadness may hinder quit attempts. Future research can explicate how spontaneous versus induced self-affirmation can promote smoking cessation and examine boundary conditions for the effectiveness of disseminated self-affirmation interventions.

Trial Registration

ISRCTN Registry 56646695; https://www.isrctn.com/ISRCTN56646695

Understanding self-affirmation effects: The moderating role of self-esteem

OBJECTIVES

Whether people benefit from self-affirmation in overcoming resistance to health messages may depend on their level of self-esteem. However, extant theories offer rival hypotheses about the role of self-esteem. We pitted these hypotheses against each other, building on the argument that how self-esteem shapes self-affirmation effects may depend on how and when people self-affirm.

DESIGN

A 3 (Self-affirmation type: value essay, attribute scale, control task) by 2 (Timing: pre-message, post-message) plus 1 (message-only) experimental, between-subjects design.

METHODS

Participants (N = 422) completed a value essay, an attribute scale, a control task, or no task, either before or after reading a message about health risks of excessive drinking. Participants then completed defensiveness and message acceptance measures.

RESULTS

Self-esteem moderated self-affirmation effects across different types and timing of self-affirmation. While participants with relatively high self-esteem consistently benefited from self-affirmation, participants with relatively low self-esteem experienced adverse effects from self-affirmation. Self-affirmed participants with high self-esteem showed lower psychological discomfort, lower personal risk discounting, and higher message acceptance than unaffirmed participants, while self-affirmed participants with low self-esteem showed higher psychological discomfort, higher personal risk discounting, and lower message acceptance than unaffirmed participants.

CONCLUSIONS

These findings support the proposition that self-esteem serves as affirmational resources, which implies that self-affirmation interventions to reduce defensiveness to health messages may be beneficial for people with high self-esteem but less so for people with lower self-esteem. Similar to much other self-esteem research, self-esteem was negatively skewed, which warrants caution in generalization of the findings across all levels of self-esteem.

Self-Affirmation Does Not Change Smokers' Explicit or Implicit Attitudes toward Smoking Following Exposure to Graphic Cigarette Warning Labels

Self-affirmation has shown promise in promoting pro-health attitudes following exposure to threatening health messages by reducing defensive processing of such messages. We examine the impact of self-affirmation prior to viewing graphic cigarette warning labels on implicit and explicit attitudes toward smoking in a sample of African American smokers (N = 151). Participants held negative explicit and implicit attitudes toward smoking. We found no direct effect of self-affirmation on either implicit or explicit attitudes. Self-affirmation and risk level did not interact to predict either attitude type. We discuss findings in terms of self-affirmation theory, attitude measurement, and the meta-cognitive model of attitude change.

Effects of self-affirmation on responses toward graphic cigarette warning labels: testing the mediating role of perceived susceptibility and self-efficacy

Purpose

The purpose of this study is to examine the effects of self-affirmation on African American smokers' intentions to quit smoking sooner and desire to stop smoking altogether in response to viewing graphic cigarette warning labels. It also tested the mediating role of perceived susceptibility and self-efficacy in explaining the impact of self-affirmation.

Design/methodology/approach

African American smokers (N = 158) were recruited to participate in a controlled experiment. Participants first completed a short questionnaire about their demographic background and smoking-related attitudes and behavior. They were then randomly assigned to engage in either a self-affirmation task or a control task and viewed two graphic cigarette warning labels subsequently. Participants then responded to a questionnaire about their perceived susceptibility to smoking-related diseases, perceived self-efficacy to quit smoking, intentions to quit smoking and desire to stop smoking altogether.

Findings

Results showed that engaging in self-affirmation prior to exposure to graphic cigarette warning labels increased African American smokers' perceived susceptibility to smoking-related diseases, but decreased their perceived self-efficacy to quit smoking. Furthermore, self-affirmation indirectly enhanced smokers' intentions to quit smoking sooner and desire to stop smoking altogether through increased perceived susceptibility. It also had an unexpected negative indirect effect on intentions to quit smoking sooner through decreased self-efficacy.

Originality/value

This study is one of the few studies that investigates the effect of self-affirmation on African American smokers' responses toward graphic cigarette warning labels.

Greater benefit of self-affirmation for prevention-focused individuals prior to threatening health messages

OBJECTIVE

Individuals are often defensive toward health messages that suggest they are putting their health at risk because such messages threaten their self-competence and integrity. Although self-affirmation can facilitate prevention behaviors in response to health messages, effects are variable. We examined whether disease prevention focus might strengthen self-affirmation's effects in response to disease prevention messages, given that prevention-focused individuals are likeliest to be persuaded by those messages after self-affirmation attenuates defensiveness.

DESIGN

In Study 1, participants were self-affirmed before a message about sexually transmitted infections. In Studies 2 and 3, individuals were self-affirmed prior to a message about alcohol and cancer risk.

MAIN OUTCOME MEASURES

Studies assessed intentions to use condoms, intentions to reduce alcohol, and willingness to drink alcohol in specific scenarios.

RESULTS

In Study 1, self-affirmation facilitated condom use intentions among those higher in prevention focus. In Studies 2 and 3, self-affirmation facilitated lower willingness to consume alcohol among those high in prevention focus. A meta-analysis across the three studies indicated that self-affirmation improved intentions and willingness under high, but not low, prevention focus (d = 0.20, p = .003).

CONCLUSION

These findings demonstrate that health prevention-focus can strengthen self-affirmation's effects, thereby improving responsiveness to health communications about behaviors that increase disease risk.

Effects of Self-Affirmation Feedback on Exercise Intention of Women in Their Twenties Depending on Construal Level

This study examines how type of instructor feedback influences cognitive processes conducive to participants' health behavior, using a new theoretical approach based on self-affirmation and construal level theory. In Study 1, feasibility self-affirmed feedback (FSF) and desirability self-affirmed feedback (DSF) were qualitatively explored with Vinyasa Yoga instructors, and four FSF and DSF feedback scenarios were developed. In Study 2, 55 (FSF group: 28 and DSF group: 27) women in their twenties participating in a Vinyasa Yoga program were randomly assigned to two experimental self-affirmation feedback groups (FSF and DSF) and exposed to FSF and DSF, respectively, for four weeks based on the scenarios developed in Study 1. The analysis of changes in exercise intention triggered by the participants' exposure to self-affirmation feedback showed that participants exposed to DSF experienced a more positive influence than those exposed to FSF in their continuation intentions of success.

Associations Between Internalized HIV Stigma and Tobacco Smoking Among Adolescents and Young Adults Living with HIV: The Moderating Role of Future Orientations

HIV stigma and future orientations impact the health of adolescents and young adults living with HIV (AYALWH); however, little is known about how these factors may impact tobacco use, and thereby long-term health status. This study examined associations between internalized HIV stigma, future orientations, and smoking behavior using a cross sectional survey of AYALWH ages 18 to 29 (N = 109). Greater levels of stigma were associated with increased odds of smoking, and greater future orientations were associated with a reduced odds of smoking. The interaction was significant, illustrating that stigma was significantly associated with an increased odds of smoking among AYALWH who reported low levels of future orientations, but not for those with high levels of future orientations. Findings underscore the importance of understanding how HIV stigma may undermine future aspirations of AYALWH. Interventions that target HIV stigma and future orientations may be critical for tobacco prevention and cessation.

Smoker identity and resistance to antismoking campaigns: The role of group entitativity

Past works have shown that identification with smokers predicts increased resistance to antismoking campaigns. In this research, we hypothesized that group entitativity, because it affects the extent to which people feel committed to act for their group, can mitigate this link. We conducted two studies with convenient samples of smokers that both included a measure of identification and measured (Study 1) or manipulated (Study 2) entitativity. Then, participants read an antismoking message and, finally, reported their attitude toward smoking (Studies 1 and 2), as well as their urge to smoke and intention to quit (Study 2). Consistently, both studies revealed more resistance among high (vs. low) identifiers, but only when they perceived smokers as a highly entitative group. These findings emphasized the importance of group processes and social identity factors for accounting for responses to antismoking information.

Combining a UV photo intervention with self-affirmation or self-compassion exercises: implications for skin protection

The current study tested whether self-affirmation or self-compassion exercises, shown to increase message acceptance, could maximize the benefit of a UV photo intervention on skin protection cognitions. College women (N = 167) were randomly assigned to: (1) view a UV photo or Black and White (no-UV) photo of their face and (2) write a self-affirmation, self-compassion, or neutral essay. Participants who saw their UV photo reported healthier cognitions, including greater perceived vulnerability and intentions to protect skin. Within the self-compassion condition, participants who saw their UV photo were also more likely to take the sunscreen packets offered. However, neither self-affirmation nor self-compassion enhanced the effect of the UV photo. Within the UV condition, women who completed these exercises had similar (and occasionally less healthy) cognitions and behavior as those who wrote a neutral essay. The benefits of self-affirmation and self-compassion in conjunction with health messages may be limited to higher risk groups who experience more message defensiveness than the current sample.

Self-Affirmation Reduces Delay Discounting of the Financially Deprived

Financial deprivation is associated with excessive discounting of delayed rewards. In the present research, we argue that this counterproductive tendency may be driven, at least in part, by the aversive and self-threatening nature of experiencing financial deprivation. Accordingly, we propose that self-affirmation-an intervention known to buffer negative consequences of psychological threats-may reduce delay discounting of the financially deprived. Results of two high-powered, preregistered experiments support this proposition. Specifically, in Study 1 (n = 546), we show that among participants with relatively lower income, self-affirmation effectively reduces delay discounting. In Study 2 (n = 432), we manipulate the feeling of financial deprivation and demonstrate that self-affirmation reduces delay discounting among those who feel financially deprived. We also examine the underlying process of this effect and find that self-affirmation bolsters a sense of personal control among those who feel financially deprived, which in turn reduces their delay discounting (Study 2). Overall, our findings suggest that the relationship between financial deprivation and delay discounting is malleable and psychological interventions that attenuate self-threats and bolster a sense of personal control can be applied to reduce myopic tendencies of the poor.

Do graphic health warning labels on cigarette packages deter purchases at point-of-sale? An experiment with adult smokers

This experiment tested whether the presence of graphic health warning labels on cigarette packages deterred adult smokers from purchasing cigarettes at retail point-of-sale (POS), and whether individual difference variables moderated this relationship. The study was conducted in the RAND StoreLab (RSL), a life-sized replica of a convenience store that was developed to evaluate how changing POS tobacco advertising influences tobacco use outcomes during simulated shopping experiences. Adult smokers (n = 294; 65% female; 59% African-American; 35% White) were assigned randomly to shop in the RSL under one of two experimental conditions: graphic health warning labels present on cigarette packages versus absent on cigarette packages. Cigarette packages in both conditions were displayed on a tobacco power wall, which was located behind the RSL cashier counter. Results revealed that the presence of graphic health warning labels did not influence participants' purchase of cigarettes as a main effect. However, nicotine dependence acted as a significant moderator of experimental condition. Graphic health warning labels reduced the chances of cigarette purchases for smokers lower in nicotine dependence but had no effect on smokers higher in dependence.

Investigating the Interplay of Self-Construal and Independent Vs. Interdependent Self-Affirmation

This study examines how the relative effects of independent and interdependent self-affirmation might be influenced by individuals' self-construal. A controlled experiment involving 186 Chinese adult smokers revealed a significant interactive effect of self-affirmation type and self-construal on message derogation and posttest attitudes toward smoking. For individuals with a dominant independent self-construal, independent self-affirmation (i.e., affirming the most important value to the self) led to less message derogation and more negative attitudes toward smoking than interdependent self-affirmation (i.e., affirming the most important value to the self and the family). In contrast, for individuals with a dominant interdependent self-construal, interdependent self-affirmation resulted in less message derogation and more negative attitudes toward smoking than independent self-affirmation. In addition, the interaction between self-affirmation type and self-construal had an indirect effect on perceived susceptibility to smoking-related diseases through message derogation. Theoretical and practical implications are discussed.

Adapting a self-affirmation intervention for use in a mobile application for smokers

Self-affirmation interventions can reduce defensive responses to threats to the self, but have had limited reach to the general population. We sought to create an effective and feasible version of the Kindness Questionnaire self-affirmation intervention for use on a mobile device outside the traditional university laboratory setting and by non-student participants. In an online experiment, 603 cigarette smokers (M_age= 37.5 years, SD = 10.2) were randomly assigned to one of six conditions in a 2 (Self-Affirmation: Self-Affirmation, No Self-Affirmation Control) × 3 (Example Type: Written, Imagined, No Examples) fully-crossed design. Participants read a message about the health harms of smoking. None of the self-affirmation variations were effective or feasible: the self-affirmation showed null effects on the primary outcomes of message acceptance, perceived message effectiveness, and reactance. It also backfired by reducing intentions to quit smoking and risk perceptions. Participants spent little time reading the health message, and those in the written self-affirmation condition infrequently provided detailed responses. Translating interventions developed and tested for efficacy in laboratory settings to "real-world" settings is necessary but challenging.

Social Tobacco Warnings Can Influence Implicit Associations and Explicit Cognitions

Previous research showed that fear-inducing graphic warning labels can lead to cognitive dissonance and defensive responses. Less threatening, social-related warning labels do not elicit these defensive responses, making them more effective in preventing smoking in adults. Given that smoking numbers are still too high among youngsters, it is crucial to investigate how warning labels should be designed to prevent teenagers from starting smoking in the first place. In two studies, we investigated whether comparable effects of social-related warning labels could be observed in a group of teenagers (14-17 years) who are not yet legally allowed to smoke. In addition, we tried to replicate earlier findings with smoking and non-smoking adults. Participants were presented with either health warning labels, social warning labels, or no warning labels. Subsequently, their explicit cognitions (i.e., risk perception, attitude toward smoking) and their implicit associations of smoking with healthiness/unhealthiness (Study 1a and Study 1b) and with positivity/negativity (Study 2a and Study 2b) were assessed. Results showed that in both studies, adult smokers had a higher risk perception and a more positive attitude toward smoking than adult non-smokers. Additionally, social warning labels lead to stronger implicit associations between smoking and negativity in Study 2 in the adult groups. In the teenage group, social warning labels lead to more positive attitudes than health warning labels in Study 2. No further effects on risk perception or implicit associations were found in the teenage group. Possible explanations are discussed.

Alcohol pictorial health warning labels: the impact of self-affirmation and health warning severity

BACKGROUND

We examined whether enhancing self-affirmation among a population of drinkers, prior to viewing threatening alcohol pictorial health warning labels, would reduce defensive reactions and promote reactions related to behaviour change. We also examined how health warning severity influences these reactions and whether there is an interaction between self-affirmation and severity.

METHODS

In this experimental human laboratory study, participants (n = 128) were randomised to a self-affirmation or control group. After the self-affirmation manipulation was administered, we tracked participants' eye movements while they viewed images of six moderately-severe and six highly-severe pictorial health warning labels presented on large beer cans. Self-reported responses to the pictorial health warning labels were then measured, including avoidance, reactance, effectiveness, susceptibility and motivation to drink less. Finally, participants reported their self-efficacy to drink less and their alcohol use.

RESULTS

There was no clear evidence that enhancing self-affirmation influenced any outcome. In comparison to moderately-severe health warnings, highly-severe health warnings increased avoidance and reactance and were perceived as more effective and increased motivation to drink less.

CONCLUSIONS

These findings call into question the validity of the self-affirmation manipulation, which is purported to reduce defensive reactions to threatening warnings. We discuss possible explanations for this null effect, including the impact of participants' low perceived susceptibility to the risks shown on these pictorial health warning labels. Our finding that highly-severe health warnings increase avoidance and reactance but are also perceived as being more effective and more likely to motivate people to drink less will inform future health warning design and have implications for health warning label theory.

Reconceptualizing Self-Affirmation With the Trigger and Channel Framework: Lessons From the Health Domain

Self-affirmation—a theory-based technique to affirm the adaptive adequacy of the self—can promote positive behavior change and adaptive outcomes, although effects are variable. We extend a novel framework (Trigger and Channel), proposing three conditions that facilitate self-affirmation-induced behavior change: (a) presence of psychological threat, (b) presence of resources to foster change, and (c) timeliness of the self-affirmation with respect to threat and resources. Using health behavior as a focus, we present meta-analytic evidence demonstrating that when these conditions are met, self-affirmation acts as a psychological trigger into a positive channel of resources that facilitate behavior change. The presence of a timely threat and the availability of timely resources independently predicted larger self-affirmation effects on behavior change, and the two interacted synergistically to predict still larger effects. The results illustrate the conditionality of self-affirmation effects and offer guidelines for when, where, and for whom self-affirmation will be most effective.

Effects of self-transcendence on neural responses to persuasive messages and health behavior change

Self-transcendence refers to a shift in mindset from focusing on self-interests to the well-being of others. We offer an integrative neural model of self-transcendence in the context of persuasive messaging by examining the mechanisms of self-transcendence in promoting receptivity to health messages and behavior change. Specifically, we posited that focusing on values and activities that transcend the self can allow people to see that their self-worth is not tied to a specific behavior in question, and in turn become more receptive to subsequent, otherwise threatening health information. To test whether inducing self-transcendent mindsets before message delivery would help overcome defensiveness and increase receptivity, we used two priming tasks, affirmation and compassion, to elicit a transcendent mindset among 220 sedentary adults. As preregistered, those who completed a self-transcendence task before health message exposure, compared with controls, showed greater increases in objectively logged levels of physical activity throughout the following month. In the brain, self-transcendence tasks up-regulated activity in a region of the ventromedial prefrontal cortex, chosen for its role in positive valuation and reward processing. During subsequent health message exposure, self-transcendence priming was associated with increased activity in subregions of the ventromedial prefrontal cortex, implicated in self-related processing and positive valuation, which predicted later decreases in sedentary behavior. The present findings suggest that having a positive self-transcendent mindset can increase behavior change, in part by increasing neural receptivity to health messaging.

Severity and susceptibility: measuring the perceived effectiveness and believability of tobacco health warnings

BACKGROUND

Pictorial tobacco health warning labels (HWLs) have been shown to be more effective than text-only HWLs in changing smoking attitudes and intentions. However, there is contradictory evidence regarding how the severity of the content of HWLs influences responses to them.

METHODS

We examined the perceived believability and effectiveness of HWLs in an online study using a convenience sample of non-smokers (N = 437) and smokers (N = 436). HWLs were in one of three presentation formats: (text-only, a moderately severe image or highly severe image) and focussed on three disease outcomes (lung cancer, blindness or tooth and gum disease). Participants rated the effectiveness and believability of each HWL and also rated their perceived susceptibility to each disease.

RESULTS

A 2 (smoking status) × 3 (presentation format) × 3 (disease outcome) ANOVA was run for both believability and effectiveness ratings. The most severe pictorial HWLs received the highest believability and effectiveness ratings and as expected, the text-only HWLs received the lowest. Lung cancer HWLs were rated most believable and effective, with the blindness HWLs receiving the lowest scores. A 2 (smoking status) × 3 (disease outcome) ANOVA was conducted on the ratings of perceived susceptibility to the three diseases. Smokers considered themselves to be more susceptible to all three diseases, and among smokers, perceived susceptibility to the diseases was positively correlated with effectiveness and believability ratings of the HWLs.

CONCLUSION

Our findings support previous evidence that pictorial HWLs are rated as more effective and believable than text-only warnings, and provide some support for the use of severe or 'grotesque' HWLs on tobacco products. Our data also suggest that HWLs should aim to increase perceived susceptibility to disease, as this was positively related to perceived message effectiveness and believability.

Can self-affirmation exacerbate adverse reactions to stress under certain conditions?

OBJECTIVE

Self-affirmation has repeatedly been shown to reduce adverse psychological and physiological responses to stress. However, it is plausible that self-affirmation could exacerbate negative reactions to stress under certain conditions. The current research explored whether self-affirmation would increase negative psychological responses to a stressor occurring in a central life domain characterised by low levels of control.

DESIGN

Female participants (Study 1 N = 132; Study 2 N = 141) completed baseline measures of anxiety and mood. They were then randomly allocated to complete a self-affirmation or control task, before reading a narrative documenting a stressful birth and imagining themselves in the place of the woman giving birth. After completing this task, participants again reported their levels of anxiety and positive mood.

MAIN OUTCOME MEASURES

Anxiety and positive mood assessed at follow-up.

RESULTS

Study 1 demonstrated that self-affirmed women experienced increased anxiety and less positive mood at follow-up, compared both to baseline and to women in the control condition. Study 2 revealed that the effect of self-affirmation on outcomes was moderated by fear of childbirth.

CONCLUSION

These results provide preliminary evidence that self-affirmation may worsen negative responses to stressors under certain conditions and for certain individuals.

Effects of Social Norms Information and Self-Affirmation on Sugar-Sweetened Beverage Consumption Intentions and Behaviors

The separate and combined efficacy of a social norms and a self-affirmation intervention to motivate decreased sugar-sweetened beverage (SSB) consumption was examined in two experiments. College students were randomly assigned to receive information about SSB consumption risks, norms, both, or neither. In addition, participants performed either a self-affirmation or control task. Self-affirmation only weakly affected SSB consumption intentions and behaviors. However, participants in Experiment 2 who received risks information, norms information, or both reported greater SSB reduction intentions than did those who received no information. Two-weeks later, those who received both types of information reported more frequent behavior change preparations, and it appears this effect may have been partially mediated by the changes in intentions to reduce SSB consumption.

Cigarette graphic warning labels increase both risk perceptions and smoking myth endorsement

OBJECTIVE

Cigarette graphic warning labels elicit negative emotion, which increases risk perceptions through multiple processes. We examined whether this emotion simultaneously affects motivated cognitions like smoking myth endorsement (e.g. 'exercise can undo the negative effects of smoking') and perceptions of cigarette danger versus other products.

DESIGN

736 adult and 469 teen smokers/vulnerable smokers viewed one of three warning label types (text-only, low emotion graphic or high emotion graphic) four times over two weeks.

MAIN OUTCOME MEASURES

Emotional reactions to the warnings were reported during the first and fourth exposures. Participants reported how often they considered the warnings, smoking myth endorsement, risk perceptions and perceptions of cigarette danger relative to smokeless tobacco and electronic cigarettes.

RESULTS

In structural equation models, emotional reactions influenced risk perceptions and smoking myth endorsement through two processes. Emotion acted as information about risk, directly increasing smoking risk perceptions and decreasing smoking myth endorsement. Emotion also acted as a spotlight, motivating consideration of the warning information. Warning consideration increased risk perceptions, but also increased smoking myth endorsement. Emotional reactions to warnings decreased perceptions of cigarette danger relative to other products.

CONCLUSIONS

Emotional reactions to cigarette warnings increase smoking risk perceptions, but also smoking myth endorsement and misperceptions that cigarettes are less dangerous than potentially harm-reducing tobacco products.

Using Self-affirmation to Increase the Effects of Emotive Health Warnings on Smoking: A Randomized Exploratory Trial

Introduction

Emotive health messages are widely used tools in tobacco control. However, under some circumstances, they can be less effective than desired by eliciting defensive responses in smokers.

Aims

This study tests whether enhancing a currently used emotive graphic smoking health warning with a self-affirmation component reduces cigarette consumption and whether potential effects are stronger in heavier smokers, as suggested by previous research.

Methods

Participants (n = 265) were randomly allocated to a self-affirmation (reflecting on personal values and positive traits using a questionnaire) or matched control condition before viewing an emotive graphic health message from a current Australian government public health campaign. The primary outcome (cigarettes per day [CPD]) was assessed both before and a week following the intervention.

Results

No main effect of self-affirmation on smoking, but as hypothesized, a significant interaction between baseline smoking and self-affirmation was found that showed that heavier smokers (>21 CPD) who self-affirmed significantly reduced CPD compared to nonaffirmed smokers.

Conclusions

These findings support the use of self-affirmation to enhance smoking awareness campaigns in heavier smokers.

Implications

This study shows that enhancing emotive graphic smoking health messages with self-affirmation (the act of reflecting on positive aspects of oneself) increases their effectiveness in heavier smokers. This suggests that self-affirmation might be a particularly useful tool for health promotion targeting heavier smokers. This study adds to previous research in that it is the first to test the add-on effects of self-affirmation to current graphic health messages on smoking rather than smoking-related cognitions.

The influence of threatening visual warnings on tobacco packaging: Measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods

The first aim of this research was to assess the effectiveness, in terms of emotional and behavioral reactions, of moderately vs. highly TVWs (Threatening Visual Warnings) displayed on tobacco packs. Given the key role that emotional reactions play in explaining the effect of TVWs on behaviors, psychophysiological and self-report methods were used-for the first time in this context-to measure the emotions provoked by TVWs. The second aim of this research was to determine whether increasing the size of warnings, and their display on plain packaging (compared with branded packaging) would improve their effectiveness. A within-subjects experiment was conducted. Three variables were manipulated: health warning threat level (high vs. moderate), image size (40% vs. 75%) and pack type (plain vs. branded). A convenience sample of 48 French daily smokers participated. They were exposed to eight different packs of cigarettes in a research lab at the University of Rennes. Smokers' emotions and behavioral intentions were recorded through self-reports. Emotions were also evaluated using psychophysiological measurements: electrodermal activity and facial electromyography. The results revealed that TVWs with a high threat level are the most effective in increasing negative emotions (fear, disgust, valence, arousal) and behavioral intentions conducive to public health (desire to quit, etc.). They also highlight the appeal of increasing the size of the warnings and displaying them on plain packs, because this influences emotions, which is the first step toward behavioral change. Increasing the threat level of TVWs from moderate to high seems beneficial for public health. Our results also confirm the relevance of recent governmental decisions to adopt plain packaging and larger TVWs (in the UK, France, Ireland, Canada, New Zealand, Hungary, etc.).