Avoidance of tobacco health warnings? An eye-tracking approach

Abstract

Aims: Across three eye-tracking studies, we examined how the location, framing, immediacy, and severity of health warnings on branded cigarette packs affected visual attention and self-reported avoidance of and reactance to warnings. Design: Study 1: smoking status × warning immediacy (short-term vs. long-term) × warning location (top of back vs. bottom of pack). Study 2: smoking status × warning framing (gain-framed vs. loss-framed) × warning format (text-only vs. pictorial). Study 3: smoking status × warning severity (highly-severe vs. moderately-severe). Setting: University of Bristol, UK, eye-tracking laboratory. Participants Study 1: non-smokers (n=25), weekly smokers (n=25), and daily smokers (n=25). Study 2: non-smokers (n=37), smokers contemplating quitting (n=37) and smokers not contemplating quitting (n=43). Study 3: non-smokers (n=27), weekly smokers (n=26) and daily smokers (n=26). Measurements: For all studies: relative number of fixations to the warning vs. the brand, self-reported avoidance of and reactance to warnings and for Study 3: effect of warning on quitting motivation. Findings: Study 1: Greater self-reported avoidance (p<0.001) and greater visual attention (p=0.03) to long-term warnings, but no difference for reactance (p=0.12). Increased visual attention to warnings on the upper- versus lower-half of the pack (p=0.02). Study 2: Higher self-reported avoidance of (p<0.001) and reactance to (p<0.001) loss-framed warnings but little evidence of a difference for visual attention (p=0.30). Greater visual attention, avoidance and reactance to pictorial versus text-only warnings (all ps>0.001). Study 3: Greater self-reported avoidance of (p<0.001) and reactance (p=0.003) to highly-severe warnings but no clear difference in visual attention (p=0.24). Conclusions: Subjective (self-report) and objective (eye-tracking) measures of warning avoidance produced different outcomes, suggesting these capture different constructs. Visual avoidance of warnings indicates low-level disengagement with warnings, while self-reported avoidance reflects higher-level cognitive awareness and engagement with warnings. We suggest that loss-framed, long-term, highly-severe images are likely to be most effective in communicating harm.

Are graphic health warnings impacting on message processing and quitting intentions?

“…A 20 s exposure was used to ensure adequate exposure of the tobacco GHW warnings to participants across each of the 14 GHW treatments for the subsequent analysis of variance (ANOVA) analysis. The 20 s exposure was in line with past tobacco eye-tracking studies (Kaufman et al , 2018) using similar fixed exposure timings ranging from 10 s (Sillero‐Rejon et al , 2019), 30 s (Lochbuehler et al , 2016) and 44 s (Bansal-Travers et al , 2016).…”

Nudge versus sludge in gambling warning labels: How the effectiveness of a consumer protection measure can be undermined

“…Enhancing gambling warning labels with similar fear-based appeals, especially ones which maintain people's self-efficacy (27), may serve as an even more effective behavior change mechanism in gambling, as the tobacco literature suggests (28).…”

Standardised packs and larger health warnings: visual attention and perceptions among Colombian smokers and non‐smokers

“…Visual attention to warnings is, therefore, a critical first step in warning engagement [10,14,15]. Eye‐tracking is considered a gold standard objective measure of attention to tobacco warnings [14,16–18]. Our previous research found that whereas daily smokers avert their gaze from warnings (i.e., avoid warnings), standardised tobacco packaging increases visual attention to health warnings among non‐smokers and non‐daily smokers [9,19,20].…”

“…Before this, however, warnings must first be noticed and must provoke a series of reactions (e.g., negative affect) [10,12]. Visual attention to warnings is, therefore, a critical first step in warning engagement [10,14,15]. Eye‐tracking is considered a gold standard objective measure of attention to tobacco warnings [14,16–18].…”