Avoidance of tobacco health warnings? An eye‐tracking approach

Abstract

Aims Among three eye‐tracking studies, we examined how cigarette pack features affected visual attention and self‐reported avoidance of and reactance to warnings. Design Study 1: smoking status × warning immediacy (short‐term versus long‐term health consequences) × warning location (top versus bottom of pack). Study 2: smoking status × warning framing (gain‐framed versus loss‐framed) × warning format (text‐only versus pictorial). Study 3: smoking status × warning severity (highly severe versus moderately severe consequences of smoking). 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: visual attention, measured as the ratio of the number of fixations to the warning versus the branding, self‐reported predicted avoidance of and reactance to warnings and for study 3, effect of warning on quitting motivation. Findings Study 1: greater self‐reported avoidance [mean difference (MD) = 1.14; 95% confidence interval (CI) = 0.94, 1.35, P < 0.001, ηp2 = 0.64] and visual attention (MD = 0.89, 95% CI = 0.09, 1.68, P = 0.03, ηp2 = 0.06) to long‐term warnings, but not for reactance (MD = 0.14, 95% CI = –0.04, 0.32, P = 0.12, ηp2 = 0.03). Increased visual attention to warnings on the upper versus lower half of the pack (MD = 1.8; 95% CI = 0.33, 3.26, P = 0.02, ηp2 = 0.08). Study 2: higher self‐reported avoidance of (MD = 0.70; 95% CI = 0.59,0.80, P < 0.001, ηp2 = 0.61) and reactance to (MD = 0.37; 95% CI = 0.27, 0.47, P < 0.001, ηp2 = 0.34) loss‐framed warnings but little evidence of a difference for visual attention (MD = 0.52; 95% CI = –0.54, 1.58, P = 0.30, ηp2 = 0.01). Greater visual attention, avoidance and reactance to pictorial versus text‐only warnings (all Ps < 0.001, ηp2 > 0.25). Study 3: greater self‐reported avoidance of (MD = 0.37; 95% CI = 0.25, 0.48, P < 0.001, ηp2 = 0.33) and reactance to (MD = 0.14; 95% CI = 0.05, 0.23, P = 0.003, ηp2 = 0.11) highly severe warnings but findings were inconclusive as to whether there was a difference in visual attention (MD = –0.55; 95% CI = –1.5, 0.41, P = 0.24, ηp2 = 0.02). Conclusions Subjective and objective (eye‐tracking) measures of avoidance of health warnings on cigarette packs produce different results, suggesting these measure different constructs. Visual avoidance of warnings indicates low‐level disengagement with warnings, while self‐reported predicted avoidance reflects higher‐level engagement with warnings.

Your Eyes Do Not Lie! Dissecting Humor Effects in Health Messages Using Eye Tracker Technology

“…Fifth, the benefits of using humor on tobacco ads were more salient with smokers who revisited more often humorous messages compared to nonhumorous ones. This result suggests that humor could counteract the visual avoidance of tobacco health warnings observed in smokers on cigarette packs [e.g., ( 19 , 29 – 31 )]. With respect to a worrying increase in lung cancer recently reported in French women ( 28 ), this specific result provides some indication that humorous messages are a good strategy to communicate health risk messages to this target audience.…”

Risk communication improvements for gambling: House-edge information and volatility statements.

“…There may be drawbacks to including more information in gambling product messages, as gamblers may not attend to highly descriptive messages. It is therefore important that future studies employ process-tracing measures (e.g., eye-tracking) to explore optimal gambling message design, as has been done in the alcohol (Kersbergen & Field, 2017) and tobacco fields (Sillero-Rejon et al, 2020). Future studies should consider whether similar product messages can provide helpful advice in other gambling forms, such as sports betting (Hassanniakalager & Newall, 2019).…”

Eye tracking applied to tobacco smoking: current directions and future perspectives

“…More research on the issue is necessary also in the light of recent evidence suggesting that both subjectively reported avoidance and reactance, i.e. the subjective experience of threat, can be dissociated from overt attention to health warnings within specific contexts ( 90 ).…”