Eye movement responses to health messages on cigarette packages

Bilingual Cigarette Warning Labels: Effects on Young People's Recall and Attention in Lebanon

The goal was to determine the effects of bilingual cigarette warning labels on the recall performance and attention of young bilingual Lebanese college students. Forty-eight students were shown English-only, Arabic-only, or bilingual cigarette warning labels in 2020. Participants recalled as many of the labels as they could after the experiment and then two weeks later. Eye tracking was used to determine attention to the label and subjective data were collected. Results showed that bilingual labels did not lead to better recall; participants needed more time to extract data from bilingual labels and first looked at them later in time, although bilingual labels were revisited more. However, participants believed that bilingual labels were better. It appeared that bilingual labels led to clutter rather than helped recall.

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

Over the years the general awareness of the health costs associated with tobacco smoking has motivated scientists to apply the measurement of eye movements to this form of addiction. On one hand they have investigated whether smokers attend and look preferentially at smoking related scenes and objects. In parallel, on the other hand eye tracking has been used to test how smokers and nonsmokers interact with the different types of health warning that policymakers have mandated in tobacco advertisements and packages. Here we provide an overview of the main findings from the different lines of research, such as the evidence related to the attentional bias for smoking cues in smokers and the evidence that graphic warning labels and plain packages measurably increase the salience of the warning labels. We point to some open questions, such as the conditions that determine whether heavy smokers exhibit a tendency to actively avoid looking at graphic warning labels. Finally we argue that the research applied to gaze exploration of warning labels would benefit from a more widespread use of the more naturalistic testing conditions (e.g. mobile eye tracking or virtual reality) that have been introduced to study the smokers' attentional bias for tobacco-related objects when freely exploring the surrounding environment.

Do negative emotions in social advertising really work? Confrontation of classic vs. EEG reaction toward advertising that promotes safe driving

Social campaigns are persuasive messages that attempt to communicate positive ideas and practices. One of the main challenges in designing effective social campaigns is the need to compete with other advertisements for viewers' attention. One of the most widely used methods of drawing attention to social advertising is the use of negative emotions. However, the effectiveness of negative emotional appeals in social campaigns is still a topic of debates. The aim of the study was to use both declarative and neural (EEG) measures to examine whether increasing the intensity of negative emotions in a social campaign enhances its effectiveness linearly or only to a certain level (curvilinear relation). The experimental study was conducted (N = 62) with road safety campaign, using three different levels of negative emotional intensity. The results showed that even though advertising with the strongest negative stimuli evoked the strongest negative emotions, it had no significantly stronger influence on behavioral intention (driving less risky) than moderately negative stimuli. Moreover, neural reaction to the negative stimuli in advertising depended on driving style-people with risky driving style payed less attention to more threatening message (higher beta oscillations).

Effects of Different Graphic Health Warning Types on the Intention to Quit Smoking

Anti-smoking advertisements are widely used to demonstrate to smokers the harm of smoking, and graphic health warnings (GHWs) are expected to have a positive effect on the intention to quit smoking. This study investigated which type of GHW (health-related threat (H-GHW) vs. social threat (S-GHW)) is more effective. Two types of GHWs for tobacco were shown to 28 daily smokers and 25 non-smokers while measuring their eye movements using an eye tracker. The time spent fixating on the GHWs was measured as an index of attentional bias. Participants were also asked to evaluate the unpleasantness of the images. They stated their intention to quit smoking in response to each image in a separate session. Multiple regression analysis was used to identify the effects of psychosocial factors on the intention to quit smoking in smokers and the intention to remain as non-smokers in the non-smokers. Both smokers and non-smokers reported greater unpleasantness and cessation intentions in response to H-GHWs than to S-GHWs. Non-smokers found both types of GHWs more unpleasant than smokers did. No differences were found in gaze fixation on GHWs between the two groups. When smokers viewed S-GHWs, the intention to quit smoking was greater as they felt more unpleasant. For non-smokers, the intention to remain non-smokers was greater when they felt more unpleasant and when the attention to H-GHWs was lower. Different psychological factors in anti-smoking advertisements are involved in the intention to quit smoking in smokers and to maintain a non-smoking status in non-smokers. Different approaches should be used according to the types of warning (e.g., warnings emphasizing a negative influence on others or on their own health) in anti-smoking campaigns.

Adolescent Attention to Disgust Visuals in Cigarette Graphic Warning Labels

PURPOSE

Adolescents are often a target audience for disgust-eliciting antismoking messages, including graphic warning labels (GWLs) on cigarette packages. Yet, few studies have examined how adolescents attend and respond to disgust imagery frequently depicted in these messages.

METHODS

A within-subjects eye-tracking experiment with middle school youth (N = 436) examined attention for GWLs that feature disgust versus nondisgust images. Hypotheses were based on emotion theory and previous findings with adult participants. This study also tested whether living with a smoker moderated effects of attention on negative emotions and risk beliefs.

RESULTS

Participants paid similar levels of attention to warnings with disgust visuals as they did warnings with nondisgust visuals, accounting for other differences in the warnings. The presence of a disgust visual drew greater attention to the warning image and reduced attention for the warning text. These viewing patterns were similar for youth who live with a smoker and those who do not. Attention to disgust imagery was the only attentional factor to predict negative emotional reactions, and this relationship was driven by results observed among youth who live with a smoker. Attention to neither image nor text predicted risk beliefs.

CONCLUSIONS

GWLs with disgust imagery do not trigger more or less attention to the overall warnings but do influence allocation of attention to images over text. Future work should confirm whether attention to disgust imagery itself is important for triggering negative emotional responses, particularly with youth for whom the message is more personally relevant.

Using Neuroscience to Inform Tobacco Control Policy

INTRODUCTION

Techniques employed in the field of neuroscience, such as eye tracking, electroencephalography, and functional magnetic resonance imaging, have been important in informing our understanding of the cognitive mechanisms underlying tobacco smoking. These techniques are now increasingly being used to investigate the likely impact of tobacco control policies.

AIMS AND METHODS

In this narrative review, we outline the value of these methodological approaches in answering policy-relevant tobacco control research questions, with a particular focus on their use in examining the impact of standardized cigarette packaging and health warnings. We also examine the limitations of these methodologies and provide examples of how they can be used to answer other policy-relevant questions.

RESULTS

We argue that neuroscience techniques can provide more objective evidence of the impacts of policy measures, allow investigation where it is not possible to conduct behavioral manipulations, and facilitate a deeper understanding of the cognitive mechanisms underlying the impacts of tobacco control policies such as standardized packaging, health warnings, point-of-sale displays, and mass media campaigns.

CONCLUSIONS

Rather than replacing more traditional methods of examining tobacco control measures, such as observational experiments, surveys, and questionnaires, neuroscience techniques can complement and extend these methods.

IMPLICATIONS

Neuroscience techniques facilitate objective examination of the mechanisms underlying the impacts of tobacco control measures. These techniques can therefore complement and extend other methodologies typically used in this field, such as observational experiments, surveys, and questionnaires.

Impact of tobacco-pack pictorial warnings on youth and young adults: A systematic review of experimental studies

INTRODUCTION

We conducted a systematic review of the experimental literature on the impact of tobacco-pack pictorial warning labels (PWLs) on youth and young adults.

METHODS

We systematically searched computerized databases and the reference lists of relevant articles. We included studies that used an experimental protocol to assess PWLs. Studies had to report findings for youth or young adult samples (aged <30 years). Thirty-one studies met the inclusion criteria, with a total sample size of 27506. Two coders independently coded all study characteristics and outcomes.

RESULTS

Twenty-eight studies experimentally evaluated PWLs for cigarette packs while three studies evaluated PWLs for smokeless tobacco packs. Generally, PWLs led to higher attention, stronger cognitive and affective reactions, more negative pack attitudes and smoking attitudes, and increased intentions not to use tobacco products compared to text warnings. PWLs were perceived to be more effective than text warnings for both cigarette packs and smokeless tobacco packs.

CONCLUSIONS

The systematic review showed that PWLs on tobacco products are effective across a wide range of tobacco-related outcomes among young people. Gaps in the literature include a lack of research on tobacco initiation and cessation and a dearth of literature on non-cigarette tobacco products.

Eye Movement Patterns in Response to Anti-Binge Drinking Messages

Health message design combines selected visual and textual components that are thought to work in concert to produce a particular intended message effect. Most health message effects research assumes rather than determines that message recipients attend to those visual and textual components. In contrast, the present research mapped viewing patterns of 50 participants in response to a set of anti-binge drinking print messages using eye-tracking methodology. Results showed that participants primarily viewed faces of persons portrayed in the messages, as well as alcohol use cues and cryptic one-liners. Textual components (e.g., information about consequences of heavy drinking) were viewed infrequently and briefly. Viewing patterns were associated with perceptions of message effectiveness, but more so for women than for men. Additionally, men, for whom anti-binge drinking messages were more self-relevant than for women, viewed message components more often and longer than women. These findings suggest that when message recipients view a self-relevant health message, they may attend primarily to a subset of components that do not necessarily convey the full message.

Differences in visual fixation duration according to the position of graphic health warning labels: An eye-tracking approach

INTRODUCTION

The Framework Convention on Tobacco Control (FCTC) recommends that graphic health warning labels (GHWLs) be positioned at the top of the principal area of cigarette packs, rather than at the bottom, to increase visibility. However, during the legislative process of introducing GHWLs in South Korea, the position of GHWLs has become a contested issue. The pro-tobacco industry group argued that the warnings should be placed at the bottom of cigarette packs because evidence for the effectiveness of the upper position was insufficient. Therefore, this study investigated whether the position of the GHWL affects eye movement.

METHODS

Participants (30 daily smokers and 24 non-smokers) were shown six cigarette packs in random order with different position combinations (top, middle, bottom) and image concepts (skin aging, toxic constituents). Participants’ eye movements were recorded using eye-tracking equipment to measure visual fixation duration in milliseconds (ms)

RESULTS

Participants visually fixated longer on the health warning area than on the tobacco branding area (p<0.05). Mean fixation duration on the health warning area was significantly longer at the top or middle positions compared to the bottom, by 28% (mean difference=340 ms, p=0.006) and by 30% (mean difference=368 ms, p=0.002), respectively. By contrast, mean fixation duration on the branding area was longer with the warning at the bottom compared to top or middle positions by 25% and 33%, with mean differences of 157 ms (p=0.100) and 212 ms (p=0.026), respectively. No significant difference in fixation time was observed between the top and middle positions (p>0.05)

CONCLUSIONS

The duration of visual fixation on GHWLs was longer when they were displayed at the top and middle, rather than at the bottom. Therefore, GHWLs should be positioned from the top to the middle of the tobacco package.

Path analysis of warning label effects on negative emotions and quit attempts: A longitudinal study of smokers in Australia, Canada, Mexico, and the US

BACKGROUND

Cigarette pack health warning labels can elicit negative emotions among smokers, yet little is known about how these negative emotions influence behavior change.

OBJECTIVE

Guided by psychological theories emphasizing the role of emotions on risk concern and behavior change, we investigated whether smokers who reported stronger negative emotional responses when viewing warnings reported stronger responses to warnings in daily life and were more likely to try to quit at follow-up.

METHODS

We analyzed data from 5439 adult smokers from Australia, Canada, Mexico, and the US, who were surveyed every four months from September 2012 to September 2014. Participants were shown warnings already implemented on packs in their country and reported negative emotional responses (i.e., fear, disgust, worry), which were averaged (range = 1 to 9). Country-stratified logistic and linear generalized estimating equations were used to analyze the effect of negative emotional responses on self-reported responses to warnings in daily life (i.e., attention, risk concern, avoidance of warnings, forgoing planned cigarettes) and quit attempts at follow-up. Models were adjusted for socio-demographic and smoking-related characteristics, survey wave, and the number of prior surveys answered.

RESULTS

Smokers who reported stronger negative emotions were more likely to make quit attempts at follow-up (Adjusted ORs ranged from 1.09 [95% CI 1.04 to 1.14] to 1.17 [95% CI 1.12 to 1.23]; p < .001) than those who reported lower negative emotions. This relationship was mediated through attention to warnings and behavioral responses to warnings. There was no significant interaction of negative emotions with self-efficacy or nicotine dependence.

CONCLUSION

Negative emotions elicited by warnings encourage behavior change, promoting attention to warnings and behavioral responses that positively predict quit attempts.

The use of neurocognitive methods in assessing health communication messages: A systematic review

We review 20 studies that examined persuasive processing and outcomes of health messages using neurocognitive measures. The results suggest that cognitive processes and neural activity in regions thought to reflect self-related processing may be more prominent in the persuasive process of self-relevant messages. Furthermore, activity in the medial prefrontal cortex, the superior temporal gyrus and the middle frontal gyrus were identified as predictors of message effectiveness, with the medial prefrontal cortex accounting for additional variance in behaviour change beyond that accounted for by self-report measures. Incorporating neurocognitive measures may provide a more comprehensive understanding of the processing and outcomes of health messages.

Eye Tracking Outcomes in Tobacco Control Regulation and Communication: A Systematic Review

OBJECTIVE

In this paper we synthesize the evidence from eye tracking research in tobacco control to inform tobacco regulatory strategies and tobacco communication campaigns.

METHODS

We systematically searched 11 databases for studies that reported eye tracking outcomes in regards to tobacco regulation and communication. Two coders independently reviewed studies for inclusion and abstracted study characteristics and findings.

RESULTS

Eighteen studies met full criteria for inclusion. Eye tracking studies on health warnings consistently showed these warnings often were ignored, though eye tracking demonstrated that novel warnings, graphic warnings, and plain packaging can increase attention toward warnings. Eye tracking also revealed that greater visual attention to warnings on advertisements and packages consistently was associated with cognitive processing as measured by warning recall.

CONCLUSIONS

Eye tracking is a valid indicator of attention, cognitive processing, and memory. The use of this technology in tobacco control research complements existing methods in tobacco regulatory and communication science; it also can be used to examine the effects of health warnings and other tobacco product communications on consumer behavior in experimental settings prior to the implementation of novel health communication policies. However, the utility of eye tracking will be enhanced by the standardization of methodology and reporting metrics.

Targeting smokers with empathy appeal antismoking public service announcements: a field experiment

A field experiment study (N = 189) was conducted to investigate the effectiveness of empathy appeal antismoking messages and their potential advantage over fear appeal messages. Data from 12 antismoking public service announcements showed that (a) smokers resist antismoking messages and (b) overall empathy appeal was equally effective as fear appeal messages. There was also evidence for moderators. First, empathy messages were more effective to women than to men. Second, fear appeal messages were more effective to occasional smokers than were empathy messages. Third, empathy messages were more effective to regular smokers than were fear appeal messages. Implications for audience segmentation and message targeting in public health antismoking efforts are discussed.

Standardised (plain) cigarette packaging increases attention to both text-based and graphical health warnings: experimental evidence

Objective

To investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings.

Study design

A factorial (two pack styles x three warning types) within-subject experiment, with participants randomised to different orders of conditions, completed at a university in London, UK.

Methods

Mock-ups of cigarette packets were presented to participants with their branded portion in either standardised (plain) or manufacturer-designed (branded) format. Health warnings were present on all packets, representing all three types currently in use in the UK: black & white text, colour text, or colour images with accompanying text. Gaze position was recorded using a specialised eye tracker, providing the main outcome measure, which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet.

Results

An opportunity sample of 30 (six male, mean age = 23) young adults met the following inclusion criteria: 1) not currently a smoker; 2) <100 lifetime cigarettes smoked; 3) gaze position successfully tracked for > 50% viewing time. These participants spent a greater proportion of the available time gazing at the warning-label region when the branded section of the pack was standardised (following current Australian guidelines) rather than containing the manufacturer's preferred design (mean difference in proportions = 0.078, 95% confidence interval 0.049 to 0.106, p < 0.001). There was no evidence that this effect varied based on the type of warning label (black & white text vs. colour text vs. colour image & text; interaction p = 0.295).

Conclusions

During incidental viewing of cigarette packets, young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use standardised packaging, regardless of the warning design.

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Standardised cigarette packs could increase the saliency of health warnings.

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Eye tracking can reveal how visual attention is allocated.

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Previous studies only assessed combined image-and-text health warnings.

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We found standardised packs increased attention to all current UK warning types.

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This provides additional support for statutory standardised cigarette packaging.

Young children's perceptions of health warning labels on cigarette packages: a study in six countries

Aim

Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children.

Subjects and methods

Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia.

Results

Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding.

Conclusion

While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.