Abstract
BackgroundPrevious research with adults and adolescents indicates that plain cigarette packs increase visual attention to health warnings among non-smokers and non-regular smokers, but not among regular smokers. This may be because regular smokers: (1) are familiar with the health warnings, (2) preferentially attend to branding, or (3) actively avoid health warnings. We sought to distinguish between these explanations using eye-tracking technology. MethodA convenience sample of 30 adult dependent smokers participated in an eye-tracking study. Participants viewed branded, plain and blank packs of cigarettes with familiar and unfamiliar health warnings. The number of fixations to health warnings and branding on the different pack types were recorded. ResultsAnalysis of variance indicated that regular smokers were biased towards fixating the branding rather than the health warning on all three pack types. This bias was smaller, but still evident, for blank packs, where smokers preferentially attended the blank region over the health warnings. Time-course analysis showed that for branded and plain packs, attention was preferentially directed to the branding location for the entire 10s of the stimulus presentation, while for blank packs this occurred for the last 8s of the stimulus presentation. Familiarity with health warnings had no effect on eye gaze location. ConclusionSmokers actively avoid cigarette pack health warnings, and this remains the case even in the absence of salient branding information. Smokers may have learned to divert their attention away from cigarette pack health warnings. These findings have implications for cigarette packaging and health warning policy.
Highlights
A number of countries are considering, or have already implemented, plain packaging of cigarettes, as recommended by Article 13 of the World Health Organisation’s Framework Convention on Tobacco Control (WHO FCTC, 2005)
Analysis of variance indicated that regular smokers were biased towards fixating the branding location rather than the health warning location on all three pack types (p < 0.002)
This bias was smaller, but still evident, for blank packs, where smokers preferentially attended the blank region over the health warnings
Summary
A number of countries are considering, or have already implemented, plain packaging of cigarettes, as recommended by Article 13 of the World Health Organisation’s Framework Convention on Tobacco Control (WHO FCTC, 2005). In a series of eyetracking experiments, adult (Munafò et al, 2011) and adolescent (Maynard et al, 2013) nonsmokers and non-regular smokers made more saccades (eye movements) to health warnings, and fewer towards branding, on plain as compared with branded packs of cigarettes. Through sensory-driven bottom-up processes, attention is automatically drawn towards the most salient part of an image, where salience refers to the interplay between physical features and internal factors, such as the observer’s intentions and goals, which can potentially override automatic shifts of attention (Vincent et al, 2009) This increase in attention to health warnings on plain packs was not observed among either adult or adolescent regular smokers. We sought to distinguish between these explanations using eye-tracking technology
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