Abstract
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.
Highlights
To inform consumers about the risks of smoking, graphic health warnings (GHWs) are required on tobacco product packaging in over 100 countries
The participants were were performed using the statistical software package and the Jamovi shown cigarette packs labeled with the GHWs used in the first session, and the smokers were asked to rate their intention to quit smoking after seeing the picture using a five-point Likert-type rating scale (1 = do not really want to quit, 5 = really want to quit)
The results demonstrated that (1) when smokers viewed S-GHWs, the intention to quit smoking was greater as they found them more unpleasant, and (2) when non-smokers viewed H-GHWs, the intention to remain as non-smokers was greater, as they found them more unpleasant, and as they showed lower visual attention
Summary
To inform consumers about the risks of smoking, graphic health warnings (GHWs) are required on tobacco product packaging in over 100 countries. Res. Public Health 2020, 17, 3267 studies found that empathy-arousing messages were more effective than fear-arousing messages in anti-smoking campaigns [2], while induced hypocrisy had greater effects than fear appeals did on attitudes toward smoking cessation and intention to quit, at least in Eastern societies [3]. The similar effect was found in adolescent, except that adolescent non-smokers showed biased visual attention to health warnings on both packages plain or branded [11]. As GHWs are supposed to attract attention, it is necessary to measure the attentional behavior of the target consumers (smokers) and non-smokers to better understand their reactions to GHWs and the effectiveness of GHWs. In this study, we categorized the newly updated GHWs into images of health threats and social threats and examined which type of GHW was more effective in an anti-smoking campaign. We investigated the selective attention to each type of GHW using eye-tracking equipment and identified the psychosocial factors influencing the intention to quit smoking in smokers and to not start smoking in non-smokers
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