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

M Shankleman,C Sykes,K.L Mandeville,S Di Costa,K Yarrow

doi:10.1016/j.puhe.2014.10.019

M Shankleman, C Sykes + Show 3 more

Open Access

https://doi.org/10.1016/j.puhe.2014.10.019

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Abstract

ObjectiveTo investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings. Study designA 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. MethodsMock-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. ResultsAn 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). ConclusionsDuring 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.

Highlights

Tobacco use is a global public-health priority
The health warning types, with three levels, varied publichealth 1 2 9 ( 2 0 1 5 ) 3 7 e4 2 between monochrome text-only warnings, graphic colour warnings containing an image alongside a text warning, and colour text-only warnings
There were clear differences in accumulated gaze time between the three types of health warnings, with greater gaze times for colour text compared to colour image & text, and for colour image & text compared to black & white text (F(2,58) 1⁄4 52.6, p < 0.001, partial h2 1⁄4 0.645)

Summary

Introduction

Tobacco use is a global public-health priority. Half of users will die prematurely because of their habit.[1]. 80,000 people a year.[2] Once smokers start, it is very hard to give up (two thirds of smokers would like to quit) and young people are vulnerable, with the majority of smokers starting before the age of 18.2 Various tobacco control measures have been proposed to help reduce the number of new smokers taking up the habit, including the use of standardised packaging for tobacco products. The UK government, having initially appeared to reject standardised packaging, is developing regulations for its introduction.[4] There are several potential benefits to standardised packaging, which include decreasing the appeal of cigarette packs, reducing confusion between different colour packs and associated health risks, and potentially increasing the effectiveness of health warnings.[5] a systematic review commissioned for the UK government's first consultation suggested that standardised packaging enhances the salience of health warnings.[6] The review identified a number of studies investigating, for example, the effect of standardised packaging on both recall and assessment of health warnings. That the review identified only one study recording eye movements, which are arguably the most direct and objective measure available for investigating visual attention.[7]

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