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, η p 2 = 0.64] and visual attention (MD = 0.89, 95% CI = 0.09, 1.68, P = 0.03, η p 2 = 0.06) to long-term warnings, but not for reactance (MD = 0.14, 95% CI = –0.04, 0.32, P = 0.12, η p 2 = 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, η p 2 = 0.08). Study 2: higher self-reported avoidance of (MD = 0.70; 95% CI = 0.59,0.80, P < 0.001, η p 2 = 0.61) and reactance to (MD = 0.37; 95% CI = 0.27, 0.47, P < 0.001, η p 2 = 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, η p 2 = 0.01). Greater visual attention, avoidance and reactance to pictorial versus text-only warnings (all Ps < 0.001, η p 2 > 0.25). Study 3: greater self-reported avoidance of (MD = 0.37; 95% CI = 0.25, 0.48, P < 0.001, η p 2 = 0.33) and reactance to (MD = 0.14; 95% CI = 0.05, 0.23, P = 0.003, η p 2 = 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, η p 2 = 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.

Publication DOI: https://doi.org/10.1111/add.15148
Divisions: College of Health & Life Sciences
College of Health & Life Sciences > School of Psychology
College of Health & Life Sciences > Applied Health Research Group
Additional Information: © 2020 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. Funding: Cancer Research UK. Grant Number: C51287/A19332 Economic and Social Research Council. Grant Number: ES/R003424/1 Medical Research Council. Grant Number: MC_UU_12013/6
Uncontrolled Keywords: Attention,avoidance,eye-tracking,message framing,reactance,tobacco health warnings,Medicine (miscellaneous),Psychiatry and Mental health
Full Text Link: http://europepm ... ct/med/32506597
Related URLs: https://onlinel ... .1111/add.15148 (Publisher URL)
http://www.scop ... tnerID=8YFLogxK (Scopus URL)
PURE Output Type: Article
Published Date: 2021-01
Published Online Date: 2020-06-07
Accepted Date: 2020-05-29
Authors: Sillero-Rejon, C
Leonards, U
Munafò, MR
Hedge, C (ORCID Profile 0000-0001-6145-3319)
Hoek, J
Toll, B
Gove, H
Willis, I
Barry, R
Robinson, A
Maynard, OM

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