Avoidance of cigarette pack health warnings among regular cigarette smokers

Abstract

Background: Previous 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.

Method: A 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.

Results: Analysis 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.

Conclusion: Smokers 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.

Keywords: Adult smokers; Eye-tracking; Health warnings; Plain packaging; Smoking.

Figure 1

Examples of branded, plain and blank pack stimuli, respectively.

Figure 2

Number of saccades to branding (grey line) and health warnings (black line) on the three pack types. Error bars represent adjusted standard errors corrected for within-subjects comparisons.

Figure 3

Time-course analysis across the entire stimulus presentation of 10,000 ms to show the percentage of trials (20 trials per pack type) in which participants were fixating the branding (grey lines) as opposed to health warnings (black lines) for branded (A), plain (B) and blank (C) packs of cigarettes.