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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.

Effects of Different Graphic Health Warning Types on the Intention to Quit Smoking