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Avoidance of tobacco health warnings? An eye‐tracking approach
Author(s) -
SilleroRejon Carlos,
Leonards Ute,
Munafò Marcus R.,
Hedge Craig,
Hoek Janet,
Toll Benjamin,
Gove Harry,
Willis Isabel,
Barry Rose,
Robinson Abi,
Maynard Olivia M.
Publication year - 2021
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.15148
Subject(s) - medicine , immediacy , eye tracking , confidence interval , reactance , psychology , demography , audiology , philosophy , physics , epistemology , quantum mechanics , voltage , sociology , optics
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 P s < 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.