Avoidance of cigarette pack health warnings among regular cigarette smokers.
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.


METHODS
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.


CONCLUSIONS
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.
MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; UK Centre for Tobacco and Alcohol Studies, United Kingdom; School of Experimental Psychology, University of Bristol, United Kingdom. Electronic address: olivia.maynard@bristol.ac.uk.
Olivia M
OM
Maynard
MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; UK Centre for Tobacco and Alcohol Studies, United Kingdom; School of Experimental Psychology, University of Bristol, United Kingdom.
Angela
A
Attwood
School of Experimental Psychology, University of Bristol, United Kingdom.
Laura
L
O'Brien
School of Experimental Psychology, University of Bristol, United Kingdom.
Sabrina
S
Brooks
School of Experimental Psychology, University of Bristol, United Kingdom.
Craig
C
Hedge
School of Experimental Psychology, University of Bristol, United Kingdom.
Ute
U
Leonards
MRC Integrative Epidemiology Unit, University of Bristol, United Kingdom; UK Centre for Tobacco and Alcohol Studies, United Kingdom; School of Experimental Psychology, University of Bristol, United Kingdom.
Marcus R
MR
Munafò
D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D001519:Behavior; D005133:Eye Movements; D005260:Female; D006801:Humans; D008297:Male; D010775:Photic Stimulation; D011356:Product Labeling; D019064:Product Packaging; D012907:Smoking / Q000523:psychology; D062789:Tobacco Products; D055815:Young Adult
Adult smokers; Eye-tracking; Health warnings; Plain packaging; Smoking