title: Standardised (plain) cigarette packaging increases attention to both text-based and graphical health warnings: experimental evidence.
abstract: OBJECTIVE
  To investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings.
  
  
  METHODS
  A factorial (two pack styles x three warning types) within-subject experiment, with participants randomised to different orders of conditions, completed at a university in London, UK.
  
  
  METHODS
  Mock-ups of cigarette packets were presented to participants with their branded portion in either standardised (plain) or manufacturer-designed (branded) format. Health warnings were present on all packets, representing all three types currently in use in the UK: black & white text, colour text, or colour images with accompanying text. Gaze position was recorded using a specialised eye tracker, providing the main outcome measure, which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet.
  
  
  RESULTS
  An opportunity sample of 30 (six male, mean age = 23) young adults met the following inclusion criteria: 1) not currently a smoker; 2) <100 lifetime cigarettes smoked; 3) gaze position successfully tracked for > 50% viewing time. These participants spent a greater proportion of the available time gazing at the warning-label region when the branded section of the pack was standardised (following current Australian guidelines) rather than containing the manufacturer's preferred design (mean difference in proportions = 0.078, 95% confidence interval 0.049 to 0.106, p < 0.001). There was no evidence that this effect varied based on the type of warning label (black & white text vs. colour text vs. colour image & text; interaction p = 0.295).
  
  
  CONCLUSIONS
  During incidental viewing of cigarette packets, young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use standardised packaging, regardless of the warning design.
authors.affiliation: Department of Psychology, City University London, London, UK; Barts Health NHS Trust, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Shankleman
authors.affiliation: Department of Psychology, City University London, London, UK.
authors.forename: C
authors.initials: C
authors.lastname: Sykes
authors.affiliation: Department of Global Health & Development, London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Mandeville
authors.affiliation: Institute of Cognitive Neuroscience & Department of Psychology, University College London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Di Costa
authors.affiliation: Department of Psychology, City University London, London, UK. Electronic address: kielan.yarrow.1@city.ac.uk.
authors.forename: K
authors.initials: K
authors.lastname: Yarrow
mesh_terms: D000328:Adult; D001288:Attention; D001315:Australia; D005133:Eye Movements; D005260:Female; D006801:Humans; D008131:London; D008297:Male; D011356:Product Labeling; D019064:Product Packaging / Q000379:methods*; D012907:Smoking / Q000523:psychology; D013997:Time Factors; D062789:Tobacco Products; D055815:Young Adult
keywords: Attention; Cigarettes; Eye tracking; Health warnings; Standardised packaging; UK