Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving.
BACKGROUND
Little research has examined the impacts of graphic health warnings on the users of smokeless tobacco products.


METHODS
A convenience sample of past-month, male smokeless tobacco users (n = 142; 100% male) was randomly assigned to view a smokeless tobacco advertisement with a graphic health warning (GHW) or a text-only warning. Eye-tracking equipment measured viewing time, or dwell time, in milliseconds. Following the advertisement exposure, participants self-reported smokeless tobacco craving and recalled any content in the health warning message (unaided recall). Linear and logistic regression analyses evaluated the proportion of time viewing the GHW, craving, and GHW recall.


RESULTS
Participants who viewed a GHW spent a significantly greater proportion of their ad viewing time on GHWs (2.87 seconds or 30%), compared to those viewing a text-only warning (2.05 seconds or 24%). Although there were no significant differences by condition in total advertisement viewing duration, those participants viewing a GHW had increased recall of health warning messages compared to the text-only warning (76% had any warning message recall compared to 53%; p < .05). Self-reported craving after advertisement exposure was lower in the GHW compared to text-only condition, but the difference was not statistically significant (a rating of 4.4 vs. 5.3 on a 10-point scale; p = .08).


CONCLUSIONS
GHWs attracted greater attention and greater recall of health warning messages compared to text-only warnings among rural male smokeless tobacco users.


CONCLUSIONS
Among a sample of rural smokeless tobacco users, GHWs attracted more attention and recall of health warning messages compared to text-only warnings when viewed within smokeless tobacco advertising. These findings provide additional empirical support that GHWs are an effective tobacco control tool for all tobacco products and advertisements.
College of Public Health, Ohio State University, Columbus, OH.
Elizabeth G
EG
Klein
College of Public Health, Ohio State University, Columbus, OH.
Amanda J
AJ
Quisenberry
College of Public Health, Ohio State University, Columbus, OH.
Abigail B
AB
Shoben
College of Public Health, Ohio State University, Columbus, OH.
Sarah
S
Cooper
College of Public Health, Ohio State University, Columbus, OH.
Amy K
AK
Ferketich
College of Public Health, Ohio State University, Columbus, OH.|College of Law, Ohio State University, Columbus, OH.
Micah
M
Berman
College of Arts and Sciences, Ohio State University, Columbus, OH.
Ellen
E
Peters
College of Public Health, Ohio State University, Columbus, OH.
Mary Ellen
ME
Wewers
D000328:Adult; D000329:Advertising; D001288:Attention; D066249:Craving; D053483:Eye Movement Measurements; D006801:Humans; D008297:Male; D011939:Mental Recall; D009820:Ohio; D011356:Product Labeling; D016540:Smoking Cessation / Q000523:psychology*; D014030:Tobacco, Smokeless / Q000009:adverse effects*