Attention and recall to graphic versus text warnings within cigarette advertising: An eye tracking study

American cigarette advertising is plentiful, with industry spending at over $8 billion annually.  The Food and Drug Administration (FDA) has mandated cigarette advertisements to include a graphic health warning label over 20% of the advertisement area.  Little research has focused on the optimum characteristics of health warnings labels (HWL) within cigarette advertisements.

 Methods: The study goal was to experimentally evaluate the impact of warning label size on attention.  Smokers (n=298) viewed 6 advertisements on a computer equipped with eye-tracking software, randomly assigned to view a cigarette ad with HWLs over 20% of the ad area, 33% of the ad area, or with a text only version.  Post-experiment surveys captured unaided recall of ad.  Regression analyses were used to examine the associations between attention and HWL recall.

 Results:   Participants spend an average of 17.7% of their time viewing the HWL (~1.8 seconds).  For all groups, the unadjusted odds of any unaided recall was increased by 1.4 for every second of attention paid to the HWLs (CI: 1.22-1.66).  After adjusting for group, the odds of recall remained significant.  Those who viewed a graphic HWL had increased odds of recall (p<0.05), but there was no difference in recall between the 20% and 33% experimental groups.

 Conclusions:  Findings support the use of graphic HWLs within cigarette advertising to attract consumer attention and encourage recall of health warning message themes.  The FDA proposed HWLs over 20% of advertising space were as effective as the larger warnings at attracting attention and recall among smokers.