Do health warning labels on alcohol packaging attract visual attention? A systematic review.

OBJECTIVES: To synthesize eye-tracking-based evidence on consumers' visual attention devoted to alcohol warning labels (AWLs) on alcohol packaging. STUDY DESIGN: A systematic review was conducted and reported in accordance with the PRISMA guidelines. METHODS: Two rounds of a literature search were conducted to identify relevant peer-reviewed articles and unpublished grey literature. While the first round (July 3 to August 21, 2023) was based on three electronic databases (PubMed, Web of Science, and PsycINFO), the second round (May 20 to 28, 2024) followed a multiple-step protocol that systematically searched the grey literature. Five criteria were applied to screen eligible articles. Using established quality control tools, the identified articles were assessed for overall quality and then for quality specific to the eye-tracking method. RESULTS: Six published peer-reviewed articles were thus included in the current review along with one unpublished research paper from a doctoral thesis. This review paper summarizes earlier findings in terms of bottom-up (i.e., AWL design-related) factors such as size, color, surrounding border, and pictorial elements, and top-down (i.e., goal-driven) factors such as motivation to change drinking behavior and self-affirmation. The review found that people tend to pay very little attention to AWLs displayed on alcohol packaging, although there is mixed evidence as to the effectiveness of specific factors. CONCLUSIONS: Further investigations using eye-tracking are needed to collect additional evidence on attention devoted to AWLs. Meanwhile, we put forward implications for policymakers and future avenues for research based on our review of the existing literature.

Improving the effectiveness of pregnancy warning labels displayed on alcohol containers: a French eye-tracking study.

OBJECTIVES: Every year, foetal alcohol spectrum disorders impact 1 in 100 live births in France. France is one of the few countries with mandated labelling that must include a pregnancy warning. However, as the regulation passed with minimal specifications regarding the size and colour of the ensuing pictogram, the current pregnancy warning labels (PWLs) is often barely visible. This study investigated the potential influence of the PWL design on women's attention and alcohol product choice. STUDY DESIGN: The study used a within-subject experiment, with participants exposed to four PWL conditions. METHODS: An eye-tracking method was adopted. Eye movement was used as a proxy for measuring visual attention. In total, 4752 observations were collected (99 participants × 48 wine bottles) among women of childbearing age. RESULTS: The results show that almost none of the participants paid attention to the current French PWL. However, the findings also indicate that a larger colourful PWL, with a combined text and pictogram, attracts far more attention, and that participants chose the bottles of wine displaying this type of PWL less frequently. CONCLUSIONS: The study indicates that the current French PWL is insufficient to draw women's attention and suggests improvements to the PWL design to help increase its effectiveness.

Effect of combining fear and anger in anti-smoking messages to discourage young smokers.

OBJECTIVES: Previous studies have reported mixed results in reducing the prevalence of tobacco use among young people. The present study investigates the influence of a combined emotions (fear and anger) approach to strengthen the persuasive impact of anti-smoking messages aimed at young smokers. STUDY DESIGN: The study adopts a between-subject design experiment. METHODS: Participants were exposed to either a fear appeal or a fear and anger appeal message, after which they answered questions about their emotions, perceived message effectiveness, and intention to reduce cigarette consumption and to quit smoking. An original measure of the co-occurrence of emotions felt by the participants (minimum [MIN] score) was used and mediation analyses were conducted to test the relationship between the emotional content of the message and behavioral intentions through the co-occurrence of fear and anger and perceived message effectiveness. RESULTS: The findings show that the co-occurrence of fear and anger felt by individuals and perceived message effectiveness serially mediate the positive influence of a fear and anger appeal message compared to a fear alone appeal on changes in intention behavior (intention to reduce cigarette consumption, indirect effect = 0.152, 95% confidence interval (CI) [0.014, 0.340], and intention to quit smoking, indirect effect = 0.236, 95% CI [0.096, 0.413]). CONCLUSIONS: The study shows the interest of combining negative emotions in prevention messages and offers guidance for government agencies responsible for tobacco control policies to help them improve the effectiveness of anti-smoking messages.

Dissuasive cigarettes: which cues are the most effective at deterring young people from smoking?

OBJECTIVES: To counter the attractiveness of cigarettes, Article 11 of the Framework Convention on Tobacco Control provides for the possibility of including warnings on cigarettes. The objective of our research was to explore perceptions of cigarettes designed to be dissuasive (displaying the warning 'Smoking kills' in uppercase or lowercase, a 'skull and crossbones' pictogram, unattractive shades of brown or dark green or a combination of all these negative cues). STUDY DESIGN: In-depth interviews were conducted with 31 people in France aged 15-25 years (10 daily smokers, 10 occasional smokers and 11 non-smokers; 15 females and 16 males). METHODS: Participants were shown different dissuasive cigarettes (displaying the warning 'Smoking kills', a 'skull and crossbones' pictogram, unattractive shades of brown or dark green or a combination of all three) and current branded ones. Open-ended questions were asked about the attractiveness of the cigarettes, perception of risk, the image of the smoker and influence on the desire to quit or not to start. Discussions were audio-recorded and transcribed. RESULTS: The different dissuasive cues were found to increase negative health perceptions (e.g., increase risk), reduce positive smoker image and the perceived pleasure of smoking (e.g., embarrassment of smoking in front of friends), decrease the desire to start smoking and increase the desire to quit. The most dissuasive cigarette was an unattractively dark-coloured cigarette which displayed both the warning 'Smoking kills' and a 'skull and crossbones' pictogram. CONCLUSION: This study highlights the importance of the appearance of cigarettes and suggests that dissuasive cigarettes may be an innovative tobacco control measure for governments.

Attention to food health warnings in children's advertising: a French perspective.

OBJECTIVES: The objective of this study was to evaluate how much attention children pay to health warnings displayed on TV and print advertisements promoting drinks with added sugar, salt, or artificial sweeteners, and processed food products. STUDY DESIGN: The research was conducted in France among 50 children, using an eye-tracking system to record participants' eye movements on TV and print advertisements. METHODS: To reproduce the natural exposure conditions to TV commercials, the children were asked to watch a 12-min extract of an animated comedy film with two commercial breaks sandwiched between the extract. For the print ads, all the children were exposed to eight ads. The use of an eye-tracking system gave an objective measurement of the attention paid to the food health warnings. RESULTS: The results show that children exposed to these food product advertisements pay little or no attention to the warnings. Only 18% of the children made more than one eye fixation on the central message of the health warnings (the part displaying the health recommendation) for TV commercials, and almost no attention was given to warnings displayed on the print ads. CONCLUSIONS: This study shows that the French authorities should take stronger and more decisive measures to help children adopt healthy behavior because the current health warnings appear insufficient to inform children.