Adolescent Attention to Disgust Visuals in Cigarette Graphic Warning Labels.

PURPOSE: Adolescents are often a target audience for disgust-eliciting antismoking messages, including graphic warning labels (GWLs) on cigarette packages. Yet, few studies have examined how adolescents attend and respond to disgust imagery frequently depicted in these messages. METHODS: A within-subjects eye-tracking experiment with middle school youth (N = 436) examined attention for GWLs that feature disgust versus nondisgust images. Hypotheses were based on emotion theory and previous findings with adult participants. This study also tested whether living with a smoker moderated effects of attention on negative emotions and risk beliefs. RESULTS: Participants paid similar levels of attention to warnings with disgust visuals as they did warnings with nondisgust visuals, accounting for other differences in the warnings. The presence of a disgust visual drew greater attention to the warning image and reduced attention for the warning text. These viewing patterns were similar for youth who live with a smoker and those who do not. Attention to disgust imagery was the only attentional factor to predict negative emotional reactions, and this relationship was driven by results observed among youth who live with a smoker. Attention to neither image nor text predicted risk beliefs. CONCLUSIONS: GWLs with disgust imagery do not trigger more or less attention to the overall warnings but do influence allocation of attention to images over text. Future work should confirm whether attention to disgust imagery itself is important for triggering negative emotional responses, particularly with youth for whom the message is more personally relevant.

Independent or synergistic? Effects of varying size and using pictorial images in tobacco health warning labels.

INTRODUCTION: Legal challenges have blocked the implementation of large, pictorial health warning labels (HWLs) in the U.S. In light of future legal questions the U.S. Food and Drug Administration may face in proposing alternative HWLs, we examined whether less restrictive HWL versions on the front of packs-smaller HWLs and/or text-only HWLs that do not include pictorial imagery-may be sufficient to promote cognitive and affective outcomes associated with smoking cessation. METHODS: We recruited low-income smokers in two separate experiments through field-based recruitment methods (Study 1, N = 497) or Amazon Mechanical Turk (MTurk) (Study 2, N = 495). In both studies, we randomly assigned participants to a no-HWL control condition or one of four HWL conditions in a 2 (pictorial vs. text-only) × 2 (50% vs. 30% size) between-subjects design. RESULTS: Relative to text-only HWLs, pictorial HWLs increased negative affect but not risk belief acceptance, cognitive elaboration about smoking harms, or quit intentions. The 50% HWLs increased quit intentions relative to the control condition in both studies. The 50% HWLs also outperformed the 30% HWLs in promoting quit intentions in Study 2. Subsequent analyses revealed that this effect in Study 2 may have been driven by the 50% HWLs strengthening the relationship between risk-related thoughts and intentions, although there was no evidence for this pattern in Study 1. We found no evidence for interaction effects between the pictorial and size manipulations. CONCLUSIONS: Our findings suggest that 50% HWLs, whether pictorial or text-only, can encourage low-income smokers to consider quitting under some conditions.

Effects of Varying Color, Imagery, and Text of Cigarette Package Warning Labels among Socioeconomically Disadvantaged Middle School Youth and Adult Smokers.

The U.S. Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) of 2009 paved the way for the Food and Drug Administration (FDA) to propose nine different graphic warning labels (GWLs) intended for prominent placement on the front and back of cigarette packs and on cigarette advertisements. Those GWLs were adjudicated as unconstitutional on the ground that they unnecessarily infringed tobacco companies' free speech without sufficiently advancing the government's public health interests. This study examines whether less extensive alternatives to the original full-color GWLs, including black-and-white GWLs and text-only options, have similar or divergent effects on visual attention, negative affect, and health risk beliefs. We used a mobile media research lab to conduct a randomized experiment with two populations residing in socioeconomically disadvantaged communities: biochemically confirmed adult smokers (N = 313) and middle school youth (N = 340). Results indicate that full-color GWLs capture attention for longer than black-and-white GWLs among both youth and adult smokers. Among adults, packages with GWLs (in either color or black-and-white) engendered more negative affect than those with text-only labels, while text-only produced greater negative affect than the packages with brand imagery only. Among youth, GWLs and text-only labels produced comparable levels of negative affect, albeit more so than brand imagery. We thus offer mixed findings related to the claim that a less extensive alternative could satisfy the government's compelling public health interest to reduce cigarette smoking rates.

Health Halo Effects from Product Titles and Nutrient Content Claims in the Context of "Protein" Bars.

Research on front-of-package (FOP) labeling demonstrates that nutrient content claims (e.g., "low fat") can lead consumers to perceive foods as healthier in general-effects that have been interpreted using halo effect theories of impression formation. Extending this work, the present study investigates whether these effects may depend on whether nutrient information comes in the form of a nutrient content claim ("good source of protein") or embedded within the product title itself ("protein" bar)-an important question given the popularity of energy/nutrition bars and ongoing policy debates over food-labeling regulation. Results from a between-subjects experiment (n = 274) revealed that although both conditions increased perceived protein content for a nutritional bar, only the product title condition increased overall perceptions of product healthfulness-an effect mediated by increased perceptions of additional non-claimed "healthy" nutrients (fiber, iron). Finally, although the presence of a traffic light warning label increased perceived sugar and calorie content, it did not counteract the effect of the product title on perceived healthfulness. We conclude with a discussion focused on implications for policy and health halo effects in the context of food labeling.

Socioeconomic variation in recall and perceived effectiveness of campaign advertisements to promote smoking cessation.

There are large disparities in cigarette smoking rates by socioeconomic status (SES) in many countries. There is mixed evidence about the relative effectiveness of smoking cessation media campaigns in promoting quitting between lower and higher SES populations, and studies suggest that some types of ad content may have differential effects by SES. We analyzed data from five waves of the New York Media Tracking Survey Online (MTSO), a web survey involving over 7000 adult smokers conducted between 2007 and 2009, to assess SES variation in response to smoking cessation ads. Smokers with low levels of education and income less often recalled ads focused on how to quit, and perceived them as less effective, than ads using graphic imagery or personal testimonials to convey why to quit. Contrary to predictions offered by the Stages of Change Model, we found no evidence that variation in readiness to quit smoking explained patterns of response by education. Results offer guidance for theorists and campaign planners in developing campaigns that are likely to promote cessation among less educated populations.