Eye-tracking Viewing Patterns in High Versus Low Avoidance Warning Labels

Objectives: A critique of graphic warning labels has been concerning their potential to elicit avoidance where smokers avoid engaging with tobacco risk messages. To date, there are no studies that objectively measure how smokers visually engage with high versus low avoidance warning labels. Methods: Smokers (N = 360) were randomized to one of 9 warning labels, subsequently categorized as high (ie, depicting images of disease) or low avoidance. Participants attended 4 sessions over 10 days; eye movements were recorded while viewing warning labels to assess differences on attention and recall of specific areas of interest. Results: Latency to the image was not significantly different between groups, however, latency for text was longer in the high versus low avoidance group (p < .01). The total fixation duration on the image for high avoidance labels was longer than low avoidance labels (p < .001). Independent of warning label type, the image recall was high throughout; text and message recall started low and reached 80% correct recall by day 7. Conclusion: Graphic high avoidance images gain attention just as quickly as low avoidance images but tend to hold attention significantly longer than low avoidance images.