Avoidance of cigarette pack health warnings among regular cigarette smokers

Olivia M. Maynard*, Angela Attwood, Laura O'Brien, Sabrina Brooks, Craig Hedge, Ute Leonards, Marcus R. Munafò

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Previous research with adults and adolescents indicates that plain cigarette packs increase visual attention to health warnings among non-smokers and non-regular smokers, but not among regular smokers. This may be because regular smokers: (1) are familiar with the health warnings, (2) preferentially attend to branding, or (3) actively avoid health warnings. We sought to distinguish between these explanations using eye-tracking technology. Method: A convenience sample of 30 adult dependent smokers participated in an eye-tracking study. Participants viewed branded, plain and blank packs of cigarettes with familiar and unfamiliar health warnings. The number of fixations to health warnings and branding on the different pack types were recorded. Results: Analysis of variance indicated that regular smokers were biased towards fixating the branding rather than the health warning on all three pack types. This bias was smaller, but still evident, for blank packs, where smokers preferentially attended the blank region over the health warnings. Time-course analysis showed that for branded and plain packs, attention was preferentially directed to the branding location for the entire 10. s of the stimulus presentation, while for blank packs this occurred for the last 8. s of the stimulus presentation. Familiarity with health warnings had no effect on eye gaze location. Conclusion: Smokers actively avoid cigarette pack health warnings, and this remains the case even in the absence of salient branding information. Smokers may have learned to divert their attention away from cigarette pack health warnings. These findings have implications for cigarette packaging and health warning policy.

Original languageEnglish
Pages (from-to)170-174
Number of pages5
JournalDrug and Alcohol Dependence
Early online date15 Jan 2014
Publication statusPublished - 1 Mar 2014

Bibliographical note

Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd. Under a Creative Commons CC BY license.

Funding: Funding from the UK Centre for Tobacco and Alcohol Studies , British Heart Foundation, Cancer Research UK , Economic and Social Research Council , Medical Research Council , and the National Institute for Health Research , under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged.


  • Adult smokers
  • Eye-tracking
  • Health warnings
  • Plain packaging
  • Smoking


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