BACKGROUND: Since 2016, South Korea has required that 50% of cigarette packs display pictorial health warning images and messages, with updates required every 24 months. This regulation applies to all tobacco products, including e-cigarettes and heated tobacco products (HTPs). To increase public awareness of the risks associated with tobacco use and to counteract marketing strategies that use tobacco package design, efforts have focused on expanding pictorial health warnings on packaging.
METHODS: This study investigates the optimal design elements, including size, placement, and color, for pictorial health warnings through an eye-tracking experiment. The study sample consisted of 40 participants, including 30 adults and 10 adolescents, selected to account for smoking status, gender, and age distribution. A total of 130 cigarette pack warning designs were developed as target stimuli, supplemented by 254 filler images to obscure the purpose of the study. Experimental conditions varied in the placement and size of the warnings, and participants' average fixation times on the warning areas were recorded. Stimuli were presented randomly across trials, and participants were asked to identify the cigarette pack design that most discouraged smoking during specific sessions.
RESULTS: Key findings indicate that warning effectiveness is maximized when warnings cover 90% of the cigarette package when pictorial health warning images and text overlap, and when the text background is red or black.
CONCLUSIONS: The study suggests that overlapping pictorial warnings and text and expanding the area covered by warnings through legislative changes could improve the effectiveness of pictorial health warnings. In addition, the adoption of standardized packaging policies is needed to complement these measures and strengthen tobacco control efforts.