BACKGROUND: Capsule cigarettes have become popular among Chinese smokers. While appealing packaging elements like colorful capsule are widespread, the health warnings remain text-only. This study aims to assess visual attention of capsule cigarette package elements, and its associations with package attraction, purchase intention and risk perception.
METHODS: We recruited 20 smokers and 20 non-smokers for an eye-tracking experiment. Each participant viewed 12 capsule cigarette packages randomly selected from a pool of 42 currently available in the Chinese market, all of which contained four elements: brand, capsule, graphic and health warning label (HWL). Participants viewed each package for 15 seconds, during which two eye-tracking variables were recorded: the fixation counts and fixation durations on pre-defined areas of interest (AOI). Fixation density was calculated by dividing the fixation count by the relative area of the AOI. After viewing each package, participants answered three questions to evaluate their perceived package attraction, purchase intention and risk perception.
RESULTS: For all participants, the brand and graphic received significantly higher fixation counts and longer fixation durations than HWLs (P＜0.001). Although the fixation counts and duration on capsule were lower than HWLs, its fixation density (2.92±2.89) was much higher than HWLs (1.00±0.76, P＜0.001). Especially for smokers, the fixation counts, durations and density on HWLs were significantly lower than those of non-smokers (P＜0.001).
For smokers, when placing more fixation on capsule, they were more likely to perceive higher package attraction (OR=1.13, 95% CI: 1.04–1.22), but also more likely to perceive higher health risks (OR=1.12, 95% CI: 1.01–1.22). For non-smokers, their fixation on the graphic was positively associated with attraction (OR=1.07, 95% CI: 1.04–1.22).
CONCLUSIONS: The text-only HWLs fail to compete with brands, graphics and capsules in capturing people's attention, especially for the smokers, ultimately rendering the HWLs on tobacco packaging ineffective.