• Andrea C Johnson, Melissa Mercincavage, Valentina Souprountchouk, Teresa Deatley, Darren Mays, and Andrew A Strasser.
• Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Tobacco Center of Regulatory Science (TCORS), Annenberg School of Communication, University of Pennsylvania-Rutgers University, Philadelphia, Pennsylvania. Electronic address: andrea.johnson1@pennmedicine.upenn.edu.
• Am J Prev Med. 2023 Nov 1; 65 (5): 809817809-817.

IntroductionAttention is a critical outcome to understanding the impacts of tobacco warning labels and is commonly measured using eye tracking. Self-report, online methods may be efficient, scalable alternatives to capture attention. This study assesses warning label attention on cigarette marketing using a heatmapping task.MethodsYoung adults (n=1,608) aged 18-30 years and registered on Mechanical Turk with a WorkerID verified in the U.S. were included. Data were collected in 2021-2022 and analyzed in 2022. Tobacco advertisement exposure included a 2 × 3 between-subjects factorial design for varying contexts and warnings. Attention was operationalized with self-reported frequency and timing of warning selection. Outcomes include credibility, willingness to use the advertised cigarettes, and intentions to use cigarettes and low-nicotine cigarettes.ResultsEarly and more frequent attention to the warning was associated with higher credibility (frequent: β=0.28, 95% CI=0.11, 0.44; early: β=0.14, 95% CI=0.02, 0.25), lower willingness to use the advertised cigarettes (frequent: β= -1.78, 95% CI= -2.24, -1.32; early: β= -1.16, 95% CI= -1.49, -0.84), lower cigarette use intentions in the next week (frequent: β= -0.44, 95% CI= -0.64, -0.25; early: β= -0.21, 95% CI= -0.35, -0.08), and lower low-nicotine cigarette use intentions in the next week (frequent: β= -0.47, 95% CI= -0.66, -0.28; early: β= -0.25, 95% CI= -0.38, -0.12) than no attention at all.ConclusionsGreater attention as measured by a heatmapping task was observed for pictorial warnings and associated with lower intentions to use tobacco. Heatmapping selection patterns were a suitable proxy for attention in this online sample.Copyright © 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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