Visual attention to health warnings on plain tobacco packaging in adolescent smokers and non-smokers

Addiction. 2013 Feb;108(2):413-9. doi: 10.1111/j.1360-0443.2012.04028.x. Epub 2012 Oct 18.


Aims: Previous research with adults indicates that plain packaging increases visual attention to health warnings in adult non-smokers and weekly smokers, but not daily smokers. The present research extends this study to adolescents aged 14-19 years.

Design: Mixed-model experimental design, with smoking status as a between-subjects factor and pack type (branded or plain pack) and eye gaze location (health warning or branding) as within-subjects factors.

Setting: Three secondary schools in Bristol, UK.

Participants: A convenience sample of adolescents comprising never-smokers (n = 26), experimenters (n = 34), weekly smokers (n = 13) and daily smokers (n = 14).

Measurements: Number of eye movements to health warnings and branding on plain and branded packs.

Findings: Analysis of variance, irrespective of smoking status revealed more eye movements to health warnings than branding on plain packs, but an equal number of eye movements to both regions on branded packs (P = 0.033). This was observed among experimenters (P < 0.001) and weekly smokers (P = 0.047), but not among never-smokers or daily smokers.

Conclusion: Among experimenters and weekly smokers, plain packaging increases visual attention to health warnings and away from branding. Daily smokers, even relatively early in their smoking careers, seem to avoid the health warnings on cigarette packs. Adolescent never-smokers attend the health warnings preferentially on both types of packs, a finding which may reflect their decision not to smoke.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Attention / physiology*
  • Attitude to Health
  • Carbon Monoxide / analysis
  • Eye Movements / physiology*
  • Female
  • Humans
  • Male
  • Product Labeling*
  • Product Packaging / methods*
  • Self Report
  • Smoking / psychology*
  • Smoking Prevention
  • United Kingdom
  • Young Adult


  • Carbon Monoxide