Kessels and Ruiter BMC Public Health 2012, 12:352 http://www.biomedcentral.com/1471-2458/12/352 repeated exposure to warning label messages. Finally, al- though we tested smokers that did not made any attempts to quit smoking, there are different kinds of smokers that could respond differently to the different messages. For example, the coping messages may have their greatest impact among smokers who are intending to quit. Conclusions By recording eye movements, the present study finds evidence that written coping information presented on cigarette packages attracts more attention from the viewer than high risk textual information, especially for those for whom the information is self-relevant (i.e., smokers). For non-smokers, for whom the health infor- mation is not self-relevant findings show mixed results, with attention preferences for coping information only when the information is combined with a low threat photo. This finding is in line with meta-analysis studies into the effectives of behavioural change interventions in other health domains such as HIV/AIDS and nutrition and physical activity [60,61]. These studies show that providing instructions about how to effectively adopt healthy behaviour could be a more useful tool in health education message design than providing threat infor- mation about the negative consequences of unhealthy behaviour X. The findings of the present study support this conclusion. Competing interests The authors declare that they have no competing interests. Authors' contributions LTEK carried out the eye-movement study, the analyses and drafted the manuscript. RACR participated in the design of the study, supervised the study conduct and helped to draft the manuscript. All authors read and approved the final manuscript. Received: 6 July 2011 Accepted: 14 May 2012 Published: 14 May 2012 References 1. Blumberg SJ: Guarding against threatening HIV prevention messages: An information-processing model. Health Educ Behav 2000, 27:780–795. 2. McGuire WJ: Attitude and attitude change. In The handbook of social psychology. Edited by Lindzey G, Aronson E. New York: Random House; 1985:233–346. 3. Baumeister RF, Bratslavsky E, Finkenauer C, Vohs KD: Bad is stronger than good. Review of General Psychology 2001, 5:323–370. 4. Smith NK, Cacioppo JT, Larsen JT, Chartrand TL: May I have your attention, please: Electrocortical responses to positive and negative stimuli. Neuropsychologia 2003, 41:171–183. 5. Taylor SE: Asymmetrical effects of positive and negative events: The mobilization-minimization hypothesis. Psychol Bull 1991, 110:67–85. 6. de Hoog N, Stroebe W, De Wit J: The impact of vulnerability to and severity of a health risk on processing and acceptance of fear-arousing communications: a meta-analysis. Review of General Psychology 2007, 11:258–285. 7. DeTurck M, Rachlin R, Young M: Effects of a role-model and fear in warning label on perceptions of safety behavior. Advances in Consumer Research 1994, 21:208–212. Page 8 of 9 8. Hammond D, Fong G, McNeill A, Borland R, Cummings K: Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2006, 15:19–25. 9. Nascimento BEM, Oliveira L, Vieira AS, Joffily M, Gleiser S, Pereira MG, Cavalcante T, Volchan E: Avoidance of smoking: The impact of warning labels in Brazil. Tobacco Control: An International Journal 2008, 17:405–409. 10. Hammond D: Health warning messages on tobacco products: a review. Tob Control 2011, . 11. Bansal-Travers M, Hammond D, Smith P, Cummings KM: The impact of cigarette pack design, descriptors, and warning labels on risk perception in the U.S. American. Journal of Preventive Medicine 2011, 40:674–682. 12. Thrasher JF, Rousu MC, Hammond D, Navarro A, Corrigan JR: Estimating the impact of pictorial health warnings and plain cigarette packaging: Evidence from experimental auctions among adult smokers in the United States. Health Policy 2011, 102:41–48. 13. Thrasher JF, Rousu MC, Anaya-Ocampo R, Reynales-Shigematsu LM, Arillo- Santillan E, Hernandez-A-1vila A: Estimating the impact of different cigarette package warning label policies: The auction method. Addict Behav 2007, 32:2916–2925. 14. Fong G, Hammond D, Jiang Y, Li Q, Quah A, Driezen P, Yan M: Perceptions of tobacco health warnings in China compare with picture and text-only health warnings from other countries: an experimental study. Tob Control 2010, 19:69–77. 15. Thrasher J, Villalobos V, Szklo A, Fong G, Pérez C, Sebrié E: Assessing the impact of cigarette package warning labels: a cross-country comparison in Brazil, Uruguay and Mexico. Salud Publica Mex 2010, 52:S206–215. 16. Terry-McElrath Y, Wakefield M, Ruel E, Balch GI, Emery S, Szczypka G, Clegg- Smith K, Flay B: The Effect of Antismoking Advertisement Executional Characteristics on Youth Comprehension, Appraisal, Recall, and Engagement. J Health Commun 2005, 10:127–143. 17. Harris PR, Mayle K, Mabbott L, Napper L: Self-affirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels. Health Psychol 2007, 26:437–446. 18. Ruiter RAC, Kok G: Saying is not (always) doing: Cigarette warning labels are useless. Eur J Public Health 2005, 15:329–330. 19. Ruiter RAC, Kok G: Response to Hammond et al. Showing leads to doing, but doing what? The need for experimental pre-testing. Eur J Public Health 2006, 16:225. 20. Falk E: Communication neuroscience as a tool for health psychologists. Health Psychol 2010, 29:355–357. 21. Kessels LTE, Ruiter RAC, Brug J, Jansma BM: The effects of tailored and threatening nutrition information on message attention. Evidence from an event-related potential study. Appetite 2010, 56:32–38. 22. Kessels LTE, Ruiter RAC, Jansma BM: Increased attention but more efficient disengagement: Neuroscientific evidence for defensive processing of threatening health information. Health Psychol 2010, 29:346–354. 23. Ruiter RAC, Abraham C, Kok G: Scary warnings and rational precautions: A review of the psychology of fear appeals. Psychol Health 2001, 16:613–630. 24. Barlow T, Wogalter MS: Alcoholic Beverage Warnings in Magazine and Television Advertisements. The Journal of Consumer Research 1993, 20:147–156. 25. Brown S, Locker E: Defensive responses to an emotive anti-alcohol message. Psychol Health 2009, 24:517–528. 26. Croyle RT, Sun YC, Hart M: Processing risk factor information: Defensive biases in health-related judgments and memory. In Perceptions of health and illness: Current research and applications. Edited by Petrie KJ, Weinman J. Amsterdam: Harwood Academic Publishers; 1997:267–290. 27. Ditto PH, Croyle RT: Understanding the impact of risk factor test results: Insights from a basic research program. In Social psychology of health. Edited by Salovey P, Rothman AJ. New York: Psychology Press; 2003:98–117. Key readings in social psychology]. 28. Fischer PM, Richards JW Jr, Berman EJ, Krugman DM: Recall and Eye Tracking Study of Adolescents Viewing Tobacco Advertisements. JAMA 1989, 261:84–89. 29. Freeman MA, Hennessy EV, Marzullo DM: Defensive evaluation of antismoking messages among college-age smokers: The role of possible selves. Health Psychol 2001, 20:424–433. 30. Keller PA: Converting the unconverted: The effect of inclination and opportunity to discount health-related fear appeals. J Appl Psychol 1999, 84:403–415.