Kessels and Ruiter BMC Public Health 2012, 12:352 http://www.biomedcentral.com/1471-2458/12/352 R E S E A R C H A R T I C L E Loes TE Kessels* and Robert AC Ruiter Abstract Open Access Eye movement responses to health messages on cigarette packages Background: While the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions. Methods: Eye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo. Results: Results of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos. Conclusions: Non-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion. Background An important goal of health education information is to encourage and motivate people to engage in health pro- moting and disease preventive behaviours. A prerequisite for achieving this goal is that people attend to the per- suasive message to which they are exposed to [1,2]. One way to achieve attention for the health information is to explicitly present the severe consequences of risky beha- viours performed by the target population, presumably * Correspondence: lte.kessels@maastrichtuniversity.nl Work & Social Psychology, Faculty of Psychology and Neuroscience, Maastricht University, PO Box 6166200MD, Maastricht, The Netherlands because negative information is believed to attract more attention than positive information [3-5]. Nowadays, cigarette packages frequently include health warnings (e.g., “Smoking causes fatal lung cancer”) with the aim to motivate people to refrain from smoking. A large body of self-report studies suggest that health warning labels are effective in informing people about the negative health consequences of smoking [6-14]. The self-reported cognitive and behavioural impact of health warning labels was found to be largest with prominent labels (i.e., in front and back of the package) supplemen- ted with emotionally graphic warnings that demonstrate the negative bodily impacts or human suffering due to © 2012 Kessels and Ruiter; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.