Kessels and Ruiter BMC Public Health 2012, 12:352 http://www.biomedcentral.com/1471-2458/12/352 smokers together further support the hypothesis that threatening health information attracts the least atten- tion among those to whom the health threat is most per- sonally relevant [22,40]. At the same time, studies are needed that examine the extent to which decreased at- tention for self-relevant high risk information transfers to positive effects of health messages with regard to the prevention of smoking uptake and the promotion of smoking cessation. Contrary to our expectations based on the evolutionary value of detecting risk in an early stage of information processing, and the finding that non-smokers judged the materials as less personally relevant than smokers, smo- kers and non-smokers did not differ on the amount of fixations and length of dwell time for the two types of texts when these were presented in combination with low threat photos. Instead both smokers and non-smo- kers, allocated more attention to coping information than to high risk information. In addition, with respect to the eye-movement data for the photos, smokers and non- smokers did not allocate attention differently to high threat and low threat photos. The results did show how- ever that both groups had more fixations and longer dwell time for low threat photos presented with a high risk text than for low threat photos presented with a cop- ing text. No attention differences were found for the high-threat photos in combination with either high risk or coping information. Overall, these secondary findings suggest that a high-threat photo seems to have a stronger impact on directing attention allocation processes for written health messages on a cigarette package than a low-threat photo. Similar to one of our previous studies [22], high-threat images seem to attract people’s atten- tion, but subsequent allocation processes are dependent on the self-relevance of the textual information with more attention for risk information among non-smokers and more attention for coping information (or more dis- engagement with risk information) among smokers. The finding that coping text information received more attention than high risk text information in smo- kers does not seem to be the result of the novelty of the presented textual information. Although coping infor- mation is much less visible on cigarette packages in the EU than threat information – 12 out of 14 health texts containing high risk information and only two texts con- taining coping information – smokers (and also non- smokers) did not judge the coping information to be more novel than the high risk information. In many countries outside Europe, risk and coping information are frequently combined in a single message. Future re- search should investigate whether this type of mixed messaging works better than either approach by itself. A potential weakening of the conclusion regarding the greater importance of coping information above threat Page 7 of 9 information among smokers is the finding that smokers judged the coping information as less positive and less personally relevant than the high risk information. This finding is in line with previous research showing that photos of people smoking (like those we used as low threat photos) are rated more positively by smokers than photos without smoking scenes [12]. A possible explan- ation could be that because the coping information received most attention, the viewers had more time to be critical on the information and subsequently judged the information as less positive and less personally rele- vant than the risk information. Another explanation is that risk information is simply more imminent than cop- ing information because referring directly to personally relevant threats and therefore is more positively evalu- ated and considered to be more personally relevant. Des- pite these differences it is important to note that coping information was evaluated positively rather than nega- tively with mean scores situated about the above scale midpoints. Finally, participants may have responded with social desirable statements. This study thus provides fur- ther evidence for the need to use more direct measures when studying important psychological processes that are conditional to the effectiveness of health communi- cations [20-22]. The present study has some limitations. First, we did not include a control text with neutral smoking informa- tion (e.g., “cigarette packages contain at least 19 cigar- ettes”). Although a comparison between neutral versus coping or high risk information would be useful to de- termine whether coping information results into more attention or less defensive avoidance compared with high risk information in smokers, neutral smoking texts would be at odds with the goal of the health messages and could therefore raise questions about the relevance and quality of this information and thus may interfere with attention processes under study. Second, we did not measure any recall or behaviour effects of the pre- sented health texts. Consequently, we cannot make any assumptions about an association between attention and memory or between attention and behaviour for the pre- sented information. It should be noted however that within-subjects designs are preferred in attention research to control for often strong inter-individual differences. At the same time, these designs make comparisons between experimental conditions at the level of recall and behaviour complicated due to possible contamin- ation of experimental conditions. Another limitation is that attention was measured under conditions of forced exposure to novel stimuli. Although previous ERP atten- tion studies already showed defensive reactions towards repeatedly presented high threat health information that is personally relevant [21,22], future research should investigate eye movement responses for initial and