The effect of pictorial warnings on cigarette packages on attentional bias of smokers

Given that previous studies demonstrated that smoking-related cues (like cigarette packages) grab the attention of smokers and thereby contribute to craving and tobacco seeking we investigated how pictorial health warnings presented on cigarette packages affect attention allocation towards cigarette packages. The WHO advises the use of pictorial health warnings on cigarette packages. However, at present no experimental studies are available investigating if pictorial warnings modulate incentive properties of cigarette packages. Fifty-nine tobacco smokers and 55 non-smokers performed a visual dot probe task to assess attention allocation towards cigarette packages with and without health warnings. Smokers were divided a priori in a group of light smokers (<20 cigarettes/day; n=39) and heavy smokers (≥20 cigarettes/day; n=20). Psychometric measures on anxiety and nicotine craving were administered. Light smokers showed an attentional bias towards packages without pictorial warnings while no effects were observed in the other groups. In heavy smokers attention allocation towards pictorial health warnings was associated with an increase of craving and anxiety. The results have a potential public health perspective as pictorial health warnings might be an effective strategy to reduce attentional bias towards cigarette packages of light smokers, while counterproductive effects in heavy smokers warrant further investigation.

[1]  M. Wakefield,et al.  Do graphic health warning labels have an impact on adolescents' smoking-related beliefs and behaviours? , 2008, Addiction.

[2]  K. Ackermann,et al.  Die Erfassung des Cravings bei Rauchern mit einer deutschen Version des "Questionaire on Smoking Urges" (QSU-G) , 2001 .

[3]  G. Kok,et al.  Response to Hammond et al. Showing leads to doing, but doing what? The need for experimental pilot-testing , 2006 .

[4]  Karl Mann,et al.  Attentional bias in alcohol-dependent patients: the role of chronicity and executive functioning. , 2009, Addiction biology.

[5]  M. Field,et al.  Attentional bias in addictive behaviors: a review of its development, causes, and consequences. , 2008, Drug and alcohol dependence.

[6]  K. Mogg,et al.  Attentional and approach biases for smoking cues in smokers: an investigation of competing theoretical views of addiction , 2005, Psychopharmacology.

[7]  Xavier Noël,et al.  Time course of attention for alcohol cues in abstinent alcoholic patients: the role of initial orienting. , 2006, Alcoholism, clinical and experimental research.

[8]  K. Berridge,et al.  The incentive sensitization theory of addiction: some current issues , 2008, Philosophical Transactions of the Royal Society B: Biological Sciences.

[9]  Maurizio Fava,et al.  Neural Substrates of Attentional Bias for Smoking-Related Cues: An fMRI Study , 2010, Neuropsychopharmacology.

[10]  A. Dickinson,et al.  Discriminative stimuli that control instrumental tobacco-seeking by human smokers also command selective attention , 2003, Psychopharmacology.

[11]  S. Tiffany,et al.  The development and initial validation of a questionnaire on smoking urges. , 1991, British journal of addiction.

[12]  P. Lang.  International affective picture system (IAPS) : affective ratings of pictures and instruction manual , 2005 .

[13]  Lee Hogarth,et al.  Attentional orienting towards smoking-related stimuli , 2003, Behavioural pharmacology.

[14]  G. Fong,et al.  Perceptions of tobacco health warnings in China compared with picture and text-only health warnings from other countries: an experimental study , 2010, Tobacco Control.

[15]  Christopher J L Murray,et al.  WHO Framework Convention on Tobacco Control: development of an evidence based global public health treaty , 2003, BMJ : British Medical Journal.

[16]  Karl Mann,et al.  Avoidance of alcohol-related stimuli increases during the early stage of abstinence in alcohol-dependent patients. , 2009, Alcohol and alcoholism.

[17]  Mueller,et al.  Die Erfassung des Cravings bei Rauchern mit einer deutschen Version des “Ouestionnaire on Smoking Urges” (OSU-G) [The assessment of craving in smokers with a German version of the “Questionnaire on Smoking Urges” (QSU-G)] , 2001 .

[18]  P. Quester,et al.  Response of mass media, tobacco industry and smokers to the introduction of graphic cigarette pack warnings in Australia. , 2009, European journal of public health.

[19]  Nick Wilson,et al.  How reactions to cigarette packet health warnings influence quitting: findings from the ITC Four-Country survey. , 2009, Addiction.

[20]  Matt Field,et al.  Eye movements to smoking-related pictures in smokers: relationship between attentional biases and implicit and explicit measures of stimulus valence. , 2003, Addiction.

[21]  K. Berridge,et al.  The psychology and neurobiology of addiction: an incentive-sensitization view. , 2000, Addiction.

[22]  Daniel N. Allen,et al.  Trail-Making Test , 2010 .

[23]  Matt Field,et al.  Attentional bias in drug dependence: vigilance for cigarette-related cues in smokers. , 2003, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[24]  Thomas J. Ross,et al.  Nicotine modulation of information processing is not limited to input (attention) but extends to output (intention) , 2010, Psychopharmacology.

[25]  Diana S. Natalicio,et al.  The State-Trait Anxiety Inventory , 1971 .

[26]  Peter R Harris,et al.  Self-affirmation reduces smokers' defensiveness to graphic on-pack cigarette warning labels. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[27]  S. Shiffman,et al.  Attentional bias predicts outcome in smoking cessation. , 2003, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[28]  Matt Field,et al.  A meta-analytic investigation of the relationship between attentional bias and subjective craving in substance abuse. , 2009, Psychological bulletin.

[29]  L. Kozlowski,et al.  The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. , 1991, British journal of addiction.

[30]  M. Fillmore,et al.  The effect of image complexity on attentional bias towards alcohol-related images in adult drinkers. , 2010, Addiction.

[31]  Ingmar H. A. Franken,et al.  Drug craving and addiction: integrating psychological and neuropsychopharmacological approaches , 2003, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[32]  T. Duka,et al.  Avoidance of alcohol-related stimuli in alcohol-dependent inpatients. , 2007, Alcoholism, clinical and experimental research.

[33]  Markus H. Winkler,et al.  Neural Responses to BEGIN- and END-Stimuli of the Smoking Ritual in Nonsmokers, Nondeprived Smokers, and Deprived Smokers , 2010, Neuropsychopharmacology.

[34]  Roy Cameron,et al.  Graphic Canadian cigarette warning labels and adverse outcomes: evidence from Canadian smokers. , 2004, American journal of public health.

[35]  G. Chiara.  Role of dopamine in the behavioural actions of nicotine related to addiction. , 2000 .

[36]  N. Risch,et al.  The continuous performance test, identical pairs version (CPT-IP): I. new findings about sustained attention in normal families , 1988, Psychiatry Research.

[37]  K. Mann,et al.  Severity of dependence modulates smokers' neuronal cue reactivity and cigarette craving elicited by tobacco advertisement , 2011, Addiction biology.

[38]  Herman Cp.  External and internal cues as determinants of the smoking behavior of light and heavy smokers. , 1974 .