Assessing Attention to Tobacco Warnings With a Heatmapping Task

Introduction: Attention is a critical outcome to understanding the impacts of tobacco warning labels and is commonly measured using eye tracking. Self-report, online methods may be efficient, scalable alternatives to capture attention. This study assesses warning label attention on cigarette marketing using a heatmapping task. Methods: Young adults (n=1,608) aged 18–30 years and registered on Mechanical Turk with a WorkerID verified in the U.S. were included. Data were collected in 2021–2022 and analyzed in 2022. Tobacco advertisement exposure included a 2 × 3 between-subjects factorial design for varying contexts and warnings. Attention was operationalized with self-reported frequency and timing of warning selection. Outcomes include credibility, willingness to use the advertised cigarettes, and intentions to use cigarettes and low-nicotine cigarettes. Results: Early and more frequent attention to the warning was associated with higher credibility (frequent: β=0.28, 95% CI=0.11, 0.44; early: β=0.14, 95% CI=0.02, 0.25), lower willingness to use the advertised cigarettes (frequent: β= –1.78, 95% CI= –2.24, –1.32; early: β= –1.16, 95% CI= –1.49, –0.84), lower cigarette use intentions in the next week (frequent: β= –0.44, 95% CI= –0.64, –0.25; early: β= –0.21, 95% CI= –0.35, –0.08), and lower low-nicotine cigarette use intentions in the next week (frequent: β= –0.47, 95% CI= –0.66, –0.28; early: β= –0.25, 95% CI= –0.38, –0.12) than no attention at all. Conclusions: Greater attention as measured by a heatmapping task was observed for pictorial warnings and associated with lower intentions to use tobacco. Heatmapping selection patterns were a suitable proxy for attention in this online sample.