Visual attention to nicotine product packaging: Evidence from an eye-tracking study among university students
Background: Nicotine product packaging conveys both branding and health information, yet marketing elements may visually compete with warning labels and weaken risk communication, particularly for novel nicotine products.
Objective: This study aims to assess how visual attention is distributed across key packaging features of conventional cigarettes, heated tobacco, e-cigarettes, and nicotine pouches among young adult nicotine users.
Methods: We conducted an experimental eye-tracking study with 45 Czech university students, all of whom had used nicotine products in the previous two weeks. Participants physically handled and inspected the packaging of four product types: conventional cigarettes, heated tobacco, e-cigarettes, and nicotine pouches. Visual attention was analyzed across five predefined areas of interest, including warning labels, branding, and product composition. Two eye-tracking indicators were assessed: fixation duration and dwell time within each area of interest. Repeated-measures analysis of variance and post hoc tests were used to determine statistically significant differences both within and across product types.
Results: Branding and product composition consistently received more attention than warning labels or general text. Warning labels attracted the most attention, only for conventional cigarettes. In cross-product comparisons, branding was significantly more engaging for e-cigarettes and nicotine pouches, while attention to health warnings remained low. Fixation data supported these trends, suggesting more intensive processing of branding than of health-related information.
Conclusion: Warning labels on conventional cigarettes attracted substantially more visual attention than those on novel nicotine products, where branding and composition dominated instead. This suggests that current packaging requirements for e-cigarettes, heated tobacco, and nicotine pouches may not achieve comparable warning salience. Extending established cigarette packaging standards to these categories, alongside clearer communication of relative product risk, could improve consumer engagement with health information.
- Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT. Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob Control. 2015;25(3):341-354. doi: 10.1136/tobaccocontrol-2014-051978
- World Health Organization. WHO Report on the Global Tobacco Epidemic 2021: Addressing New and Emerging Products. Geneva, Switzerland: World Health Organization; 2021. Accessed January 10, 2025. https://www.who.int/ publications/i/item/9789240032095
- Maynard OM, Munafò MR, Leonards U. Visual attention to health warnings on plain tobacco packaging in adolescent smokers and non-smokers. Addiction. 2012;108(2):413-419. doi: 10.1111/j.1360-0443.2012.04028.x
- Kahnert S, Driezen P, Balmford J, et al. Effectiveness of tobacco warning labels before and after implementation of the European Tobacco Products Directive: findings from the longitudinal EUREST-PLUS ITC Europe surveys. Eur J Public Health. 2020;30(supplement_3):iii84-iii90. doi: 10.1093/eurpub/ckaa039
- Vardavas CI, Connolly G, Karamanolis K, Kafatos A. Adolescents’ perceived effectiveness of the proposed European graphic tobacco warning labels. Eur J Public Health. 2009;19(2):212-217. doi: 10.1093/eurpub/ckp015
- Hitchman SC, Mons U, Nagelhout GE, et al. Effectiveness of the European Union text-only cigarette health warnings: findings from four countries. Eur J Public Health. 2011;22(5):693-699. doi: 10.1093/eurpub/ckr099
- Tan ASL, Mercincavage M, Young WJ, Hrywna M, Delnevo CD, Strasser AA. Perceived relative harm and addictiveness compared with cigarettes and intentions to use modified risk tobacco products utilizing FDA-authorized marketing claims among adults in the United States. Drug Alcohol Depend. 2024;261:111291. doi: 10.1016/j.drugalcdep.2024.111291
- Snell LM, Barnes AJ, Eissenberg T. Variation in relative risk perceptions and tobacco use by race and socioeconomic status among older adults who smoke: evidence from the Population Assessment of Tobacco and Health Study. Nicotine Tob Res. 2024;27(7):1168-1176. doi: 10.1093/ntr/ntae242
- O’Brien EK, Baig SA, Persoskie A. Absolute and relative smokeless tobacco product risk perceptions: developing and validating new measures that are up-to-snuff. Nicotine Tob Res. 2021;24(2):265-269. doi: 10.1093/ntr/ntab167
- Czoli CD, Fong GT, Mays D, Hammond D. How do consumers perceive differences in risk across nicotine products? A review of relative risk perceptions across smokeless tobacco, e-cigarettes, nicotine replacement therapy and combustible cigarettes. Tob Control. 2016;26(e1):e49-e58. doi: 10.1136/tobaccocontrol-2016-053060
- Kaleta D, Polanska K, Bak-Romaniszyn L, Wojtysiak P. Perceived Relative Harm of Selected Cigarettes and Non- Cigarette Tobacco Products—A Study of Young People from a Socio-Economically Disadvantaged Rural Area in Poland. Int J Environ Res Public Health 2016;13(9):885. doi: 10.3390/ijerph13090885
- Klein H, Sterk CE, Elifson KW. Smoke and mirrors: the perceived benefits of continued tobacco use among current smokers. Health Psychol Res. 2014;2(2):1. doi: 10.4081/hpr.2014.1519
- Csémy L, Dvořáková Z, Fialová A, Malý M, Skývová M. Národní výzkum užívání tabáku a alkoholu v České republice 2024 [National Survey on Tobacco and Alcohol Use in the Czech Republic 2024]. National Institute of Public Health; 2025. [In Czech] Accessed September 27, 2025. https://szu. gov.cz/odborna-centra-a-pracoviste/centrum-podpory-verejneho-zdravi/prevence-zavislosti/studie/nauta/
- Peters E, Dieckmann N, Dixon A, Hibbard JH, Mertz CK. Less is more in presenting quality information to consumers. Med Care Res Rev. 2007;64(2):169-190. doi: 10.1177/10775587070640020301
- Sillero-Rejon C, Leonards U, Munafò MR, et al. Avoidance of tobacco health warnings? An eye-tracking approach. Addiction. 2020;116(1):126-138. doi: 10.1111/add.15148
- Hammond D. Health warning messages on tobacco products: a review. Tob Control. 2011;20(5):327-337. doi: 10.1136/tc.2010.037630
- Sillero-Rejon C, Mahmoud O, Tamayo RM, Clavijo‐Alvarez AA, Adams S, Maynard OM. Standardised packs and larger health warnings: visual attention and perceptions among Colombian smokers and non-smokers. Addiction. 2022;117(6):1737-1747. doi: 10.1111/add.15779
- White V, Williams T, Faulkner A, Wakefield M. Do larger graphic health warnings on standardised cigarette packs increase adolescents’ cognitive processing of consumer health information and beliefs about smoking-related harms? Tob Control. 2015;24(suppl 2):ii50-ii57. doi: 10.1136/tobaccocontrol-2014-052085
- Taylor EV, East KA, McNeill A, et al. Changes in responses to nicotine vaping product warnings and leaflets in England compared with Canada, the US and Australia: findings from the 2016–2018 ITC Four Country Smoking and Vaping Surveys. Tob Control. 2020;31(1):107-111. doi: 10.1136/tobaccocontrol-2020-055739
- Trofor AC, Papadakis S, Lotrean LM, et al. Knowledge of the health risks of smoking and impact of cigarette warning labels among tobacco users in six European countries: findings from the EUREST-PLUS ITC Europe Surveys. Tob Induc Dis. 2019;16(2). doi: 10.18332/tid/99542
- King JL, Lazard A, Reboussin BA, et al. Optimizing warnings on e-cigarette advertisements. Nicotine Tob Res. 2019;22(5):630-637. doi: 10.1093/ntr/ntz091
- Strasser AA, Tang KZ, Romer D, Jepson C, Cappella JN. Graphic warning labels in cigarette advertisements: recall and viewing patterns. Am J Prev Med. 2012;43(1):41-47. doi: 10.1016/j.amepre.2012.02.026
- Johnson AC, Mercincavage M, Souprountchouk V, Deatley T, Mays D, Strasser AA. Assessing attention to tobacco warnings with a heatmapping task. Am J Prev Med. 2023;65(5):809-817. doi: 10.1016/j.amepre.2023.05.020
- Sidhu AK, Mercincavage M, Souprountchouk V, Capella JN, Strasser AA. Eye-tracking viewing patterns in high versus low avoidance warning labels. Tob Regul Sci. 2021;7:118-129. doi: 10.18001/TRS.7.2.3
- Liu J, Phua J, Krugman D, Xu L, Nowak G, Popova L. Do young adults attend to health warnings in the first IQOS advertisement in the US? An eye-tracking approach. Nicotine Tob Res. 2020;23(5):815-822. doi: 10.1093/ntr/ntaa243
- Chen-Sankey J, Weiger C, La Capria K. Using eye tracking to examine young adults’ visual attention to e-cigarette advertising features and associated positive e-cigarette perceptions. Ann Behav Med. 2024;58(6):445-456. doi: 10.1093/abm/kaae018
- Lyu JC, Huang P, Jiang N, Ling PM. A systematic review of e-cigarette marketing communication: messages, communication channels, and strategies. Int J Environ Res Public Health. 2022;19(15):9263. doi: 10.3390/ijerph19159263
- Akter S, Rahman MM, Rouyard T, Aktar S, Nsashiyi RS, Nakamura R. A systematic review and network meta-analysis of population-level interventions to tackle smoking behaviour. Nat Hum Behav. 2024;8(12):2367-2391. doi: 10.1038/s41562-024-02002-7
- Drovandi A, Teague PA, Glass B, Malau-Aduli B. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: a four-country study. Tob Induc Dis. 2019;17(March). doi: 10.18332/tid/104753
- Taylor E, Arnott D, Cheeseman H, et al. Association of fully branded and standardized e-cigarette packaging with interest in trying products among youths and adults in Great Britain. JAMA Netw Open. 2023;6(3):e231799. doi: 10.1001/jamanetworkopen.2023.1799