Visual Attention to Health Warning Labels on Waterpipe Venue Menus in Immersive Virtual Reality

Area of Science:

• Public Health
• Behavioral Science
• Tobacco Control

Background:

• Waterpipe tobacco smoking (WTS) is a growing public health concern, particularly among young adults.
• Misperceptions regarding the risks associated with WTS are common, necessitating effective communication strategies.
• Health warning labels (HWLs) are a potential tool to convey harm information and influence behavior.

Purpose of the Study:

• To investigate the impact of health warning labels (HWLs) on waterpipe venue menus on consumer attention.
• To assess how HWLs influence waterpipe tobacco smoking (WTS) attitudes, beliefs, and behavioral intentions.
• To examine the role of negative attitudes in mediating the relationship between HWLs and the intention to quit WTS.

Main Methods:

• A randomized experiment involving 96 young adult waterpipe smokers in a virtual reality laboratory.
• Participants were exposed to menus with or without HWLs and nicotine concentration information.
• Eye-tracking metrics and post-experiment questionnaires were used to collect data on attention, attitudes, and behaviors.

Main Results:

• The HWL group showed increased visual attention to warning and nicotine content areas, and decreased attention to flavor/ingredients.
• Participants exposed to HWLs reported more negative attitudes toward WTS (p = .002) and greater perceived risk of decreased lung function (p = .026).
• A significant increase in the intention to quit WTS was observed in the HWL group (p = 0.003), mediated by negative attitudes.

Conclusions:

• Health warning labels on waterpipe menus effectively capture and retain consumer attention.
• HWLs enhance negative attitudes, risk perceptions, and the intention to quit waterpipe tobacco smoking.
• Including HWLs and nicotine concentration on menus is a promising strategy to correct misperceptions and reduce WTS.