Do health warning labels on alcohol packaging attract visual attention? A systematic review

Objectives: To synthesize eye-tracking-based evidence on consumers' visual attention devoted to alcohol warning labels (AWLs) on alcohol packaging. Study design: A systematic review was conducted and reported in accordance with the PRISMA guidelines. Methods: Two rounds of a literature search were conducted to identify relevant peer-reviewed articles and unpublished grey literature. While the first round (July 3 to August 21, 2023) was based on three electronic databases (PubMed, Web of Science, and PsycINFO), the second round (May 20 to 28, 2024) followed a multiple-step protocol that systematically searched the grey literature. Five criteria were applied to screen eligible articles. Using established quality control tools, the identified articles were assessed for overall quality and then for quality specific to the eye-tracking method. Results: Six published peer-reviewed articles were thus included in the current review along with one unpublished research paper from a doctoral thesis. This review paper summarizes earlier findings in terms of bottom-up (i.e., AWL design-related) factors such as size, color, surrounding border, and pictorial elements, and top-down (i.e., goal-driven) factors such as motivation to change drinking behavior and self-affirmation. The review found that people tend to pay very little attention to AWLs displayed on alcohol packaging, although there is mixed evidence as to the effectiveness of specific factors. Conclusions: Further investigations using eye-tracking are needed to collect additional evidence on attention devoted to AWLs. Meanwhile, we put forward implications for policymakers and future avenues for research based on our review of the existing literature. (c) 2024 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).