Effects of narrative versus non-narrative pictorial warning labels on visual attention and alcohol-related cancer risk perceptions: An eye-tracking study

Background: Alcohol use is a preventable risk factor for cancer, but public awareness remains low. A promising approach to raising awareness is to include pictorial warning labels (PWLs) on alcohol-containing products, but the typical graphic images used in such warnings can cause inattention. This study investigated whether narrative PWLs (depicting the lived experiences) could lead to greater attention and higher risk perceptions than graphic, non-narrative PWLs (showing graphic health effects). Methods: Moderate and heavy drinkers participated in an online, webcam-based eye-tracking experiment (N = 649). They were randomized to view an order-randomized stimulus set containing either three narrative PWLs or three non-narrative PWLs. Visual attention was assessed by metrics of participant eye movements, including the visit count and dwell time to separate image and text area of interest (AOI) while viewing each PWL. Risk perceptions were assessed by participant responses to questions presented after viewing all PWLs. Results: Participants paid more attention to the image than the text AOI on both metrics (p's < 0.05). They also spent more time viewing narrative versus non-narrative PWLs (p's < 0.05). However, PWL type had no significant effect on risk perceptions (p's > 0.1), and visual attention did not mediate this relationship. Conclusions: Our findings highlight the potential of narrative PWLs to visually engage alcohol consumers' attention. Further research is needed to understand why narrative PWLs do not outperform non-narrative PWLs in shaping risk perceptions either directly or through attention, the proposed mediator.