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Effect of message congruency on attention and recall in pictorial health warning labels
  1. Kirsten Lochbuehler1,2,
  2. Melissa Mercincavage1,2,
  3. Kathy Z Tang2,
  4. C Dana Tomlin3,
  5. Joseph N Cappella1,4,
  6. Andrew A Strasser1,2
  1. 1University of Pennsylvania Tobacco Center of Regulatory Science (TCORS), Philadelphia, Pennsylvania, USA
  2. 2Department of Psychiatry, Center for Interdisciplinary Research on Nicotine Addiction, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  3. 3Department of Landscape Architecture, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  4. 4Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Andrew A Strasser, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA; strasse3{at}


Objective The nine pictorial health warning labels (PWLs) proposed by the US Food and Drug Administration vary in format and feature of visual and textual information. Congruency is the degree to which visual and textual features reflect a common theme. This characteristic can affect attention and recall of label content. This study investigates the effect of congruency in PWLs on smoker’s attention and recall of label content.

Methods 120 daily smokers were randomly assigned to view either congruent or incongruent PWLs, while having their eye movements recorded. Participants were asked to recall label content immediately after exposure and 5 days later.

Results Overall, the image was viewed more and recalled better than the text. Smokers in the incongruent condition spent more time focusing on the text than smokers in the congruent condition (p=0.03), but dwell time of the image did not differ. Despite lower dwell time on the text, smokers in the congruent condition were more likely to correctly recall it on day 1 (p=0.02) and the risk message of the PWLs on both day 1 (p=0.01) and day 5 (p=0.006) than smokers in the incongruent condition.

Conclusions This study identifies an important design feature of PWLs and demonstrates objective differences in how smokers process PWLs. Our results suggest that message congruency between visual and textual information is beneficial to recall of label content. Moreover, images captured and held smokers’ attention better than the text.

  • health warning labels
  • attention
  • eye-tracking
  • recall
  • congruency

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  • Contributors AAS conceived and supervised the study. Data collection was conducted by KZT. KL completed the analyses and led the writing with major contributions from all authors. All authors have approved the final article.

  • Funding Research reported in this publication was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) and FDA Center for Tobacco Products (CTP) under Award Numbers P50CA179546, R01CA180929, and P20CA095856. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the Food and Drug Administration (FDA).

  • Competing interests None declared.

  • Ethics approval University of Pennsylvania Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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