Young Adults' Visual Attention to, Unaided Recall, and Perspectives of Tobacco Public Education Messages: An Experimental Eye-Tracking Study.

introductionMass-reach tobacco public education campaigns may need to be optimized for marginalized populations, including lesbian, gay, bisexual, transgender, and queer (LGBTQ+) young adults (YA). We examined attention to and unaided recall of culturally targeted (CT) tobacco education among LGBTQ+ YA in an experimental trial. AIMS AND

methodsLGBTQ+ YA reporting current nicotine or tobacco (N/T) use completed a baseline survey, eye-tracking experiment (viewing 8 CT or nontargeted stimuli), and a postsurvey. Areas of interest (AOIs) were harms message, efficacy message, and image. We compared dwell time (DT) and fixation duration (FD) to AOIs by condition and modeled associations between DT/FD and message relevance and perceived message effectiveness (PME). One week postexposure, participants completed open-ended items assessing unaided recall (memory of stimuli). We coded responses using a data-driven inductive approach.

resultsThere was no difference in DT/FD to AOIs by condition. Attention to harms AOIs was positively associated with message relevance (DT: Beta = 0.11; 95% CI = 0.05% to 0.17%; FD: Beta = 0.38; 95% CI = 0.18% to 0.58%) and PME (DT: Beta = 0.09; 95% CI = 0.04% to 0.15%). Attention to image AOIs was associated with increased message relevance. Participants across conditions positively recalled sociodemographic diversity in images. Experimental participants resonated with LGBTQ+ representation, while control participants recalled racial and age diversity. Participants recalled messages highlighting the tobacco industry targeting and long-term health harms. Participants expressed interest in quitting or reducing N/T use.

conclusionsLGBTQ+ YA find CT tobacco public education memorable; however, nontargeted campaigns featuring diverse models are also effective at fostering visual attention and recall. IMPLICATIONS: This study assessed how cultural targeting affects visual attention, perceptions, and unaided recall of tobacco public education among LGBTQ+ YA who use nicotine and tobacco. Regardless of condition, LGBTQ+ YA recalled stimuli featuring diverse visual representation (eg, sexual orientation, race) and messages about the tobacco industry's manipulation of minoritized communities. Visual attention to imagery and harms messages increased message relevance and PME (harms messages only). Most participants qualitatively expressed intentions to quit or reduce use post-exposure. Tobacco public education integrating CT content, representative models, and counter-industry marketing may engage LGBTQ+ YA and motivate behavior change in this population.