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Cigarette packaging and health warnings: the impact of plain packaging and message framing on young smokers
  1. Darren Mays1,
  2. Raymond S Niaura1,2,3,
  3. W Douglas Evans4,
  4. David Hammond5,
  5. George Luta1,6,
  6. Kenneth P Tercyak1
  1. 1Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC, USA
  2. 2Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
  3. 3Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  4. 4Department of Prevention & Community Health, School of Public Health and Health Services, George Washington University, Washington, DC, USA
  5. 5Department of Health Studies & Gerontology, University of Waterloo, Waterloo, Canada
  6. 6Department of Biostatistics, Bioinformatics and Biomathematics, Georgetown University Medical Center, Washington, DC, USA
  1. Correspondence to Dr Darren Mays, Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, 3300 Whitehaven Street, NW, Suite 4100, Washington, DC 20007, USA; dmm239{at}


Objective This study examined the impact of pictorial cigarette-warning labels, warning-label message framing and plain cigarette packaging, on young adult smokers’ motivation to quit.

Methods Smokers aged 18–30 years (n=740) from a consumer research panel were randomised to one of four experimental conditions where they viewed online images of four cigarette packs with warnings about lung disease, cancer, stroke/heart disease and death, respectively. Packs differed across conditions by warning-message framing (gain vs loss) and packaging (branded vs plain). Measures captured demographics, smoking behaviour, covariates and motivation to quit in response to cigarette packs.

Results Pictorial warnings about lung disease and cancer generated the strongest motivation to quit across conditions. Adjusting for pretest motivation and covariates, a message framing by packaging interaction revealed gain-framed warnings on plain packs generated greater motivation to quit for lung disease, cancer and mortality warnings (p<0.05), compared with loss-framed warnings on plain packs.

Conclusions Warnings combining pictorial depictions of smoking-related health risks with text-based messages about how quitting reduces risks, may achieve better outcomes among young adults, especially in countries considering or implementing plain packaging regulations.

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