Background On-pack tobacco warnings can deter smoking initiation and provide powerful cessation cues. However, these warnings typically feature graphic health images, which many young adults dismiss as irrelevant. We estimated responses to more diverse warnings and examined how these performed relative to each other.
Methods We conducted a behavioural likelihood experiment and a choice modelling experiment in which 474 smokers and 476 susceptible non-smokers aged between 16 and 30 years evaluated 12 warnings featuring health, social, financial and cosmetic themes. The choice data were analysed by estimating Sequential-Best-Worst Choice and Scale-Adjusted Latent Class Models.
Results Smokers found all test warnings aversive, particularly warnings featuring the effect of smoking on vulnerable third parties, including babies and animals, and showing a dying smoker. Susceptible non-smokers found graphic health warnings and a warning that combined graphic health with loss of physical attractiveness, significantly more aversive than other images tested.
Conclusions Illustrating the harms smoking causes to vulnerable groups may reduce the temporal distance and perceived control over smoking that young adults use to rationalise health warnings. Introducing more diverse warnings could recognise heterogeneity within smoker and susceptible non-smoker populations, and complement warnings featuring long-term health harms.
- temporal construal
- choice modelling
- on-pack warnings
- warning images
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Contributors JH conceptualised the project and obtained funding. PG and JH designed the research instrument, PG managed the data collection and, with CE, analysed the data. JL designed the choice experiment. PG and JH led the MS development; all authors have seen and approved the final MS version. PG and JH are guarantors of the MS.
Funding This project was funded by the Health Research Council of New Zealand (Grant 13/062).
Competing interests Although we do not consider it a competing interest, for the sake of full transparency we note that PG and JH have undertaken work for health sector agencies working in tobacco control.
Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.
Ethics approval University of Otago Human Ethics Committee.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement There are no unpublished data from the study available.