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Roll-your-own smokers’ reactions to cessation-efficacy messaging integrated into tobacco packaging design: a sequential mixed-methods study
  1. Mei-Ling Blank1,2,
  2. Janet Hoek1,
  3. Philip Gendall1
  1. 1 Public Health, University of Otago, Wellington, New Zealand
  2. 2 Marketing, University of Otago, Dunedin, New Zealand
  1. Correspondence to Mei-Ling Blank, Public Health, University of Otago, Wellington 9054, New Zealand; meiling.blank{at}


Background Although loss-framed pictorial warning labels (PWLs) have increased knowledge of the health harms caused by smoking, they may elicit maladaptive responses among some smokers who have tried repeatedly, yet unsuccessfully, to quit smoking. However, research suggests that maladaptive responses may diminish if warnings are complemented with efficacy enhancing messages. Therefore, we explored New Zealand (NZ) adult roll-your-own (RYO) loose tobacco smokers’ reactions to self-efficacy and response efficacy messages integrated into the RYO packaging structure and designed to complement PWLs.

Design We used a sequential mixed-methods design. In-depth interviews gauged participants’ (n=22) acceptance of the designs and informed stimuli development for an online survey. The survey (n=785) compared self-efficacy and response efficacy designs to standard Quitline information, and examined agreement with emotions, beliefs and projected behaviours associated with quit attempts.

Results Our findings suggest placing gain-framed response efficacy messages on the inside flap of RYO tobacco pouches may stimulate specific emotional reactions, beliefs and projected behaviours associated with future quit attempts more effectively than NZ’s status quo Quitline information. Those potentially more likely to benefit include smokers who have high baseline response efficacy and who intend to make a quit attempt.

Conclusions Integrating cessation-related messaging within tobacco packaging could be a high reach, just-in-time micro-intervention at the point of decision-making. Enhanced efficacy messages could complement and enhance PWLs, and support quitting among groups where smoking prevalence is especially high.

  • hand-rolled/RYO tobacco
  • packaging and labelling
  • public policy

Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. Data are available upon reasonable request.

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  • Contributors M-LB and JH conceptualised the project and obtained research funding. M-LB led development of the study protocol, interview guide and online survey, on which JH and PG provided critical feedback. M-LB conducted the interviews, programmed the survey, led the data analyses and interpretation and drafting of the manuscript and led responses to the reviewers’ comments. JH and PG reviewed data interpretation and worked on later iterations of the manuscript. All authors have seen and approved the final version; M-LB is the guarantor.

  • Funding University of Otago Research Grant.

  • Competing interests All authors are members of ASPIRE 2025, a research collaboration working to achieve the New Zealand Government’s Smokefree 2025 goal.

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