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Reactions to, and trial intentions for, three dissuasive cigarette designs: a cross-sectional survey of adolescents in Scotland
  1. Danielle Mitchell1,
  2. Nathan Critchlow1,
  3. Crawford Moodie1,
  4. Linda Bauld2,3
  1. 1Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling, UK
  2. 2Usher Institute, UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
  3. 3SPECTRUM consortium, Univeristy of Edinburgh, Edinburgh, United Kingdom
  1. Correspondence to Danielle Mitchell, Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling FK9 4LA, UK; danielle.mitchell1{at}


Objectives There has been growing academic and policy interest in opportunities to decrease the appeal of cigarette sticks, such as making them an unattractive colour or requiring them to display a health warning. We therefore explored reactions to, and trial intentions for, three ‘dissuasive’ cigarette designs among adolescents in Scotland.

Methods A cross-sectional survey with 12–17 year olds in Scotland (n=594) was conducted between November 2017 and November 2018. Participants were shown one ‘standard’ cigarette (imitation cork filter with white paper casing) and three dissuasive cigarettes: (1) a cigarette with the warning ‘smoking kills’; (2) a cigarette with the warning ‘toxic’ and a skull and cross-bones image and (3) a dark green cigarette. Participants rated each cigarette on nine five-point reaction measures (eg, appealing/unappealing or attractive/unattractive). A composite reaction score was computed for each cigarette, which was binary coded (overall negative reactions vs neutral/positive reactions). Participants also indicated whether they would try each cigarette (coded: Yes/No). Demographics, smoking status and smoking susceptibility were also measured.

Results More participants had negative reactions to the dark green (93% of adolescents), ‘smoking kills’ (94%) and ‘toxic’ (96%) cigarettes, compared with the standard cigarette (85%). For all three dissuasive designs, Chi-square tests found that negative reactions were more likely among younger adolescents (vs older adolescents), never-smokers (vs ever smokers) and non-susceptible never-smokers (vs susceptible never-smokers). Most participants indicated that they would not try any of the cigarettes (range: 84%–91%).

Conclusion Dissuasive cigarettes present an opportunity to further reduce the appeal of smoking among adolescents.

  • packaging and labelling
  • prevention
  • social marketing

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  • Contributors DM contributed to conceptualisation, methodology, formal analysis, investigation, data curation, writing—original draft preparation, writing—review and editing, project administration. NC contributed to methodology, formal analysis, writing—review and editing, supervision. CM contributed to conceptualisation, methodology, writing—review and editing, supervision, funding acquisition. LB contributed to conceptualisation, writing—review and editing, supervision, funding acquisition. Resources, Software and Validation: N/A.

  • Funding PhD studentship awarded by the University of Stirling.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was obtained from the University of Stirling’s General University Ethics Panel (GUEP273). At the beginning of the survey, participants were informed that participation would be confidential and anonymous, and consent was obtained. Once completed, participants were provided with a debrief leaflet, which included information on the harms of smoking and where to find further advice and information.

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

  • Data availability statement The data is part of a PhD thesis that has not yet been submitted. Data will be available up on reasonable request from the corresponding author.