Dissuasive cigarettes: which cues are the most effective at deterring young people from smoking?

To counter the attractiveness of cigarettes, Article 11 of the Framework Convention on Tobacco Control provides for the possibility of including warnings on cigarettes. The objective of our research was to explore perceptions of cigarettes designed to be dissuasive (displaying the warning 'Smoking kills' in uppercase or lowercase, a 'skull and crossbones' pictogram, unattractive shades of brown or dark green or a combination of all these negative cues).

In-depth interviews were conducted with 31 people in France aged 15-25 years (10 daily smokers, 10 occasional smokers and 11 non-smokers; 15 females and 16 males).

Participants were shown different dissuasive cigarettes (displaying the warning 'Smoking kills', a 'skull and crossbones' pictogram, unattractive shades of brown or dark green or a combination of all three) and current branded ones. Open-ended questions were asked about the attractiveness of the cigarettes, perception of risk, the image of the smoker and influence on the desire to quit or not to start. Discussions were audio-recorded and transcribed.

The different dissuasive cues were found to increase negative health perceptions (e.g., increase risk), reduce positive smoker image and the perceived pleasure of smoking (e.g., embarrassment of smoking in front of friends), decrease the desire to start smoking and increase the desire to quit. The most dissuasive cigarette was an unattractively dark-coloured cigarette which displayed both the warning 'Smoking kills' and a 'skull and crossbones' pictogram.

This study highlights the importance of the appearance of cigarettes and suggests that dissuasive cigarettes may be an innovative tobacco control measure for governments.