Characteristics of the sample are shown in . Smokers who participated in this study were significantly more likely to be male, younger, and have fewer years of formal education compared to the nonsmokers (χ2 statistic, p-value <0.05). Among nonsmokers, 58% reported having ever smoked even one cigarette in their lifetime and 22% reported currently living with a smoker.
Demographics and tobacco use characteristics of sample of adult smokers and nonsmokers from western New York, n=397
When asked questions regarding awareness of the current warning labels on cigarette packs sold in the U.S., 60% of smokers said they never or rarely noticed the labels in the last month, 87% of smokers said they did not attempt to avoid looking at or thinking about the warning labels, and 62% of smokers said that the labels made them think a little or not at all about the health risks of smoking.
Smokers were asked if their current brand choice decision was based on a number of factors, including tar and nicotine, health concerns, assistance in quitting, price, taste, or satisfaction. Of the 193 smokers (of a total of 197 smokers) who responded to questions regarding this decision, a significantly greater percentage of “light/mild” cigarette smokers, compared to full flavor cigarette smokers, stated that their current brand choice decision was based on health concerns (27% vs 4%, respectively; χ2=23.7, p-value<0.001) or as a way to help them quit (11% vs 2% respectively; χ2=6.8, p-value=0.009). A significantly greater percentage of “light/mild” smokers also considered their usual brand of cigarettes to be “a little less harmful compared to other cigarettes brands” (29% “light/mild” vs 7% full flavor cigarette smokers; n=194; χ2=20.8, p-value<0.001). On the other hand, more full flavor cigarette smokers selected their current brand based on satisfaction (71% full flavor vs 55% “light/mild” cigarette smokers; χ2=4.8, p-value=0.029).
As summarized in , when asked which pack they thought had the smoothest taste or which pack they would buy, a significantly greater number of participants were likely to choose the pack with the health warning label presented in a text format, in a smaller size, or with a gain-framed warning message. However, when asked which health warning would attract their attention, made them think about the health risks of smoking, motivated smokers to quit, and which pack they would buy to try to reduce health risks, participants chose the graphic, larger, and loss-framed warning label styles and formats (p-value<0.05). Smokers and nonsmokers also selected the graphic, larger, and loss-framed warning label styles when asked which warning they found to be the most effective (p-value<0.001).
When asked about perceptions regarding source attribution of message, a greater percentage of participants responded that they found the Surgeon General’s message to be the “most truthful” (χ2=108.6, p-value<0.001) and the “most believable” (χ2=109.5, p-value<0.001) of the three packs presented. Sixty-five percent (65%) of smokers stated that the health warning attributed to the Surgeon General also made them think about quitting smoking.
Pack Design Characteristics
The results for pack selection were fairly consistent across all six sets of pack design characteristics. Nearly 90% of participants selected the package labeled full flavor, 10, or with dark blue shading when asked which pack they perceived containing the most tar. Additionally, a significantly greater number of participants were likely to choose the pack that had the lighter color shading or descriptors that implied less risk (i.e., a lower number [6 vs 10], descriptors such as light, smooth, or silver, as compared to the pack labeled full flavor) when asked which of the two packs would have the smoothest taste or which pack they would buy if trying to reduce the risks to their health (χ2 statistic, p-value<0.001). Participants were more likely to select the branded pack when asked which pack they thought delivered the most tar, had the smoothest taste, was more attractive, appealed to youth aged <18 years, and contained cigarettes of better quality (χ2 statistic, p-value≤0.001).
Smokers versus Nonsmokers
The responses of smokers and nonsmokers to the different sets of packs were similar with regards to ratings of expected delivery of tar, smoothest taste, or intentions to purchase if trying to reduce risks to their health. However, smokers were split as to which pack they might purchase, while nonsmokers consistently selected the packs that implied reduced risk. For example, when presented with two packs, one with a descriptor full flavor and the other with the descriptor smooth, nearly half of smokers selected each of the two packs (47% selected full flavor and 53% selected smooth) for purchase, while 72% of nonsmokers selected the pack labeled smooth (χ2=16.1, p-value <0.001). Results from these analyses remained consistent after logistic regression analyses were conducted, adjusting for age, gender, race/ethnicity, and education (results not presented).
Smokers were also significantly more likely than nonsmokers to select the pack with the graphic health warning when asked, compared to the pack with the text-based health warning, which health warning was more likely to attract their attention (Brain vs text warning: χ2=5.3, p-value=0.02; Smoker vs text warning: χ2=3.9, p-value=0.05), which health warning was more likely to make people think about the health risks of smoking (Brain vs text warning: χ2=8.2, p-value<0.01), was more likely to motivate smokers to quit (Brain vs text warning: χ2=4.5, p-value=0.03), and is the most effective (Brain vs text warning: χ2=8.3, p-value<0.01). Logistic regression analyses found that these differences were no longer significant after adjusting for age, gender, race/ethnicity, and education (results not presented). Additionally, no significant differences were detected between smokers and nonsmokers when examining selections made from sets of packs manipulated by message framing or plain packaging.
Current Smokers: Full Flavor vs “Light/Mild” Brands
Pack selections were analyzed after stratifying for smokers who currently reported smoking a full flavor versus any “light/mild” variety (light, ultra light, mild, or medium). Based on self-report, nearly 30% of smokers reported currently smoking a so-called low-tar variety of their cigarette brand. When asked to rate sets of packs that vary by descriptor for perception of smoothest taste, current smokers of “light/mild” brand cigarettes were significantly more likely to select the pack that included a descriptor that implied reduced risk: light (χ2=5.5 p-value=0.02), 6 (χ2=5.9, p-value=0.02), or the pack with light blue shading (χ2=4.7 p-value=0.03), as compared to current smokers of full flavor cigarettes. Results from these analyses remained consistent after logistic regression analyses were conducted, adjusting for age, gender, race/ethnicity, education, and cigarettes per day.