How do UK Adolescents Perceive Graphic Health Warning Labels on Cigarette Packages? A Scoping Study

Background: Graphic health warnings (GHW) are an integral component of the comprehensive package of tobacco control policies laid out in the WHO Framework Convention on Tobacco Control. Current UK GHW use fear appeal to motivate smokers to quit. Yet, the use of fear appeal, and specifically its potential unintended consequences on adolescents, have been a subject of debate among scholars. Several scholars argue that fear appeal might lead to: defensive mechanisms among adolescents such as disengagement with the message as they depict long term health consequences that adolescents may not relate to; negative reactions due to feelings of being paternalised, potentially fuelling desires to rebel against health messages; and feelings of guilt and self-blame that might impede self-efficacy beliefs and stigmatise adolescents. Aim: The aim of this study is twofold: to investigate UK adolescents’ perceptions of GHW on cigarette packages, and to explore the individual, social and cultural factors that may shape their perceptions of risk, harm and relevance of public health messages. Method: The research approach is qualitative: we conduct a series of focus groups and individual interviews with adolescents in the UK (13-18 years old). We report early findings from the UK fieldwork, which commenced in March 2018. Findings: 20 adolescents were interviewed in five focus groups and four individual interviews. Preliminary findings showed that adolescents in the UK mainly show disengagement with the existing messages on GHW labels as well as some unintended consequences. Adolescents seemed to rationalise smoking as addictive and thus find existing GHW labels ineffective. Instead, adolescents suggested alternative messages that they might be more likely to relate to. Conclusion: The results of the study can help to enhance the effectiveness of GHW targeted at adolescents by suggesting improvements to existing GHW labels in the UK and could inform the development of GHW policies targeted at adolescents in the UK and other legislatures