Harm to myself or others? A qualitative study of the preferences of people who smoke for messages to be included in cigarette pack inserts.

Introduction: Tobacco package inserts [TPIs] are a novel channel to transmit smoking cessation messages. Research has shown associations between inserts, intentions to quit and increased self-efficacy. In Israel, TPIs have been legislated, but not yet implemented. This study aimed to learn what kind of messages would appeal to people who smoke, for the purpose of developing effective TPIs.

Methods: Semi-structured interviews with 25 people who smoke or formerly smoked, aged 18-67. An inductive and deductive thematic analysis was conducted to enable a dynamic process coding and identifying themes and categories across interviews.

Results: Two main themes identified were: harms of smoking and motivators for quitting. Many participants were averse to information about the harms of smoking but interested in specific information about the harm of smoking to others, particularly children, on comparative risks of different tobacco/nicotine products, and about how to address the challenge of addiction. There was a preference for motivational messages encouraging quitting, including how the body recovers, personal quit stories, practical quit tips, and information on cessation services.

Conclusions: Adult who smoke were receptive to the idea of TPI, but considered some types of information superfluous. It is important to emphasize harm to others, provide information on quit services, and deliver information that is reliable, specific, and evidence-based regarding quitting, so that it can be encouraging, useful, and practical. The merits of providing information to people who smoke on relative risks of different nicotine and tobacco products should also be considered. The findings provide a basis for developing TPI content.

Implications: A large proportion of adults who smoke are interested in quitting. Pack inserts with positive motivating messages, quitline details, and novel information about risks to people who smoke and particularly to others, should be developed and tested, and subsequently distributed nationally to reach all those who open a cigarette package.