The impact of price and image warnings on the social perception of gifting cigarettes in China.

INTRODUCTION: The tobacco gift-giving culture in China poses a significant challenge to public health; however, there is limited research on effectively curbing the tobacco gift-giving culture and its associated tobacco gift consumption. This study examines the potential impact of two tobacco control measures that the Chinese government may consider adopting on cigarette gifting behavior in the future in Chinese society. METHODS: This study employed a randomized survey experiment to examine the effects of cigarette price treatment and pictorial health warning labels (HWLs) on cigarette gifting. The total sample size of this study is 1035. Four groups of participants were presented with representative cigarettes categorized into high-, medium-, and low-priced products, along with different prices (normal and double) or external packaging imagery (normal and pictorial HWL versions). RESULTS: The price of cigarettes for personal consumption forms an L-shaped distribution, and the price of cigarette gifts forms a W-shaped distribution. Increasing cigarette prices reduces smokers' willingness to gift high-priced cigarettes but stimulates the consumption of low-price cigarettes as gifts. Pictorial HWLs do not directly influence smokers' intentions to gift cigarettes, but they enhance the effectiveness of price regulation concerning medium-priced cigarette products. CONCLUSIONS: If the price variance of cigarettes is not reduced, the effect of price regulation will be very limited. Implementing combined interventions of pictorial HWLs and price regulation or modifying the pricing structure of tobacco products may yield stronger control outcomes.

Reactions to Pictorial and Text Cigarette Pack Warning Labels among Chinese Smokers.

Objectives. This study aims at examining the impact of graphic pictorial warning labels on inten-tion to quit smoking and perceived harms among Chinese working-age adults (n = 661). Methods. A randomized controlled trial is utilized as the research design by comparing three scenarios: Group 1 as baseline (n = 193) and presented with real market tobacco products with text-only la-bels, Group 2 as price group and with hypothetical scenarios of manipulated prices, and Group 3 as the imaging group and with hypothetical scenarios of graphic pictorial cigarette warning la-bels. Both bivariate and multivariate analyses are utilized to determine the effectiveness of warn-ing labels. Results. Graphic pictorial cigarette warning labels are associated with stronger inten-tion to quit smoking and greater perceived harms. Smokers have a greater number of attempts if they are less nicotine dependent and express greater smoking risk perceptions. Conclusions. This study adds to the evidence that graphic pictorial warning labels are more effective than text-only labels in increasing intention to quit smoking. As China strives to achieve a reduction in smoking to meet the goal of the Healthy China 2030 initiative, this work strengthens the evidence base for policy makers, practitioners, and researchers to design low-cost warning labels on cigarette packs to promote tobacco control.