The Role of e-Cigarette Packaging as a Health Communications Tool: A Focus Group Study With Adolescents and Adults in England and Scotland

Introduction:
This article reports the findings of a qualitative study exploring adolescent and adult responses to the current nicotine addiction warning, alternative on-pack messages, and other options for using e-cigarette packaging to discourage youth and people who neither smoke nor use e-cigarettes while encouraging smokers to switch. The study was conducted in Greater Glasgow, Scotland, and Manchester, England, and involved 16 focus groups with 70 participants.

Key Points:

* The current nicotine addiction warning on e-cigarette packs is not effective in capturing attention or deterring use.
* Alternative messages about harms, toxicities, litter, and wellness received mixed responses, with some messages considered more believable and relevant than others.
* Participants proposed several ideas to reduce the appeal of e-cigarette packaging and devices to deter youth uptake, including more prominent warnings, standardized packaging, and devices that are plain or include health messages.
* Relative risk messages were perceived as most beneficial for smokers switching but also potentially encouraging uptake among nonsmokers.
* Standardized tobacco packaging has been shown to increase warning salience and reduce the appeal of packaging and smoking, but there is limited research on the impact of standardized e-cigarette packaging.
* A randomized online experiment found an association between standardized packaging and lower interest in trying products and higher health risk perceptions.
* Most studies on warnings on e-cigarette packs are US-based or quantitative, and our understanding of the potential impact of the nicotine warning required in the United Kingdom and different warning themes is relatively limited.

Main Message:
The study highlights the need for more effective on-pack messaging and packaging regulations to reduce interest in e-cigarettes among adolescents and non-nicotine users while encouraging smokers to switch to less harmful alternatives. The findings suggest that relative risk messages could be promising, but further research is needed to ensure they do not encourage uptake among nonsmokers. Strengthening on-pack messaging, reducing the appeal of packaging and devices, and exploring the potential impact of standardized e-cigarette packaging could help increase awareness of e-cigarette harms and deter use among adolescents and nonsmokers.

Daniel Jones, Amber Morgan, Crawford Moodie, Georgia Alexandrou, Allison Ford, Danielle Mitchell, The Role of e-Cigarette Packaging as a Health Communications Tool: A Focus Group Study With Adolescents and Adults in England and Scotland, Nicotine & Tobacco Research, Volume 27, Issue 4, April 2025, Pages 705–713, https://doi.org/10.1093/ntr/ntae107