Background:
The Scottish Government has identified dissuasive cigarettes, which provide exposure to health warnings at the point of consumption and reduce product attractiveness, as a future tobacco control measure to reduce smoking prevalence and encourage cessation.

Objectives:
We explore reactions to, and trial intentions for, three dissuasive cigarette designs, including varied colours and written text warnings, among adolescents in Scotland.

Methods:
A cross-sectional survey was conducted with adolescents aged 12–17 years in Scotland (n=594), between November 2017 and November 2018. Participants were shown one ‘standard’ cigarette (imitation cork filter with white paper casing) and three dissuasive cigarettes: 1) cigarette with warning ‘smoking kills’; 2) cigarette with message ‘toxic’ and skull and cross-bones image; and 3) a dark green cigarette. Participants rated each cigarette on 9 five-point reaction measures (e.g. appeal, harm). A composite reaction score was computed across the reactions items for each cigarette, and these were binary coded as overall negative reaction or not. Participants also indicated whether they would trial each cigarette design (Yes/No). Demographics, smoking status, and smoking susceptibility were also measured.

Results:
Most participants had negative reactions to the ‘smoking kills’ (85%), dark green (93%) and ‘toxic’ (96%) cigarette. For all three dissuasive designs, negative reactions were more likely among younger adolescents (vs older), never-smokers (vs ever), and non-susceptible never-smokers (vs susceptible never-smokers). Most participants reported they would not trial any of the cigarettes (range: 89–92%).

Conclusion:
Dissuasive cigarettes present a further opportunity to reduce the appeal of smoking among adolescents, in particular, those with explicit messages and imagery.