Roll-your-own loose tobacco packaging warning labels: a qualitative study using a novel elicitation method.

Background Many countries have seen roll-your-own (RYO) loose tobacco use increase, despite policies to reduce smoking prevalence. On-pack pictorial warning labels (PWLs) typically feature general warnings about smoking, and no jurisdictions link these to specific types of tobacco (ie, RYO tobacco or tailor made cigarettes). We explored the warning narratives a sample of RYO smokers created when given an opportunity to create their own PWL. Methods We conducted 20 in-depth interviews with New Zealand RYO smokers aged between 18 and 67 years. Participants used a novel elicitation method-a 'construct-a-pouch' exercise-to develop an on-pouch warning they regarded as effective. We used a qualitative descriptive approach to interpret the transcripts. Results Participants engaged with the novel and emotive content of the images and text messages, and constructed PWLs that typically drew on themes of regret, sadness and loss. Participants perceived the warning narratives they created as highly credible and emotionally salient. These contrasted sharply with existing PWLs on RYO pouches, which they rationalised as tired, uninteresting and unlikely to prompt cessation. Conclusions Our findings reinforce the importance of high-affect arousing PWLs and suggest involving smokers in the formative creation of PWLs may result in markedly more impactful warnings. Linking PWLs to the type of tobacco smoked may also reduce the rationalisations smokers employ to discount warnings, and result in warnings that prompt engagement and personal reflection.