A hopeful journey: responses to efficacy labels from people using RYO tobacco in Aotearoa New Zealand.

Introduction: Although many countries have introduced pictorial warning labels (PWLs), few use efficacy labels or inserts offering supportive cessation advice or outlining benefits of quitting. Theory and evidence suggest efficacy labels foster positive responses to the threats presented rather than elicit maladaptive responses that manage the fear aroused. We explored how people who smoke roll-your-own (RYO) tobacco responded to potential on-pack efficacy labels that could complement PWLs by promoting self-efficacy and response-efficacy.

Methods: We undertook 27 in-depth interviews with people aged 18 and over (16 female, 8 Māori, 13 aged ≤35) who smoked RYO cigarettes and lived in Aotearoa New Zealand. We probed participants' responses to efficacy labels and provided them with stimuli they could use to construct their own inspiring label. We used the Extended Parallel Process Model and hope theory to interpret the data, which we analysed using a reflexive thematic analysis approach.

Results: Participants strongly endorsed efficacy labels; unlike current warning labels, which they saw as didactic and judgemental, efficacy labels offered hope and agency, and helped them envisage the benefits of becoming smokefree. Creating hope valued and empowered participants, while practical advice offered helped them anticipate how they could overcome addiction and become smokefree.

Conclusions: On-pack efficacy labels could complement PWLs and support people to address the threat these warnings describe. Policymakers should explore and implement interventions such as efficacy stimuli, given these appear to resonate with priority population groups and could help reduce health inequities.