BACKGROUND: In Canada, research on tobacco pack inserts has yielded evidence regarding their impact on smokers' knowledge and behaviors. Israel legislated for pack inserts in 2018 but has yet to implement them. Qualitative research showed preference for information on harm to others, quitting tips and success stories. We developed 16 pack inserts using an informative, motivational approach, and tested smokers' responses.
METHODS: In May 2023, 809 adult Israeli smokers (56% male; mean age 41±14; range 18-79) completed an online panel survey and were randomly assigned to rate 4 inserts on novelty, importance, and thoughts about quitting/seeking support.
RESULTS: 62% liked the positive messages very much (rated 4-5/5). Inserts with the highest mean composite score were about recovery and addiction, and messages concerning children (taking up smoking or being exposed to smoke). There was a significant association between the belief that inserts could encourage seeking cessation support with smoking intensity and previous quit attempt (p<0.001). In an ordinal regression, the strongest predictor was smoking intensity (b=1.143, p<0.001), where lighter smokers were more likely to give higher ratings. Furthermore, those who had tried to quit multiple times were more likely to rate the inserts higher (p<0.001). Regarding preferred topics, 70% chose quitting tips; 57% wanted information on health risks, with a higher proportion among light smokers (60% vs 45% in heavy smokers)(p=0.011). More light smokers were interested in information on e-cigarettes (35% vs 18% heavy smokers) (p<0.001) and on secondhand smoke (47% vs 34%)(p=0.028).
CONCLUSIONS: Israeli adult smokers expressed positive attitudes towards tobacco pack inserts with motivational and cessation messages, and over a third thought they could help motivate them to quit. Messages about recovery and quitting had high ratings. Israel has the opportunity to be the second country to implement tobacco pack inserts to influence smokers' behavior and contribute to smoking cessation efforts.