Objective:
Text and graphic warnings on cigarette packs focus on the negative consequences of smoking. Although some studies have shown that warning labels on cigarette packets to be effective for smoking cessation, smoker adolescents in Turkey have generally find ineffective these messages or have changed their assessments according to the content. In this study, the impact of both punishment-based (e.g. ‘Smoking causes lung cancer’) and reward-based (e.g. ‘If you do not smoke, you will have a beautiful smile’) warnings on the intention to quit smoking was examined.

Methods:
The sample of the study consisted of 22 undergraduate students from Istanbul University who have been smoking for the past 6 months. Participants filled out a brief information form about their smoking habits, followed by displayed a PowerPoint presentation with 20 images (10 punishment-based/10 reward-based) which they have never seen before randomly arranged on the computer screen. After each images, students were asked to respond the question of ‘Did you think that you should stop smoking?’ with a 5-point scale.

Results:
The mean duration of smoking was 5.1 ± 3.3 years and the average number of cigarettes per day was 9.6 ± 7.8. Participants who smoke ≤10 cigarettes per day found punishment-based images more effective (p=.042) however participants who wanted to quit smoking within 6 months rated reward-based images more effective (p=.017). In addition, 90.9% of the participants reported that current warnings on cigarette packages had no effect on thinking of stopping smoking.

Conclusions:
These results showed that in addition to punishment-based warnings some reward-based images can be used on cigarette packages in order to more motivate smokers to quit smoking.