Background
death
Smoking is a leading preventable cause of death worldwide [Tobacco product packaging is an integral part of marketing in building brand awareness and customer loyalty. Therefore, the tobacco industry has historically put substantial effort into branding and package design [PP is expected to alter smoking behaviour through three channels. First, by reducing the appeal of packages [There is mixed evidence on whether the reduction in appeal, increase in attention to health warnings, and change in perceptions of the health effects (induced by PP) translate into actual changes in smoking behaviour. Some studies have shown that PP is effective in increasing the intention to quit [Earlier research has shown that compared to text-only warnings, graphic health warnings (GHWs) are more effective in attracting attention and increasing the intention to quit [This study is also related to the strand of literature that evaluates the effects of different combinations of GHWs and PPs in altering smoking-related perceptions and behaviours. GHWs have been found to be more effective than PP in impacting cigarette cravings, evoking fear, and increasing thoughts of quitting [In Turkey, Law No. 4207 passed in 1996 required a text warning about the detrimental health effects of smoking (“Disclaimer: Harmful to Health”) to be placed on cigarette packs [Until 2010, cigarette packs sold in Turkey had only text warnings. Brand logos were visible and packs were printed in brand-specific colours. With the regulation in 2010, combined health warnings were introduced by adding graphic health warnings (GHWs) to text warnings that were already on cigarette packs [Law No. 7151 in November 2018 and the subsequent regulations in March 2019 [In Turkey, only a few studies have been conducted on GHWs or PP. Related studies in the literature have focused on the thoughts and perceptions of high school or university students about the effectiveness of GHWs and PP in deterring consumers or encouraging them to quit smoking [In this study, we aimed to estimate the impact of PP and stronger GHWs on three outcome variables (negative affect, avoidant responses, and intentions to quit) in Turkey using a survey-based experiment that included 623 ever-smokers from four universities in Ankara. We specifically focused on university students for several reasons. First, evidence suggests that health warnings and graphics have differential effects depending on the age profile [This paper contributes to the literature, first, by providing evidence from an upper-middle income country with a high smoking prevalence rate (at around 28% of the population over age 15, constituting the second highest rate among OECD countries [