# Reframing cigarettes as social currency: A randomized survey experiment on the role of warning images and pricing

## TL;DR

This study explores how graphic warnings and price changes affect cigarette gifting in China, finding that graphic warnings reduce gifting in non-intimate relationships.

## Contribution

The study introduces a novel approach to reducing cigarette gifting by targeting its symbolic value through graphic warnings.

## Key findings

- Graphic warnings significantly reduced willingness to gift cigarettes in weak relationships.
- Price increases alone did not change gifting behavior but reduced brand preference in weak relationships.
- Tobacco control should focus on altering symbolic meanings rather than economic measures.

## Abstract

In China, cigarettes function as both consumer goods and ‘social currency’. Despite increased awareness of smoking risks, cigarette gifting persists. This study examines whether graphic warning images and price increases can reduce the social value of cigarettes in gifting contexts.

A survey experiment was conducted (n=744), randomly assigning participants to a control group (n=189), a price treatment group (n=285), and an image warning group (n=270). Eligible participants were adults with stable incomes. Participants in the price treatment group viewed the same cigarette brands as in the control condition but with retail prices doubled relative to the market price, whereas those in the image treatment group viewed cigarette packs with added graphic warning images while prices remained unchanged. The primary outcomes were willingness to gift or receive cigarettes in strong and weak relationships (1=very unwilling to 5=very willing) and brand tier preference (1=low, 2=mid, 3=high), and logistic regressions were applied to assess treatment effects. All comparisons were made against the control group, and logistic regression results are presented as coefficients (β) with 95% confidence intervals (CI).

Graphic warning images significantly reduced willingness to gift cigarettes (β= -0.88; 95% CI: -1.33 – -0.42, p<0.001) and expectations to receive cigarettes (β= -0.62; 95% CI: -1.08 – -0.16, p<0.01) in weak relationships but had no significant effect in strong relationships. Price increases did not affect gifting willingness but reduced brand preference in weak relationships (β= -0.67; 95% CI: -1.11 – -0.23, p<0.01).

Graphic warnings effectively weaken the symbolic value of cigarettes in non-intimate relationships, while price increases alone are insufficient. Tobacco control strategies should prioritize altering symbolic meanings rather than relying solely on economic measures.