Do smokers and non-smokers have to be offended to be desincited to smoke?

Background. - As recommended by WHO in the fight against smoking, the French authorities have decided to implement the display of 14 "shock pictures'' on cigarette packages in 2011. This study examines the effectiveness of this policy. Methods. - The present study is based on a self-reported questionnaire administered to a sample of 418 first-year medical students from a private faculty in January 2010. We consider a set of 12 European visual warnings that address different smoking problems. Econometric modeling is used to study the determinants of answers. Results. - Our results were twofold. Firstly, the most effective symbols concern the smoker himself/herself, they are explicit and related to an advanced stage of disease. Secondly, the warnings seem to be more effective to confirm the non-smokers in their choice than to deter smokers to smoke. Conclusion. - This tobacco control policy seems to be effective. Therefore, visual warnings have to be carefully chosen before implementation. (C) 2011 Elsevier Masson SAS. All rights reserved.