RESUMEN
BACKGROUND AND AIMS: Standardized tobacco packaging was introduced in the United Kingdom in May 2016, together with larger graphic warnings. This study explored young Scottish people's awareness of and perceptions about standardized tobacco packaging in the United Kingdom. DESIGN: Qualitative study using 16 focus groups conducted February-March 2017. SETTING: Four schools in Scotland based in areas of differing socio-economic status (high versus medium/low) and two levels of urbanity (large urban versus small town/other urban). PARTICIPANTS: Eighty-two S2 (13-14 years) and S4 (15-16 years) students who were smokers or at-risk non-smokers. MEASUREMENTS: Focus groups explored perceptions of standardized packaging and health warnings. The qualitative data underwent thematic analysis. FINDINGS: Views about standardized packaging were generally negative. Packs were described as being unattractive, drab and less appealing than non-standardized versions. The new health warnings generated negative affective, often aversive, responses. These varied depending on the image's perceived 'gruesomeness' and authenticity. Most participants thought that the impact would be greatest on young non/occasional smokers. There were divergent views about whether established smokers would be affected. CONCLUSIONS: The introduction of standardized tobacco packaging and new larger graphic health warnings in the United Kingdom seems have reduced the perceived attractiveness of cigarette packs among young people in the United Kingdom who smoke or are at elevated risk of becoming smokers, disrupting positive brand imagery (the brand heuristic), increasing the salience of health warnings and contributing to denormalizing smoking.