Background: Effective June 22, 2010, cigarette manufacturers were prohibited from adding misleading “lights” descriptors on cigarette packs in the US. To help understand the impact of this policy on a population that began using tobacco in an environment devoid of “lights” descriptors, this study examined youth and youth adult perceptions of cigarette packs with different colors. We also assessed what youth and young adult smokers call these packs to determine if “lights” are being used by this population to name packs once labeled with this descriptor.

Methods: We recruited a sample (N=4074) of 15-24 year olds currently using tobacco products to complete an online survey. Participants were randomly assigned to view a pair of cigarette packs of either Marlboro Red (MR), Marlboro Gold (MG; previously labeled “lights”), or Marlboro Silver (MS; previously labeled “ultra lights”). Outcomes included relative perceived harm, addiction, ease of inhalation, and taste (i.e., comparing Pack A vs. Pack B). We also asked current cigarette smokers (n=2,728) what they would call the two packs they viewed. The write-in responses for pack names were coded for banned descriptors (e.g., “lights”), colors (e.g., gold), and other descriptors (e.g., smooth).

Results: We found no differences in mean scores for relative harm, addiction, and taste, when comparing MG vs. MR. In contrast, mean scores for relative ease of inhalation (p<0.001) were lower (i.e., easier to inhale) for MG vs. MR. There was no difference in mean scores for relative harm for MS vs. MR. However, mean scores for relative addiction (p=<0.001), taste (p=0.026), and ease of inhalation (p<0.001) were lower (all indicating more favorable perceptions) for MS vs. MR. Current smokers rarely used “lights” descriptors when naming MG (4.6%). Instead, “gold” (25.0%) and “smooth” (16.4%) descriptors were more common. Similarly, participants rarely used “lights” descriptors when naming MS (3.1%), while “mellow” (22.2%) and “silver” (15.5%) descriptors were more frequent.

Conclusion: Over a decade after “lights” descriptors were banned from US cigarette packs, we found that cigarette pack color was not associated with reduced relative harm perceptions among a sample of youth and young adults. Moreover, “lights” were rarely used when naming MG and MS. However, MS had more favorable perceptions (i.e., less addictive, easier to inhale, better taste) than MR, prompting concerns about MS appeal to youth and young adults.