Allison Ford

Young adult smokers' perceptions of plain packaging: a pilot naturalistic study

Aims To explore the impact, if any, that using plain (non-branded) cigarette packs in real-life settings has on young adult smokers. Methods Naturalistic-type research was employed, where smokers used brown ‘plain’ packs for 2 weeks and their regular packs for 2 weeks, in real-life settings. Participants were recruited in Glasgow, Scotland. Of the 140 smokers aged 18–35 years who participated in the naturalistic study, 48 correctly completed and returned all questionnaires. Over the 4-week study period, participants completed a questionnaire twice a week assessing pack perceptions and feelings, feelings about smoking, salience of health warnings and smoking-related behaviours. A subsample of 18 participated in a post-study interview, which employed a semistructured topic guide to assess perceptions and experiences of using plain packs. Results Trends in the data show that in comparison with branded packaging, plain packaging increased negative perceptions and feelings about the pack and about smoking. Plain packaging also increased avoidant behaviour (hiding the pack, covering the pack), certain smoking cessation behaviours, such as smoking less around others and forgoing cigarettes, and thinking about quitting. Almost half (n=8) of those in the post-study interview, predominantly women (n=6), reported that the use of plain packs had either increased avoidant behaviour or reduced consumption. Conclusions This pilot naturalistic study suggests that plain packaging could potentially help reduce tobacco consumption among some young adult smokers, and women in particular. Employing an innovative research methodology, the findings of this study are consistent with, and indeed support, past plain packaging research.

Cigarette pack design and adolescent smoking susceptibility: a cross-sectional survey

Objectives To compare adolescents’ responses to three different styles of cigarette packaging: novelty (branded packs designed with a distinctive shape, opening style or bright colour), regular (branded pack with no special design features) and plain (brown pack with a standard shape and opening and all branding removed, aside from brand name). Design Cross-sectional in-home survey. Setting UK. Participants Random location quota sample of 1025 never smokers aged 11–16 years. Main outcome measures Susceptibility to smoking and composite measures of pack appraisal and pack receptivity derived from 11 survey items. Results Mean responses to the three pack types were negative for all survey items. However, ‘novelty’ packs were rated significantly less negatively than the ‘regular’ pack on most items, and the novelty and regular packs were rated less negatively than the ‘plain’ pack. For the novelty packs, logistic regressions, controlling for factors known to influence youth smoking, showed that susceptibility was associated with positive appraisal and also receptivity. For example, those receptive to the innovative Silk Cut Superslims pack were more than four times as likely to be susceptible to smoking than those not receptive to this pack (AOR=4.42, 95% CI 2.50 to 7.81, p<0.001). For the regular pack, an association was found between positive appraisal and susceptibility but not with receptivity and susceptibility. There was no association with pack appraisal or receptivity for the plain pack. Conclusions Pack structure (shape and opening style) and colour are independently associated, not just with appreciation of and receptivity to the pack, but also with susceptibility to smoke. In other words, those who think most highly of novelty cigarette packaging are also the ones who indicate that they are most likely to go on to smoke. Plain packaging, in contrast, was found to directly reduce the appeal of smoking to adolescents.

The role of packaging for consumer products: Understanding the move towards ‘plain’ tobacco packaging

The Australian Government intends to introduce plain tobacco packaging in 2012. We consider whether such a move appears justified by examining the wider marketing literature in order to understand the role that packaging has for consumer goods. Packaging is often called the fifth ‘p’ of the marketing mix. It is an effective marketing medium for all consumer products and helps build consumer relationships through possession and usage. Common packaging strategies to promote the product, distinguish products from competitors, communicate brand values and target specific consumer groups include innovative, special edition, value and green packaging. These strategies, combined with the visual and structural aspects of packaging design, such as colour, size and shape, influence consumer perceptions and purchase and usage behaviour. This gives packaging an important role at point-of-purchase and also post-purchase. Packaging also has a close relationship with the product, influencing perceived product attributes, and is a key representative of the brand. We conclude that plain tobacco packaging appears justified, based on the importance of packaging as a promotional tool, and will fundamentally restrict the opportunity for tobacco companies to influence consumers through package design.

Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatized and capsule cigarettes

Twelve focus groups in Glasgow (Scotland) were conducted with female non-smokers and occasional smokers aged 12-24 years (N = 75), with each group shown 11 cigarettes: two (standard) cigarettes with cork filters; two coloured cigarettes (pink or brown); four slim cigarettes; an aromatized black cigarette; a menthol cigarette and a cigarette with a flavour-changing rupturable capsule in the filter. Participants were asked to rank the cigarettes by appeal, taste and harm. The capsule cigarette was then discussed in depth. The pink coloured cigarette and slim cigarettes created significant interest and were generally perceived as most appealing and pleasant tasting, and least harmful. The black aromatized cigarette received a mixed response, with some disliking the dark colour and associating it with low appeal, strong taste and increased harm, whereas for others the smell helped to enhance appeal and taste perceptions and lower perceptions of harm. The novel capsule cigarette, when discussed in-depth, was viewed very positively. Just as research shows that cigarette packs can influence perceptions of appeal, harm and taste, this study suggests that the actual cigarettes can do likewise. The findings have implications for tobacco education and policy.

The importance of cigarette packaging in a ‘dark’ market: the ‘Silk Cut’ experience

In a growing number of countries tobacco companies are severely restricted in how they can legally market their products. In these ‘dark’ markets the role of packaging as a promotional and communications tool becomes more pronounced. How packaging is used for the most expensive cigarette brands in dark markets has received limited attention however, even though these ‘premium’ cigarette brands significantly impact upon the profitability of tobacco companies. We outline, using retail trade press journals, how packaging was used for premium brand ‘Silk Cut’ in the UK from 2004 to 2011, following a comprehensive ban on tobacco advertising, promotions and sponsorship. From 2004 to 2008 packaging was used to help launch two new variants and during this period Silk Cut market share of the premium sector grew by 1.1%. Overall share of the cigarette market for the Silk Cut house (brand family) fell however due to the continuing decline of the premium sector. From 2008 to 2011 changes to the packaging were much more frequent, including the repeated use of limited-edition designs, and modifications to pack shape, texture, style of opening, cellophane, foil and inner frame. Silk Cuts share of the premium sector grew a further 2.9% from 2008 to 2011, and overall cigarette market share increased. That a premium brand can report any level of growth within such a hostile market, where most advertising, promotion and sponsorship is banned, taxation is among the highest in the world, and in the midst of a recession, is testament to the value of packaging.

Young People’s Use of E-Cigarettes across the United Kingdom: Findings from Five Surveys 2015–2017

Concern has been expressed about the use of e-cigarettes among young people. Our study reported e-cigarette and tobacco cigarette ever and regular use among 11–16 year olds across the UK. Data came from five large scale surveys with different designs and sampling strategies conducted between 2015 and 2017: The Youth Tobacco Policy Survey; the Schools Health Research Network Wales survey; two Action on Smoking and Health (ASH) Smokefree Great Britain-Youth Surveys; and the Scottish Schools Adolescent Lifestyle and Substance Use Survey. Cumulatively these surveys collected data from over 60,000 young people. For 2015/16 data for 11–16 year olds: ever smoking ranged from 11% to 20%; regular (at least weekly) smoking between 1% and 4%; ever use of e-cigarettes 7% to 18%; regular (at least weekly) use 1% to 3%; among never smokers, ever e-cigarette use ranged from 4% to 10% with regular use between 0.1% and 0.5%; among regular smokers, ever e-cigarette use ranged from 67% to 92% and regular use 7% to 38%. ASH surveys showed a rise in the prevalence of ever use of e-cigarettes from 7% (2016) to 11% (2017) but prevalence of regular use did not change remaining at 1%. In summary, surveys across the UK show a consistent pattern: most e-cigarette experimentation does not turn into regular use, and levels of regular use in young people who have never smoked remain very low.

Adolescent perceptions of cigarette appearance

BACKGROUND To reduce the possibility of cigarette appearance misleading consumers about harm caused by the product, the European Commissions draft Tobacco Products Directive proposed banning cigarettes <7.5 mm in diameter. It appears however, following a plenary vote in the European Parliament, that this will not be part of the final Tobacco Products Directive. To reduce the appeal of cigarettes, the Australian Government banned the use of branding on cigarettes and stipulated a maximum cigarette length as part of the Tobacco Plain Packaging Act. We explored the role, if any, of cigarette appearance on perceptions of appeal and harm among adolescents. METHODS Focus group research with 15-year-olds (N = 48) was conducted in Glasgow (Scotland) to explore young peoples perceptions of eight cigarettes differing in length, diameter, colour and decorative design. RESULTS Slim and superslim cigarettes with white filter tips and decorative features were viewed most favourably and rated most attractive across gender and socio-economic groups. The slimmer diameters of these cigarettes communicated weaker tasting and less harmful looking cigarettes. This was closely linked to appeal as thinness implied a more pleasant and palatable smoke for young smokers. A long brown cigarette was viewed as particularly unattractive and communicated a stronger and more harmful product. CONCLUSION This exploratory study provides some support that standardising cigarette appearance could reduce the appeal of cigarettes in adolescents and reduce the opportunity for stick design to mislead young smokers in terms of harm.

Young women smokers' response to using plain cigarette packaging: Qualitative findings from a naturalistic study

BackgroundThe aim of this study was to explore in-depth the response of young women smokers (18–35 years) to using dark brown ‘plain’ cigarette packs in naturalistic settings.MethodsParticipants were recruited in six towns and cities in Scotland to take part in a naturalistic study, where they used plain cigarette packs for a week. Participants completed a number of questionnaires during the study period (reported elsewhere), and a sub-sample participated in post-study telephone interviews to explore their experiences of using the plain packs. Of the 187 participants who completed the study, 23 were randomly selected to participate in the post-study interviews. Within the interviews a semi-structured topic guide was used to assess perceptions of the plain pack, feelings created by the pack, feelings about smoking, and avoidant and smoking behaviour.ResultsThe brown (plain) packs were perceived negatively due to the colour, the undesirable image the pack conveyed, and the reaction from others. The plain packs were also associated with negative feelings, such as embarrassment, discomfort and guilt. Some participants also commented that they felt differently about the product, considered to be less enjoyable or more harmful, when using the plain packs, and were less interested in, or felt more negatively about, smoking. A number of participants said that they had engaged in avoidant behavior with the plain packs, such as hiding it, due to their negative thoughts about the packs and the reaction of others. Some participants also mentioned cessation-related behaviours when using the plain packs, such as forgoing cigarettes, stubbing cigarettes out early and thinking about quitting, largely due to the decreased enjoyment of smoking.ConclusionsThe experience of using cigarettes in plain packs prompted a range of negative responses from young women smokers, who are a crucial target group for tobacco control interventions.

Bereavement through substance use: findings from an interview study with adults in England and Scotland

Abstract Background: Deaths associated with alcohol and/or drugs belong to a category of ‘special’ deaths due to three characteristics: traumatic circumstances of the death, stigma directed to both the bereaved and the deceased, and resulting disenfranchised grief experienced by the bereaved. These factors can impede those who are bereaved in this way from both grieving and accessing support. In response to a lack of research in this area this paper reports on an interview study that has aimed to better understand the experiences and needs of this neglected group of bereaved people. Method: Interviews with 106 adults (parents, children, spouses, siblings, nieces and friends) bereaved through substance use in Scotland and England. Results: Five themes describe interviewee experiences: possibility of death, official processes, stigma, grief and support. These findings suggest what is dominant or unique in this group of bereaved people; namely, that living with substance use (including anticipatory grief), experiencing the subsequent death (often traumatic and stigmatised) and the responses of professionals and others (more likely negative than positive) can disenfranchise grief and negatively impact bereavement and seeking support. Conclusions: This article describes a large and unique sample, the largest in the world to be recruited from this population. Our study raises awareness of a hitherto largely ignored and marginalised group of bereaved people, highlighting what might be particular to their bereavement experience and how this may differ from other bereavements, thereby providing an evidence base for improving the availability, level and quality of support.

Bereavement following a fatal overdose: The experiences of adults in England and Scotland

Abstract Aims: Overdoses contribute disproportionately to drug-related deaths (DRDs) in the UK, yet little is known about the experiences and needs of those who are bereaved by such deaths, and how their experiences and needs might differ from other bereavements associated with substance use. Methods: An interview study with 32 adults in England and Scotland (part of a larger study). Findings: Five themes describe the core experiences of this group of bereaved people: drug use, the death, official processes, stigma, and overdose awareness and prevention. Together, these findings offer new insights in to the key features of this type of bereavement; for example, living with substance use including previous overdoses, difficult circumstances surrounding the death, having to negotiate the complex procedures involved in processing the death, the stigma such deaths attract, and feelings of guilt, self-blame and an unworthiness to grieve. Conclusions: There are ways in which bereavement following an overdose differs from bereavement following other deaths associated with alcohol or drugs. Understanding the experiences and needs of this marginalised group can help improve support for them. Furthermore, this group’s experience of witnessing and/or responding to previous overdoses indicates the value in prevention programmes targeting relatives/friends.