Crawford Moodie

Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies

Background and Objectives Standardised or ‘plain’ tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Methods Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Results Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. Conclusions The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm based upon package design; and will help make the legally required on-pack health warnings more salient.

The association between point-of-sale displays and youth smoking susceptibility

INTRODUCTION According to tobacco industry documents, tobacco displays within the retail environment assume a much greater importance with the loss of other marketing channels. The impact of these displays upon young people and their future intentions to smoke (susceptibility) is, therefore, of significant interest to public health. METHODS A cross-sectional in-home survey was conducted in 2008 with young people (N = 1,401) aged 11-16 years, recruited from across the United Kingdom. We examine the salience of and attraction to cigarette displays at point-of-sale (POS), among youth, and whether this is associated with susceptibility. We concentrate exclusively on the 956 never-smokers. RESULTS Logistic regression, controlling for known risk factors of youth smoking, found that noticing cigarette displays was associated with higher levels of susceptibility (odds ratio [OR] = 1.77, p < .05) and greater attraction to displays was associated with higher susceptibility (OR = 1.07, p < .001). CONCLUSIONS It is difficult, if not impossible, to safeguard young people from exposure to displays of tobacco at POS. That these displays were associated with increased susceptibility suggests that moves to place tobacco out of sight in the United Kingdom, and elsewhere, are justified.

Young adult women smokers’ response to using plain cigarette packaging: a naturalistic approach

Objectives To explore young adult women smokers’ cognitive and emotional response to using dark brown ‘plain’ cigarette packs in natural settings and whether plain packaging is associated with any short-term change in smoking behaviour. Design A naturalistic approach. Participants used plain cigarette packs provided to them for 1 week and for 1 week their own fully branded packs, but otherwise smoked and socialised as normal. Participants completed questionnaires twice a week. Setting The six most populated cities and towns in Scotland. Participants 301 young women smokers were recruited, with a final sample of 187 (62.1%). To meet the inclusion criteria women had to be between the ages of 18 and 35, daily cigarette smokers and provide a breath sample to confirm smoking status. Primary and secondary outcome measures Pack perceptions and feelings, feelings about smoking, salience and perceptions of health warnings and avoidant and cessation behaviours. Results In comparison to fully branded packaging, plain packaging was associated with more negative perceptions and feelings about the pack and about smoking (p<0.001). No significant overall differences in salience, seriousness or believability of health warnings were found between the pack types, but participants reported looking more closely at the warnings on plain packs and also thinking more about what the warnings were telling them (p<0.001). Participants reported being more likely to engage in avoidant behaviours, such as hiding or covering the pack (p<0.001), and cessation behaviours, such as foregoing cigarettes (p<0.05), smoking less around others (p<0.001), thinking about quitting (p<0.001) and reduced consumption (p<0.05), while using the plain packs. Results did not differ by dependence level or socioeconomic status. Conclusions No research design can capture the true impacts of plain packaging prior to its introduction, but this study suggests that plain packaging may help reduce cigarette consumption and encourage cessation in the short term.

Adolescents' response to text-only tobacco health warnings: results from the 2008 UK Youth Tobacco Policy Survey.

BACKGROUND As of June 2009 most (89%) European Union member states continue to use mandated text-only health warnings on tobacco products. This study assessed adolescent (aged 11-16 years) perceptions of and reactions to these text warnings on cigarette packs in the UK. METHODS Data comes from wave five of the cross-sectional Youth Tobacco Policy Survey in 2008. A total of 1401 adolescents were recruited and health warnings were assessed in terms of salience (noticing, reading), comprehension and credibility, memorability (recall), depth of processing (contemplating, discussing) and persuasiveness (put off smoking, make more likely to stop). Smokers were also asked about behavioural compliance (foregoing cigarettes due to warnings, avoidance of warnings) and perceptions of harm from their smoking (to indirectly assess possible knowledge gained from warnings). RESULTS Despite moderately high salience of warnings, memorability and, in particular, depth of processing was quite low, with warnings only sometimes thought about and very rarely discussed. Warnings were however considered comprehensible, credible and a reasonable deterrent for occasional and never smokers. Additionally, a third of regular smokers indicated that, in the last month, warnings had stopped them from having a cigarette. However, only 6% of smokers indicated that warnings made them forego cigarettes frequently. CONCLUSION Text warnings help to communicate the dangers associated with smoking and, resultantly, prompt a small number of smokers to forgo cigarettes and take action to avoid warnings, but depth of processing is low and warnings do not appear to be achieving their full potential among smokers.

Tobacco marketing awareness on youth smoking susceptibility and perceived prevalence before and after an advertising ban

BACKGROUND The Tobacco Advertising and Promotion Act (TAPA) was implemented in the United Kingdom in 2003. This study is the first to assess its impact on young people, examining smoking susceptibility (intention to smoke among never smokers) and perceived prevalence across three British cross-sectional samples (aged 11-16) before and after the introduction of the ban. METHODS Three in-home surveys (n = 1078, 1121 and 1121) were conducted before (1999 and 2002) and after (2004) the implementation of the TAPA. RESULTS Significant declines in awareness of tobacco marketing and perceived prevalence occurred across the three waves. Higher levels of awareness and perceived prevalence were associated with increased susceptibility, but direct measures of susceptibility remained stable. CONCLUSIONS The TAPA is protecting young people in United Kingdom from tobacco marketing and reducing perceived prevalence, both of which are linked to susceptibility. The stability of susceptibility across the three waves is probably best explained by both the partial implementation of TAPA at the final survey point and the time such effects take to emerge. The evidence from this and previous studies is, however, that, ultimately, they will appear.

Tobacco packaging as promotion

Almost 20 years ago it was suggested that restrictions in tobacco advertising would only be partly successful as the ‘pack itself is a powerful form of advertising’.1 These words have proved prescient as the pack has indeed emerged as the primary marketing tool in jurisdictions with tight marketing controls. In the UK, for instance, following the introduction of the Tobacco Advertising and Promotion Act between 2003 and 2005, which banned all forms of tobacco advertising and promotion, the pack has became the main marketing driver.2 Moodie and Hastings2 explain how UK tobacco industry marketing documents from between 1995 and 2000 both predicted the increasing importance of the pack in the face of marketing restrictions and highlighted the different ways the pack can be employed to promote the product, via what they refer to as value, image and innovation (or gimmick) packaging. Value packaging is used to communicate value via altered pack size (for instance, packs containing 24 cigarettes rather than the standard 20) or price-marking (which displays the price of the cigarettes on the pack, see figure 1). Both altered pack size and price-marking, most evident for value and economy brands, are used to communicate value to the consumer although they are not necessarily indicative of reduced price relative to other …

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.

Tobacco harm reduction: the devil is in the deployment

The concept of harm reduction in tobacco control is exciting interest among policy makers and industry. Gerard Hastings, Marisa de Andrade, and Crawford Moodie argue that it presents public health with some challenges