Can dissuasive cigarettes influence young peoples’ perceptions of smoking?

Background In order to counter the attractiveness of cigarettes, Article 11 of the Framework Convention on Tobacco Control mentions the possibility of including a health warning on cigarettes. The objective of this study was toexplore perceptions of cigarettes designed to be dissuasive (either displaying a text health warning or pictogram, unattractively coloured, or a combination of these). Methods In-depth interviews were conducted with 31 people in France aged 15-25 years (11daily smokers, 10 occasional smokers, 10 non-smokers, 15 females, 16 males). Participants were shown the different dissuasive cigarettes (displaying the warning \u27Smoking kills\u27, a ‘skull and crossbones’ pictogram, unattractive shades of brown or green, or a combination of all three). Open-ended questions were asked about the attractiveness of the cigarettes, perception of risk, the image of the smoker, and influence on desire to quit or not to start. Discussions were audio-recorded and transcribed. Manual coding and « IRaMuTeQ » software was used to analyse the data. Results The different dissuasive elements used were found to increase negative health perceptions (e.g.  increase risk), reduce positive smoker image and the perceived pleasure of smoking (e.g. embarrassment of smoking in front of friends), decrease desire to start smoking and increase desire to quit. The most dissuasive cigarette was an unattractively coloured cigarette which displayed both the warning \u27smoking kills\u27 and \u27skull and bones\u27 pictogram. Conclusion This study highlights the importance of the appearance of the cigarette, and suggests that dissuasive cigarettes may be an innovative tobacco control measure for governments

Dissuasive cigarettes: which cues are the most effective at deterring young people from smoking?

Objectives In order to counter the attractiveness of cigarettes, Article 11 of the Framework Convention on Tobacco Control provides for the possibility of including warnings on cigarettes. The objective of our research was to explore perceptions of cigarettes designed to be dissuasive (either displaying the warning ‘Smoking kills’ in uppercase or lowercase, a ‘skull and crossbones’ pictogram, unattractive shades of brown or dark green, or a combination of all these negative cues). Study design In-depth interviews were conducted with 31 people in France aged 15-25 (10 daily smokers, 10 occasional smokers, 11 non-smokers; 15 females, 16 males). Methods Participants were shown different dissuasive cigarettes (displaying the warning ‘Smoking kills’, a ‘skull and crossbones’ pictogram, unattractive shades of brown or dark green, or a combination of all three), and current branded ones. Open-ended questions were asked about the attractiveness of the cigarettes, perception of risk, the image of the smoker, and influence on the desire to quit or not to start. Discussions were audio-recorded and transcribed. Results The different dissuasive cues were found to increase negative health perceptions (e.g., increase risk), reduce positive smoker image and the perceived pleasure of smoking (e.g., embarrassment of smoking in front of friends), decrease the desire to start smoking and increase the desire to quit. The most dissuasive cigarette was an unattractively dark-coloured cigarette which displayed both the warning ‘smoking kills’ and a ‘skull and crossbones’ pictogram. Conclusion This study highlights the importance of the appearance of cigarettes and suggests that dissuasive cigarettes may be an innovative tobacco control measure for governments

Plain packaging: Legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations

Introduction By July 2018, five countries (Australia, France, United Kingdom, New Zealand, Norway) had fully implemented plain (standardised) packaging. Methods Using government documents, we reviewed the key legislative differences between these five countries to identify best practice measures and potential lacuna. We then discuss how governments planning to introduce plain packaging could strengthen their legislation. Results Differences between countries include the terminology used (either ‘plain’, ‘standardised’, or ‘plain and standardised’), products covered, and transition times (ranging from two to twelve months). Myriad differences exist with respect to the packaging, including the dimensions (explicitly stated for height, width and depth vs minimum dimensions for the health warnings only), structure (straight-edged flip-top packs vs straight, rounded and bevelled-edged flip-top packs and shoulder boxes) and size (minimum number of cigarettes and weight of tobacco vs fixed amounts), and warning content (e.g. inclusion of a stop-smoking web address and/or quitline displayed on warnings on one or both principal display areas). Future options that merit further analysis include banning colour descriptors in brand and variant names, allowing pack inserts promoting cessation, and permitting cigarettes that are designed to be dissuasive. Conclusions Plain packaging legislation and regulations are divergent. Countries moving towards plain packaging should consider incorporating the strengths of existing policies and review opportunities for extending these. While plain packaging represents a milestone in tobacco control policy, future legislation need not simply reflect the past but could set new benchmarks to maximise the potential benefits of this policy

Consumer Perceptions of Cigarette Design in France: A Comparison of Regular, Slim, Pink and Plain Cigarettes

Introduction The cigarette, like the cigarette pack, is used by tobacco companies as a promotional tool. We explore how the cigarette could potentially be used as a dissuasive tool. Methods An online survey was conducted with 15-30 year old smokers and non-smokers (N=998) in France to explore their perceptions of a plain cigarette (grey with no brand name) and three branded cigarettes (regular, slim, pink). Participants were randomly assigned to view the plain cigarette and either the regular, slim or pink cigarette. They were asked to rate the cigarettes by Appeal (tastiest, highest quality, most expensive), Harm (most dangerous, most effective for motivating people to talk about tobacco dangers), and Perceived behavioral impact (most effective to convince teenagers not to start, to motivate smokers to reduce consumption and quit). Results In comparison to the grey cigarette, each of the branded cigarettes were considered more appealing, less harmful, and more likely to motivate teenagers to start and less likely to motivate smokers to reduce consumption or quit. Conclusions The study suggests that altering the appearance of the cigarette may reduce cigarette appeal, increase harm perceptions, and deter both young people and smokers. Implications Very little research has focused on dissuasive cigarettes whereas the cigarette stick has become very important for tobacco companies for communication purposes. This is the first study to compare the effect of various branded cigarettes (regular, slim, pink) with a plain grey cigarette on young adult smokers and non-smokers. The findings suggest that a plain grey cigarette can reduce cigarette appeal, increase perceptions of harm, and may deter use among both smokers and non-smokers

Restricting the content of alcohol advertising and including text health warnings: A between-group online experiment with a non-probability adult sample in the United Kingdom

Background: Statutory options for restricting alcohol advertising include limiting it to product-orientated information and requiring health warnings. We assess the impact of removing positive contextual factors from alcohol advertising and including a health warning among adults in the United Kingdom (UK). Methods: We conducted a 2 × 2 online between-group experiment with adults (18+) (n = 2421) recruited from a non-probability research panel in the United Kingdom. Participants were randomized to see an alcohol (vodka) advertisement (advert) which varied by context (no context vs. imagery depicting positive social interactions around alcohol) and message (multiple text health warning vs. “drink responsibly”). The multiple text health warning, based on recent legislation in Ireland, comprised three separate warnings (liver disease, cancers, drinking during pregnancy) and a web address for alcohol-related information and support. The “drink responsibly” control reflected the self-regulatory messages commonly used by alcohol companies. Participants rated the advert on 7-point scales for advert attractiveness, product appeal, trial intentions, perceived harm, and whether it made drinking alcohol seem enjoyable. Results: Removing the positive social context reduced positive advert and product reactions (difference in estimated marginal means [EMM]: −1.57 [makes drinking alcohol seem enjoyable] to −0.23 [intention to try]). Including the multiple text health warning also reduced positive advert and product reactions (difference in EMM: −0.55 [advert attractiveness] to −0.25 [intention to try]) and increased perceived product harm (difference in EMM: +0.25). There were no interactions between advert context and message for any outcome. Conclusions: Restricting content and including a multiple text health warning (compared to a “drink responsibly” message) may attenuate the persuasive impact of alcohol advertising and increase perceived product harm. Further research is needed to examine different degrees of content restrictions, alternative warning content and design, generalizability to different alcohol products and advert formats, and whether the impact of content controls varies among population subgroups

Restricting the content of alcohol advertising

Background: Statutory options for restricting alcohol advertising include limiting it to product-orientated information and requiring health warnings. We assess the impact of removing positive contextual factors from alcohol advertising and including a health warning among adults in the United Kingdom (UK). Methods: We conducted a 2 × 2 online between-group experiment with adults (18+) (n = 2421) recruited from a non-probability research panel in the United Kingdom. Participants were randomized to see an alcohol (vodka) advertisement (advert) which varied by context (no context vs. imagery depicting positive social interactions around alcohol) and message (multiple text health warning vs. “drink responsibly”). The multiple text health warning, based on recent legislation in Ireland, comprised three separate warnings (liver disease, cancers, drinking during pregnancy) and a web address for alcohol-related information and support. The “drink responsibly” control reflected the self-regulatory messages commonly used by alcohol companies. Participants rated the advert on 7-point scales for advert attractiveness, product appeal, trial intentions, perceived harm, and whether it made drinking alcohol seem enjoyable. Results: Removing the positive social context reduced positive advert and product reactions (difference in estimated marginal means [EMM]: −1.57 [makes drinking alcohol seem enjoyable] to −0.23 [intention to try]). Including the multiple text health warning also reduced positive advert and product reactions (difference in EMM: −0.55 [advert attractiveness] to −0.25 [intention to try]) and increased perceived product harm (difference in EMM: +0.25). There were no interactions between advert context and message for any outcome. Conclusions: Restricting content and including a multiple text health warning (compared to a “drink responsibly” message) may attenuate the persuasive impact of alcohol advertising and increase perceived product harm. Further research is needed to examine different degrees of content restrictions, alternative warning content and design, generalizability to different alcohol products and advert formats, and whether the impact of content controls varies among population subgroups

Perceptions of plain cigarette packaging among smokers and non-smokers in Andalusia (Spain)

OBJECTIVES: Each year tobacco is responsible for 650,000 deaths in Europe and 55,000 in Spain. With tobacco advertising and promotion banned in Spain and most of Europe, the last bastion of marketing is the packaging. Plain tobacco packaging -which involves packs having a standardised appearance- has been proposed to counter this. The objective of this study is to research perceptions arising from the plain packaging of tobacco products. METHODS: We employed a qualitative research methodology -focus groups- with smokers and non-smokers in in two medium-sized Andalusian towns (Spain). RESULTS: Results show the importance of plain cigarette packaging as a form of promotion, particularly among women and young people, how pack colour influences product perceptions, and how removing full branding increases the salience of the warnings. CONCLUSIONS: Plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking

Peut-on influencer la représentation du tabagisme et l’envie de fumer chez les jeunes en modifiant le design des cigarettes

The objective of this research is to study the role of deterrent cigarettes (deterrence activated via colour, a warning label and a pictogram) on perceptions and smoking behaviour among youth people (15-25 years). The results show that different elements (green or brown colours, degree of covering, a warning, a « skull and cross bones » pictogram) impact the negative representations raised by the tobacco product (dangers), affect the image of smokers, reduce the pleasure to smoke and smoking behavioural intentions

Efficacité des paquets de cigarettes neutres sur des fumeuses en France: Une étude dans un contexte réel de consummation

Background - The present study explored, for the first time in France female smokers' response to using plain packaging in real-world settings. Methods - Naturalistic research was employed, where 142 casual and regular female adult smokers (25-40 years) used plain packs for ten days; the plain packs contained their usual brand of cigarettes and displayed the name of their usual brand. Participants completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, product perceptions, feelings about smoking, feelings when using the pack in front of others, warning response and smoking-related behavior. Results - Compared to their own fully branded packs, plain packs were associated with less positive pack, product and brand perceptions, and less positive feelings about smoking and using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like looking for information on quitting. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar. Conclusions - This study confirms the results found in previous research on plain packaging and shows that it has potential public health benefits

Effectiveness of plain packaging combined with warnings among female smokers in France: A naturalistic approach

Background - The present study explored, for the first time in France female smokers' response to using plain packaging in real-world settings. Methods - Naturalistic research was employed, where 142 casual and regular female adult smokers (25-40 years) used plain packs for ten days; the plain packs contained their usual brand of cigarettes and displayed the name of their usual brand. Participants completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, product perceptions, feelings about smoking, feelings when using the pack in front of others, warning response and smoking-related behavior. Results - Compared to their own fully branded packs, plain packs were associated with less positive pack, product and brand perceptions, and less positive feelings about smoking and using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like looking for information on quitting. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar. Conclusions - This study confirms the results found in previous research on plain packaging and shows that it has potential public health benefits