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

How adolescents perceive cigarette packaging and possible benefits of plain packaging

Surveys in secondary schools in Scotland show 3% of 13 year olds to be regular smokers, i.e. smoke one or more cigarettes a week, with this number rising to 13% for 15 year olds (Black et al., 2011). While smoking prevalence is in long-term decline in Scotland, and indeed most of Europe, these figures are concerning given that trying a single cigarette increases the risk that an adolescent will become a later smoker, even after a gap of not smoking for up to three years (Fidler et al., 2006). Furthermore, the earlier that adolescents start smoking regularly, the greater the risk of developing tobaccorelated cancers and other diseases (International Agency for Research on Cancer, 2004; Muller, 2007). For smoking prevention to be effective a coordinated approach is required. This may include policy measures such as increasing taxation on tobacco products to keep prices high, and non-policy measures such as providing health advice to parents and carers, as well as promoting smoke-free domestic environments and encouraging smoking cessation (Muller, 2007). School-based interventions can also play a key role in helping prevention efforts (NICE, 2010)

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 UK in 2003, although its impact on young people has not been assessed. This study assessed smoking susceptibility (intention to smoke among never smokers) and perceived prevalence across three British cross-sectional samples (aged 11 to 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 successfully protecting young people in the UK 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

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

Background: The 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. Methods: Participants 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. Results: The 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. Conclusions: The 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

Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study

Objectives: To explore perceptions of superslims packaging, including compact ‘lipstick’ packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks.  Design: Qualitative focus group study. SettingInformal community venues in Scotland, UK.  Participants: 75 female non-smokers and occasional smokers (age range 12–24).  Results: Compact ‘lipstick’-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, ‘lipstick’ packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning.  Conclusions: As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban ‘lipstick’-style cigarette packs in the EU and has implications for policy elsewhere

Attitudes towards bystander cardiopulmonary resuscitation:Results from a cross-sectional general population survey

Survival from out-of-hospital cardiac arrest (OHCA) varies across the developed world. Although not all OHCA are recoverable, the survival rate in Scotland is lower than in comparable countries, with higher average survival rates of 7.9% in England and 9% across Europe. The purpose of this paper is to explore the barriers, facilitators and public attitudes to administering bystander cardiopulmonary resuscitation (CPR) which could inform future policy and initiatives to improve the rate of bystander CPR. Data was collected via a cross-sectional general population survey of 1027 adults in Scotland. 52% of respondents had been trained in CPR. Of those who were not trained, two fifths (42%) expressed a willingness to receive CPR training. Fewer than half (49%) felt confident administering CPR, rising to 82% if they were talked through it by a call handler. Multivariate analyses identified that people in social grade C2DE were less likely than those in social grade ABC1 to be CPR trained and less confident to administer CPR if talked through by a call handler. The older a person was, the less likely they were to be CPR trained, show willingness to be CPR trained or be confident to administer bystander CPR with or without instruction from an emergency call handler. These findings are particularly relevant considering that most OHCA happen in the homes of older people. In a developed country such as Scotland with widely available CPR training, only half of the adult population reported feeling confident about administering bystander CPR. Further efforts tailored specifically for people who are older, unemployed and have a lower social grade are required to increase knowledge, confidence and uptake of training in bystander CPR

Introduction of standardized tobacco packaging during a 12-month transition period: Findings from small retailers in the United Kingdom

Introduction: Factory-made cigarettes (FMC) and roll-your-own (RYO) tobacco have had to be produced in standardised packaging since 20th May 2016 in the United Kingdom, with a minimum pack size of 20 sticks for FMC and 30 grams for RYO. Manufacturers and retailers were given a 12-month transition period.  Methods: An observational study was conducted using monthly Electronic Point of Sale data from 500 small retailers in England, Scotland, and Wales, between May 2016 and May 2017. The 20 top selling tobacco products (15 FMC, 5 RYO) were monitored to observe when standardised packs were first introduced, the proportion of retailers selling each fully branded and standardised product, and the average number of monitored fully branded and standardised products sold by each retailer. The number of unique tobacco-related product codes sold by each retailer was also recorded each month.  Results: Eighteen of the fully branded products continued to be sold throughout the transition period and no standardised variants were sold in the first five months. It was not until month eleven that the average number of standardised products sold by retailers exceeded the fully branded products. The average number of unique tobacco-related product codes sold by each retailer decreased by a third over the transition period.  Conclusions: Tobacco companies used the transition period to delay the removal of fully branded products and gradually introduce standardised variants. This staggered introduction may have mitigated some of the immediate intended effects of the legislation by desensitising consumers to new pack designs

Improving uptake of seasonal influenza vaccination by healthcare workers: Implementation differences between higher and lower uptake NHS trusts in England

Background Uptake of influenza vaccination by healthcare workers (HCWs) may be related to how influenza campaigns are implemented. This study explores differences in annual influenza campaign implementation between NHS trusts (healthcare organisations) with higher and lower vaccine uptake. Methods A cross-sectional survey with influenza campaign staff in 2016/2017 in 87 NHS trusts in England. The survey measured vaccination policy and uptake target, staff involvement, accessibility, use of peer vaccinators, communication strategies, strategies to address HCW concerns, use of incentives, and management support. The analysis considered implementation differences between higher (n Z 50) and lower (n Z 37) uptake trusts. Results and Conclusions Higher uptake trusts were more likely to set higher uptake targets, involve a broader range of staff groups in the campaign, and make the vaccine easy to access by core or hard-toreach HCWs. Higher uptake trusts were also more likely to use a greater range of communication strategies, provide real-time feedback on uptake, provide a greater range of incentives to be vaccinated, and have vaccine uptake considered important by managers. Successful influenza vaccination programmes are multifaceted and involve implementation factors at a strategic, organisational, logistical, and personnel level. Lower uptake trusts could improve uptake by identifying and implementing examples of best practice from higher uptake trusts

Alcohol marketing and consumption in young people in the UK

Objectives: To explore awareness of alcohol marketing and ownership of alcohol branded merchandise in adolescents and young adults in the United Kingdom (UK), what factors are associated with awareness and ownership, and what association awareness and ownership has with alcohol consumption, higher-risk drinking, and susceptibility. Design: Online cross-sectional survey conducted April–May 2017. Setting: UK. Participants: Adolescents and young adults aged 11-19 years old in the UK (n=3,399). Main outcome measures: Alcohol Use Disorders Identification Test–Consumption (AUDIT-C) (0-12) and indication of higher-risk consumption (>5 AUDIT-C) in current drinkers. Susceptibility to drink (Yes/No) in never drinkers. Results: Eighty-two percent of respondents were aware of at least one form of alcohol marketing in the past month and 17% owned branded merchandise. Chi-square tests found that awareness of marketing and ownership of branded merchandise varied within drinking variables. For example, higher awareness of alcohol marketing was associated with being a current drinker (χ2=114.04, p < 0.001), higher-risk drinking (χ2=85.84, p < 0.001), and perceived parental (χ2=63.06, p < 0.001) and peer approval of consumption (χ2=73.08, p < 0.001). Among current drinkers, multivariate regressions (controlling for demographics and covariates) found that marketing awareness and owning branded merchandise was positively associated with AUDIT-C score and higher-risk consumption. For example, current drinkers reporting medium marketing awareness were twice as likely to be higher-risk drinkers as those reporting low awareness (AOR=2.18, 95% CI: 1.39-3.42,

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, &lsquo;novelty' packs were rated significantly less negatively than the &lsquo;regular' pack on most items, and the novelty and regular packs were rated less negatively than the &lsquo;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&lt;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