Death of a salesman

First paragraph: In December 2012 Australia became the first jurisdiction to mandate plain (or standardised) packaging for tobacco products. Many governments have been looking on with interest, anxious to learn if this is also the next step forward in their own efforts to tackle the harms caused by tobacco. This special issue begins to answer this question by presenting a series of studies which provide an initial evaluation of the policy. What have been the early impacts of plain packaging on young people and adult smokers? And are there any unintended consequences—has it reduced prices, for instance, or encouraged illicit tobacco use

Adult smokers' perceptions of cigarette pack inserts promoting cessation: A focus group study

Introduction Tobacco companies have a long tradition of including promotional material within cigarette packs, such as cigarette cards and coupons. Only in Canada are they required, by the government, to include educational material within cigarette packs, in the form of inserts highlighting the benefits of quitting or providing tips on how to do so.  Methods Twenty focus groups were conducted in Glasgow and Edinburgh in 2015, with smokers (n=120) segmented by age (16–17, 18–24, 25–35, 36–50, >50), gender and social grade, to explore perceptions of the inserts used in Canada.  Results The consensus was that these inserts would capture attention and be read due to their novelty and visibility before reaching the cigarettes, and as they can be removed from the pack. While they may be ignored or discarded, and rotation was considered necessary, they were generally thought to prolong the health message. The positive style of messaging was described as refreshing, educational, encouraging, reassuring and inspirational and thought to increase message engagement. It was regarded as more sympathetic than command-style messaging, offering smokers ‘a bit of hope’. The inserts were often considered preferable to the on-pack warnings, although it was felt that both were needed. Some participants suggested that inserts could encourage them to stop smoking, and they were generally viewed as having the potential to alter the behaviour of others, particularly younger people, would-be smokers and those wanting to quit.  Conclusions Inserts are an inexpensive means of communication and offer regulators a simple way of supplementing on-pack warnings

Warnings on every cigarette: extending health messaging to the consumption experience

First paragraph: Tobacco use is the leading cause of premature death in Canada and costs $17 billion in health care and indirect economic costs each year. Health Canada has highlighted the need for a novel, multiprong approach to reach its target of less than 5$330 million over the next five years to protecting young people and nonsmokers and helping smokers quit. But more must be done to reduce the appeal of tobacco further and update warning messages. One new idea, recently supported by Federal Health Minister Ginette Petitpas Taylor, is to put health warnings on individual cigarettes

Tobacco packaging as promotion

Almost twenty 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’. 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. Moodie and Hastings 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

Responsible gambling signage on electronic gaming machines, before and after the implementation of the United Kingdom Gambling Act: An observational study

The 2005 Gambling Act in Britain requires all gambling operators to satisfy responsibility codes as a condition of licence, such as signage on electronic machines, and in the venues in which they are located, encouraging responsible gambling and signposting help available. This observational study found that eighteen months prior to the implementation of the Act, only 4.1% of the 1,351 electronic machines located in Glasgow City Centre displayed signs promoting responsible gambling and signposting the national Gamcare helpline. One month after the introduction of the Act, which stipulated that all machines must display such signage, this was only evident on 65% of machines. Other responsible gambling signage (posters, signs, leaflets, brochures) was not highly visible in either phase. These findings highlight two important points; first, most sectors of the gambling industry are not embracing the new social responsibility codes (or indeed even adhering to them); and, second, if licensing conditions are not made explicit, as is the case in Britain, the gambling industry can dictate what is meant by ‘responsible’ and so define what measures are sufficient to meet this criteria

Young adult smokers' perceptions of plain packs, numbered packs and pack inserts in Turkey: A focus group study

Introduction The Turkish Government’s ‘National Tobacco Control Program 2015–2018’ included plans to introduce plain packaging and also a ban on brand names on cigarette packs, allowing only assigned numbers on packs. We explored perceptions of these proposed measures, and also pack inserts with cessation messages, another novel way of using the packaging to communicate with consumers.  Methods Eight focus groups were conducted with 47 young adult smokers in Manisa and Kutahya (Turkey) in December 2016. Participants were shown three straight-edged plain cigarette packs, as required in Australia, and then three bevelled-edged plain packs, as permitted in the UK. They were then shown plain packs with numbers rather than brand names, and finally three pack inserts with messages encouraging quitting or offering tips on how to do so. Participants were asked about their perceptions of each.  Results Plain packs were considered unappealing and off-putting, although the bevelled-edged packs were viewed more favourably than the straight-edged packs. Numbered packs were thought by some to diminish the appeal created by the brand name and potentially decrease interest among never smokers and newer smokers. Pack inserts were thought to have less of an impact than the on-pack warnings, but could potentially help discourage initiation and encourage cessation.  Conclusions That bevelled-edged plain packs were perceived more positively than straight-edged plain packs is relevant to countries planning to introduce plain packaging. The study provides a first insight into smokers’ perceptions of a ban on brand names, which was perceived to reduce appeal among young people

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

UK government's delay on plain tobacco packaging: how much evidence is enough?

First paragraph: In the wake of the UK government's announcement on 12 July that its decision on plain (standardised) tobacco packaging would be delayed until evidence emerged from Australia, Wakefield and colleagues report timely findings from a study exploring the early effects of plain packaging in Victoria.1 2 Conducted during the phase-in period, when plain and branded packs were concurrently on sale, the study found that smokers who used plain packs were more likely than smokers who used fully branded packs to perceive their cigarettes to be less satisfying and poorer quality, were more supportive of plain packaging, and were more likely to think about and to prioritise quitting

A systematic review of research exploring the response of consumers, retailers and tobacco companies to standardised packaging in the United Kingdom

Introduction The UK fully implemented standardised packaging for cigarettes and rolling tobacco in May 2017, after a twelve month transition period. We conducted a systematic review of published research exploring consumer, tobacco company and retail response to this policy. Methods We searched for peer-reviewed published studies which explored consumer, retailer or tobacco company response to standardised packaging in the UK. Studies were screened against inclusion criteria. Data from included studies were extracted into standardised forms and each study was critically appraised. Findings were reported by narrative synthesis. Results Eleven papers, reporting on ten studies, were included, with five studies examining consumer responses to standardised packaging, and five studies exploring the response of tobacco companies and changes in the retail environment. In three consumer studies standardised packaging was associated with increased warning salience, but there was limited evidence of the impacts on smoking behaviour. Evidence from tobacco company and retail studies showed that standardised packs were not widely available until late in the transition period, although compliance with the legislation was high. Tobacco prices, for rolling tobacco and for cigarettes in each price segment (premium, mid-price, value), increased from May 2016 to October 2017. Discussion Standardised packaging appears to have increased warning salience but there is a need for research, after it was fully implemented, on perceptions of appeal and harm, behavioural impact, and unintended consequences, if any. Possible pack, price and retail related policy options are discussed