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

How tobacco companies in the United Kingdom prepared for, and responded to, standardised packaging of cigarettes and rolling tobacco

Introduction As a result of the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive, all packs of cigarettes (factory-made and hand-rolled) in the United Kingdom must be drab brown, display pictorial warnings on the principal display areas, and contain no less than 20 cigarettes or 30 grams of tobacco. The legislation was phased in between May 2016 and May 2017. Our objective was to monitor pack, brand and product changes pre- and post-implementation.  Methods Our surveillance of the cigarette market involved a review of the trade press, a monthly monitor of online supermarkets, and regular visits to stores, from May 2015 to June 2017.  Results Pre-standardised packaging there were changes to the pack graphics (e.g. redesigned packs and limited-editions) and pack structure (e.g. re-sealable inner foil), and the issue of a number of re-usable tins. Post-standardised packaging, changes included newer cigarette pack sizes for some brand variants (e.g. 23 and 24 packs). Changes to the branding pre-standardised packaging included brand extensions, and post-standardised packaging included brand and/or variant name change, often with the inclusion of colour descriptors, and brand migrations. Product changes pre-standardised packaging included the introduction of novel filters (e.g. filters with two flavour-changing capsules, tube filters, firmer filters, and filters with granular additives). There was non-compliance with the legislation, with slim packs, which are not permitted, on sale after standardised packaging was implemented.  Conclusions Our findings highlight the need to monitor developments in markets introducing standardised packaging, and have policy implications for countries considering this measure

Plain tobacco packaging research: An update

This briefing paper provides an update on research published between August 2011 and mid-September 2013 since the 2012 systematic review of plain tobacco packaging was released (Moodie et al. 2012)

Plain Tobacco Packaging: A Systematic Review

(From the Executive Summary): This systematic review outlines findings from 37 studies that provide evidence of the impacts of plain tobacco packaging. The review was conducted following the publication of the March 2011 White Paper Healthy Lives: Healthy People which set out a renewed Tobacco Control Plan for England. One of the key actions identified in the plan was to consult on possible options to reduce the promotional impact of tobacco packaging, including plain packaging. This systematic review was commissioned to provide a comprehensive overview of evidence on the impact of plain packaging in order to inform a public consultation on the issue

Consumer Response to Standardized Tobacco Packaging in the United Kingdom: A Synthesis of Evidence from Two Systematic Reviews

Standardized packaging of tobacco products has now been fully implemented in 15 countries. However, there is limited evidence, apart from in Australia, on how consumers have responded to the policy. Two systematic reviews explored consumer, tobacco industry and retailer response to standardized packaging in the United Kingdom (UK), which became mandatory for cigarettes (factory-made and hand-rolled) from May 2017, following a twelve-month transition period. In the first review, electronic databases were searched for published primary research from January 2016 to February 2019. The second review used the same methods, with searches conducted between February 2019 and September 2020. The current study conducted a narrative synthesis of the findings exploring consumer response from these two systematic reviews. Eleven studies met the inclusion criteria. Studies examined consumer response to on-pack warnings (n=7 studies), appeal of packs and smoking (n=4), perceptions of harm (n=5), and behavioral responses (n=8). There was consistent evidence that standardized packaging was associated with increased warning salience and effectiveness, and reduced appeal. Findings were mixed with respect to whether standardized packs were associated with increased perceptions of harm. Standardized packaging was generally thought to deter never or occasional smokers. Standardized packaging was associated with increased thoughts of quitting during the transition period, but no study directly explored cessation or relapse prevention. Some smokers switched to cheaper cigarettes. Standardized packaging in the UK seems to be reducing the appeal of packaging and smoking and making warnings more salient, but the behavioral impact is unclear. More consumer research is needed to assess longer-term behavioral response

Tobacco pricing and standardised packaging

Background and aims: Tobacco companies claimed that standardized packaging, phased in/introduced May 2016–May 2017, would reduce prices and increase consumption. We: (1) describe changes in price-per-cigarette and price-per-gram during, and after, the introduction of standardized packaging; (2) describe price changes by cigarette price segment; and (3) analyse price changes by stage of implementation. Design: An observational study, using electronic point-of-sale data, monitored price trends in three periods: (1) May–September 2016, start of transition period; (2) October 2016–May 2017, when fully branded and standardized products were sold and duty escalators implemented; and (3) June–October 2017, when standardized packaging was mandatory. Setting: United Kingdom. Participants: Small retailers (n = 500) stratified by region and deprivation. Data were monitored for 20 leading fully branded tobacco products [15 factory made cigarettes (FMC), 5 roll-your-own (RYO)] and their standardized equivalents. Measurement: Price-per-cigarette and price-per-gram, based on monthly average Recommended Retail Price (RRP) and actual sale price, adjusted for inflation using the Consumer Pricing Index (CPIH). Net changes (£GBP, %) were analysed by product type (FMC versus RYO) and FMC price segment (value, mid-price, premium). Findings: Between May 2016 and October 2017, the average inflation-adjusted RRP/price-per-cigarette and price-per-gram increased for FMC (all price segments) and RYO. For example, sales price-per-cigarette increased +4.64%, with the largest increases for value (+6.81%), premium (+5.32%) and mid-price FMCs (+3.30%). Net sales price-per-cigarette and price-per-gram increases were largest in period 2, when fully branded and standardized products were sold and duty escalators were implemented (FMC = +4.70%; RYO = +3.75%). There were small decreases in sales price-per-cigarette and price-per-gram once standardized packaging became mandatory (FMC = –1.14%; RYO = –0.88%). Conclusion: In the United Kingdom, the price of leading roll-your-own and factory-made cigarette brands sold by small retailers increased as standardized packaging was phased in, with increases larger than expected through duty escalation

Standardised packaging and RRP

Aim: Recommended Retail Price (RRP) is a marketing strategy used by tobacco companies to maintain competitiveness, communicate product positioning, and drive sales. We explored small retailer adherence to RRP before and after the introduction of the Standardised Packaging of Tobacco Products Regulations in the United Kingdom (fully implemented 20th May 2017), which mandated standardised packaging of cigarettes and rolling tobacco, set minimum pack/pouch sizes, and prohibited price-marking. Method: Monthly Electronic Point of Sale data from 500 small retailers in England, Scotland, and Wales were analysed. From May 2016-October 2017, we monitored 20 of the best-selling fully-branded tobacco products (15 factory-made cigarettes, 5 rolling tobacco) and their standardised equivalents. Adherence to RRP was measured as the average difference (%) between monthly RRPs and Sale Prices by pack type (fully-branded vs. standardised), price-marking on packaging, and price segment. Results: The average difference between RRP and Sales Price increased from +0.36% above RRP (SD=0.72) in May 2016, when only fully-branded packs were sold, to +1.37% in October 2017 (SD=0.30), when standardised packs were mandatory. Increases above RRP for fully-branded packs increased as they were phased out, with deviation greater for non-price-marked packs and premium products. Discussion: Despite tobacco companies emphasising the importance of RRP, small retailers implemented small increases above RRP as standardised packaging was introduced. Consequently, any intended price changes by tobacco companies in response to the legislation (i.e. to increase affordability or brand positioning) may be confounded by retailer behaviour, and such deviation may increase consumer price sensitivity

Backfiring and favouring:how design processes in HCI lead to anti-patterns and repentant designers

Design is typically envisioned as aiming to improve situations for users, but this can fail. Failure can be the result of flawed design solutions, i.e. anti-patterns. Prior work in anti-patterns has largely focused on their characteristics. We instead concentrate on why they occur by outlining two processes that result in anti-patterns: 1) backfiring, and 2) favouring. The purpose of the paper is to help designers and researchers better understand how design processes can lead to negative impacts and to repentant designers by introducing a richer vocabulary for discussing such processes. We explore how anti-patterns evolve in HCI by specifically applying the vocabulary to examples of social media design. We believe that highlighting these processes will help the HCI community reflect on their own work and also raise awareness of the opportunities for avoiding anti-patterns. Our hope is that this will result in fewer negative experiences for designers and users alike

Mentalization for Offending Adult Males (MOAM): study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation.

BACKGROUND: Antisocial personality disorder (ASPD), although associated with very significant health and social burden, is an under-researched mental disorder for which clinically effective and cost-effective treatment methods are urgently needed. No intervention has been established for prevention or as the treatment of choice for this disorder. Mentalization-based treatment (MBT) is a psychotherapeutic treatment that has shown some promising preliminary results for reducing personality disorder symptomatology by specifically targeting the ability to recognize and understand the mental states of oneself and others, an ability that is compromised in people with ASPD. This paper describes the protocol of a multi-site RCT designed to test the effectiveness and cost-effectiveness of MBT for reducing aggression and alleviating the wider symptoms of ASPD in male offenders subject to probation supervision who fulfil diagnostic criteria for ASPD. METHODS: Three hundred and two participants recruited from a pool of offenders subject to statutory supervision by the National Probation Service at 13 sites across the UK will be randomized on a 1:1 basis to 12 months of probation plus MBT or standard probation as usual, with follow-up to 24 months post-randomization. The primary outcome is frequency of aggressive antisocial behaviour as assessed by the Overt Aggression Scale - Modified. Secondary outcomes include violence, offending rates, alcohol use, drug use, mental health status, quality of life, and total service use costs. Data will be gathered from police and criminal justice databases, NHS record linkage, and interviews and self-report measures administered to participants. Primary analysis will be on an intent-to-treat basis; per-protocol analysis will be undertaken as secondary analysis. The primary outcome will be analysed using hierarchical mixed-effects linear regression. Secondary outcomes will be analysed using mixed-effects linear regression, mixed-effects logistic regression, and mixed-effects Poisson models for secondary outcomes depending on whether the outcome is continuous, binary, or count data. A cost-effectiveness and cost-utility analysis will be undertaken. DISCUSSION: This definitive, national, multi-site trial is of sufficient size to evaluate MBT to inform policymakers, service commissioners, clinicians, and service users about its potential to treat offenders with ASPD and the likely impact on the population at risk. TRIAL REGISTRATION: ISRCTN 32309003 . Registered on 8 April 2016