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Critchlow N, Moodie C, Gallopel-Morvan K. 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. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1155-1167. [PMID: 38787498 DOI: 10.1111/acer.15327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 05/25/2024]
Abstract
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.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Karine Gallopel-Morvan
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
- Univ Rennes, EHESP, CNRS, Inserm, Arènes - UMR 6051, RSMS - U1309, Rennes, France
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Alcaraz A, Adedeji A, Pichón-Riviere A, Amara Ekeruche M, Casarini A, Rodríguez Cairoli F, Espinola N, Roberti J, Palacios A, Bardach A. Estimating the Effectiveness of Health Warnings on Cigarette Packaging in Nigeria: A Modeling Study. Nicotine Tob Res 2023; 25:1736-1743. [PMID: 37262432 DOI: 10.1093/ntr/ntad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 05/14/2023] [Accepted: 06/01/2023] [Indexed: 06/03/2023]
Abstract
INTRODUCTION Tobacco consumption is associated with nearly 30 000 deaths annually in Nigeria alongside other adverse health and economic effects. Our objective was to estimate the health and economic implications of the current cigarette labeling policies (text-only HWs); new health warnings policies in the country (adding graphic health warnings with up to 60% coverage), and plain packaging policy as recommended by the World Health Organization. AIMS AND METHODS We used a probabilistic state-transition individual microsimulation model, considering natural history, healthcare costs, and quality-of-life losses associated with main tobacco-attributable diseases; and the potential effects of packaging and labeling policies. We used three scenarios: (1) text-only health warnings (HWs) covering 50% of the pack, (2) introduction of graphic HWs of 50% (and later increasing to 80%) of the pack, and (3) plain packaging with HWs covering 80% of the pack. RESULTS A total of 748 deaths are averted in the current situation; 7478 and 14 208 deaths can be averted with the new policy and with plain packaging, respectively. The number of cardiac, cerebrovascular, and cancer events that could be averted by adopting text and graphic HWs are 3093, 5093, and 1346, respectively; increasing to 5876, 9676, and 2557, respectively, with plain packaging. Up to 251 794 years were lost because of early deaths and disability, and ₦144.6 billion (USD 469 million) in health costs could be saved with HWs covering 50% to 80% of the pack over 10 years. With plain packaging and graphic HWs covering 80% of the package 478,408 years and ₦274.7 billion (USD 895 million) would be saved. CONCLUSIONS The new cigarette labeling policy in Nigeria may yield significant health and economic benefits over 10 years. Moving the current policy to plain packaging can significantly improve these benefits. IMPLICATIONS The new cigarette labeling policy that Nigeria is implementing should aim to achieve 100% compliance with its current regulation and the logical next step: Plain packaging with large warnings. The present study adds evidence of the potential health effects and cost savings of these levels of implementation, which is valuable for local policymakers.
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Affiliation(s)
- Andrea Alcaraz
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Adeniran Adedeji
- Macroeconomics and Public Financial Management, Center for the Study of the Economies of Africa, Abuja, Nigeria
| | - Andrés Pichón-Riviere
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| | - Mma Amara Ekeruche
- Macroeconomics and Public Financial Management, Center for the Study of the Economies of Africa, Abuja, Nigeria
| | - Agustín Casarini
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Natalia Espinola
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
| | - Alfredo Palacios
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Health Technology Assessment and Health Economics, Institute for Clinical Effectiveness and Public Policy (IECS), Buenos Aires, Argentina
- Center for Research in Epidemiology and Public Health (CIESP), CONICET, Buenos Aires, Argentina
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Czaplicki L, Barker HE, Welding K, Islam F, Dao S, Ba Chan Nhu H, Cohen JE. Effects of cigarette price and packaging on hypothetical quit-smoking behaviour: a discrete choice experiment among Vietnamese adults who smoke. Tob Control 2023:tc-2023-058062. [PMID: 37438093 DOI: 10.1136/tc-2023-058062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/24/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION Raising cigarette prices, increasing graphic health warning label (HWL) coverage and requiring plain packaging could reduce cigarette smoking in Vietnam. This discrete choice experiment estimates the potential impact of these policies on smoking behaviour. METHODS In February-May 2022, we conducted a phone-based, cross-sectional survey of 1494 Vietnamese adults who smoke. Participants were randomly assigned to view four individual cigarette pack images, varied on price (15 000 (reference group); 20 000; 30 000 or 40 000 Vietnamese dong (VND)) and packaging (branded pack with 50% graphic HWL (reference group); branded pack with 85% graphic HWL; plain pack with 50% graphic HWL or branded pack without HWL). Participants responded if they would quit or continue smoking if they could only purchase the pack shown. We used binomial logistic regressions to estimate the relative risk (RR) of price and packaging on hypothetical quitting. RESULTS Participants were more likely to report they would quit when presented with 30 000 VND (RR 1.20, 95% CI 1.07 to 1.35) and 40 000 VND packs (RR 1.40, 95% CI 1.23 to 1.58) vs the 15 000 VND pack. Participants were also more likely to report they would quit when shown the branded pack with 85% HWL (RR 1.30, 95% CI 1.18 to 1.42) and plain pack with 50% HWL (RR 1.34, 95% CI 1.21 to 1.49) vs the branded pack with 50% HWL coverage. Participants had significantly lower quit likelihood (RR 0.41, 95% CI 0.35 to 0.48) when shown the branded pack without a HWL. CONCLUSIONS Results suggest raising cigarette prices to at least 30 000 VND, implementing larger graphic HWLs or plain packaging could decrease smoking rates in Vietnam.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior and SocietyI, nstitute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Hannah E Barker
- Department of Health, Behavior and SocietyI, nstitute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior and SocietyI, nstitute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, Columbia, South Carolina, USA
| | - Son Dao
- Department of Economics, Thuongmai University, Ha Noi, Viet Nam
- International Union Against Tuberculosis and Lung Disease, Ha Noi, Viet Nam
| | | | - Joanna E Cohen
- Department of Health, Behavior and SocietyI, nstitute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Moodie C, Best C, Hitchman SC, Critchlow N, MacKintosh AM, McNeill A, Stead M. Impact of standardised packaging in the UK on warning salience, appeal, harm perceptions and cessation-related behaviours: a longitudinal online survey. Tob Control 2023; 32:188-194. [PMID: 34272338 DOI: 10.1136/tobaccocontrol-2021-056634] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 06/22/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In the UK, since 20 May 2017, tobacco companies must sell cigarettes and rolling tobacco in standardised packs. METHODS Three waves of a longitudinal online survey with smokers (≥16) before standardised packaging (wave 1 (W1): April to May 2016) and after standardised packaging (wave 2 (W2): September to November 2017; wave 3 (W3): May to July 2019). Of the 6233 smokers at W1, 4293 responded at W2 and 3175 at W3. We explored smokers' response to warning salience, appeal (appeal, quality, value, satisfaction and taste compared with a year ago), harm (harmfulness compared with a year ago, harm compared with other brands and whether some brands have more harmful substances), and quit plans, attempts and quitting. RESULTS Compared with W1, the proportions noticing warnings first on packs, and rating cigarettes/rolling tobacco less appealing and worse value than a year ago, were higher at W2 and W3. Disagreeing that some brands contain more harmful substances was higher at W2. Interactions between social grade and survey wave for warning salience, and each appeal and harm outcome, were non-significant. Smokers switching from not noticing warnings first at W1 to noticing warnings first at W2, or who had a lower composite appeal score at W2, were more likely to plan to quit and to have made a quit attempt at W2. Smokers who switched to disagreeing that some brands contain more harmful substances at W2, after giving a different response at W1, were more likely to quit at W3. CONCLUSIONS Standardised packaging appears to be having the intended impacts.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Catherine Best
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Sara C Hitchman
- National Addictions Centre, Institute of Psychiatry, King's College London, London, UK
| | - Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Anne-Marie MacKintosh
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ann McNeill
- National Addictions Centre, Institute of Psychiatry, King's College London, London, UK
| | - Martine Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Gravely S, Chung-Hall J, Craig LV, Fong GT, Cummings KM, Borland R, Yong HH, Loewen R, Martin N, Quah ACK, Hammond D, Ouimet J, Boudreau C, Thompson ME, Driezen P. Evaluating the impact of plain packaging among Canadian smokers: findings from the 2018 and 2020 ITC Smoking and Vaping Surveys. Tob Control 2023; 32:153-162. [PMID: 34548384 PMCID: PMC9330177 DOI: 10.1136/tobaccocontrol-2021-056635] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND In February 2020, Canada implemented plain packaging without any changes to the size and content of health warning labels (HWLs), which were last updated in 2012 (pictorial HWLs on 75% of the pack front and back). This pre-post evaluation study assessed the impact of plain packaging in Canada on: (1) pack appeal; (2) HWL effectiveness; and (3) support for plain packaging. Additionally, a quasi-experimental design was used to assess the Canadian results relative to two comparator countries: Australia, where plain packaging (with new larger HWLs) was implemented in 2012, and the United States (USA), where plain packaging has not been implemented and the same text warnings have appeared on cigarette packs since 1985. METHODS Data are from adult smokers who participated in the 2018 and/or 2020 International Tobacco Control Smoking and Vaping Surveys in Canada (n=4600), Australia (n=1834) and the USA (n=3046). Online surveys were conducted before (February to July 2018) and after (February to June 2020) the implementation of plain packaging in Canada. Adjusted regression analyses were conducted on weighted data. RESULTS Plain packaging was associated with a significant increase in the percentage of Canadian smokers who did not like the look of their cigarette pack (2018: 28.6% vs 2020: 44.7%, p<0.001), whereas no change in pack appeal was observed among smokers in Australia and the USA over the same period. Plain packaging was not associated with changes in HWL effectiveness in Canada. Support for plain packaging increased significantly among Canadian smokers (2018: 25.6% vs 2020: 33.7%, p<0.001). CONCLUSIONS Plain packaging in Canada substantially reduced pack appeal and increased support for the policy among adult smokers; however, there was no increase in the effectiveness of Canada's 8-year-old HWLs. The impact of plain packaging on health warning effectiveness may depend on the design of the warnings and length of time since implementation.
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Affiliation(s)
- Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Lorraine V Craig
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,Ontario Institute for Cancer Research, Toronto, Ontario, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Hua-Hie Yong
- Department of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Ruth Loewen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Nadia Martin
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Christian Boudreau
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.,School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Moodie C, Hoek J, Hammond D, Gallopel-Morvan K, Sendoya D, Rosen L, Mucan Özcan B, van der Eijk Y. Plain tobacco packaging: progress, challenges, learning and opportunities. Tob Control 2022; 31:263-271. [PMID: 35241599 DOI: 10.1136/tobaccocontrol-2021-056559] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/12/2021] [Indexed: 11/03/2022]
Abstract
The aim of this paper is to overview progress made with respect to the adoption of plain (or standardised) packaging, key challenges faced, evaluative evidence and opportunities for extending this policy. It has been a decade since Australia became the first country to require tobacco products to be sold in plain packaging; after slow initial uptake, 16 countries have now fully implemented this policy. Since 2020, plain packaging laws have become more comprehensive in some countries, expanding coverage beyond traditional tobacco products to include heated tobacco, tobacco accessories (rolling papers) and other nicotine-containing products (e-cigarettes). Laws have also become more innovative: some now ban non-biodegradable filters, include provision for a periodic change of the pack colour or require both plain packaging and health-promoting pack inserts. The tobacco industry has and will continue to use multi-jurisdictional strategies to oppose this policy. Evaluations suggest that plain packaging has improved health outcomes and has not burdened retailers, although research is limited to early policy adopters and important gaps in the literature remain. While the power of packaging as a sales tool has diminished in markets with plain packaging, tobacco companies have exploited loopholes to continue to promote their products and have increasingly focused on filter innovations. Opportunities exist for governments to strengthen plain packaging laws.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Janet Hoek
- Departments of Public Health and Marketing, University of Otago, Dunedin, New Zealand
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Diego Sendoya
- Facultad de Derecho, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Laura Rosen
- Department of Health Promotion, School of Public Health, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Burcu Mucan Özcan
- Department of Business Administration, Celal Bayar University, Manisa, Turkey
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Freeman B, Watts C, Astuti PAS. Global tobacco advertising, promotion and sponsorship regulation: what's old, what's new and where to next? Tob Control 2022; 31:216-221. [PMID: 35241591 DOI: 10.1136/tobaccocontrol-2021-056551] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 09/23/2021] [Indexed: 11/04/2022]
Abstract
Tobacco advertising, promotion and sponsorship (TAPS) bans are a cornerstone of comprehensive tobacco control laws. Global progress in implementing TAPS bans has been enabled by the adoption of the WHO Framework Convention on Tobacco Control. Innovative TAPS policies are in place internationally and include: point-of-sale display bans, plain packaging of products, industry spending on TAPS disclosure reporting, bans on retailer incentive programmes, and regulation of TAPS in entertainment and online media. However, there is an over-reliance on entertainment and digital content producers and platforms to self-regulate TAPS. Ensuring TAPS laws are regularly examined to limit loopholes and remove exemptions is crucial to continued success. The definition of what constitutes TAPS can allow the tobacco industry to deploy corporate communication and political campaigns that skirt TAPS bans. TAPS laws must also maintain pace with the changing media landscape, which includes monitoring and reporting TAPS that cross international borders, primarily through digital media platforms. Limiting tobacco retail supply will also serve to prevent the continued undermining of TAPS bans. Leveraging global corporation to ensure enforcement of TAPS bans across borders is urgently needed.
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Affiliation(s)
- Becky Freeman
- School of Public Health, The University of Sydney Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Christina Watts
- Daffodil Centre, Faulty of Medicine and Health, The Univeristy of Sydney, Sydney, New South Wales, Australia
| | - Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Udayana University Faculty of Medicine, Denpasar, Bali, Indonesia
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Halkjelsvik T, Gasparrini A, Vedøy TF. The short-term impact of standardised packaging on smoking and snus use in Norway. Nicotine Tob Res 2021; 24:220-226. [PMID: 34558626 PMCID: PMC8807171 DOI: 10.1093/ntr/ntab194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/21/2021] [Indexed: 11/22/2022]
Abstract
Introduction Standardised packaging on tobacco products was required in Norway July 1, 2018. We report pre-registered analyses of the potential impact on daily smoking and on daily snus use among women and men. Methods Interrupted time series (segmented regression) on repeated cross-sectional surveys (2012–2019) from two sources: probability samples (Registry Sample, N = 46,957) and market research samples (Market Research Sample, N = 64,465) of Norwegian adults aged 16–79. Self-reported daily smoking and snus use were regressed on a step change impact variable, controlled for trend and demographics (sex, age, region, and education based on national registers in the Registry Sample, and self-reported in the Market Research Sample). Results There were tendencies of a decline in smoking (Odds Ratio [OR] = 0.94; 95% confidence interval [CI] = 0.87, 1.02; lower-tail p-value [Plower] = 0.07), and women’s snus use (OR = 0.89; CI = 0.77, 1.03; Plower = 0.06), but not men’s snus use (OR = 1.01; CI = 0.92, 1.11; Plower = 0.59). Analyses using only the Registry Sample did not detect declines in smoking (OR = 0.99; CI = 0.88, 1.11; Plower = 0.43) or women’s snus use (OR = 0.99; CI = 0.80, 1.24]; Plower = 0.48), and indicated no decline in men’s snus use (OR = 1.18; CI = 1.03, 1.35; Plower = 0.99). Exploratory analyses suggested potential acceleration of the declining trend in smoking (change in trends, OR = 0.97) and of the increasing trend in men’s snus use (OR = 1.03). Conclusions The analyses indicate that standardised packaging in Norway did not produce a decline in men’s snus use. Results are inconclusive regarding smoking and women’s snus use. Exploratory analyses indicated a decrease in smoking and an increase in men’s snus use. Implications We could not confirm or disconfirm whether standardised packaging is an effective tobacco control measure in a Norwegian context. According to our analyses, standardized packaging may have effects on smoking prevalence and women’s snus use, but is unlikely to reduce men’s snus use. The present results may reflect higher effectiveness of standardised packaging for products with stronger health warnings. As the results varied according to samples and outcomes, the study underlines the importance of pre-registering future analyses on this topic. Future confirmatory research should test models of gradual impact of standardised packaging.
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Affiliation(s)
- Torleif Halkjelsvik
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway.,Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
| | - Antonio Gasparrini
- Department of Public Health Environments and Society, London School of Hygiene & Tropical Medicine, London, UK.,Centre for Statistical Methodology, London School of Hygiene & Tropical Medicine, London, UK
| | - Tord Finne Vedøy
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, PO Box 222 Skøyen, 0213 Oslo, Norway
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Moodie C, Best C, Lund I, Scheffels J, Critchlow N, Stead M, McNeill A, Hitchman S, Mackintosh AM. The Response of Smokers to Health Warnings on Packs in the United Kingdom and Norway Following the Introduction of Standardized Packaging. Nicotine Tob Res 2021; 23:1551-1558. [PMID: 33599723 PMCID: PMC8372634 DOI: 10.1093/ntr/ntab027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Accepted: 02/10/2021] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Standardized packaging was phased in between May 2016 and May 2017 in the United Kingdom and July 2017 and July 2018 in Norway. In both countries, the health warnings on packs prior to standardized packaging being implemented were from the former Tobacco Products Directive library of warnings (text warnings covering 43% of the pack front and pictorial warnings covering 53% of the pack reverse). The warnings on packs, postimplementation, were from the current Tobacco Products Directive library of warnings (novel pictorial warnings covering 65% of the pack front and reverse) for the United Kingdom but unchanged in Norway. AIMS AND METHODS Longitudinal online surveys were conducted prior to standardized packaging (United Kingdom: April-May 2016; Norway: May-June 2017) and postimplementation (United Kingdom: September-November 2017 and May-July 2019; Norway: August-September 2018). We explored smokers' response to the on-pack warnings (salience, cognitive reactions, and behavioral reactions). RESULTS In the United Kingdom, noticing warnings on packs, reading or looking closely at them, thinking about them, thinking about the health risks, avoidant behaviors, forgoing cigarettes, and being more likely to quit due to the warnings significantly increased from waves 1 to 2, and then decreased from waves 2 to 3, but remained higher than at wave 1. In Norway, noticing warnings, reading or looking closely at them, thinking about them, thinking about the health risks, and being more likely to quit due to the warnings significantly decreased from waves 1 to 2; avoidant behaviors and forgoing cigarettes remained unchanged. CONCLUSIONS The inclusion of large novel pictorial warnings on standardized packs increases warning salience and effectiveness. IMPLICATIONS Two longitudinal online surveys in the United Kingdom and Norway explored the impact of standardized packaging on warning salience and effectiveness. That warning salience and effectiveness only increased in the UK postimplementation, where standardized packaging was implemented alongside new larger pictorial warnings on the pack front and reverse, and not in Norway, where standardized packaging was introduced but older smaller text warnings (pack front) and pictorial warnings (pack reverse) were retained, highlights the importance of removing full branding and introducing stronger warnings simultaneously.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Catherine Best
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ingeborg Lund
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute for Public Health, Oslo, Norway
| | - Janne Scheffels
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute for Public Health, Oslo, Norway
| | - Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Martine Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Sara Hitchman
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Anne Marie Mackintosh
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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10
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Moodie C, Angus K, Stead M. Consumer Response to Standardized Tobacco Packaging in the United Kingdom: A Synthesis of Evidence from Two Systematic Reviews. Risk Manag Healthc Policy 2021; 14:1465-1480. [PMID: 33883953 PMCID: PMC8053612 DOI: 10.2147/rmhp.s272259] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 03/20/2021] [Indexed: 11/23/2022] Open
Abstract
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.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland
| | - Kathryn Angus
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland
| | - Martine Stead
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland
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Critchlow N, Moodie C. Understanding the Broader Impacts Of Alcohol Marketing: Time For a Research Agenda Which Includes Adults. Alcohol Alcohol 2021; 56:614-616. [PMID: 33835137 PMCID: PMC8406049 DOI: 10.1093/alcalc/agab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 03/11/2021] [Accepted: 03/16/2021] [Indexed: 11/14/2022] Open
Abstract
Most research on alcohol marketing involves young people. Consequently, gaps remain in our understanding of how alcohol marketing reaches, engages and influences adults, who are the legitimate and primary targets for marketing communications. Responding to these lacunae in knowledge is necessary to help inform and evaluate population-level controls on alcohol marketing.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, FK9 4LA, Scotland
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12
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Critchlow N, Moodie C, Best C, Stead M. Anticipated responses to a hypothetical minimum price for cigarettes and roll-your-own tobacco: an online cross-sectional survey with cigarette smokers and ex-smokers in the UK. BMJ Open 2021; 11:e042724. [PMID: 33753438 PMCID: PMC7986940 DOI: 10.1136/bmjopen-2020-042724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/30/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES As tobacco companies can circumvent tax increases, a minimum retail price per-cigarette/per-gram of roll-your-own tobacco presents an additional mechanism for governments to reduce smoking. We examined (1) anticipated responses to a hypothetical minimum price-per-cigarette/per-gram among smokers in the UK; (2) what demographic and smoker characteristics are associated with anticipated responses; and (3) whether minimum pricing may help ex-smokers stay quit. DESIGN Cross-sectional survey (May-July 2019). SETTING UK. PARTICIPANTS Adult cigarette smokers (n=2412) and ex-smokers (n=700). MAIN OUTCOME MEASUREMENTS Anticipated responses to a hypothetical minimum price of £10.00 for 20 cigarettes (£0.50 per-cigarette) and £13.50 for 30 grams of roll-your-own tobacco (£0.45 per-gram); approximately £0.10 per-cigarette/per-gram increases on the cheapest prices in leading UK supermarkets (January 2019). Smokers were presented with ten options (eg, 'Try to quit') and asked which they would do (Yes/No) and then which they would most likely do. Ex-smokers were asked to what extent the minimum prices would help them stay quit (A lot vs Lesser agreement). RESULTS Among smokers, 55.6% said they would most likely smoke the same amount, 10.7% they would smoke less, 9.5% they would try to quit and 5.8% they would use e-cigarettes more often. Anticipated reactions were associated with demography and smoker characteristics, for example, C2DE (lower social grade) smokers were less likely than ABC1 (higher social grade) smokers to say they would smoke the same as they do now (ORAdj=0.74, 95% CI 0.62 to 0.88). Among ex-smokers, 38.5% said the minimum prices would help them stay quit 'A lot', more so among C2DE than ABC1 participants (ORAdj=1.80, 95% CI 1.30 to 2.49). CONCLUSIONS In response to a hypothetical minimum price for cigarettes and roll-your-own tobacco, approximately a fifth of smokers in the UK indicated they would smoke less or quit and almost two-fifths of ex-smokers indicated the prices would help them stay quit.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Catherine Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Martine Stead
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Vardavas CI, Kyriakos CN, McNeill A, Fong GT. Evaluating the impact of the Tobacco Products Directive within the context of the FCTC in Europe-findings from the EUREST-PLUS ITC Europe Surveys: introductory Commentary. Eur J Public Health 2020; 30:iii1-iii3. [PMID: 32918823 PMCID: PMC7526776 DOI: 10.1093/eurpub/ckaa110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Constantine I Vardavas
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Christina N Kyriakos
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
- School of Medicine, University of Crete, Heraklion, Greece
| | - Ann McNeill
- Department of Addictions, King’s College London, London, UK
| | - Geoffrey T Fong
- Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
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