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Edwards R, Thomas L, Stanley J, Hoek J. New Zealand adolescents' responses to plain packaging and new pictorial warning labels: Repeat cross-sectional survey analysis. Aust N Z J Public Health 2023; 47:100066. [PMID: 37302905 DOI: 10.1016/j.anzjph.2023.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE This article aims to examine the impact on adolescents of New Zealand's 2018 legislation introducing plain (standardised) packaging and enhanced pictorial warning labels (PWLs). METHODS Data came from Year 10 (14-15 years old) students in the 2016 (2,884 participants) and 2018 (2,689 participants) Youth Insights Surveys conducted 2 years before and immediately after legislation implementation. We used binary and ordinal logistic regression to investigate changes in brand awareness and preference, brand and pack appeal, and PWL salience and impact. RESULTS The proportion of all participants, and ever, ex/experimental and current smokers who could name one or five tobacco product brands decreased in 2018. There was a modest and nonstatistically significant decrease in the proportion of current smokers citing brand name and image, and a larger decrease in the proportion stating perceived harm to health, influenced preferred brand choice. Having a preferred brand among current smokers and pack appeal, and PWL salience and impact among ex/experimental and current smokers were largely unchanged. CONCLUSIONS We found preliminary evidence that plain packaging and enhanced PWLs reduced tobacco brand awareness and salience, and misperceptions about tobacco brand harmfulness. Data collection occurred shortly after implementation. Additional studies are required to assess longer term impacts of these interventions. PUBLIC HEALTH IMPLICATIONS The findings complement existing evidence documenting the impact of plain packaging and PWLs on adolescents. Given limitations due to the proximity of the 2018 survey to legislation implementation, further studies with longer follow-up are required.
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Affiliation(s)
- Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Lathan Thomas
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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Salgado MV, Penko J, Fernandez A, Mejia R. Modelling the impact of plain packaging of tobacco products on cardiovascular disease in Argentina. Tob Control 2023; 32:255-258. [PMID: 34261789 DOI: 10.1136/tobaccocontrol-2021-056651] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/19/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Tobacco packaging design is conceived to be attractive. Plain packaging of tobacco products reduces this attractiveness by standardising their shape, size, font and colours. METHODS To evaluate the effect of applying plain packaging to tobacco products on cardiovascular events and mortality in Argentina, we used the Cardiovascular Disease Policy Model-Argentina, a local adaptation of a well-established computer simulation model that projects cardiovascular and mortality events for the population 35-94 years old using local demographic and consumption data, during the period 2015-2024. After a literature review, we estimated that the implementation of plain packaging of tobacco products would result in an absolute decrease in tobacco prevalence of 0.55% (base-case scenario) and performed a sensitivity analysis assuming a higher and lower decrease of 1.01% and 0.095%, respectively. RESULTS Over the 2015-2024 period, the decrease in smoking prevalence associated with plain packaging (0.55%) is projected to avert 1880 myocardial infarctions (MI), 820 strokes and 4320 total deaths in Argentina. The higher estimate of smoking prevalence reduction (1.01%) would translate into 3450 fewer MIs, 1490 fewer strokes and 7920 fewer deaths, while the lower estimate of smoking prevalence reduction (0.095%) would result in 330 fewer MIs, 140 fewer strokes and 750 fewer deaths. CONCLUSIONS The implementation of plain packaging of tobacco products could reduce cardiovascular events in Argentina, even in the absence of other tobacco control measures. Actual health benefits are likely higher than those presented here, since plain packaging may be most impactful by preventing young people from initiating smoking.
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Affiliation(s)
- M Victoria Salgado
- Área de Salud, Economía y Sociedad, Centro de Estudios de Estado y Sociedad, Ciudad de Buenos Aires, Argentina
- Servicio de Medicina Familiar, Hospital SAMIC El Calafate, El Calafate, Argentina
| | - Joanne Penko
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Alicia Fernandez
- Center for Vulnerable Populations, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Raul Mejia
- Área de Salud, Economía y Sociedad, Centro de Estudios de Estado y Sociedad, Ciudad de Buenos Aires, Argentina
- Programa de Medicina Interna General, Hospital de Clinicas Jose de San Martin, Buenos Aires, Argentina
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de Looze ME, Henking C, Torsheim T, Currie DB, Weber MW, Alemán-Díaz AY. The association between MPOWER tobacco control policies and adolescent smoking across 36 countries: An ecological study over time (2006–2014). THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 109:103871. [DOI: 10.1016/j.drugpo.2022.103871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/16/2022] [Accepted: 09/18/2022] [Indexed: 10/31/2022]
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van der Eijk Y, Yang AY. Tobacco industry marketing adaptations to Singapore plain packaging. Tob Control 2022; 31:744-749. [PMID: 33980723 DOI: 10.1136/tobaccocontrol-2020-056324] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/28/2021] [Accepted: 02/23/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Singapore has implemented plain packaging, a measure that strips all colours, logos and branding elements from tobacco packs. In other countries, tobacco companies responded to plain packaging with a variety of marketing tactics. Our goal was to describe the tobacco industry's marketing adaptations to Singapore plain packaging. METHODS Qualitative analysis of 378 cigarette packs sampled from Singapore retailers in March 2019, March 2020 and January 2021, 12 months prior to, 2 weeks prior to and 6 months after plain packaging phase-in, respectively. For each pack, we collected descriptive information on the brand and variant name, pack and stick dimensions, pack shape, differentiating features and distinctive scents, as well as photographic data of the pack, cigarette sticks and any distinct features. We used the March 2019 collection as our baseline dataset, and March 2020 and January 2021 collections as comparison datasets to examine changes in tobacco marketing strategies just before and after plain packaging phase-in. RESULTS Around Singapore's plain packaging phase-in, tobacco companies launched variants with flavour capsules, novelty filter features and new flavours and used more descriptive variant names reflecting the variant's colour coding or market positioning. Tobacco companies revamped some existing variants, often with Japanese marketing themes to convey a more premium product image. After plain packaging, tobacco companies used longer packs and variations in stick length, filter length and foil texture to further differentiate products. CONCLUSIONS Following plain packaging in Singapore, tobacco companies rely increasingly on nomenclature and the cigarette stick itself to market and differentiate products.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Adonsia Yating Yang
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Pierce JP, Kealey S, Leas EC, Pulvers K, Stone MD, Oratowski J, Brighton E, Villaseñor A, Strong DR. Effect of Graphic Warning Labels on Cigarette Pack-Hiding Behavior Among Smokers: The CASA Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2214242. [PMID: 35653155 PMCID: PMC9164006 DOI: 10.1001/jamanetworkopen.2022.14242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
IMPORTANCE The inclusion of graphic warning labels (GWLs) on cigarette packs is recommended for tobacco control but has not yet been implemented in the US. It is unknown whether and to what extent the inclusion of GWLs on cigarette packs affects smokers' willingness to display the packs in public. OBJECTIVE To determine whether the inclusion of GWLs on cigarette packs affects pack-hiding behavior among smokers in social settings. DESIGN, SETTING, AND PARTICIPANTS This community-based randomized clinical trial assessed smokers' real-world experience of using cigarettes repackaged to include GWLs (GWL packs) compared with standard US packs and blank packs over a 3-month intervention period with 12 months of follow-up between September 6, 2016, and December 3, 2019. The study included 357 participants aged 21 to 65 years from San Diego County, California, who smoked 5 or more cigarettes per day, were not actively planning to quit smoking, were not pregnant, and had no unstable medical conditions. Participants purchased and received cigarette packs through the study website. INTERVENTIONS During the 1-month run-in period, participants received their usual US cigarette packs. During the 3-month intervention period, participants were randomized to receive GWL packs (study-manufactured packs with 3 rotating images under license from the Commonwealth of Australia; GWL pack group), blank packs (study-manufactured packs devoid of industry marketing imagery; blank pack group), or standard US packs (US pack group). MAIN OUTCOMES AND MEASURES Pack hiding was queried daily (with participants reporting behavior within the last 4 hours) and weekly via interactive text messages during the 1-month run-in and intervention periods. Self-reported smoking behavior was biochemically validated. RESULTS Among 357 enrolled participants, the mean (SD) age was 39.3 (11.8) years; 195 participants (54.6%) were female, 40 (11.2%) were Hispanic, 243 (68.1%) were non-Hispanic White, and 74 (20.7%) were of other non-Hispanic races (including American Indian or Alaska Native, Asian or Pacific Islander, Black or African American, or multiracial). A total of 18 987 cigarette packs were purchased and delivered during the run-in and intervention periods. Daily querying showed that the inclusion of GWLs on cigarette packs increased the percentage of smokers who hid their packs at least some of the time from 41.3% (95% CI, 39.6%-43.0%) during the run-in period to 57.1% (95% CI, 55.9%-58.1%) by the end of the intervention period. In the postintervention period, returning to standard US packs reduced pack-hiding behavior to the levels observed during the run-in period. Pack hiding remained at run-in levels for both the blank pack group (35.2%; 95% CI, 33.6%-36.8%) and the US pack group (41.4%; 95% CI, 39.7%-43.1%]) throughout the study. Although even participants in the GWL group with the lowest prestudy tendency to conceal score (ie, 1) had a mean (SE) probability of pack hiding during the intervention of 0.84 (0.02), this group's probability of pack hiding decreased to a mean (SE) of 0.43 (0.03) after intervention. When social reactions to packs were queried at the end of the study, the modal response from participants in the GWL pack group was observers' aversive reactions to the packs, whereas the modal response from participants in the blank pack group was observers' positive interest in the study. Neither smoking prevalence nor consumption differed by group at any point in the study. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, receiving cigarettes in GWL packs vs blank packs increased pack-hiding behavior in social settings, which may be associated with aversive reactions from observers. However, 12-month smoking behavior did not change. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02676193.
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Affiliation(s)
- John P. Pierce
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Kim Pulvers
- Department of Psychology, California State University, San Marcos
| | - Matthew D. Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
| | - Jesica Oratowski
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Elizabeth Brighton
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
| | - Adriana Villaseñor
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
- Department of Epidemiology, Public Health Services, San Diego County, San Diego, California
| | - David R. Strong
- Cancer Control Program, Moores Cancer Center, University of California, San Diego, La Jolla
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, San Diego
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Pasquereau A, Guignard R, Andler R, Gallopel-Morvan K, Nguyen-Thanh V. Plain packaging on tobacco products in France: Effectiveness
on smokers’ attitudes one year after implementation. Tob Induc Dis 2022; 20:35. [PMID: 35529322 PMCID: PMC8985692 DOI: 10.18332/tid/146600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/07/2022] [Accepted: 02/10/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION New packaging of tobacco products, with plain packaging and new enlarged health warnings, was made compulsory in France in 2017. This study aims to measure the impact of new packaging on smokers’ embarrassment and their motivation to quit smoking. METHODS Data from Santé publique France 2016, 2017 and 2018 Health Barometer surveys were used. These randomized surveys were conducted by telephone with samples of 15216 (2016), 25319 (2017), and 9074 (2018) people aged 18–75 years. The association between smokers’ embarrassment and the influence of new packaging on motivation to quit smoking was studied using multivariate logistic regressions. RESULTS After the introduction of new plain packaging, the proportion of smokers who felt embarrassed taking out their pack of cigarettes in plain sight because of its appearance doubled in 2017 (11.9%, 95% CI: 10.2–13.9 vs 5.9%, 95% CI: 4.4–7.8 in 2016, p<0.001) and continued to increase in 2018 (15.5%, 95% CI: 13.7–17.5, p<0.01). In 2018, women were more embarrassed than men (OR=2.0; 95% CI: 1.5–2.6, p<0.001). In 2018, 26.8% (95% CI: 24.6–29.1) of smokers said the appearance of a pack of cigarettes motivated them to quit, and 22.5% (95% CI: 18.3–27.2) ex-smokers cited it as having motivated them to quit. Smokers who were embarrassed by displaying their pack were more likely to be motivated to quit because of the pack’s appearance. People with higher incomes were less likely to report motivation to quit due to the pack than people with the lowest income (OR=0.5; 95% CI: 0.3–0.7, p<0.001). CONCLUSIONS In the French context, the new plain packaging of tobacco products probably had an impact on smokers’ perception of tobacco by increasing the embarrassment they felt when they took out their pack of cigarettes in plain sight. It also influenced the motivation to quit smoking, and more generally, it could contribute to the denormalization of tobacco.
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Affiliation(s)
- Anne Pasquereau
- Santé Publique France, the National Public Health Agency, Paris, France
| | - Romain Guignard
- Santé Publique France, the National Public Health Agency, Paris, France
| | - Raphaël Andler
- Santé Publique France, the National Public Health Agency, Paris, France
| | | | - Viêt Nguyen-Thanh
- Santé Publique France, the National Public Health Agency, Paris, France
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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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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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Durkin SJ, Schoenaker D, Brennan E, Bayly M, Wakefield MA. Are anti-smoking social norms associated with tobacco control mass media campaigns, tax and policy changes? Findings from an Australian serial cross-sectional population study of smokers. Tob Control 2021; 30:177-184. [PMID: 32269172 DOI: 10.1136/tobaccocontrol-2019-055325] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 12/11/2019] [Accepted: 01/08/2020] [Indexed: 11/03/2022]
Abstract
BACKGROUND Anti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and friends) and internalised injunctive norms (embarrassed about telling others you are a smoker). METHODS A serial cross-sectional population survey of Australian adult smokers (n=6649; 2012 to 2015). Logistic regression analyses examined associations of social norms with exposure to different types of tobacco control advertisements, tax increases and other tobacco control policies, adjusting for key demographic, smoking and media exposure covariates. Interaction analyses examined differences by age and socioeconomic status (SES). RESULTS Greater past month exposure to predominantly fear-evoking advertisements was associated with increased odds of perceiving disapproval (per 1000 gross rating points: adjusted OR (AOR) 2.69, 95% CI: 1.34 to 5.39), while exposure to advertisements evoking multiple negative emotions (fear, guilt, sadness) reduced perceived disapproval (AOR 0.61, 95% CI: 0.42 to 0.87). Increased perceived disapproval was also associated with anticipation (AOR 1.38, 95% CI: 1.02 to 1.88), and implementation of a series of annual 12.5% tobacco tax rises (AOR 1.41, 95% CI: 1.03 to 1.94). Associations were consistent across age and SES. There were no associations nor subgroup interactions between advertisement exposure or policy changes and feeling embarrassed about telling others you are a smoker. CONCLUSION Smokers' perceptions of family and friends' disapproval of their smoking was more common after exposure to fear-evoking tobacco control campaigns and after large tobacco tax increases were announced and implemented.
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Affiliation(s)
- Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Danielle Schoenaker
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
- School of Medicine and Illawarra Health and Medical Research Institute, University of Wollongong, Wollongong, New South Wales, Australia
| | - Emily Brennan
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Megan Bayly
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melanie A Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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Maynard OM. Tobacco Control Policies to Tackle the Problem of Adolescent Tobacco Use. Nicotine Tob Res 2020; 22:1935-1936. [DOI: 10.1093/ntr/ntaa172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/08/2020] [Indexed: 11/13/2022]
Affiliation(s)
- Olivia M Maynard
- School of Psychological Science, MRC Integrative Epidemiology Unit (IEU), University of Bristol, Bristol, UK
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11
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Mitchell D, Critchlow N, Moodie C, Bauld L. Reactions to Standardized Cigarette Packs With Varying Structural Designs, and the Association With Smoking Susceptibility: A Postimplementation Cross-Sectional Survey With Never-Smoking Adolescents in Scotland. Nicotine Tob Res 2020; 22:2041-2050. [PMID: 32577739 DOI: 10.1093/ntr/ntaa109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 06/15/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION From May 20, 2017, cigarettes in the United Kingdom must be sold in standardized (plain) packaging. We explore postimplementation reactions to standardized cigarette packaging among never-smokers in Scotland, whether reactions vary in relation to permitted variations in pack structure, and whether reactions are associated with susceptibility. AIMS AND METHODS A cross-sectional survey with 12-17-year-old never-smokers (n = 507) in Scotland, conducted November 2017-November 2018. Participants were shown one "regular" standardized cigarette pack (flip-top lid and straight-edged pack, similar to designs in Australia) and three standardized packs with varied pack structures (beveled-edges, slim pack, and shoulder box), which are permitted postimplementation in the United Kingdom. Participants rated each pack on eight five-point reaction measures (eg, attractiveness). Participants also indicated which pack, if any, they would choose. Smoking susceptibility was the outcome. RESULTS The mean reaction scores for all four packs were mostly negative, however the shoulder box was consistently rated less negatively than the regular, slim, or beveled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than nonsusceptible participants (25% vs. 7%; χ 2 = 29.70; p < .001). For all four packs, not finding them off-putting was associated with susceptibility (Adjusted Odds Ratio range: 2.73-3.69), albeit only a minority of adolescents did not find each pack off-putting. CONCLUSIONS Adolescents have negative reactions to the standardized cigarette packs implemented in the United Kingdom, albeit permitted variations in structure can reduce the extent of negativity. Most reactions to standardized packaging had no association with susceptibility. IMPLICATIONS We provide the first empirical evidence that adolescents find the standardized cigarette packs implemented in the United Kingdom unappealing and that most pack reactions have no association with susceptibility among never-smokers, with the exception of the minority who did not think that they would put them off smoking. This suggests that the legislation is achieving one of its primary aims, to reduce the appeal of packaging. That permitted variations in pack structure (eg, shoulder boxes) somewhat reduce negative reactions suggests that the United Kingdom, and other countries introducing similar legislation, should ensure that all aspects of pack design are fully standardized.
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Affiliation(s)
- Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Stirlingshire, UK
- SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
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MacGregor A, Delaney H, Amos A, Stead M, Eadie D, Pearce J, Ozakinci G, Haw S. 'It's like sludge green': young people's perceptions of standardized tobacco packaging in the UK. Addiction 2020; 115:1736-1744. [PMID: 32032450 DOI: 10.1111/add.14999] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 12/06/2019] [Accepted: 01/31/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Standardized tobacco packaging was introduced in the United Kingdom in May 2016, together with larger graphic warnings. This study explored young Scottish people's awareness of and perceptions about standardized tobacco packaging in the United Kingdom. DESIGN Qualitative study using 16 focus groups conducted February-March 2017. SETTING Four schools in Scotland based in areas of differing socio-economic status (high versus medium/low) and two levels of urbanity (large urban versus small town/other urban). PARTICIPANTS Eighty-two S2 (13-14 years) and S4 (15-16 years) students who were smokers or at-risk non-smokers. MEASUREMENTS Focus groups explored perceptions of standardized packaging and health warnings. The qualitative data underwent thematic analysis. FINDINGS Views about standardized packaging were generally negative. Packs were described as being unattractive, drab and less appealing than non-standardized versions. The new health warnings generated negative affective, often aversive, responses. These varied depending on the image's perceived 'gruesomeness' and authenticity. Most participants thought that the impact would be greatest on young non/occasional smokers. There were divergent views about whether established smokers would be affected. CONCLUSIONS The introduction of standardized tobacco packaging and new larger graphic health warnings in the United Kingdom seems have reduced the perceived attractiveness of cigarette packs among young people in the United Kingdom who smoke or are at elevated risk of becoming smokers, disrupting positive brand imagery (the brand heuristic), increasing the salience of health warnings and contributing to denormalizing smoking.
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Affiliation(s)
| | - Hannah Delaney
- School of Nursing and Midwifery, National University of Ireland, Galway and Trinity College Dublin, Ireland
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Martine Stead
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Douglas Eadie
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Jamie Pearce
- School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Gozde Ozakinci
- School of Medicine, University of St Andrews, St Andrews, UK
| | - Sally Haw
- Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Awareness and Perceptions on Health Warning Labels on Cigarette Packs among Smokers: A Cross-Sectional Study. BIOMED RESEARCH INTERNATIONAL 2020; 2020:9462903. [PMID: 32775452 PMCID: PMC7391087 DOI: 10.1155/2020/9462903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/20/2020] [Accepted: 07/13/2020] [Indexed: 11/17/2022]
Abstract
Backgrounds Tobacco use is the leading preventable cause of premature deaths. Tobacco control remains a top priority, and health warning labels (HWLs) are one of the recommended methods. This study is aimed at examining the awareness and perceptions of HWLs on cigarette packs among smokers. Methods A cross-sectional study was conducted among 240 smokers who were randomly recruited from three townships in Mandalay in 2018. A face-to-face interview was done using a questionnaire. Multivariate logistic regression was used to analyse the data. Results About half were 18-40 years old; the majority were males (96.3%) and smokers (93.4%). Nearly all respondents noticed both pictorial warning and text messages, and about half could identify the current size of HWLs. Most of the smokers generally had positive perceptions and opinions on HWLS, and they strongly supported it. About 75% intended to reduce the number of cigarettes, and 18% were willing to quit within 6 months. Those who desired to reduce the number of cigarettes were more likely to quit within 6 months (aOR = 7.6, 95% CI 1.6-35.9 and aOR = 19.6, 95% CI 13.0-294.7 for those who had a little and strong desire, respectively). Conclusion Awareness status and perceptions of the respondents were acceptable, and HWLs have motivated smokers to quit smoking. The Tobacco Control Program needs to strengthen the tobacco control law that prohibits selling loosies in order to maximize the benefits of HWLs.
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Barrientos-Gutierrez I, Islam F, Cho YJ, Salloum RG, Louviere J, Arillo-Santillán E, Reynales-Shigematsu LM, Barnoya J, Saenz de Miera Juarez B, Hardin J, Thrasher JF. Assessing cigarette packaging and labelling policy effects on early adolescents: results from a discrete choice experiment. Tob Control 2020; 30:tobaccocontrol-2019-055463. [PMID: 32665358 PMCID: PMC7855531 DOI: 10.1136/tobaccocontrol-2019-055463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 05/15/2020] [Accepted: 05/19/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Cigarette packaging is a primary channel for tobacco advertising, particularly in countries where traditional channels are restricted. The current study evaluated the independent and interactive effects of cigarette packaging and health warning label (HWL) characteristics on perceived appeal of cigarette brands for early adolescents in Mexico. METHODS A discrete choice experiment (DCE) was conducted with early adolescents, aged 12-14 years (n=4251). The DCE involved a 3×25 design with six attributes: brand (Marlboro, Pall Mall, Camel), tobacco flavour (regular, menthol), flavour capsule (none, 1 or 2 capsules), presence of descriptive terms, branding (vs plain packaging), HWL size (30%, 75%) and HWL content (emphysema vs mouth cancer). Participants viewed eight sets of three cigarette packs and selected a pack in each set that: (1) is most/least attractive, (2) they are most/least interested in trying or (3) is most/least harmful, with a no difference option. RESULTS Participants perceived packs as less attractive, less interesting to try and more harmful if they had plain packaging or had larger HWLs, with the effect being most pronounced when plain packaging is combined with larger HWLs. For attractiveness, plain packaging had the biggest influence on choice (43%), followed by HWL size (19%). Interest in trying was most influenced by brand name (34%), followed by plain packaging (29%). Perceived harm was most influenced by brand name (30%), followed by HWL size (29%). CONCLUSION Increasing the size of HWLs and implementing plain packaging appear to reduce the appeal of cigarettes to early adolescents. Countries should adopt these policies to minimise the impact of tobacco marketing.
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Affiliation(s)
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - Yoo Jin Cho
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | | | - Jordan Louviere
- School of Marketing, University of South Australia, Adelaide, South Australia, Australia
| | - Edna Arillo-Santillán
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Joaquin Barnoya
- Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Mississippi, USA
| | | | - James Hardin
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
| | - James F Thrasher
- Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
- Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
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Hassounah MM, Al-Zalabani AH, AlAhmari MD, Murriky AA, Makeen AM, Alanazi AM. Implementation of Cigarette Plain Packaging: Triadic Reactions of Consumers, State Officials, and Tobacco Companies-The Case of Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2668. [PMID: 32295009 PMCID: PMC7215406 DOI: 10.3390/ijerph17082668] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES In August 2019, Saudi Arabia started implementing plain packaging for cigarettes. Three months later, an opposing campaign on twitter using an Arabic hashtag "the new smoke" gained momentum amongst smokers. The purpose of this study is to document this opposing campaign's timeline and describe consumers, government, and tobacco industry rhetoric. METHODS We created a timeline of the campaign events then performed online social listening of Arabic twitter hashtags related to the campaign. RESULTS Campaigners mainly complained of an unfavorable new taste in cigarette packs with plain packaging. The messaging developed to accusations to government entities and neighboring countries, and then after threats to boycott tobacco companies. The campaign received a significant amount of media coverage and elicited an official response from a number of Saudi government bodies, such as the Saudi Food and Drug Authority and Ministry of Commerce and Investment. CONCLUSION This case points at a need for risk communication training, possible tobacco industry manipulation, and a need to gain consumer trust with evidence-based messaging techniques. The case of cigarette plain packaging adoption in Saudi Arabia serves as an example to other countries of potential consumer interaction, tobacco industry interference, and state official counter-reactions.
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Affiliation(s)
- Marwah M. Hassounah
- Community Medicine Unit, Family and Community Medicine Department, King Saud University, Riyadh 11564, Saudi Arabia;
| | - Abdulmohsen H. Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al-Madinah 42353, Saudi Arabia;
| | - Mohammed D. AlAhmari
- Department of Respiratory Care, Prince Sultan Military College of Health Sciences, Dhahran 34464, Saudi Arabia;
| | - Afraa A. Murriky
- Department of Restorative Dentistry, Riyadh Elm University, Riyadh 11564, Saudi Arabia;
| | - Anwar M. Makeen
- Department of Family and Community Medicine, Jazan University, Jazan 88723, Saudi Arabia;
| | - Abdullah M.M. Alanazi
- Department of Respiratory Therapy, King Saud bin Abdulaziz University For Health Sciences, Riyadh 11564, Saudi Arabia
- Sparkman Center for Global Health, The University of Alabama at Birmingham, Birmingham, AL 35205, USA
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White VM, Guerin N, Williams T, Wakefield MA. Long-term impact of plain packaging of cigarettes with larger graphic health warnings: findings from cross-sectional surveys of Australian adolescents between 2011 and 2017. Tob Control 2019; 28:e77-e84. [DOI: 10.1136/tobaccocontrol-2019-054988] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 05/02/2019] [Accepted: 05/15/2019] [Indexed: 11/04/2022]
Abstract
ObjectiveTo assess the long-term impact of plain packaging (PP) of cigarettes with larger graphic health warnings (HW) introduced in December 2012 on adolescents’ relevant tobacco-related perceptions.MethodsCross-sectional school-based surveys of 12 to 17 year olds in 2011 (n=4413), 2013 (n=4423), 2014 (n=4576) and 2017 (n=4266). Students rated the character of four popular cigarette brands, indicated their agreement regarding brand differences in smoking ease, quitting, addictiveness, harmfulness and pack attractiveness and positive/negative perceptions of pack image. The frequency of students reading, attending to, thinking and talking about HW was assessed. Responses of students seeing cigarette packs in the previous 6 months (2011: 63%; 2013: 67%, 2014: 56%, 2017: 56%) were examined.ResultsSmoking prevalence declined from 2011 to 2017. Among students who had recently seen packs, cigarette packs were rated less positively and more negatively in 2017 than in 2011 (p<0.001) with ratings similar between 2013 and 2017. Positive character ratings for each brand reduced between 2011 and 2013 (ps<0.05) with further reductions between 2013 and 2017 (ps<0.05). Fewer students agreed, and more were uncertain, that brands differed in their smoking ease, addictiveness, harmfulness and pack attractiveness in 2017 than 2011. The frequency of students reading, attending, talking or thinking about HW did not change between 2011 and 2017.ConclusionsPP’s initial impact in reducing adolescent’s positive perceptions of cigarette packs and brand differences continued in the following years with tobacco packaging less appealing to young people in 2017 than 2011 and students more uncertain about brand differences.
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Dunbar MS, Setodji CM, Martino SC, Shadel WG. Graphic health warning posters increase some adolescents' future cigarette use susceptibility by changing normative perceptions of smoking: A case of mediated moderation. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:649-658. [PMID: 31424243 DOI: 10.1037/adb0000503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Prior work suggests that exposure to graphic health warning posters (GWPs) at retail point-of-sale may increase future cigarette smoking susceptibility in adolescents who are already at risk for future smoking, but not among committed never-smokers. However, little is known about what psychological mechanisms may account for this effect of GWPs on at-risk youths. Participants (N = 441) aged 11-17 years were randomized to experimental shopping conditions in a life-sized model convenience store, in which GWPs were absent ("status quo"; n = 107) or visibly displayed near the check-out area (n = 334). Participants completed pre- and post- "shopping" measures of future smoking susceptibility, descriptive and injunctive smoking norms, and perceived harms of smoking. A series of linear regression analyses assessed whether norms and harms differentially mediated the effect of experimental condition on future smoking susceptibility in committed never smokers compared with at-risk youths. Tests showed evidence for mediated moderation of the effect of GWP exposure on future smoking susceptibility, such that changes in injunctive norms (i.e., greater perceived social disapproval)-but not descriptive norms or perceived smoking harms-partially accounted for the effect of GWPs on smoking susceptibility in at-risk youths (average causal mediation effect: B = 0.51 [0.14-1.22], p = .02), but not among committed never smokers. For adolescents already at risk of future smoking, GWPs increase perceptions of cigarettes as less socially acceptable, which may increase susceptibility to future smoking in this group. Future work should examine reactance to antismoking messaging among youth at risk for future smoking. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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O'Connor R. Warnings and packaging. Tob Control 2019; 28:e1-e2. [DOI: 10.1136/tobaccocontrol-2019-055192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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