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Jones D, Morgan A, Moodie C, Alexandrou G, Ford A, Mitchell D. The Role of e-Cigarette Packaging as a Health Communications Tool: A Focus Group Study With Adolescents and Adults in England and Scotland. Nicotine Tob Res 2024:ntae107. [PMID: 38839060 DOI: 10.1093/ntr/ntae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 02/26/2024] [Accepted: 04/25/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION In the United Kingdom, e-cigarette and refill packaging must display a nicotine addiction warning. This study explored how this message is perceived, responses to alternative on-pack messages, and other options for using e-cigarette packaging to discourage youth and people who neither smoke nor use e-cigarettes while encouraging smokers to switch. AIMS AND METHODS Between August and September 2022, 16 focus groups (n = 70) were conducted to explore these topics with adolescents (n = 31, aged 11-17 years) and adults (n = 39, nonsmokers, smokers that use e-cigarettes, smokers that do not use e-cigarettes) in England and Scotland. RESULTS While several participants thought the current nicotine addiction warning could help increase awareness of nicotine addiction, most reported that it failed to capture attention and was not a deterrent. Alternative messages shown on packs (about harm, toxicity, wellness, litter, or relative risk) received mixed responses. Relative risk messages were perceived as most beneficial for smokers switching but also thought to potentially encourage uptake among nonsmokers. Some participants considered certain harm and toxicity messages to potentially dissuade uptake. Participants proposed several ideas to reduce the appeal of e-cigarette packaging and devices to deter youth uptake, including more prominent warnings, standardized packaging, and devices that are plain or include health messages. CONCLUSIONS Packaging can play a crucial role in communicating product and health messages to different consumer groups. Further consideration of how packaging and labeling can meet the needs of non-nicotine users while simultaneously reaching those who may benefit from using e-cigarettes to stop smoking is warranted. IMPLICATIONS While some viewed the nicotine addiction warning required on e-cigarettes and refill packaging in the United Kingdom as helpful in raising awareness of nicotine addiction, it did not resonate with most of our sample of adolescents and adults. The findings suggest that e-cigarette packaging could be better used to encourage smokers to switch to a less harmful alternative, with relative risk messages showing promise. Furthermore, strengthening on-pack messaging (eg increasing salience and rotating messages) and reducing the appeal of packaging (eg drab colors) and devices (eg including warnings) may help increase awareness of e-cigarette harms while deterring use among adolescents and nonsmokers.
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Affiliation(s)
- Daniel Jones
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Amber Morgan
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Georgia Alexandrou
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Allison Ford
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
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Al-Ahmadi AF, Almatrafi MA, Ali AK, Alsaedi OH, Al-Zalabani AH. Perceptions of health warnings on cigarette sticks among the adult population in Al-Madinah, Saudi Arabia: A cross-sectional survey. Tob Induc Dis 2024; 22:TID-22-44. [PMID: 38384733 PMCID: PMC10879763 DOI: 10.18332/tid/182912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/18/2024] [Accepted: 01/21/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION Health warnings on cigarette sticks are emerging as a tool to control tobacco consumption; hence, understanding how they are perceived is valuable in determining their effectiveness. Our study aimed to evaluate the perception of health-related messages and warnings on individual cigarette sticks. It also aimed to evaluate the perceptions of the effectiveness of cigarette packaging warnings and the acceptance level for the inclusion of health warnings on cigarette sticks. METHODS This cross-sectional survey was conducted on 285 individuals in Al-Madinah, Saudi Arabia. The survey was distributed online using a non-probability convenience sampling technique. The chi-squared test and logistic regression analysis were used to determine the association of sociodemographic characteristics and smoking-related variables with participants' perceptions of health warnings on cigarette sticks and packaging. The responses were also assessed qualitatively using conceptual content analysis. RESULTS In all, 18.6% of participants perceived that the package warnings were either 'quite effective' or 'very effective' in prompting smokers to quit. For health warnings on cigarette sticks, 28.1% of participants perceived that the theme of statistics on mortality was either 'quite effective' or 'very effective' in prompting smokers to quit, compared to 35.0 % for the theme of social and financial consequences. Respondents who had secondary education and lower were almost two times more likely to support the inclusion of health warnings than those who had a university education and higher (OR=1.9; 95% CI: 1.02-3.7, p=0.042). Most of the comments were positive for the inclusion of health warnings on cigarette sticks. CONCLUSIONS Most participants perceived that package warnings were ineffective, but warnings on cigarette sticks were effective methods of dissuasion of cigarette use. Smokers were almost twice as likely to perceive as effective supportive messages to quit than non-smokers. The majority of participants 'agreed' or 'strongly agreed' to the inclusion of health warnings on cigarette sticks.
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Affiliation(s)
- Ahmed F. Al-Ahmadi
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
- Model of Care, Madinah Health Cluster, Al-Madinah, Saudi Arabia
- Quit Smoking Clinic, Public Health Department, King Salman Medical City, Al-Madinah, Saudi Arabia
- Preventive Medicine Program for Postgraduate Studies, Ministry of Health, Al-Madinah, Saudi Arabia
| | - Mohammed A. Almatrafi
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
| | - Ahmed K. Ali
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
- Model of Care, Madinah Health Cluster, Al-Madinah, Saudi Arabia
| | - Osama H. Alsaedi
- General Directorate of Health Affairs of Medina, Ministry of Health, Al Madinah, Saudi Arabia
- Model of Care, Madinah Health Cluster, Al-Madinah, Saudi Arabia
| | - Abdulmohsen H. Al-Zalabani
- Department of Family and Community Medicine, College of Medicine, Taibah University, Al Madinah, Saudi Arabia
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Al-Zalabani AH, Monshi SS, Al-Ahmadi AF, Ali AKA, Mirdad GA, Alanazi MM, Alsaedi MQ, Alanazi AM. Dissuasive cigarettes as a tobacco control measure: a scoping review. Tob Control 2023:tc-2023-057974. [PMID: 37414527 DOI: 10.1136/tc-2023-057974] [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: 01/30/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim was to identify and review the research literature on dissuasive cigarettes, including key concepts, types, sources of evidence and research gaps. DATA SOURCES PubMed, Scopus and Web of Science databases were searched up to January 2023 with no language or date restrictions. All study designs were included. Reference lists of the identified studies were manually searched. Studies on tobacco products other than cigarettes or on external cigarette packaging alone were excluded. STUDY SELECTION Two reviewers screened titles and abstracts independently using eligibility criteria. The full text of the selected articles was subsequently screened independently by two reviewers to confirm eligibility. DATA EXTRACTION Two reviewers independently extracted data from all studies using data abstraction forms. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS We identified 24 original studies, 3 review articles and 4 commentary articles. Research on dissuasive cigarettes was reported from Australia, New Zealand, Europe and North America. We presented results in four themes: the concept of dissuasive cigarettes; approaches and types; potential benefits, barriers and concerns; and current research gaps. CONCLUSIONS Dissuasive cigarettes represent a promising strategy that could be used in tobacco control. Parallel implementation with plain packaging would be feasible and synergistic.
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Affiliation(s)
| | - Sarah S Monshi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Ahmed Khalid A Ali
- Model of Care, Al-Madinah Health Cluster, Al-Madinah Al-Munawarah, Saudi Arabia
| | | | - Manal Muteb Alanazi
- Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mawada Qabl Alsaedi
- Saudi Board Preventive Medicine Program, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Abdullah M Alanazi
- Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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Mullapudi S, Kulkarni MM, Kamath VG, Britton J, Moodie C, Kamath A. Perceptions of novel warnings compared with current warning on tobacco packs, and warnings on cigarette sticks: A cross-sectional survey of college students in Southern India. Tob Induc Dis 2023; 21:50. [PMID: 37123347 PMCID: PMC10141829 DOI: 10.18332/tid/160082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 12/24/2022] [Accepted: 01/30/2023] [Indexed: 05/02/2023] Open
Abstract
INTRODUCTION In India there is insufficient knowledge of the risks associated with tobacco use. Increasing awareness of these risks is critical, with pictorial warnings on tobacco packs a cost-effective way to communicate this information. We explored perceptions of the current warning, 'Tobacco causes cancer', displayed on packs in India and four novel warnings about other potential impacts of tobacco use including social, financial, and environmental, but also complications with diabetes. As loose cigarette sales are common in India, we also explored perceptions of warnings on cigarette sticks. METHODS A cross-sectional survey of college students aged ≥18 years in Karnataka, India, was conducted between January 2019 and February 2020. Participants were asked about salience, believability, and cognitive processing of warnings currently on packs. They were then shown an image of one current and four novel warnings and asked about their perceived effectiveness in preventing uptake and reducing and stopping tobacco use. They were then asked about warnings on cigarette sticks. RESULTS Most participants (70.2%) recalled warnings on packs and considered them believable (55.7%), but only 12.0% read and 12.4% thought about them often. Warnings about the health impacts of tobacco use were viewed as most effective in preventing uptake, and reducing and stopping tobacco use. Nevertheless, at least a third of participants rated warnings pertaining to financial, social, and environmental impacts effective in preventing uptake, and reducing and stopping tobacco use. Approximately one-fifth (22.0%) thought that warnings on cigarette sticks would deter initiation. CONCLUSIONS Our results suggest that health warnings are perceived as most effective in discouraging tobacco use among college students in Karnataka. While viewed as less effective than health warnings, novel non-health related messages were viewed as effective in preventing uptake, and reducing and stopping tobacco use by at least one in three participants. Warnings on cigarette sticks may help complement warnings on cigarette packs.
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Affiliation(s)
- Somya Mullapudi
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Veena G. Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - John Britton
- UK Centre for Tobacco & Alcohol Studies, Faculty of Medicine & Health Sciences, University of Nottingham, Nottingham, England
| | - Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, United Kingdom
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
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van der Eijk Y. Standardised cigarettes: the next step for tobacco policy? Tob Control 2022:tobaccocontrol-2022-057417. [PMID: 35768214 DOI: 10.1136/tc-2022-057417] [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: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
As tobacco marketing restrictions intensify, tobacco companies increasingly turn to the cigarette product itself as a marketing medium with new flavours, capsules, novelty filter features and attractive cigarette stick designs. This paper considers a 'standardised cigarettes' policy as a potential next step in restricting tobacco marketing. This policy would remove from cigarette products all the elements that increase their appeal and addictiveness: added flavours, nicotine, and visual designs and branding. The result would be a cigarette that is flavourless, not especially addicting, and visually off-putting. This paper discusses what a standardised cigarettes policy might look like from a regulatory standpoint, and how it fits into current policy obligations under the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Adams S, Clavijo A, Tamayo R, Maynard O. Cross-sectional online survey of the impact of new tobacco health warnings in Colombia. BMJ Open 2022; 12:e056754. [PMID: 35760539 PMCID: PMC9237901 DOI: 10.1136/bmjopen-2021-056754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 04/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aimed to explore the impact of a new set of six pictorial warnings introduced in 2018. DESIGN AND SETTING Using a cross-sectional design, we examined awareness of the new warnings among Colombian smokers across two time points of data collection. PARTICIPANTS Adult smokers (≥18 years of age), defined as having smoked at least 100 cigarettes in their lifetime and currently smoking at least one cigarette per week participated at time 1, prior to the introduction of the new health warnings in Colombia in 2018 (n=1985, 72% male), and at time 2, 12 months post introduction (n=1572, 69% male). PRIMARY OUTCOMES At each time, we examined smokers' responses to warnings on packs (negative affect, thinking about warning messages and cognitive elaboration), attitudes toward smoking (perceived likelihood and severity of harm, self-efficacy, response efficacy and quit intentions), knowledge of the health risks of smoking and responses to the new warnings (negative affect, believability, thinking about the harms, reactance and perceived message effectiveness). RESULTS Awareness of the warnings was low, with only 59% of smokers reporting having seen them at time 2. Between times, we observed a reduction in negative affect toward current warnings (p<0.001), reduced thinking about (p<0.001) and cognitive elaboration of the warning message (p<0.001), and an increase in perceived severity of warnings (p<0.001). When asked about the six new health warnings, we found a reduction in negative affect (p<0.07), cognitions related to harm (p<0.01), believability (p<0.03), reactance (p<0.01) and perceived message effectiveness (p<0.02) between times. CONCLUSIONS Our data indicate that effectiveness was low prior to the introduction of the new health warnings and at 12 months post introduction. Tobacco control policy should seek to improve exposure to and noticeability of tobacco health warnings in Colombia.
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Affiliation(s)
- Sally Adams
- Department of Psychology, University of Bath, Bath, UK
| | - Arturo Clavijo
- Department of Psychology, Universidad Nacional de Colombia, Bogota, Colombia
| | - Ricardo Tamayo
- Department of Psychology, Universidad Nacional de Colombia, Bogota, Colombia
| | - Olivia Maynard
- School of Experimental Psychology, University of Bristol, Bristol, UK
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van Mourik DJA, Nagelhout GE, Poole NL, Willemsen MC, Candel MJ, Moodie C, van den Putte B, Thrasher JF, de Vries H. Non-smoking adolescents’ perceptions of dissuasive cigarettes. Addict Behav Rep 2022; 15:100433. [PMID: 35620217 PMCID: PMC9127256 DOI: 10.1016/j.abrep.2022.100433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 04/13/2022] [Accepted: 05/13/2022] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dirk Jan A. van Mourik
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Gera E. Nagelhout
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
- IVO Research Institute, The Hague, The Netherlands
- Corresponding author at: Maastricht University, Department of Health Promotion, P.O. Box 616, 6200 MD Maastricht, The Netherlands.
| | | | - Marc C. Willemsen
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
- Netherlands Expertise Centre for Tobacco Control (NET), Trimbos Institute, Utrecht, The Netherlands
| | - Math J.J.M. Candel
- Department of Methodology and Statistics, Maastricht University (CAPHRI), Maastricht, The Netherlands
| | - Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Bas van den Putte
- Department of Communication, University of Amsterdam (ASCoR), Amsterdam, The Netherlands
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Hein de Vries
- Department of Health Promotion, Maastricht University (CAPHRI), Maastricht, The Netherlands
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Australian Perceptions of Warnings on Cigarette Sticks. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Mitchell D, Critchlow N, Moodie C, Bauld L. Reactions to, and trial intentions for, three dissuasive cigarette designs: a cross-sectional survey of adolescents in Scotland. Tob Control 2021; 30:623-629. [PMID: 32817574 DOI: 10.1136/tobaccocontrol-2020-055842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 06/17/2020] [Accepted: 06/24/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVES There has been growing academic and policy interest in opportunities to decrease the appeal of cigarette sticks, such as making them an unattractive colour or requiring them to display a health warning. We therefore explored reactions to, and trial intentions for, three 'dissuasive' cigarette designs among adolescents in Scotland. METHODS A cross-sectional survey with 12-17 year olds in Scotland (n=594) was conducted between November 2017 and November 2018. Participants were shown one 'standard' cigarette (imitation cork filter with white paper casing) and three dissuasive cigarettes: (1) a cigarette with the warning 'smoking kills'; (2) a cigarette with the warning 'toxic' and a skull and cross-bones image and (3) a dark green cigarette. Participants rated each cigarette on nine five-point reaction measures (eg, appealing/unappealing or attractive/unattractive). A composite reaction score was computed for each cigarette, which was binary coded (overall negative reactions vs neutral/positive reactions). Participants also indicated whether they would try each cigarette (coded: Yes/No). Demographics, smoking status and smoking susceptibility were also measured. RESULTS More participants had negative reactions to the dark green (93% of adolescents), 'smoking kills' (94%) and 'toxic' (96%) cigarettes, compared with the standard cigarette (85%). For all three dissuasive designs, Chi-square tests found that negative reactions were more likely among younger adolescents (vs older adolescents), never-smokers (vs ever smokers) and non-susceptible never-smokers (vs susceptible never-smokers). Most participants indicated that they would not try any of the cigarettes (range: 84%-91%). CONCLUSION Dissuasive cigarettes present an opportunity to further reduce the appeal of smoking among adolescents.
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Affiliation(s)
- Danielle Mitchell
- Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Nathan Critchlow
- Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Linda Bauld
- Usher Institute, UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- SPECTRUM consortium, Univeristy of Edinburgh, Edinburgh, UK
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Clarke N, Rose AK. Impact of Labeled Glasses in a Bar Laboratory Setting: No Effect on Ad Libitum Alcohol Consumption. Alcohol Clin Exp Res 2020; 44:1666-1674. [DOI: 10.1111/acer.14392] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 05/01/2020] [Accepted: 05/28/2020] [Indexed: 01/23/2023]
Affiliation(s)
- Natasha Clarke
- University of Cambridge Institute of Public Health(NC) Cambridge UK
- Department of Psychological Sciences (NC, AKR) University of Liverpool Liverpool UK
| | - Abigail K Rose
- Department of Psychological Sciences (NC, AKR) University of Liverpool Liverpool UK
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian University Student Perceptions of Health Messages on Cigarette Sticks. HEALTH COMMUNICATION 2020; 35:456-464. [PMID: 30676104 DOI: 10.1080/10410236.2019.1567442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
University students are exposed to casual smoking, increasing their risk of developing nicotine addiction, which can extend into adulthood. A novel anti-tobacco intervention being investigated is the use of health warnings on individual cigarette sticks. We explored the perceptions of university students on the effectiveness of health warnings on cigarette packaging and individual cigarette sticks. An online survey was distributed to first-year university students enrolled at a regional university in North-Eastern Australia. Participants rated on 5-point Likert scales and commented using open-text comment boxes, the effectiveness of current cigarette packaging warnings, and 12 text warnings (divided into four themes; immediate and short-term consequences [ISC], long-term and mortality consequences [LMC], social and financial consequences [SFC], and supportive messages to quit [SMQ]) on individual cigarette sticks, in preventing non-smokers from smoking, and in encouraging current smokers to quit. Participants (n = 479; Mean age = 22 years) rated three themes (ISC, LMC, and SFC) as being overall more effective (all p < .001) than current packaging warnings (Odds Ratios = 5.93 [4.51-7.80], 3.60 [2.79-4.64], and 2.86 [2.21-3.69] respectively). Participants described a desensitisation to current packaging warnings, and the novel warnings displayed potentially overcoming this issue, with over 85% agreeing that individual cigarette sticks should include health warnings. Health warnings on cigarette sticks may serve as an effective means in reducing tobacco use, with the provision of this additional intervention for communicating the health and other negative consequences of smoking likely reinforcing the effects of current packaging warnings.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University
| | | | - Beverley Glass
- College of Medicine and Dentistry, James Cook University
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Mitchell D, Moodie C, Critchlow N, Bauld L. Adolescents’ reactions to, and perceptions of, dissuasive cigarettes: a focus group study in Scotland. DRUGS-EDUCATION PREVENTION AND POLICY 2020. [DOI: 10.1080/09687637.2020.1732300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Danielle Mitchell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Nathan Critchlow
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, UK
| | - Linda Bauld
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium, University of Edinburgh, Edinburgh, UK
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Dissuasive cigarettes: which cues are the most effective at deterring young people from smoking? Public Health 2019; 174:22-30. [DOI: 10.1016/j.puhe.2019.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
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Moodie C, O’Donnell R, Fleming J, Purves R, McKell J, Dobbie F. Extending health messaging to the consumption experience: a focus group study exploring smokers' perceptions of health warnings on cigarettes. ADDICTION RESEARCH & THEORY 2019; 28:328-334. [PMID: 32939185 PMCID: PMC7454525 DOI: 10.1080/16066359.2019.1653861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/19/2019] [Accepted: 08/06/2019] [Indexed: 05/16/2023]
Abstract
Introduction: While most countries require health warnings on cigarette packs, the Scottish and Canadian Governments are considering requiring health warnings on cigarette sticks. Methods: Twenty focus groups were conducted in Glasgow and Edinburgh (Scotland) with smokers (n = 120) segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender and social grade, to explore perceptions of cigarettes displaying the warning 'Smoking kills' on the cigarette paper and any demographic differences in how smokers responded to these. Results: A warning on each cigarette was thought to prolong the health message, as it would be visible when a cigarette was taken from a pack, lit, left in an ashtray, and with each draw, and make avoidant behavior more difficult. That it would be visible to others was perceived as off-putting for some. It was felt that a warning on each cigarette would create a negative image and be embarrassing. Within several female groups they were viewed as depressing, worrying and frightening, with it suggested that people would not feel good smoking cigarettes displaying a warning. Within every group there was mention of warnings on cigarettes potentially having an impact on themselves, others or both. Some, mostly younger groups, mentioned stubbing cigarettes out early, reducing consumption or quitting. The consensus was that they would be off-putting for young people, nonsmokers and those starting to smoke. Conclusions: Including a warning on each cigarette stick is a viable policy option and one which would, for the first time, extend health messaging to the consumption experience.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing, School of Health Sciences and Sport, University of Stirling, Stirlingshire, Scotland
| | - Rachel O’Donnell
- Institute for Social Marketing, School of Health Sciences and Sport, University of Stirling, Stirlingshire, Scotland
| | - Joy Fleming
- Institute for Social Marketing, School of Health Sciences and Sport, University of Stirling, Stirlingshire, Scotland
| | - Richard Purves
- Institute for Social Marketing, School of Health Sciences and Sport, University of Stirling, Stirlingshire, Scotland
| | - Jennifer McKell
- Institute for Social Marketing, School of Health Sciences and Sport, University of Stirling, Stirlingshire, Scotland
| | - Fiona Dobbie
- Usher Institute of Population Health, College of Medicine and Veterinary Medicine, University of Edinburgh, Stirlingshire, Scotland
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Do health warnings on cigarette sticks dissuade smokers and non-smokers? A focus group and interview study of Australian university students. Psychol Res Behav Manag 2019; 12:361-373. [PMID: 31191057 PMCID: PMC6526189 DOI: 10.2147/prbm.s193754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/13/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Young adults are a vulnerable population for experimentation with tobacco, which can lead to lifelong addiction. In an effort to ensure reductions in tobacco use through improved health promotion materials, we explored young adults' perceptions of current Australian packaging warnings, and novel health warnings on individual cigarette sticks. Methods: Focus groups and interviews were conducted with smoking and non-smoking first-year undergraduate university students at a regional Australian university. Semi-structured questions were used to gather participant perceptions. Sixteen students participated across three focus groups, and eleven students participated in the phone interviews. Data were analyzed using thematic analysis in NVivo. Results: Six emergent themes were identified. Current cigarette packaging warnings were seen as ineffective, being disregarded by current smokers (theme 1), and seen as irrelevant by young adult smokers and non-smokers (theme 2). Several cigarette stick warnings were perceived as engaging and effective, due to the novelty of the cigarette stick as a medium (theme 3), and the proximal nature of the warnings used (theme 4). The warning depicting the financial consequences of smoking was considered the most effective, followed by the impact of smoking on personal appearance, and the "minutes of life lost" warning. Social media (theme 5), and the use of more supportive messages to assist smokers (theme 6) were considered the best next steps as tobacco control interventions. Conclusions: Supplementing packaging warnings which were seen as minimally effective in this study, using cigarette stick warnings and social media may lead to further reductions in tobacco use. New and relatable warnings such as the financial consequences of smoking and impact on personal appearance may be the most effective in dissuading young adults from smoking, particularly within the university environment.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study. Tob Induc Dis 2019; 17:23. [PMID: 31582934 PMCID: PMC6751965 DOI: 10.18332/tid/104753] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Innovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries. METHODS An online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis. RESULTS Participants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p<0.001 and OR=2.85, 95% CI: 2.29–3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either ‘agreed’ or ‘strongly agreed’ to the use of cigarette-stick warnings. CONCLUSIONS The findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Rosen LJ, Rier DA, Schwartz R, Talitman M, Zwanziger L. Knowledge and risk perceptions of Israelis towards combustible cigarettes: the need for immediate remedial action. Isr J Health Policy Res 2019; 8:10. [PMID: 30642402 PMCID: PMC6330745 DOI: 10.1186/s13584-018-0276-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 12/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Devastation from the tobacco epidemic continues, with strong government tobacco control policy absent in most countries. Knowledge of the full scope of tobacco harm in populations may form the basis for healthier behavior, de-normalization of smoking, and a consensus about necessary public policy. However, many populations may be poorly-informed about the risks, and this ignorance may undermine both effective policy-making and implementation of tobacco control policies. We present knowledge and risk perceptions about smoking tobacco smoke exposure in Israel. METHODS A nationally-representative phone survey was conducted in Israel (n = 505; response rate = 61%). We assessed knowledge about active and passive smoking using four questions, three of which addressed knowledge about harm, and one of which addressed knowledge of tobacco-related harm relative to knowledge of harm due to traffic accidents. The three questions which addressed knowledge of harm were combined into a composite score. We also asked four risk perception questions concerning tobacco smoke exposure, which were measured on a 7-point Likert scale and then combined. Multivariable logistic regression and linear models were used to identify whether smoking status or socio-demographic variables were associated with knowledge of harm, comparative knowledge of harm, and risk perceptions. RESULTS Just two in five respondents, and one in five respondents who were current smokers, accurately answered three simple questions about harms of smoking. Fewer than three in ten respondents, and fewer than one in five smokers, knew that smoking causes more damage than traffic accidents. Many (30.3%) were unaware that tobacco smoke exposure causes both lung cancer and heart disease, 27.7% did not know that smoking both shortens life and injures quality of life, and 31.1% did not know that smoking-attributable health problems will afflict all or most heavy smokers. Overall, risk perceptions regarding tobacco smoke exposure were high (mean = 24.5, SD:4.5, on a scale of 7-28, with 28 the indicating highest level). Smoking status was consistently associated with lower levels of knowledge, comparative knowledge, and risk perceptions, with current smokers having the lowest levels of knowledge and the lowest risk perceptions. CONCLUSIONS Like many others, Israelis, and particularly Israeli smokers, do not fully grasp tobacco's true dangers. Effective communication of the full range of tobacco risks to the public, with a focus on communication with smokers, is an essential component of comprehensive tobacco control policy.
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Affiliation(s)
- Laura J. Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, 69978 Ramat Aviv, Israel
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 USA
| | - David A. Rier
- Department of Sociology and Anthropology, Bar Ilan University, 5290002 Ramat-Gan, Israel
| | | | - Michal Talitman
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, POB 39040, 69978 Ramat Aviv, Israel
- Department of Statistics, Tel Aviv University, 69978 Ramat Aviv, Israel
| | - Lior Zwanziger
- Sackler Medical School, Tel Aviv University, 69978 Ramat Aviv, Israel
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Houghton F, Duncan B, Houghton S, O'Doherty D, McInerney D. Responding to health inequities in New Zealand: the potential of dissuasive cigarettes. J Prim Health Care 2019. [DOI: 10.1071/hc19013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Moodie C. Warnings on every cigarette: extending health messaging to the consumption experience. CMAJ 2018; 190:E1271-E1272. [PMID: 30373739 PMCID: PMC6205829 DOI: 10.1503/cmaj.180781] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Crawford Moodie
- Centre for Tobacco Control Research, University of Stirling, Stirling, Scotland
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian School Student Perceptions of Effective Anti-tobacco Health Warnings. Front Public Health 2018; 6:297. [PMID: 30386764 PMCID: PMC6199459 DOI: 10.3389/fpubh.2018.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Recent research posits that anti-tobacco health warnings on cigarette packaging may gradually lose their effectiveness in dissuading adolescents from tobacco products several years after implementation. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population. Methods: In an online survey of school students in Queensland, Australia, participants were requested to rate (on five-point Likert scales) and comment on the perceived effectiveness of current cigarette packaging warnings, and 12 text warnings on cigarette sticks, in preventing non-smokers from smoking, and encouraging current smokers to quit. The warnings were divided into four themes to establish the most effective types of anti-tobacco messages: mortality statistics, health condition consequences, social and financial consequences, and supportive messages. These themes were based on current anti-tobacco interventions within Australia, and the rising cost of tobacco products, and designed to align with the Health Belief Model. Results: Participants (N = 150; Age = 15-18) from five schools completed the survey, and generally viewed current packaging warnings as gross and disgusting, and rating them as somewhat effective in preventing non-smokers from smoking. Current warnings were however considered less effective in prompting current smokers to quit with participants describing them as being un-relatable to teenagers, and smokers as having become desensitized to the warnings used. One theme of cigarette-stick warning (mortality statistics) was rated as significantly more effective (p < 0.001) than current cigarette packaging, with an odds ratio (OR) of 2.77 (95% confidence interval [CI]: 1.67-4.62). Overall, warnings were considered to be 4.71 times (95%CI: 2.72-6.43, p < 0.001) more effective on non-smokers than on smokers. Over three-quarters of participants supported using health warnings on individual cigarette sticks. Conclusions: Current cigarette packaging warnings have retained some effectiveness in dissuading adolescents from smoking, though novel and thought-provoking text-only warnings on cigarette sticks may serve as an additional intervention in reducing tobacco use. Further research requires identification of the most effective warnings, and the perceptions of a more diverse participant base.
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Lund I, Scheffels J. Adolescent perceptions of dissuasive sticks: a web survey among 16-20 year olds in Norway. BMC Public Health 2018; 18:974. [PMID: 30081848 PMCID: PMC6080395 DOI: 10.1186/s12889-018-5847-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 07/12/2018] [Indexed: 11/16/2022] Open
Abstract
Background While increasingly stringent rules for cigarette pack design restrict the advertising potential of cigarette packs, the cigarette stick itself remains a potential medium for marketing. Common design features are filters, slim cigarettes and capsule cigarettes. Recent research indicates lower general appeal, more negative perceptions of taste, and greater harm for cigarettes designed to be unappealing (dissuasive sticks), and the aim for the current study was to investigate perceptions of dissuasive cigarette sticks among Norwegian adolescents, and learn about factors that might make cigarettes unappealing to them. Methods Two hundred eighty-one adolescents, 16–20 years old, smokers and non-smokers, assessed the appeal, taste, harmfulness, and which one they would most likely want to try, of 6 different cigarette sticks in a web survey. The cigarette sticks included two standard designs: cork and white filter sticks, and 4 dissuasive designs: green sticks, yellow sticks, and two white sticks with a health warning printed on the side. Results All dissuasive designs were perceived as less appealing, worse tasting, more harmful than the standard cork tip and white tip cigarettes. The dissuasive sticks were less often chosen as a cigarette one would want to try. The evaluations of designs were relatively similar across gender, smoking and snus use status, and smoking susceptibility. In multinomial regressions, perceptions of taste and harm differences were associated with perceived product trial. Conclusions This study supports earlier findings, and suggest that the use of unpleasant colours and warnings printed directly on cigarette sticks could increase perceived harmfulness, reduce notions of good taste, and possibly reduce desires to experiment with cigarettes in adolescence.
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Affiliation(s)
- Ingeborg Lund
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, PO Box 4404, Nydalen, N-0403, Oslo, Norway.
| | - Janne Scheffels
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, PO Box 4404, Nydalen, N-0403, Oslo, Norway
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