The importance of cigarette packaging in a 'dark' market: the 'Silk Cut' experience

The impact of the introduction of tobacco product plain packaging on consumer responses in Ireland: a real-world policy evaluation stratified by socioeconomic groups

Smoking prevalence remains high in Europe and widening socioeconomic group differences are driving health inequalities. While plain packaging policies disrupt tobacco industry tactics that sustain smoking, evidence of their equity impact is sparse. This study evaluated the implementation of plain packaging in Ireland in 2018 on consumer responses, overall and by the socioeconomic group. Consecutive nationally representative cross-sectional surveys (2018, n = 7701 and 2019, n = 7382) measured changes in 13 consumer responses among respondents who smoked across three domains: product appeal, health warnings effectiveness, and perceived harmfulness of smoking. Multiple logistic regression-derived adjusted odds ratios with 95% confidence intervals to compare responses post- versus pre-implementation adjusting for age, gender, educational level, and heaviness of smoking. A stratified analysis examined changes by socioeconomic group indexed using educational level. There were statistically significant changes in consumer responses to plain packaging policy implementation across 7/13 outcomes studied. Five changes were aligned with expected policy impacts (2/6 product appeal outcomes and 3/4 health warning effectiveness outcomes). Two responses were also observed which were not expected policy impacts (1 appeal-related and 1 perceived harm-related outcome). There was no change in five outcomes. Differences in consumer responses between educational groups were generally small, mixed in nature, and indistinguishable when interval estimates of effect were compared. Implementation of plain packaging in Ireland had intended impacts on consumer responses. Including plain packaging requirements in revising the European Union's legislative frameworks for tobacco control will help build progress towards a Tobacco-Free Europe without exacerbating smoking inequalities.

Marketing of flavour capsule cigarettes: a systematic review

OBJECTIVE

This systematic review aims to identify marketing elements of flavour capsule variants (FCVs), cigarettes that release flavour when a capsule(s) embedded in the filter is crushed.

DATA SOURCES

A search of original research without restrictions in publication year, population, study design or language using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 13 December 2021, along with a citation search.

STUDY SELECTION

Studies were included if they presented original research relevant to marketing features of FCVs.

DATA EXTRACTION

One author performed data extraction and coded outcomes based on '4Ps' of marketing mix theory: product, place, price and promotion. The second author conducted a cross-check.

DATA SYNTHESIS

Of 2436 unduplicated database records and 30 records from other sources, 40 studies were included in the review. Studies were published between 2009 and 2021. Study methodologies primarily included content analysis of cigarette packs/sticks, review of tobacco industry documents and content analysis of advertising information. Findings suggest FCVs are marketed using a mix of strategies, particularly characterised by product innovation, timing market launches around tobacco policies, point-of-sale advertising and packaging to communicate a high-tech, customisable and flavourful product.

CONCLUSION

Findings illuminate the marketing strategies of FCVs that are likely driving their global growth, particularly among young people and in low and middle-income countries. Comprehensive tobacco control regulations are needed to close loopholes and curb industry efforts to circumvent existing policies in order to mitigate uptake of FCVs and other product innovations.

Prevalence of Menthol and Menthol Capsule Cigarette Use Among 11-16 Year Olds in Wales Prior to a Ban on Characterizing Flavors in Cigarettes: Findings From the 2019 Student Health and Wellbeing Survey

INTRODUCTION

The use of flavored cigarettes has increased in many countries because of the inclusion of one or more frangible flavor-changing capsules in the filter. Research suggests that these "capsule" cigarettes appeal most to youth, but little is known about how prevalent their use is among children.

METHODS

A cross-sectional school survey was conducted between September and December 2019 with 11-16 year-olds (N = 119 388) from 198 secondary schools across Wales; the sample represented approximately two-thirds of all 11-16 year-olds in the country. The sample was asked about smoking behavior, with a quarter (N = 26 950) also asked about awareness of menthol cigarettes, and use of menthol and menthol capsule cigarettes if a current smoker (N = 1447).

RESULTS

Current smoking prevalence was 5.7% among the entire sample and 5.9% among the analytical sample (those also asked about menthol and menthol capsule cigarettes). For the analytical sample, almost all current smokers (93.2%) were aware of menthol cigarettes, with three-fifths (60.5%) reporting having used menthol cigarettes in the past 30 days (42.3% capsule cigarettes, 18.2% noncapsule cigarettes). In comparison to nonmenthol smokers, those using menthol cigarettes (capsule and noncapsule) were more likely to be frequent smokers, with those using menthol capsule cigarettes more likely to have smoked for longer.

CONCLUSIONS

While past research suggests that flavored cigarettes appeal to youth, this study shows just how popular these products, and capsule cigarettes, in particular, were among young smokers in Wales. It also raises questions about why capsule cigarettes have received such limited public health attention.

IMPLICATIONS

That three in five 11-16 year-old smokers reported using menthol cigarettes in the past 30 days highlights how appealing these products are to young people, particularly capsule cigarettes, used by seventy percent of menthol smokers. Capsule cigarettes are one of the most successful tobacco product innovations in decades, even in countries with comprehensive bans on tobacco marketing and standardized packaging. The dearth of research on capsule cigarettes is a failure of global public health. Evaluation of the ban on characterizing flavors in the United Kingdom and across the European Union is critical.

Analysis of wedding appeals on cigarette packs in China

Introduction

Exchanging or gifting cigarettes is a common practice in Chinese culture, often occurring during weddings to connote celebrations and happiness. We examined Chinese cigarette packs for wedding terminology and imagery to assess the extent to which packs are marketed for such occasions.

Methods

Cigarette packs were collected from Beijing, Guangzhou, Shanghai, Kunming and Chengdu in February 2017 using a systematic protocol designed to capture unique packs. Packs were coded by two independent coders for text and imagery of traditional Chinese wedding symbols, such as double happiness, dragon and phoenix, and other culturally specific phrases and images associated with weddings in China.

Results

From the sample of 738 unique cigarette packs, 68 (9.2%) contained either lexical and/or imagery appeals for wedding gifting. Of these 68 packs, 65 contained both lexical and imagery appeals, 1 pack had only a lexical appeal and 2 packs only included an imagery appeal. The most common appeal was ‘double happiness’ found on 56 packs (82.4%) for both lexical and imagery, followed by ‘dragon and phoenix’ found lexically on 12 packs (17.6%), and through imagery on 15 packs (22.1%).

Conclusions

Chinese tobacco manufacturers take full advantage of the cigarette gifting and sharing culture demonstrated by packs with imagery and terminology specific to weddings. With only a 35% text health warning label, manufacturers have much real estate to make packs attractive for gifting on such occasions. Implementing plain packaging policies may be effective in decreasing gifting attractiveness for cigarette packs.

30+ years of media analysis of relevance to chronic disease: a scoping review

BACKGROUND

Chronic, non-communicable diseases are a significant public health priority, requiring action at individual, community and population levels, and public and political will for such action. Exposure to media, including news, entertainment, and advertising media, is likely to influence both individual behaviours, and attitudes towards preventive actions at the population level. In recent years there has been a proliferation of research exploring how chronic diseases and their risk factors are portrayed across various forms of media. This scoping review aims to map the literature in this area to identify key themes, gaps, and opportunities for future research in this area.

METHODS

We searched three databases (Medline, PsycINFO and Global Health) in July 2016 and identified 499 original research articles meeting inclusion criteria: original research article, published in English, focusing on media representations of chronic disease (including how issues are framed in media, impact or effect of media representations, and factors that influence media representations). We extracted key data from included articles and examined the health topics, media channels and methods of included studies, and synthesised key themes across studies.

RESULTS

Our findings show that research on media portrayals of chronic disease increased substantially between 1985 and 2016. Smoking and nutrition were the most frequent health topics, and television and print were the most common forms of media examined, although, as expected, research on online and social media channels has increased in recent years. The majority of studies focused on the amount and type of media coverage, including how issues are framed, typically using content analysis approaches. In comparison, there was much less research on the influences on and consequences of media coverage related to chronic disease, suggesting an important direction for future work.

CONCLUSIONS

The results highlight key themes across media research of relevance to chronic disease. More in-depth syntheses of studies within the identified themes will allow us to draw out the key patterns and learnings across the literature.

The impact of plain packaging and health warnings on consumer appeal of cannabis products

BACKGROUND

Canada implemented 'plain packaging' regulations and rotating health warnings for cannabis products upon legalizing non-medical cannabis in October 2018. Plain packaging and health warnings are effective policy measures for reducing appeal of tobacco products; however, there is little evidence in the cannabis domain.

METHODS

An experimental task was conducted as part of the online International Cannabis Policy Study. Participants aged 16-65 from Canada (n = 9987) and US states with 'legal' (n = 7376) and 'illegal' (n = 9682) recreational cannabis were randomly assigned to see one of 18 cannabis product images. Outcomes were product appeal (0 = Not at all appealing, 10 = Very appealing) and perceived youth orientation (4 age groups). A 3 (branding: full branding, brand logo only, or plain black packaging) x 2 (health warning labels: present or absent) x 3 (product type: edible gummies, cannabis oil, or pre-rolled joints) factorial design was used.

RESULTS

Compared to plain packaging or a brand logo, packages with full branding were considered more appealing and more likely to be youth-oriented (p < 0.001). Products with health warnings were considered less appealing than packages without warnings (p < 0.001). Edible gummies were perceived as more appealing and more likely to be youth-oriented than pre-rolled joints and cannabis oil (p < 0.001). Additionally, edible gummies were rated as significantly more appealing by 16-18 and 19-35-year-olds than by older adults (p < 0.02 for all).

CONCLUSIONS

Comprehensive health warnings and 'plain packaging' regulations may reduce the appeal of cannabis products in a legal market. The results also provide empirical evidence that edible gummies are perceived to appeal to youth.

Use of Cigarettes With Flavor-Changing Capsules Among Smokers in the United Kingdom: An Online Survey

INTRODUCTION

Cigarettes with flavor-changing capsules in the filter have experienced phenomenal global growth in the last decade. We explore sociodemographic and smoking-related factors associated with using capsule cigarettes, how frequently users burst the capsule, and reasons for using them.

METHODS

An online survey was conducted in the United Kingdom between April and May 2016 with 6234 factory-made and/or hand-rolled cigarette smokers. This analysis focuses on 3620 factory-made cigarette smokers, aged 18 years and over, who had smoked in the past month.

RESULTS

Thirteen percent smoked capsule cigarettes, with younger smokers more likely than older smokers to do so. Capsule use was significantly more common among White non-British than White British and among those planning to quit in the next 6 months than those not planning to quit. Most capsule users who crushed the capsule did so always (51%) or most of the time (18%), with more frequent crushing of capsules more common among females, younger and middle-aged participants, White British, and those with a lower score on the Heaviness of Smoking Index. The most common reasons for using capsule cigarettes were that they taste better (52%), are smoother (41%), provide a choice of flavors (32%), and the enjoyment of clicking the capsule (25%). Capsule and noncapsule smokers did not differ significantly in their perceptions of the harmfulness of their brand relative to other brands.

CONCLUSIONS

Our study provides an insight into how and why smokers of capsule cigarettes use these products, with the key drivers of use being taste, flavor choice, and interactivity.

IMPLICATIONS

Cigarettes with capsules in the filter that can be burst to change the flavor have experienced remarkable growth since being introduced in 2007, but little is known about how and why smokers use these products. Thirteen percent of factory-made cigarette smokers in our sample smoked a brand with a capsule in the filter, with approximately two-thirds crushing the capsule all or most of the time. Capsule use was more likely among younger participants. The main reasons for smoking capsule cigarettes were related to how they taste, having a choice of flavors, and enjoyment of clicking the capsule (interactivity).

Adolescents' perceptions of standardised cigarette packaging design and brand variant name post-implementation: a focus group study in Scotland

BACKGROUND

The United Kingdom (UK) fully-implemented standardised packaging for cigarettes and rolling tobacco on 20th May 2017. We explore adolescent's awareness of, and responses to, standardised cigarette packaging in the UK after it became mandatory.

METHODS

Eight focus groups were conducted in schools in Scotland with 16-17 year-olds (n = 41), between November 2017 and November 2018, to explore awareness of, and responses to, standardised cigarette packaging. Unlike in Australia, where only straight-edged flip-top cigarette packs are permitted, in the UK standardised cigarette packs can have slim designs, and different edge types (straight, rounded or bevelled) and opening styles (flip-top or shoulder box). We explored how each of these pack formats was perceived. We also explored to what extent brand variant name differentiated cigarettes sold in standardised packaging.

RESULTS

Most participants were aware of standardised packaging without being shown pack stimuli. Standardised packs were considered embarrassing and off-putting, and the health warnings salient. Among the standardised packs shown, there was a preference for the slimmer pack, viewed as more discrete and the cigarettes potentially less harmful, and the shoulder box, considered cool and different. Participants were interested in some brand variant names on standardised packs (e.g. Legendary Black), particularly those they considered to imply coolness and sophistication.

CONCLUSION

Adolescents consider standardised cigarette packs in the UK unappealing, and the warnings salient, two core aims of this measure. However, positive reactions to some of the standardised packs (slimmer pack, shoulder box), and variant names used, has implications for countries developing standardised packaging regulations.

Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations

By July 2018, five countries (Australia, France, the UK, New Zealand and Norway) had fully implemented plain (standardised) packaging. Using government documents, we reviewed the key legislative differences between these five countries to identify best practice measures and potential lacuna. We then discuss how governments planning to introduce plain packaging could strengthen their legislation. Differences between countries include the terminology used (either 'plain', 'standardised' or 'plain and standardised'), products covered and transition times (ranging from 2 to 12 months). Myriad differences exist with respect to the packaging, including the dimensions (explicitly stated for height, width and depth vs minimum dimensions for the health warnings only), structure (straight-edged flip-top packs vs straight, rounded and bevelled-edged flip-top packs and shoulder boxes) and size (minimum number of cigarettes and weight of tobacco vs fixed amounts) and warning content (eg, inclusion of a stop-smoking web address and/or quitline displayed on warnings on one or both principal display areas). Future options that merit further analysis include banning colour descriptors in brand and variant names, allowing pack inserts promoting cessation and permitting cigarettes that are designed to be dissuasive. Plain packaging legislation and regulations are divergent. Countries moving towards plain packaging should consider incorporating the strengths of existing policies and review opportunities for extending these. While plain packaging represents a milestone in tobacco-control policy, future legislation need not simply reflect the past but could set new benchmarks to maximise the potential benefits of this policy.

Introduction of Standardized Tobacco Packaging During a 12-Month Transition Period: Findings From Small Retailers in the United Kingdom

INTRODUCTION

Factory-made cigarettes (FMC) and roll-your-own (RYO) tobacco have had to be produced in standardized packaging since May 20, 2016 in the United Kingdom, with a minimum pack size of 20 sticks for FMC and 30 g for RYO. Manufacturers and retailers were given a 12-month transition period.

METHODS

An observational study was conducted using monthly Electronic Point of Sale data from 500 small retailers in England, Scotland, and Wales, between May 2016 and May 2017. The 20 top selling tobacco products (15 FMC, 5 RYO) were monitored to observe when standardized packs were first introduced, the proportion of retailers selling each fully branded and standardized product, and the average number of monitored fully branded and standardized products sold by each retailer. The number of unique tobacco-related product codes sold by each retailer was also recorded each month.

RESULTS

Eighteen of the fully branded products continued to be sold throughout the transition period and no standardized variants were sold in the first 5 months. It was not until month eleven that the average number of standardized products sold by retailers exceeded the fully branded products. The average number of unique tobacco-related product codes sold by each retailer decreased by a third over the transition period.

CONCLUSIONS

Tobacco companies used the transition period to delay the removal of fully branded products and gradually introduce standardized variants. This staggered introduction may have mitigated some of the immediate intended effects of the legislation by desensitizing consumers to new pack designs.

IMPLICATIONS

Evaluation research from countries which have introduced standardized packaging for tobacco products is key to help inform future implementation. This is the first study to monitor the transition from fully branded to standardized products using real-time retail data. The findings demonstrate that tobacco companies delayed the introduction of standardized products and removal of fully branded packaging. Countries seeking to introduce standardized packaging should consider what length of transition is allowed, as the protracted 12-month period in the United Kingdom appeared longer than needed to transition stockholding and may have mitigated immediate intended effects by desensitizing consumers to new pack designs.

Pricing of tobacco products during, and after, the introduction of standardized packaging: an observational study of retail price data from independent and convenience (small) retailers in the United Kingdom

BACKGROUND AND AIMS

Tobacco companies claimed that standardized packaging, phased in/introduced May 2016-May 2017, would reduce prices and increase consumption. We: (1) describe changes in price-per-cigarette and price-per-gram during, and after, the introduction of standardized packaging; (2) describe price changes by cigarette price segment; and (3) analyse price changes by stage of implementation.

DESIGN

An observational study, using electronic point-of-sale data, monitored price trends in three periods: (1) May-September 2016, start of transition period; (2) October 2016-May 2017, when fully branded and standardized products were sold and duty escalators implemented; and (3) June-October 2017, when standardized packaging was mandatory.

SETTING

United Kingdom.

PARTICIPANTS

Small retailers (n = 500) stratified by region and deprivation. Data were monitored for 20 leading fully branded tobacco products [15 factory-made cigarettes (FMC), 5 roll-your-own (RYO)] and their standardized equivalents.

MEASUREMENT

Price-per-cigarette and price-per-gram, based on monthly average Recommended Retail Price (RRP) and actual sale price, adjusted for inflation using the Consumer Pricing Index (CPIH). Net changes (£GBP, %) were analysed by product type (FMC versus RYO) and FMC price segment (value, mid-price, premium).

FINDINGS

Between May 2016 and October 2017, the average inflation-adjusted RRP/price-per-cigarette and price-per-gram increased for FMC (all price segments) and RYO. For example, sales price-per-cigarette increased +4.64%, with the largest increases for value (+6.81%), premium (+5.32%) and mid-price FMCs (+3.30%). Net sales price-per-cigarette and price-per-gram increases were largest in period 2, when fully branded and standardized products were sold and duty escalators were implemented (FMC = +4.70%; RYO = +3.75%). There were small decreases in sales price-per-cigarette and price-per-gram once standardized packaging became mandatory (FMC = -1.14%; RYO = -0.88%).

CONCLUSION

In the United Kingdom, the price of leading roll-your-own and factory-made cigarette brands sold by small retailers increased as standardized packaging was phased in, with increases larger than expected through duty escalation.

Is blue the new green? Repackaging menthol cigarettes in response to a flavour ban in Ontario, Canada

Background

As of 1 January 2017, the Canadian province of Ontario banned the distribution and sale of menthol tobacco products. There is limited knowledge about how tobacco companies will adapt their packaging in response to a menthol ban.

Methods

We conducted a content analysis of preban traditional menthol (no capsule) and menthol capsule cigarette packs and their postban replacements. Preban and postban packs were matched using tobacco company descriptions of replacement brands in business-to-business marketing materials, advertising on cigarette pack cellophane and a tobacco company website.

Results

A total of 63 menthol (n=30) and ‘non-menthol alternative’ (n=33) cigarette packs were included in the analysis. Approximately half of the preban packs were menthol capsule cigarettes and half traditional menthol cigarettes. While some postban brands continued to convey menthol-like qualities via the colour and/or brand descriptor ‘green’, ’blue' was the most common colour and brand descriptor postban. Packs shifted from using ‘menthol’ and/or ‘fresh’ as taste descriptor preban to using ‘smooth’ postban; some postban packs had ‘non-menthol alternative’ or ‘without menthol/capsules’ written on their cellophane. The presence of innovative filter technologies continued in the postban samples.

Conclusion

Results suggest that tobacco companies attempted to maintain menthol smokers in Ontario by aggressive preban promotion of menthol capsule cigarettes, continued promotion of innovative filter technologies and by directing smokers to non-menthol alternatives whose packaging both in text and in colour connoted menthol-like qualities (eg, green) and reduced harshness or harm (eg, blue, white, silver, smooth taste).

English on cigarette packs from six non-Anglophone low- and middle-income countries

OBJECTIVES

Low- and middle-income countries (LMICs) are vital to the global tobacco market. The pack is key to cigarette branding, and review of cigarette packs revealed English as a common feature. The prevalence of English and its potential branding utility is explored.

METHODS

Every available unique cigarette pack was purchased from diverse retailers in six LMICs where English is not the official language (Bangladesh, Brazil, China, Egypt, Ukraine, Vietnam). Packs' front panels were coded for English on pack fronts. English penetration was quantified by country and a comparison of English use between multinational and national brands was undertaken. A qualitative analysis of symbolic and utilitarian usage of English was conducted.

RESULTS

Of 1303 unique cigarette packs analyzed, 67% (n = 876) included some English. English text conveyed product information and usage instruction. English was more prevalent for multinational brands. Qualitatively, English use frequently connected cigarettes with concepts of quality, style, luxury, and aspirational lifestyle.

CONCLUSIONS

Restricting English use should be incorporated into plain packaging policy to protect populations from deceptive branding practices, specifically presenting cigarettes as an aspirational product.

Cigarette brand diversity and price changes during the implementation of plain packaging in the United Kingdom

BACKGROUND AND AIM

Plain packaging of cigarettes appeared in the United Kingdom in July 2016 and was ubiquitous by May 2017. The change coincided with another legislative change, raising the minimum pack size from 10 to 20 cigarettes. Laws imposing plain packaging on cigarette packs remove another promotional route from tobacco companies, but the effect of such laws on brand diversity, pricing and sales volume is unknown. This study aimed to (1) describe and quantify changes in brand diversity, price segmentation and sales volumes and (2) estimate the association between the introduction of plain cigarette packaging and cigarette pricing in the United Kingdom.

DESIGN

We used a natural experiment design to assess the impact of plain packaging legislation on brand diversity and cigarette prices. The data comprised a sample of 76% of sales of cigarettes in the UK between March 2013 and June 2017.

SETTING

United Kingdom.

MEASUREMENTS

Cigarette prices, number of brands and products and volumes of sales.

FINDINGS

During the period analysed, there was a slight decrease in the number of cigarette brands. There was also an initial increase observed in the number of cigarette products, due mainly to an increase in the number of products in packs of fewer than 20 cigarettes sold before July 2016, which was then followed by a rapid decrease in the number of products that coincided with the implementation of the new legislation. Cigarette sales volumes during this period did not deviate from the preceding secular trend, but prices rose substantially. Regression results showed that price per cigarette, regardless of pack size, was 5.0 [95% confidence interval (CI) = 4.8-5.3] pence higher in plain than in fully branded packs. For packs of 20 cigarettes, price increases were greater in the lower price quintiles, ranging from 2.6 (95% CI = 2.4-2.7) GBP in the lowest to 0.3 (95% CI = 0.3-0.4) GBP per pack in the highest quintile.

CONCLUSIONS

The implementation of standardized packaging legislation in the United Kingdom, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes, but no clear deviation in the ongoing downward trend in total volume of cigarette sales.

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

INTRODUCTION

As a result of the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive, all packs of cigarettes (factory-made and hand-rolled) in the UK must be drab brown, display pictorial warnings on the principal display areas and contain no less than 20 cigarettes or 30 g of tobacco. The legislation was phased in between May 2016 and May 2017. Our objective was to monitor pack, brand and product changes preimplementation and postimplementation.

METHODS

Our surveillance of the cigarette market involved a review of the trade press, a monthly monitor of online supermarkets and regular visits to stores, from May 2015 to June 2017.

RESULTS

Before standardised packaging there were changes to the pack graphics (eg, redesigned packs and limited editions) and pack structure (eg, resealable inner foil) and the issue of a number of reusable tins. After standardised packaging, changes included newer cigarette pack sizes for some brand variants (eg, 23 and 24 packs). Changes to the branding prestandardised packaging included brand extensions, and poststandardised packaging included brand and/or variant name change, often with the inclusion of colour descriptors and brand migrations. Product changes prestandardised packaging included the introduction of novel filters (eg, filters with two flavour-changing capsules, tube filters, firmer filters and filters with granular additives). There was non-compliance with the legislation, with slim packs, which are not permitted, on sale after standardised packaging was implemented.

CONCLUSIONS

Our findings highlight the need to monitor developments in markets introducing standardised packaging and have policy implications for countries considering this measure.

Qualitative assessment of a Context of Consumption Framework to inform regulation of cigarette pack design in the U.S

INTRODUCTION

Researchers and regulators need to know how changes to cigarette packages can influence population health. We sought to advance research on the role of cigarette packaging by assessing a theory-informed framework from the fields of design and consumer research. The selected Context of Consumption Framework posits cognitive, affective, and behavioral responses to visual design. To assess the Framework’s potential for guiding research on the visual design of cigarette packaging in the U.S., this study seeks to understand to what extent the Context of Consumption Framework converges with how adult smokers think and talk about cigarette pack designs.

METHODS

Data for this qualitative study came from six telephone-based focus groups conducted in March 2017. Two groups consisted of lesbian, gay, and bisexual participants; two groups of participants with less than four years college education; one group of LGB and straight identity; and one group the general population. All groups were selected for regional, gender, and racial/ethnic diversity. Participants (n=33) represented all nine U.S. Census divisions. We conducted a deductive qualitative analysis.

RESULTS

Cigarette package designs captured the participants’ attention, suggested the characteristics of the product, and reflected (or could be leveraged to convey) multiple dimensions of consumer identity. Particular to the affective responses to design, our participants shared that cigarette packaging conveyed how the pack could be used to particular ends, created an emotional response to the designs, complied with normative expectations of a cigarette, elicited interest when designs change, and prompted fascination when unique design characteristics are used.

CONCLUSIONS

Use of the Context of Consumption Framework for cigarette product packaging design can inform regulatory research on tobacco product packaging. Researchers and regulators should consider multiple cognitive, affective, and behavioral responses to cigarette pack design.

ABBREVIATIONS

FDA: Food and Drug Administration, FSPTCA: Family Smoking Prevention and Tobacco Control Act of 2009

Promotions on Newport and Marlboro Cigarette Packages: A National Study

Introduction

While cigarette pack designs are part of integrated marketing efforts, it is unclear the degree to which packs are used to advertise promotions and whether the tobacco retailers' neighborhood characteristics influence the likelihood and type of pack-based promotion in the United States.

Methods

Between June and October 2012, data collectors purchased packs of either Marlboro Red (n = 1090) or Newport Green (n = 1057) cigarettes at 2147 stores that were part of a national sample of tobacco retailers in the contiguous US. Coders rated packs for the presence of an exterior and interior pack promotion, placement of exterior promotion (eg, front, back), presentation of exterior promotion (eg, onsert, tear strip), and nature of the promotion (eg, contest/give/away). Using Census tract data, we examined the association of pack promotions with tobacco retailers' neighborhood demographic characteristics.

Results

Marlboro packs were approximately twice as likely to have promotions as Newport packs (31.7% vs. 14.7%). Fewer Marlboro packs (14.6%) and no Newport packs had interior promotions. The majority of exterior promotions were for contests (>80% for both brands), while almost all interior Marlboro promotions (97.5%) were for a discounted price. There were few differences in presence or type of promotion by tobacco retailers' neighborhood characteristics.

Conclusions

Exterior packs promotions, in particular, were fairly common and may contribute to the allure of tobacco products.

Implications

Use of promotions on the interior and exterior of cigarette packs are a mechanism that the tobacco industry uses to sell its products and should be continually assessed for their influence on consumer behavior.

Use of imagery and text that could convey reduced harm in American Spirit advertisements

BACKGROUND

In 2015, the US Food and Drug Administration issued warning letters to three tobacco companies regarding use of the terms 'natural' and/or 'additive-free' to describe their products, as these terms inaccurately convey reduced harm. Yet, tobacco companies engage in a variety of alternate techniques to attempt to convey the same 'natural' (and thus reduced harm) message. It is critical to monitor these practices to inform regulatory action.

OBJECTIVE

To describe the marketing techniques used in Natural American Spirit (American Spirit) ads that could convey a natural and less harmful product image.

METHODS

Trained coders content analysed 142 American Spirit ads from 2012 to 2016.

RESULTS

In addition to use of the terms 'natural' and 'additive-free', American Spirit ads engage in a variety of other linguistic and iconic techniques that could convey reduced harm, such as references to small, local or organic farming, eco-friendly practices, and plant, farming and other nature-related imagery.

CONCLUSIONS

American Spirit ads use a wide range of marketing techniques to convey a natural product image, which could subsequently communicate reduced harm.

Standardised tobacco packaging: a health policy case study of corporate conflict expansion and adaptation

OBJECTIVES

To investigate opposition to standardised tobacco packaging in the UK. To increase understanding of how transnational corporations are adapting to changes in their access to policymakers precipitated by Article 5.3 of the Framework Convention on Tobacco Control (FCTC).

DESIGN

Case study web-based documentary analysis, using NVivo V.10. Examination of relationships between opponents of standardised packaging and transnational tobacco companies (TTCs) and of the volume, nature, transparency and timing of their activities.

SETTING

UK standardised packaging policy debate 2011-2013.

PARTICIPANTS

Organisations selected on basis of opposition to, or facilitation thereof, standardised tobacco packaging in the UK; 422 associated documents.

RESULTS

Excluding tobacco manufacturing and packaging companies (n=12), 109 organisations were involved in opposing standardised packaging, 82 (75%) of which had a financial relationship with 1 or more TTC. These 82 organisations (43 actively opposing the measure, 39 facilitating opposition) were responsible for 60% of the 404 activities identified, including the majority of public communications and research production. TTCs were directly responsible for 28% of total activities, predominantly direct lobbying, but also financially underwrote third party research, communication, mass recruitment and lobbying. Active organisations rarely reported any financial relationship with TTCs when undertaking opposition activities.

CONCLUSIONS

The multifaceted opposition to standardised packaging was primarily undertaken by third parties with financial relationships with major tobacco manufacturers. Low levels of transparency regarding these links created a misleading impression of diverse and widespread opposition. Countries should strengthen implementation of Article 5.3 of the FCTC by systematically requiring conflict of interest declarations from all organisations participating in political or media debates on tobacco control.

Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries

Background

The current cigarette market is heavily focused on low-income and middle-income countries. Branding of tobacco products is key to establishing and maintaining a customer base. Greater restrictions on marketing and advertising of tobacco products create an incentive for companies to focus more on branding via the product itself. We consider how tobacco sticks are used for communicative purposes in 14 low-income and middle-income countries with extensive tobacco markets.

Methods

In 2013, we collected and coded 3232 cigarette and kretek packs that were purchased from vendors in diverse neighbourhoods in 44 cities across the 14 low-income and middle-income countries with the greatest number of smokers. A single stick from each pack was assessed for branding, decorative and communicative elements using a common coding framework. Stick communication variables included brand name, brand image/logo, brand descriptor, colour and design carried through from pack, ‘capsule cigarette’ symbol, and embellishment of filter end.

Results

Communication and branding on the stick is essentially ubiquitous (99.75%); 97% of sticks include explicit branding (brand name or logo present). Colour is commonly carried through from the pack (95%), and some sticks (13%) include decorative elements matching the pack. Decorative elements can be found anywhere on the stick, including the filter tip (8%), and ‘convertible’ cigarettes include a symbol to show where to push.

Conclusions

Cigarette sticks are clearly valuable ‘real estate’ that tobacco companies are using for communicative purposes. Across all countries and brands, the stick communicates branding via text, colour and imagery.

Recall, appeal and willingness to try cigarettes with flavour capsules: assessing the impact of a tobacco product innovation among early adolescents

Background

Use of flavour capsule varieties (FCVs) of cigarettes has rapidly increased in many countries. Adolescents are attracted to flavours; yet, surprisingly, no quantitative study has explored adolescents' perceptions of these products.

Objective

To characterise the appeal of FCVs for young adolescents in Mexico.

Methods

In 2015, surveys were conducted with a representative sample of Mexican middle school students (n=10 124; ages 11–16 years; mean 12.4 years). Students viewed and rated packs for FCVs and non-FCVs from major brands (Marlboro, Camel, Pall Mall), with brand names removed. For each pack, students were asked to write the brand name (ie, brand recall), to evaluate pack attractiveness, and to indicate the pack they were most interested in trying (including a ‘none’ option). Logistic generalised estimating equation (GEE) models regressed brand recall, pack attractiveness and interest in trying on brand and FCV (yes vs no), controlling for sociodemographics and smoking risk factors.

Results

Marlboro regular, Camel regular, Camel light and Pall Mall FCVs were most often recalled (25%, 17%, 9%, 8%). Packs for Pall Mall FCVs and Camel FCVs were most often rated as very attractive (13%, 9%, respectively) and of interest for trial (22%, 13%) along with Marlboro regular (14%). In GEE models, FCVs were independently associated with greater attractiveness (adjusted OR (AOR)=1.83, 95% CI 1.72 to 1.94) and interest in trying (AOR=1.74, 95% CI 1.54 to 1.96). Perceived pack attractiveness was also independently associated with greater interest in trying (AOR=5.63, 95% CI 4.74 to 6.68).

Conclusions

FCVs appear to be generating even greater appeal among young adolescents than established non-FCVs in dominant brand families.

"It Looks Like an Adult Sweetie Shop": Point-of-Sale Tobacco Display Exposure and Brand Awareness in Scottish Secondary School Students

INTRODUCTION

As further restrictions have been placed on tobacco advertising and promotions, point-of-sale (PoS) displays of cigarettes in shops have become an increasingly important source of young people's exposure to tobacco products. This study explored the relationship between PoS displays of cigarettes and brand awareness among secondary school students in Scotland.

METHODS

Cross-sectional school surveys (n = 1406) and focus groups (n = 86) were conducted with S2 (13-14 years) and S4 (15-16 years) students in four schools of differing socioeconomic status in 2013, prior to the PoS display ban in large shops. Adjusted negative binomial regression analysis examined associations between brand awareness and exposure variables (visiting tobacco retailers, noticing displays of tobacco products).

RESULTS

Students visiting small shops more frequently (relative rate ratio [RRR] 1.19, 95% confidence interval [CI] 1.01-1.41) and those who noticed cigarette displays in small shops (RRR 1.24, 95% CI 1.03-1.51) and large supermarkets (RRR 1.15, 95% CI 1.01-1.30) had higher brand awareness. The focus groups supported these findings. Participants described PoS tobacco displays as being eye-catching, colorful and potentially attractive to young people.

CONCLUSIONS

This mixed-methods study showed that higher cigarette brand awareness was significantly associated with regularly visiting small shops and noticing PoS displays in small and large shops, even when students' smoking status, smoking in their social networks, leisure activities, and demographics were included as confounding variables. This highlights the importance of PoS displays of tobacco products in increasing brand awareness, which is known to increase youth smoking susceptibility, and thus the importance of implementing PoS display bans in all shops.

IMPLICATIONS

As increasing restrictions have been placed on tobacco promotion in many countries, PoS displays of cigarettes in shops have become an important source of young people's exposure to tobacco products and marketing. This mixed-methods study showed that prior to the PoS display ban in Scotland, and controlling for other factors, 13- and 15-year olds who regularly visited small shops and those who noticed PoS displays in small and large shops, had a higher awareness of cigarette brands. This highlights the importance of PoS displays in increasing youth brand awareness, which increases smoking susceptibility, and thus the need for comprehensive bans on PoS displays which cover all shops.

The association between smokers' perceived importance of the appearance of cigarettes/cigarette packs and smoking sensory experience: a structural equation model

OBJECTIVE

We assessed the reliability of a measure of the latent construct "smoking sensory experience." We further measured the relationship between "smoking sensory experience" and smokers' rating of the importance of the appearance of cigarettes/cigarette packs in brand choice and smoking dependence.

METHODS

Analyses involved a national sample of smokers (n = 633) who participated in the 2010 South African Social Attitudes Survey (N = 3,112). Smokers ranked on a scale of 1-5, the importance of the following attributes in choosing their cigarette brand: health concerns, cost, packaging, taste, satisfaction, and flavor/strength. Using structural equation modeling, an a priori model was specified based on the hypothesis that taste, satisfaction, and flavor/strength are measures of a construct of "smoking sensory experience" and that cigarette packaging would be positively related to "smoking sensory experience." Furthermore, "smoking sensory experience" would be positively related to cigarettes smoked per day.

RESULTS

The latent construct--"smoking sensory experience" was considered reliable (Cronbach's α = 0.75). The structural equation model confirmed that the specified model fitted the data well (goodness of fit index = 0.993; normed fit index = 0.978; root mean square error of approximation = 0.031). Higher "smoking sensory experience" was positively associated with increasing cigarettes smoked per day (β = 0.12). Higher rating of the cigarette package in brand choice positively covaried with both "smoking sensory experience" (β = 0.29), and higher rating of health considerations (β = 0.42).

CONCLUSIONS

These findings support the regulation of the appearance of cigarettes/cigarette packs to reduce cigarettes' appeal and abuse liability in line with Article 11 of WHO's Framework Convention on Tobacco Control.

Is consumer response to plain/standardised tobacco packaging consistent with framework convention on tobacco control guidelines? A systematic review of quantitative studies

BACKGROUND AND OBJECTIVES

Standardised or 'plain' tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm.

METHODS

Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted.

RESULTS

Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample.

CONCLUSIONS

The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm based upon package design; and will help make the legally required on-pack health warnings more salient.

Cigarette pack design and adolescent smoking susceptibility: a cross-sectional survey

OBJECTIVES

To compare adolescents' responses to three different styles of cigarette packaging: novelty (branded packs designed with a distinctive shape, opening style or bright colour), regular (branded pack with no special design features) and plain (brown pack with a standard shape and opening and all branding removed, aside from brand name).

DESIGN

Cross-sectional in-home survey.

SETTING UK PARTICIPANTS

Random location quota sample of 1025 never smokers aged 11-16 years.

MAIN OUTCOME MEASURES

Susceptibility to smoking and composite measures of pack appraisal and pack receptivity derived from 11 survey items.

RESULTS

Mean responses to the three pack types were negative for all survey items. However, 'novelty' packs were rated significantly less negatively than the 'regular' pack on most items, and the novelty and regular packs were rated less negatively than the 'plain' pack. For the novelty packs, logistic regressions, controlling for factors known to influence youth smoking, showed that susceptibility was associated with positive appraisal and also receptivity. For example, those receptive to the innovative Silk Cut Superslims pack were more than four times as likely to be susceptible to smoking than those not receptive to this pack (AOR=4.42, 95% CI 2.50 to 7.81, p<0.001). For the regular pack, an association was found between positive appraisal and susceptibility but not with receptivity and susceptibility. There was no association with pack appraisal or receptivity for the plain pack.

CONCLUSIONS

Pack structure (shape and opening style) and colour are independently associated, not just with appreciation of and receptivity to the pack, but also with susceptibility to smoke. In other words, those who think most highly of novelty cigarette packaging are also the ones who indicate that they are most likely to go on to smoke. Plain packaging, in contrast, was found to directly reduce the appeal of smoking to adolescents.

The impact of cigarette pack shape, size and opening: evidence from tobacco company documents

AIMS

To use tobacco industry documents on cigarette pack shape, size and openings to identify industry findings on associations with brand imagery, product attributes, consumer perceptions and behaviour.

METHODS

Internal tobacco industry research and marketing documents obtained through court disclosure contained in the Legacy Tobacco Documents Library were searched using keywords related to pack shapes, sizes and opening methods. The search identified 66 documents related to consumer research and marketing plans on pack shape, size and openings, drawn from 1973 to 2002.

RESULTS

Industry research consistently found that packs that deviated from the traditional flip-top box projected impressions of 'modern', 'elegant' and 'unique' brand imagery. Alternative pack shape and openings were identified as an effective means to communicate product attributes, particularly with regard to premium quality and smooth taste. Consumer studies consistently found that pack shape, size and opening style influenced perceptions of reduced product harm, and were often used to communicate a 'lighter' product. Slim, rounded, oval and booklet packs were found to be particularly appealing among young adults, and several studies demonstrated increased purchase interest for tobacco products presented in novel packaging shape or opening. Evidence from consumer tracking reports and company presentations indicate that pack innovations in shape or opening method increased market share of brands.

CONCLUSIONS

Consumer research by the tobacco industry between 1973 and 2002 found that variations in packaging shape, size and opening method could influence brand appeal and risk perceptions and increase cigarette sales.