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Sheridan A, Conway R, Murphy E, Blake M, Mulcahy M, Howell F, Gordon C, Doyle F, Kavanagh PM. The impact of the introduction of tobacco product plain packaging on consumer responses in Ireland: a real-world policy evaluation stratified by socioeconomic groups. Eur J Public Health 2024:ckae128. [PMID: 39167744 DOI: 10.1093/eurpub/ckae128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2024] Open
Abstract
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.
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Affiliation(s)
- Aishling Sheridan
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Robert Conway
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Edward Murphy
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Martina Blake
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | | | - Fenton Howell
- Department of Health, Tobacco and Alcohol Control Unit, Ireland
| | - Claire Gordon
- Department of Health, Tobacco and Alcohol Control Unit, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul M Kavanagh
- HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Epidemiology and Public Health, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Rodríguez-Lesmes P, Góngora-Salazar P, Mentzakis E, Buckley N, Gallego JM, Guindon GE, Martínez JP, Paraje G. Would plain packaging and health warning labels reduce smoking in the presence of informal markets? A choice experiment in Colombia. Soc Sci Med 2024; 354:117069. [PMID: 38971045 DOI: 10.1016/j.socscimed.2024.117069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 06/19/2024] [Accepted: 06/21/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND Despite progress made by many countries on the adoption of plain tobacco packaging laws over the last years, low- and middle-income countries, with a large supply of loose cigarettes via informal vendors, remain far behind. AIM To study the potential effectiveness of plain tobacco packaging and dissuasive cigarette sticks, via willingness-to-pay estimates, when illicit cigarette options are available. METHODS We conducted a discrete choice experiment (DCE) in which respondents chose licit and illicit products with three attributes: packaging (standard vs. plain packaging), stick design (branded stick vs. stick with warning), and price level. The sample, collected on 12/2021, consisted of 1761 respondents from an internet panel involving smokers and nonsmokers. Conditional logit and latent class models were used to estimate the willingness-to-pay (WTP) to avoid restrictive packaging elements. RESULTS Nonsmokers are willing to pay USD $5.63 for a pack of cigarettes to avoid plain packaging, which is higher than the actual commercial price of illicit cigarettes (USD $2.40). The WTP increases to USD $12.14 in the presence of illicit alternatives. Smokers are also willing to pay to avoid illicit options, which they also deem riskier, and the presence of such options increases the WTP to avoid plain packaging. However, nonsmokers do not perceive the illicit option as riskier. The dissuasive stick (stick with warning) does not affect perceptions of risk and plays a small role in terms of choice for both smokers and nonsmokers. CONCLUSIONS Even in the presence of illicit tobacco alternatives, plain packaging seems to be as effective in reducing the attractiveness of tobacco products in Colombia as in other countries that have already adopted it. Given conflicting results on the case for dissuasive sticks, there is a need for more research.
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Affiliation(s)
| | - Pamela Góngora-Salazar
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom; Social Protection and Health Division, Inter-American Development Bank, Washington DC, United States.
| | - Emmanouil Mentzakis
- School of Policy and Global Affairs, City, University of London, London, United Kingdom.
| | - Neil Buckley
- Department of Economics, York University, Toronto, Canada.
| | | | - G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Ontario, Canada.
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Nottage MK, Taylor EV, East KA, McNeill A, Thrasher JF, Reid JL, Hammond D, Simonavičius E. Packaging of disposable vaping products and e-liquids in England, Canada and the United States: A content analysis. Addiction 2024. [PMID: 38970447 DOI: 10.1111/add.16611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/09/2024] [Indexed: 07/08/2024]
Abstract
BACKGROUND AND AIMS Vaping product packaging is varied and often features bright colours and novel designs, particularly among recently marketed disposable vapes. This study provides an overview of attributes found on the packaging of popular disposable vapes and e-liquid bottles in England, Canada and the United States (US) and assesses compliance with local packaging regulations. DESIGN Content analysis. SETTING Brick-and-mortar and online shops in England (London), Canada (Ontario) and the US (New Hampshire and South Carolina). CASES 108 vaping products (including packaging) from 76 brands in a range of flavours and nicotine levels. Specifically, 48 disposable vapes (15 from England, 16 from Canada, 17 from the US) and 60 e-liquid bottles (20 per country). MEASUREMENTS Textual and graphic branding and marketing elements, independently coded by two researchers and checked by a third. FINDINGS Compliance with local packaging regulations varied across countries. Health warnings were present on the packaging of all but one nicotine-containing product, although 33% of disposables and 17% of e-liquids featuring the warning did not adhere to formatting requirements. Leaflets were seldom included with e-liquid bottles, even in England (45%) where mandatory, and omitted elsewhere. Labelling of nicotine type and batch numbers was inconsistent. Vaping product packaging featured claims relating to sensory perceptions (41%), most often flavours, and some (32%) featured youth-appealing content. Common graphic elements included stylised brand fonts (80%), brand logos (54%), product representations on the external packaging (47%) and abstract graphic elements (64%). Colours on packaging, disposable vapes and e-liquid bottles were associated with product flavour. CONCLUSIONS In England, Canada and the United States, popular disposable vapes and e-liquid bottles appear to have varying compliance with local packaging regulations and inconsistent labelling of nicotine and product characteristics. The use of colourful designs, evocative descriptors and appealing graphics to promote flavours underscores the need for comprehensive packaging regulations and enforcement.
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Affiliation(s)
- Matilda K Nottage
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Eve V Taylor
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Katherine A East
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ann McNeill
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Erikas Simonavičius
- Addictions Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Cox S. The ends do not justify the means when it comes to Australia's vaping policy. Addiction 2024. [PMID: 38946521 DOI: 10.1111/add.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Sharon Cox
- Faculty of Population Health Sciences, University College London, London, UK
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Ozarka E, Teddy L, Blank ML, Waa A, Hoek J. Managing Fear Responses: A Qualitative Analysis of Pictorial Warning Labels Five Years Post-Plain Packaging. Nicotine Tob Res 2024:ntae112. [PMID: 38839052 DOI: 10.1093/ntr/ntae112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/24/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION Although pictorial warning labels (PWLs) now dominate tobacco packages sold in many countries, few studies have probed how people who smoke respond to the threats presented several years post-plain packaging and larger PWLs. Understanding how people manage the fear and dissonance PWLs arouse, and the strategies they use to rationalize, diminish, and reject risk messages, could inform future PWL design. AIMS AND METHODS We undertook 27 in-depth interviews with people aged 18 and over (16 female, 8 Māori, and 13 aged ≤35) who smoked roll-your-own tobacco and lived in Aotearoa New Zealand. We probed participants' views on current PWLs and how they responded to these, then asked them to use alternative images and headlines to create new PWLs. We drew on the extended parallel processing model to interpret the data, which we analyzed using a reflexive thematic analysis approach. RESULTS People who smoke dislike PWLs, which they think reduce them to diseased body parts. While a minority thought existing PWLs were believable and effective, most reported avoiding PWLs by hiding or cognitively blocking them. Participants used diverse counterarguments to diminish PWLs' relevance and impact, and a minority displayed strong reactance. Several suggested developing PWLs that recognized them as whole people rather than patients in waiting, and recommended greater use of testimonials, particularly from people who had successfully become smoke free. CONCLUSIONS PWLs using more holistic and diverse messages could elicit greater engagement and responsiveness, and motivate cessation more effectively than existing health-oriented warnings. IMPLICATIONS Our findings suggest existing PWLs, which aim to arouse fear of ill health, could be complemented by warnings that emphasize the benefits of quitting. Continuing to use threat-based PWLs could stimulate greater rationalization and reactance. By contrast, PWLs that aim to illustrate how cessation could benefit people who smoke and their families, rather than instill a fear of disease, could avoid message rejection and counter-argument, and may prove a more powerful way of motivating cessation.
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Affiliation(s)
- Ellen Ozarka
- Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
| | - Lani Teddy
- Te Rōpū Rangahau Hauora a Eru Pōmare Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
| | - Mei-Ling Blank
- Department of Preventive and Social Medicine, University of Otago, Dunedin, Aotearoa, New Zealand
| | - Andrew Waa
- Te Rōpū Rangahau Hauora a Eru Pōmare Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, Aotearoa, New Zealand
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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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Cooper M, Shi Y. The impacts of packaging on preferences for cannabis edibles: A discrete choice experiment. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 128:104453. [PMID: 38796927 DOI: 10.1016/j.drugpo.2024.104453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 04/27/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUNDS Cannabis edibles recently gained considerable market share in the United States. The tobacco and food literatures consistently suggest that product packaging regulations are crucial to substance control, but little is known about how product packaging may impact cannabis edible use. This study aims to estimate the impacts of packaging on individual preferences for cannabis edibles and explore heterogeneities in preferences by cannabis use status and use purposes. METHODS 1578 adults were recruited, who lived in 18 states and Washington D.C. in the United States that legalized recreational cannabis by the time of data collection in August and September of 2022. An online discrete choice experiment was conducted to elicit individual choices between cannabis edibles with variations in five packaging attributes: package style, health claim, potency indicator, warning label position, and warning label text. Mixed logit regressions were used to assess associations between package attributes and package choices. Subsample analysis was conducted by cannabis use status (users vs. nonusers) and use purposes (medical-only, recreational-only, and dual-purpose) to detect heterogeneities. RESULTS Almost all subsamples prefer branded packages to plain packages, any health claim to no health claim, and any potency indicator to no potency indicator. Cannabis users, particularly recreational-only users and dual-purpose users, also prefer youth-appealing packages to branded packages. Warning label position and text have limited impacts on choices. Overall, package style is perceived to be the most important attribute among the five (relative importance 33.2-50.8%), followed by health claim (relative importance 22.6-30.5%). CONCLUSION In the United States, adults' preferences for cannabis edibles are associated with packaging features. Policies requiring plain package and prohibiting youth-appealing package and unsubstantiated health claims may be effective methods of cannabis control.
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Affiliation(s)
- Michael Cooper
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, United States
| | - Yuyan Shi
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego. 9500 Gilman Dr., La Jolla, CA 92093, United States.
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Gomes MN, Reid JL, Hammond D. The effect of branded versus standardized e-cigarette packaging and device designs: an experimental study of youth interest in vaping products. Public Health 2024; 230:223-230. [PMID: 38429123 DOI: 10.1016/j.puhe.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 03/03/2024]
Abstract
OBJECTIVES Standardized ('plain') packaging is effective in reducing the appeal of cigarettes among young people. This study examined the impact of plain packaging and brand imagery on interest in trying e-cigarettes among youth. STUDY DESIGN Experimental design. METHODS Two online experiments were conducted in February 2020 as part of the ITC Youth Tobacco & Vaping Survey, conducted with 13,624 16- to 19-year-olds in Canada, England, and the USA. In the between-group Experiment 1, participants were randomized to view a set of 3 e-cigarette brands, in either their original external packaging ('branded' condition) or standardized olive-green packaging ('standardized' condition), and asked to select the product they would be most interested in trying. The within-group Experiment 2 examined brand imagery directly on devices, including potential differences in appeal among subgroups. Each participant viewed 4 pod-style e-cigarette devices: one 'plain' and 3 in colourful 'skins'. Logistic regression models were conducted to test the effect of condition, adjusting for demographics, smoking and vaping status. RESULTS In Experiment 1, participants in the 'standardized' packaging condition were significantly more likely to indicate 'I have no interest in trying any of these products' (72.3%) than those in the 'branded' condition (66.9%, AOR 1.45, 95% CI 1.33-1.59). Experiment 2 results indicated differences in e-cigarette appeal by sex in the selection of male- and female-oriented designs, and by cannabis use for a Rastafarian-themed design. CONCLUSIONS Brand imagery on e-cigarettes can target products to specific subgroups. Removal of imagery, in the form of standardized packaging, has the potential to reduce interest in trying e-cigarettes among young people.
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Affiliation(s)
- M N Gomes
- School of Public Health Sciences, University of Waterloo, Canada
| | - J L Reid
- School of Public Health Sciences, University of Waterloo, Canada
| | - D Hammond
- School of Public Health Sciences, University of Waterloo, Canada.
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Popova L, Massey ZB, Giordano NA. Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications. Annu Rev Public Health 2024; 45:425-442. [PMID: 38166502 DOI: 10.1146/annurev-publhealth-060922-042254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2024]
Abstract
Warning labels help consumers understand product risks, enabling informed decisions. Since the 1966 introduction of cigarette warning labels in the United States, research has determined the most effective message content (health effects information) and format (brand-free packaging with pictures). However, new challenges have emerged. This article reviews the current state of tobacco warning labels in the United States, where legal battles have stalled pictorial cigarette warnings and new products such as electronic cigarettes and synthetic nicotine products pose unknown health risks. This article describes the emerging research on cannabis warnings; as more places legalize recreational cannabis, they are adopting lessons from tobacco warnings. However, its uncertain legal status and widespread underestimation of harms impede strict warning standards. The article also reviews opioid medication warning labels, suggesting that lessons from tobacco could help in the development of effective and culturally appropriate FDA-compliant opioid warning labels that promote safe medication use and increased co-dispensing of naloxone.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA;
| | - Zachary B Massey
- School of Journalism, University of Missouri, Columbia, Missouri, USA
| | - Nicholas A Giordano
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia, USA
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Minacapilli Manetti ML, Gonzalez Peluffo V, Taglioretti V, Barros M, Nunez V, Melian T, Grilo G, Llambi L. Flavours and design features on tobacco product packaging near schools before and after plain packaging implementation in Montevideo, Uruguay. Tob Control 2024:tc-2023-058287. [PMID: 38519081 DOI: 10.1136/tc-2023-058287] [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: 07/19/2023] [Accepted: 02/01/2024] [Indexed: 03/24/2024]
Abstract
INTRODUCTION Monitoring tobacco industry marketing strategies in countries that have introduced plain packaging helps with documenting variations in the market during the transition period. Uruguay implemented plain packaging in February 2020. We describe changes in the characteristics of tobacco packaging, content and sticks before and after plain packaging implementation. METHODS Data were collected across 15 neighbourhoods in different socioeconomic areas in Montevideo, Uruguay, before and after implementation (2019 and 2021). A high school or college was selected in each neighbourhood as the walking protocol starting point. Two stores were visited per neighbourhood. Cigarettes and roll-your-own tobacco (RYO) were purchased and coded for the presence of taste or sensation lexical and imagery features. RESULTS The number of unique products increased between 2019 (n=23) and 2021 (n=40). Prior to implementation, all packs presented design features. After its implementation, 95.7% of cigarette packs complied with regulations. Overall, 34.7% of cigarettes and RYO were flavoured in 2019 versus 50.0% in 2021 (p=0.01). In 2019, all flavoured cigarette packs conveyed taste through language and/or imagery, while cigarettes had designs on the filter suggesting the potential for altering the flavour. In 2021, 44.0% of cigarette packs indicated flavour through lexicon; and 81.0% of cigarette sticks still included a flavour capsule. CONCLUSIONS After implementation, we noticed an increase in the availability of unique flavoured cigarettes and RYO among surveyed retailers. However, this increase was less pronounced compared with what is reported in the Latin American region. Non-compliance was identified. Greater efforts should be made enforcing current policy.
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Affiliation(s)
- Mauricio Luis Minacapilli Manetti
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
| | - Valentina Gonzalez Peluffo
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
| | - Victoria Taglioretti
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
| | - Mary Barros
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
| | - Virginia Nunez
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
| | - Tamara Melian
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
| | - Graziele Grilo
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Laura Llambi
- Unidad de Tabaquismo, Departamento Clinico de Medicina, Hospital de Clinicas, Universidad de la Republica Facultad de Medicina, Montevideo, Uruguay
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Simonavičius E, East K, Taylor E, Nottage M, Reid JL, Arnott D, Bunce L, McNeill A, Hammond D. Impact of E-liquid Packaging on Vaping Product Perceptions Among Youth in England, Canada, and the United States: A Randomized Online Experiment. Nicotine Tob Res 2024; 26:370-379. [PMID: 37542732 PMCID: PMC10882429 DOI: 10.1093/ntr/ntad144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/21/2023] [Accepted: 08/04/2023] [Indexed: 08/07/2023]
Abstract
INTRODUCTION Vaping is not risk-free but can help those who smoke to reduce harm to health and stop smoking. However, packaging of vaping products, including e-liquids, appeals to youth and might facilitate vaping among nicotine-naïve people. Standardized packaging of vaping products could moderate the appeal of vaping among youth. This study assessed how youth interest in trying and perceived health harms of using e-liquids are associated with branded or standardized (white or olive) e-liquid packaging with different nicotine levels displayed. AIMS AND METHODS A between-subject experiment with three packaging and two nicotine level conditions included youth (n = 13801) aged 16 to 19 from England, Canada, and the United States as a part of a cross-sectional online survey in August-September 2021. Participants' interest in trying and perceived harm of e-liquids were analyzed using logistic and multinomial regressions adjusted for age, sex, race or ethnicity, country, vaping, and smoking status. RESULTS Compared with branded e-liquid packs, more youth reported no interest in trying e-liquids in white (aOR = 1.48, 95% CI = 1.34 to 1.64) or olive (aOR = 1.62, 95% CI: 1.47 to 1.80) standardized packs. Compared with branded e-liquid packs, more youth inaccurately perceived e-liquids in white (aOR = 1.22, 95% CI: 1.11 to 1.34) or olive (aOR = 1.29, 95% CI: 1.18 to 1.41) standardized packs as equally or more harmful than smoking. E-liquid nicotine levels displayed on packs were not associated with youth interest in trying or harm perceptions of using e-liquids. CONCLUSIONS Among 16- to 19-year-old youth from England, Canada, and the United States, standardized packaging of e-liquids was associated with lower interest in trying and higher health risk perceptions. IMPLICATIONS Branded packaging of vaping products appeal to youth and might prompt nicotine use among those who had never smoked. This study suggests that restricting branding elements on e-liquid packaging is associated with youth's lower interest in trying e-liquids and higher misperceptions that vaping is equally or more harmful than smoking. Standardized packaging might reduce appeal of vaping among youth, but its potential to discourage vaping for harm reduction should also be considered.
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Affiliation(s)
- Erikas Simonavičius
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Katherine East
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Eve Taylor
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Matilda Nottage
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jessica L Reid
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | | | | | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
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Shadel WG, Martino SC, Setodji CM, Dunbar M, Jenson D, Wong JC, Falgoust G. Doing more with less: A proposal to advance cigarette packaging regulations in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 124:104308. [PMID: 38184903 PMCID: PMC10939880 DOI: 10.1016/j.drugpo.2023.104308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/12/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
Cigarette packages are potent marketing tools. Following guidance from the WHO Framework Convention on Tobacco Control, many countries have sought to diminish this marketing power by mandating that (1) large graphic health warnings be affixed to the packages (i.e., text warnings combined with graphic images of the health consequences of smoking) and (2) all packages be fully "plain" in their design (i.e., all packages use the same drab/bland color and font type; no brand logos, other colors, or designs are permitted). Yet, the United States lags other countries in implementing regulations designed to blunt the marketing power of cigarette packages. This is not because of a lack of effort on the part of the Food and Drug Administration, the main governmental body charged with regulating tobacco products in the United States. Rather, it is because the regulatory options that that have been advanced in the country (e.g., graphic health warnings) have not been found - yet - to be legally feasible by its courts. This commentary works through some of the conceptual, practical, and legal issues regarding packaging regulations in the United States. It considers the political and bureaucratic risks involved with issuing new regulations. The overall intent is to prompt our field to think creatively about what is realistic in this regulatory space and to offer a novel perspective that may help move the United States tobacco control community forward in its efforts to reduce the promotional power of cigarette packages.
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Affiliation(s)
- William G Shadel
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States.
| | - Steven C Martino
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Claude M Setodji
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Michael Dunbar
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Desmond Jenson
- Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, MN 55105, United States
| | - Jody Cs Wong
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
| | - Grace Falgoust
- RAND Corporation, 4570 Fifth Avenue., Suite 600, Pittsburgh, PA 15213, United States
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14
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Uren AM, Young MK. Field testing Australian bat lyssavirus risk communication resources. Health Promot J Austr 2024. [PMID: 38163672 DOI: 10.1002/hpja.837] [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: 07/12/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/03/2024] Open
Abstract
ISSUE ADDRESSED Australian bat lyssavirus (ABLV) is a fatal zoonosis, which can be transmitted to humans through scratches or bites from infected bats. Currently, there is a lack of research evaluating risk communication resources about ABLV or the dangers from handling bats. The purpose of this study was to field test resources aimed at educating the public about risks to humans and bats from human-bat interaction, then update these resources based upon feedback to ensure they were relevant and appropriately targeted to the public. METHODS Thirteen semi-structured interviews with a purposive sample of participants chosen for maximum variation of age and sex were conducted. Two investigators analysed the data independently using a deductive approach and then came to consensus by discussion. RESULTS The main themes were a wide-ranging level of knowledge and opinions about bats, the resources having an effect on people, and messaging in relation to children and pets being particularly important. CONCLUSION This study highlighted the complexities of risk communication to a broad audience with varied experience and knowledge about bats, and the importance of evaluation prior to implementation to ensure risk communication is relevant and appealing to the intended audience. SO WHAT?: Field testing of health education material prior to implementation is an effective way to ensure key messages are understood, and is important when communicating about fatal but preventable zoonoses such as ABLV.
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Affiliation(s)
- Alexandra M Uren
- Metro North Public Health Unit, Queensland Health, Windsor, Queensland, Australia
| | - Megan K Young
- Metro North Public Health Unit, Queensland Health, Windsor, Queensland, Australia
- School of Public Health, University of Queensland, Herston, Queensland, Australia
- School of Medicine and Dentistry, Griffith University, Southport, Queensland, Australia
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15
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Arco-Osuna MÁD, Blasco J, Almeida A, Martín-Álvarez JM. Impact of the Spanish smoke-free laws on cigarette sales by brands, 2000-2021: Evidence from a club convergence approach. Tob Induc Dis 2023; 21:158. [PMID: 38053754 PMCID: PMC10694830 DOI: 10.18332/tid/174407] [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: 03/09/2023] [Revised: 10/23/2023] [Accepted: 10/26/2023] [Indexed: 12/07/2023] Open
Abstract
INTRODUCTION In January 2006, the Spanish government enacted a tobacco control law that banned the advertising, promotion and sponsorship of tobacco. In January 2011, further legislation on this matter was adopted to provide a more restrictive specification of the ban. In this study, we analyze the effect produced on cigarette sales by these two prohibitions. We address this problem using a cluster time-series analysis to test whether the sales of cigarettes by brands have been homogenized with the prohibition of advertising, promotion, and sponsorship. METHODS The data source used was the official data on legal sales of cigarettes by brands in Spain, from January 2005 to December 2021 (excluding the Canary Islands and the Autonomous Communities of the cities of Ceuta and Melilla). To achieve our objective, we used log(t) test statistics to check if there is global convergence in the three selected periods according to the regulatory changes that have occurred in Spain (2005-2021, 2005-2010 and 2011-2021). Second, once absolute convergence is rejected, we applied a clustering algorithm to test for the existence of subgroup convergence. RESULTS The cigarette brands that have been marketed during the period 2005-2021 (n=40), can only be grouped into three groups according to the behavior of their sales. When we focus on the period 2005-2010 (n=74), cigarette brands are grouped into five groups according to their sales behavior. Finally, the cigarette brands marketed during the period 2011-2021 (n=67) are grouped into three groups according to the temporal evolution of their sales. These results suggest a greater homogenization of cigarette sales after the application of the law of January 2011. CONCLUSIONS Act 42/2010 (total ban on tobacco advertising, promotion, and sponsorship actions) was associated with greater homogenization of cigarette sales than the application of Act 28/2005 (partial ban). This finding supports what is established in the previous literature that indicates that Act 42/2010 provided a more restrictive specification of the ban than Act 28/2005.
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Affiliation(s)
- Miguel Ángel Del Arco-Osuna
- Department of Quantitative Analysis for Economics and Management, Universidad Internacional de La Rioja, Logroño, Spain
| | - Josep Blasco
- Department of Quantitative Analysis for Economics and Management, Universidad Internacional de La Rioja, Logroño, Spain
| | - Alejandro Almeida
- Department of Quantitative Analysis for Economics and Management, Universidad Internacional de La Rioja, Logroño, Spain
| | - Juan Manuel Martín-Álvarez
- Department of Quantitative Analysis for Economics and Management, Universidad Internacional de La Rioja, Logroño, Spain
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16
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Giovenco DP, Ganz O, Spillane TE, Easter AG, Wackowski OA, Villanti AC, Strasser AA, Delnevo CD. Changes in Pack Features Among Top-Selling Cigarettes in the U.S., 2018 and 2021. Am J Prev Med 2023; 65:1124-1128. [PMID: 37295659 PMCID: PMC10700656 DOI: 10.1016/j.amepre.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Cigarette packaging is designed to increase consumer appeal and remains a primary promotional tool in many countries, including the U.S. This study documented changes in the prevalence of pack characteristics among the top-selling cigarette products in the U.S. in 2018 and 2021. METHODS The 50 cigarette packs with the highest national unit sales in U.S. convenience stores in 2018 and 2021 were identified using Nielsen's Scantrack data and subsequently purchased. Packs were coded for features such as dominant color(s), descriptive text, and promotional language. Descriptive analyses conducted in 2022 weighted by total annual unit sales compared the prevalence of pack characteristics between years. RESULTS Three brands-Marlboro, Newport, and Camel-constituted over 80% of pack sales among the top-selling products. Packs with red as a dominant color grew less popular between years (33.3% vs 29.5%), whereas those with green became more prevalent (25.2% vs 28.9%), consistent with a rise in the proportion of menthol sales. The prevalence of descriptors such as flavor and fresh decreased from 46.0% to 39.4% and 9.7% to 5.2%, respectively. Meanwhile, the prevalence of promotional language (e.g., rewards programs) increased from 60.9% to 69.0%. CONCLUSIONS The use of visual and named colors remains common, which can implicitly communicate sensory or health-related attributes. Moreover, promotions may help recruit and retain consumers in the context of more restrictive tobacco control policies and price increases. Given the strong influence that cigarette packaging exerts on consumers, packaging-focused policies, such as plain packaging laws, may reduce appeal and accelerate declines in cigarette use.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
| | - Ollie Ganz
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Torra E Spillane
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Alexa G Easter
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Olivia A Wackowski
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrea C Villanti
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cristine D Delnevo
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Moodie C, Thrasher JF, Barnoya J, Mejia R, Barrientos-Gutierrez I, Zavaleta A, Chaloupka F. Tobacco Industry Claims About Transformation are Inconsistent With Combustible Cigarette Innovations: The Case of Flavor Capsule Cigarettes. Nicotine Tob Res 2023; 25:1891-1895. [PMID: 36149828 DOI: 10.1093/ntr/ntac224] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 08/03/2022] [Accepted: 10/17/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Crawford Moodie
- Faculty of Health Sciences and Sport, Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joaquin Barnoya
- Departamento de Ciencias de la Salud, Vicerrectoría de Investigación y Proyección, Rafael Landívar University, Guatemala City, Guatemala
- Unidad de Cirugía Cardiovascular de Guatemala, Guatemala City, Guatemala
| | - Raul Mejia
- Centro de Estudios de Estado y Sociedad (CEDES), Buenos Aires, Argentina
| | | | - Alfonso Zavaleta
- Information and Education Center for the Prevention of Drug Abuse (CEDRO), Lima, Peru
- Faculty of Sciences and Philosophy, Peruvian Cayetano Heredia University, Lima, Peru
| | - Frank Chaloupka
- School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
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18
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Stone MD, Mercincavage M, Wileyto EP, Tan ASL, Audrain-McGovern J, Villanti AC, Strasser AA. Effects of cigarette package colors and warning labels on marlboro smokers' risk beliefs, product appraisals, and smoking behavior: a randomized trial. BMC Public Health 2023; 23:2111. [PMID: 37891513 PMCID: PMC10605973 DOI: 10.1186/s12889-023-17024-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/19/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Plain packaging and graphic warning labels are two regulatory strategies that may impact cigarette risk beliefs and reduce consumption, but data are needed to better understand how smokers respond to such regulations. METHODS Adult, daily, Marlboro non-menthol smokers (Red [n = 141] or Gold [n = 43]) completed a mixed factorial randomized trial. Participants smoked their usual cigarettes during baseline (5-days) and were randomized to receive cigarette packs with a warning label manipulation (graphic vs. text-only). Within each warning label condition, participants completed three within-subjects pack color manipulations (red, gold, plain), each lasting 15 days. Participants were blinded to the fact that all packs contained their usual cigarettes. Mixed-effects models examined between- and within-subject differences on risk beliefs, product perceptions, and smoking behavior. RESULTS Warning type and package color did not impact cigarette consumption or subjective ratings. However, use increased in all conditions (2.59-3.59 cigarettes per day) relative to baseline. While smokers largely held correct risk beliefs at baseline (Mean = 6.02, SE = 0.17, Range:0-8), the cumulative number of incorrect or uncertain cigarette risk beliefs increased from baseline in all pack color manipulations in the text (IRR range = 1.70-2.16) and graphic (IRR range = 1.31-1.70) warning conditions. Across all pack color periods, those in the graphic (vs. text) warning condition had reduced odds of reporting their study cigarettes as 'safer' than regular cigarettes (OR range = 0.22-0.32). CONCLUSIONS Pack color modification may increase uncertainty about several key cigarette risk beliefs, though graphic warnings may attenuate these effects. Regulatory agencies could consider supporting policy changes with information campaigns to maximize public knowledge. TRIAL REGISTRATION November 25, 2014; Registration number: NCT02301351.
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Affiliation(s)
- Matthew D Stone
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, San Diego, CA, USA
| | - Melissa Mercincavage
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Andrea C Villanti
- Rutgers, School of Public Health, The State University of New Jersey, New Brunswick, NJ, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Lee K, Egbe CO, Bianco E, Arora M. The 20th anniversary of the WHO Framework Convention on Tobacco Control: hard won progress amid evolving challenges. Lancet 2023; 402:592-594. [PMID: 37263281 DOI: 10.1016/s0140-6736(23)01080-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Kelley Lee
- Pacific Institute on Pathogens, Pandemics and Society, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Eduardo Bianco
- The Ulrich and Frank Foundation for International Health, Philadelphia, PA, USA; Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
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20
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Edwards R, Thomas L, Stanley J, Hoek J. New Zealand adolescents' responses to plain packaging and new pictorial warning labels: Repeat cross-sectional survey analysis. Aust N Z J Public Health 2023; 47:100066. [PMID: 37302905 DOI: 10.1016/j.anzjph.2023.100066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 04/17/2023] [Accepted: 04/28/2023] [Indexed: 06/13/2023] Open
Abstract
OBJECTIVE This article aims to examine the impact on adolescents of New Zealand's 2018 legislation introducing plain (standardised) packaging and enhanced pictorial warning labels (PWLs). METHODS Data came from Year 10 (14-15 years old) students in the 2016 (2,884 participants) and 2018 (2,689 participants) Youth Insights Surveys conducted 2 years before and immediately after legislation implementation. We used binary and ordinal logistic regression to investigate changes in brand awareness and preference, brand and pack appeal, and PWL salience and impact. RESULTS The proportion of all participants, and ever, ex/experimental and current smokers who could name one or five tobacco product brands decreased in 2018. There was a modest and nonstatistically significant decrease in the proportion of current smokers citing brand name and image, and a larger decrease in the proportion stating perceived harm to health, influenced preferred brand choice. Having a preferred brand among current smokers and pack appeal, and PWL salience and impact among ex/experimental and current smokers were largely unchanged. CONCLUSIONS We found preliminary evidence that plain packaging and enhanced PWLs reduced tobacco brand awareness and salience, and misperceptions about tobacco brand harmfulness. Data collection occurred shortly after implementation. Additional studies are required to assess longer term impacts of these interventions. PUBLIC HEALTH IMPLICATIONS The findings complement existing evidence documenting the impact of plain packaging and PWLs on adolescents. Given limitations due to the proximity of the 2018 survey to legislation implementation, further studies with longer follow-up are required.
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Affiliation(s)
- Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand.
| | - Lathan Thomas
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - James Stanley
- Dean's Department, University of Otago, Wellington, New Zealand
| | - Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
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Jongenelis MI, Robinson A, Hughes A, Pettigrew S. Perceptions of a prescription model for accessing nicotine vaping products: an examination of submissions made by self-reported e-cigarette users to an Australian consultation. Health Promot Int 2023; 38:daad080. [PMID: 37555700 PMCID: PMC10411036 DOI: 10.1093/heapro/daad080] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
In response to rapid and substantial increases in rates of e-cigarette use among young people, Australia's Therapeutic Goods Administration (TGA) made changes to the regulations governing nicotine vaping products. As part of the regulatory change process, Australians were invited to comment on the proposed regulations, which featured the introduction of a prescription model for nicotine vaping products. To inform strategies to enhance compliance with the tightened regulations, this study examined submissions made by self-reported e-cigarette users to the TGA's public consultation (n = 1405). A content analysis was conducted to identify and quantify key arguments. Claims about possible negative consequences associated with the regulations (e.g. people will return to smoking, inconvenience) featured in most submissions (84%). Around half (55%) of submissions mentioned perceived benefits of e-cigarettes, including favourable health outcomes (e.g. improved breathing) and enhanced tobacco cessation. Around half (52%) featured concerns about inconsistency in treatment and the argument that e-cigarettes should not be restricted when more harmful tobacco products are readily available. Alternative approaches to a prescription model were offered in nearly one-third (31%) of submissions. One-quarter (26%) included text provided by an industry-led astroturfing campaign. The arguments made in the analysed submissions suggest a lack of appreciation of (i) the negative health outcomes associated with e-cigarette use and (ii) evidence linking these devices to smoking relapse. Results highlight the need for targeted health campaigns that address (i) gaps in consumers' knowledge and (ii) vaping-related misinformation being promulgated by the industry and its allies.
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Affiliation(s)
- Michelle I Jongenelis
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Abby Robinson
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Anastasia Hughes
- Melbourne Centre for Behaviour Change, Melbourne School of Psychological Sciences, University of Melbourne, Parkville, VIC 3010, Australia
| | - Simone Pettigrew
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
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22
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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: 1] [Impact Index Per Article: 1.0] [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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Spillane TE, Madar A, Cohen JE, Welding K, Clegg Smith K. Tobacco companies' creation of additional communication space: a content analysis of cigarette pack inserts and onserts. Tob Control 2023:tc-2023-057982. [PMID: 37380350 DOI: 10.1136/tc-2023-057982] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/08/2023] [Indexed: 06/30/2023]
Abstract
OBJECTIVES Pack inserts and onserts-removable items placed inside or on the outside of packs-are a communicative strategy used by tobacco companies that provide them with additional marketing space. A content analysis of these items was conducted across several years, countries and brands to assess how these items are used to communicate with consumers. METHODS Between 2013 and 2020, cigarette packs were systematically collected using the Tobacco Pack Surveillance System protocol. Packs with inserts or onserts (n=178) were identified from 11 low and middle-income countries. Packs were coded for tobacco company strategies, physical pack characteristics and imagery and lexical marketing appeals. RESULTS Of the 5903 packs, 3% (n=178) had an insert or onsert. 171 of these (96%) were inserts. While most (78%) pack exteriors were entirely in English, over half (51%) of the inserts/onserts were entirely in the local (non-English) language from where the pack was collected. The most common appeals on the inserts/onserts were product dependability (64%), luxury/aspirational (55%) and machinery/technology (37%). Product images were prevalent as well as images or words mentioning filters (22%). The most used appeals involved featuring aspects of a product (66%), addressing customers directly (52%) and informing customers about new aspects of a product (31%). CONCLUSIONS Cigarette pack inserts/onserts are unregulated in many countries and provide additional space for tobacco companies to extend and innovate their advertising. Tobacco advertising and packaging policies such as plain and standardised packaging should expand to address inserts/onserts to protect consumers more fully from industry promotion of deadly products.
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Affiliation(s)
- Torra E Spillane
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Alena Madar
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Kevin Welding
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
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Giovenco DP, Ganz O, Chen-Sankey J, Delnevo CD. Camel Crush pack inserts cross-promote Vuse menthol e-cigarettes ahead of impending menthol cigarette ban. Tob Control 2023:tc-2023-057959. [PMID: 37702704 PMCID: PMC10868407 DOI: 10.1136/tc-2023-057959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 03/29/2023] [Indexed: 09/14/2023]
Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Julia Chen-Sankey
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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Guo Y, Xu Y, Chen D. Impact of Visual Elements of Tobacco Packaging on Health Risk Perceptions of Youth Groups. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14097. [PMID: 36360972 PMCID: PMC9659161 DOI: 10.3390/ijerph192114097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/26/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
Tobacco products are hazardous to public health and are one of the greater public health threats facing the world to date. Although international research on tobacco packaging has been thorough and comprehensive, the risk perception of visual elements in tobacco packaging varies by country, race, and smoking status. Therefore, the study aimed to investigate the risk perceptions of visual elements in tobacco packaging among young and middle-aged people in selected cities in China. This study used a questionnaire to construct an index system for visual elements of tobacco packaging and used it to design a related questionnaire. Our group conducted an online questionnaire survey among 296 young people (18-44 years old) in selected cities in China between 16 June and 26 June 2022. The results of the influence of visual elements of tobacco packaging on the perception of tobacco health risks in the youth group were analyzed by SPSS 26.0. A chi-square test analysis yielded differences in the perception of tobacco package color among youths with different smoking status. A linear regression analysis revealed that age group and visual elements were significant, and five groups of visual element comparisons had an effect on the youth group. First, there were differences in the perceptions of tobacco products among participants with different smoking status. Secondly, the more youthful the respondents were, the greater the probability that they were able to identify that the picture fitness warnings had a greater probability of making them conscious of the fitness dangers of smoking (p < 0.05). The older the participants, the greater the probability that the textual content fitness warnings made them conscious of the fitness risks of smoking (p < 0.05). Third, the percentage of health warnings did not make a good-sized impact for the youth groups (p > 0.05). Fourth, the more youthful the participant, the greater the probability that cigarette products with whole brand images would appeal to buyer(p < 0.01).
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Affiliation(s)
- Yanlong Guo
- Social Innovation Design Research Centre, Anhui University, Hefei 203106, China
- Anhui Institute of Contemporary Studies, Anhui Academy of Social Sciences, Hefei 203106, China
| | - Yinrui Xu
- Social Innovation Design Research Centre, Anhui University, Hefei 203106, China
| | - Denghang Chen
- Department of Science and Technology Communication, University of Science and Technology of China, Hefei 203106, China
- Research Center for Science Communication, Chinese Academy of Sciences, Hefei 203106, China
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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: 2] [Impact Index Per Article: 1.0] [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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