The effect of branded versus standardized e-cigarette packaging and device designs: an experimental study of youth interest in vaping products

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.

Comparing closure compliance and ease of use for consumer product packs designed to reduce access to children

Child impeding packs are difficult for children to open so protect them from unintended access to hazardous contents inside the pack. However, if packs are difficult for adults to open, in normal usage scenarios, this may result in a higher occurrence of packs being left open. This research explores differences in ease of usage and closure compliance between two types of child impeding packs of liquid laundry detergent capsules. The two packs, "Pinch & Lift" and "Press & Lift", had different opening and closing mechanisms. "Press & Lift" also included an audible "click" signal to confirm complete closure to the user. The research was performed across two studies. In both studies, the packs were used in participants' homes according to their usual storage and usage practices as replacements to their current liquid laundry detergent capsule pack. All participants had small children living with them in their household. In Study 1, self-reported closure and ease of use data was collected from 99 adult participants in Germany. They used each package in their home for 10 days. Study 2 extended Study 1 by measuring closure rates with an objective assessment using in pack sensors for a 10-day period for each pack. Self-reported closure and ease of use data were also collected. Study 2 was conducted with 87 participants in the United Kingdom. Results across both studies showed "Press & Lift" with the audible "Click" close signal to be rated by participants to be significantly easier to open and close and have a higher self-reported closure rate than "Pinch & Lift". In addition, Study 2 results demonstrated higher closure rates using "Press & Lift" based on the sensor-measured closure compliance. Together, the results suggest transition to a pack with a mechanism that is child impeding and easier for an adult to use with an audible closure signal, like the "Press & Lift" system, has potential to reduce child access to a capsule from a pack by reducing the likelihood of the pack being left open by the adult user. Ultimately, such packs could protect children from potential poisoning injury across a range of consumer products.

Culturally specific health-related features on cigarette packs sold in China

BACKGROUND

China is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy.

METHODS

We used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is 'healthy' or 'good for you'. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time.

RESULTS

Overall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one 'healthy' or 'good for you' feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint).

CONCLUSION

Health-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.

Appeal rating and visual attention associated with youth-appealing cannabis packaging: An eye-tracking experiment

BACKGROUND

Cannabis-infused edibles have grown in popularity particularly among young people in the United States. Youth-appealing cannabis packaging is common and associated with concerns on its public health impacts. This study aims to assess associations of youth-appealing cannabis edible package attributes with appeal ratings and visual attention of young adults.

METHODS

Seventy-two young adults participated in an eye-tracking experiment, in which each participant viewed seven randomly ordered cannabis edible package images with varying youth-appealing attributes, including a cartoon character, a young adult model, bubble font, berry flavor, and gummy bear shape. Two primary outcomes were assessed: 1) appeal ratings elicited on a scale from 0 to 10 based on self-reporting, and 2) fixation durations on predefined areas of interest in the package images based on eye-tracking data. Multivariate linear regressions were conducted to assess associations.

RESULTS

Packages containing a cartoon character, bubble font, berry flavor, or gummy bear shape received higher appeal ratings than the package with no youth-appealing attributes. Youth-appealing attributes received longer fixation durations than non-youth-appealing attributes. The presence of any youth-appealing attribute is associated with reduced fixation durations on the warning label, with the largest reduction in the package with multiple youth-appealing attributes.

CONCLUSIONS

Youth-appealing attributes on cannabis edible packages are associated with higher appeal ratings, more visual attention towards those attributes, and less visual attention towards warning labels among young adults in the United States. Regulations banning youth-appealing attributes may be effective in reducing appeal of cannabis edibles and increasing attention towards warning labels.

Graphic health warnings and plain packaging in the Philippines: results of online and household surveys

In line with Article 11 of the WHO Framework Convention on Tobacco Control, the Philippines has implemented graphic health warnings on cigarette packs. To date, there has been no published literature evaluating the perceived effectiveness of GHWs in the Philippines. This study aims to contribute to the evidence on the perceived effects of graphic health warnings (GHWs) in cigarette packaging and the potential impact of plain packaging in the Philippines. The study involved an online convenience survey and a nationwide household survey. Mock-up sets of cigarette packs based on the Philippines' law on GHWs, and Thailand's and Singapore's plain packaging were shown to respondents to rate their attractiveness, quality, taste, cost, social appeal, appeal to youth, noticeability, appeal to non-smokers, attempt to quit, ease of quitting, discouraging smoking, and perceived harm to health on a five-point Lickert scale. The online and household surveys recruited 2,701 respondents in total. Online and household survey respondents considered plain packaging with larger graphic health warnings and visible quitlines from Thailand and Singapore to be more effective in discouraging them from smoking. Both sets of survey respondents also found mock-ups from Thailand and Singapore more motivating for them to attempt quitting than cigarette pack mock-ups from the Philippines. The study concludes that current graphic health warnings in the Philippines are ineffective in instilling health consciousness among Filipinos. Policymakers should consider larger graphic health warnings and plain packaging of cigarettes to motivate smokers to quit and discourage Filipinos from smoking.

New Zealand adolescents' responses to plain packaging and new pictorial warning labels: Repeat cross-sectional survey analysis

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.

Colours, capsules and concept flavour names on cigarette packs appeal to youth in Mexico

BACKGROUND

Flavoured cigarettes are popular in Mexico. We examined how cigarette packaging design features used to communicate flavour influence perceptions of appeal, harm, perceived interest and pack preference among Mexico City residents.

METHODS

We conducted an experimental survey. Participants aged 13-34 years were randomly assigned to one of three conditions, viewed packs with systematically manipulated design features (colour, capsule image and flavour name) and answered questions on appeal, perceived harm, perceived interest and pack preference. Data were analysed using mixed effects and conditional logistic regression.

RESULTS

1500 adolescents and 950 adults participated. Regardless of flavour, cigarette packs with a background colour and capsule image were more appealing to adolescents (OR=13.19, 95% CI 11.53 to 15.10; OR=1.68, 95% CI 1.45 to 1.88) and adults (OR=4.18, 95% CI 3.73 to 4.69; OR=1.66, 95% CI 1.49 to 1.85) than packs without. Among adolescents, 'Tropical Burst' named packs were more appealing (OR=1.43, 95% CI 1.20 to 1.72) than packs without a flavour name and among adults, 'Arctic Air' named packs were more appealing (OR=1.20, 95% CI 1.02 to 1.14). Adolescents and adults reported a preference for trying packs that displayed a flavour name, background colour or capsule image (b=0.104, b=0.702, b=1.316, p<0.001 and b=0.126, b=0.619, b=0.775, p<0.001).

CONCLUSIONS

Colours and flavour capsule images appeal to adolescents and adults in Mexico. Mexico should consider adopting plain packaging to reduce appeal and interest.

Influence of cigarette packet branding and colours on young male smokers' recognition, appeal and harm perceptions of tobacco brands in Cambodia: a mixed-methods study

OBJECTIVES

To explore how cigarette packet branding and colours influence young male smokers' perceptions of tobacco brands in Cambodia.

DESIGN

Mixed-methods study.

SETTING

Worksites, living accommodations, a university and public locations in Phnom Penh, Cambodia.

PARTICIPANTS

147 male Cambodian smokers (18-24 years).

INTERVENTIONS

Participants were shown mock-up pictures of different cigarette packet branding and colour variations and asked to respond to close-ended and short-response questions.

OUTCOME MEASURES

Brand recognition, appeal and harm perceptions of cigarette packet branding and colours.

RESULTS

When shown three packets with brand names removed, 98.6% of participants recognised packet one as Mevius brand, 21.1% recognised packet two as Marlboro and 38.8% recognised packet three as 555. For the three fully-branded and three matching plain packets, most participants selected a fully-branded packet as the most appealing taste (83.0%) and most appealing to youth (81.7%). Participants described their chosen brand as appealing due to beliefs about its superior taste/quality, reduced harm and symbolic attitudes surrounding tobacco brands and smokers of different brands in a social status hierarchy. When shown six different colours of unbranded packets, participants selected the blue packet (51.0%) as the most appealing for taste, the white packet as the least harmful (25.2%), and the red (15.0%) and black (12.9%) packets as the most harmful to health. They described their associations of packet colours with abstract imagery concerning smoking-related harms and their future well-being.

CONCLUSIONS

Findings suggest that packet branding and colours influence young male smokers' recognition, appeal and harm perceptions of tobacco brands in Cambodia and remain an influential marketing tool for tobacco companies where advertising is banned. Consequently, Cambodia and other low and middle-income countries in Southeast Asia should implement plain packaging.

The packaging and clean method contribute to insulation failure of electrosurgical instruments

With the rapid development of medical technology, the use of electrosurgical instruments is dramatically increased in various types of surgery. However, the damage of the insulation layer of the reusable electrosurgical instrument often causes surgical accidents. The procedures of packaging and cleaning contribute to many damages to insulating layer of reusable electrosurgical instruments.Various types of reusable electrosurgical instruments were detected for insulation failures, conduction failures, short-circuit by using a high-voltage detector, DIATEG (Morgate company). In addition, reusable electrosurgical instruments were detected for insulation failures after packaging and cleaning by different procedures.13.1% (129/740) electrosurgical instruments had an insulation test failure; 6.2% (9/146) monopolar wires were with conduction failure; and 7.7% (16/207) bipolar wires were with short-circuit. Different packaging and cleaning procedures contribute to various degrees of damages to insulating property of reusable electrosurgical instruments.Insulation failure was a wide problem of reusable electrosurgical instruments, while fixed packaging method and mild cleaning procedures result in fewer damages to insulating property of reusable electrosurgical instruments.

Quarantine supervision of Wood Packaging Materials (WPM) at Chinese ports of entry from 2003 to 2016

Exotic pests have caused huge losses to agriculture, forestry, and human health. Analyzing information on all concerned pest species and their origin will help to improve the inspection procedures and will help to clarify the relative risks of imported cargo and formulate international trade policies. Records of intercepted pests from wood packaging materials (WPM) from 2003 to 2016 in the China Port Information Network (CPIN) database were analyzed. Results showed that the number of intercepted pests from WPM was lowest in the first quarter and highest in the fourth one. The total number of interceptions increased each year, with 53.33% of intercepted insects followed by nematodes (31.54%). The original continent of most intercepted pests was Asia (49.29%). Xylophagous insects were primarily intercepted from Southeast Asian countries, whereas nematodes were primarily intercepted from Korea, Australia, Mexico, and other countries. WPM interception records were mainly concentrated in China's coastal inspection stations (98.7%), with the largest number of interceptions documented in Shanghai, followed by the inspection stations of Jiangsu Province. The proportion of pest taxa intercepted by the Chinese provinces' stations each year is becoming increasingly balanced. The number of pest disposal treatment measures for intercepted cargoes with dead non-quarantine pests increased significantly from 2012 to 2016. This reflects the fact that Chinese customs inspection stations are becoming increasingly scientific and standardizing the interception and treatment of WPM pests. The issues reflected in the database, with a view to providing a reference for future work by customs officers and researchers.

Fabrication of Paper Sheets Coatings Based on Chitosan/Bacterial Nanocellulose/ZnO with Enhanced Antibacterial and Mechanical Properties

Here, we designed paper sheets coated with chitosan, bacterial cellulose (nanofibers), and ZnO with boosted antibacterial and mechanical activity. We investigated the compositions, with ZnO exhibiting two different sizes/shapes: (1) rods and (2) irregular sphere-like particles. The proposed processing of bacterial cellulose resulted in the formation of nanofibers. Antimicrobial behavior was tested using E. coli ATCC® 25922™ following the ASTM E2149-13a standard. The mechanical properties of the paper sheets were measured by comparing tearing resistance, tensile strength, and bursting strength according to the ISO 5270 standard. The results showed an increased antibacterial response (assigned to the combination of chitosan and ZnO, independent of its shape and size) and boosted mechanical properties. Therefore, the proposed composition is an interesting multifunctional mixture for coatings in food packaging applications.

Tackling the toxics in plastics packaging

The widespread use of plastic packaging for storing, transporting, and conveniently preparing or serving foodstuffs is significantly contributing to the global plastic pollution crisis. This has led to many efforts directed toward amending plastic packaging’s end of life, such as recycling, or alternative material approaches, like increasingly using paper for food packaging. But these approaches often neglect the critical issue of chemical migration: When contacting foodstuffs, chemicals that are present in packaging transfer into food and thus unwittingly become part of the human diet. Hazardous chemicals, such as endocrine disrupters, carcinogens, or substances that bioaccumulate, are collectively referred to as “chemicals of concern.” They can transfer from plastic packaging into food, together with other unknown or toxicologically uncharacterized chemicals. This chemical transfer is scientifically undisputed and makes plastic packaging a known, and avoidable, source of human exposure to synthetic, hazardous, and untested chemicals. Here, I discuss this issue and highlight aspects in need of improvement, namely the way that chemicals present in food packaging are assessed for toxicity. Further, I provide an outlook on how chemical contamination from food packaging could be addressed in the future. Robust innovations must attempt systemic change and tackle the issue of plastic pollution and chemical migration in a way that integrates all existing knowledge.

The widespread use of plastic packaging for storing, transporting, and conveniently preparing or serving foodstuffs is significantly contributing to the global plastic pollution crisis. This Essay exhorts us to change the conversation about plastic packaging and address the chemicals that migrate into food.

Liquefaction of starch using solid-acid catalysts derived from spent coffee for the production of plasticized poly (vinyl alcohol) films

This paper reports a strategy for preparing polyether polyols from corn starch, with (i) a mixture of polyethylene glycol 400 and glycerin (7:3, w/w) as the liquefying solvent and (ii) a spent-coffee-derived solid-acid catalyst (SC-SAC) (1:10, w/w, SC-SAC/starch) at 433 K for 1.5 h, under which conditions the liquefaction yield exceeded 99 %. The SC-SAC was prepared via hydrothermal carbonization at 453 K for 12 h, followed by sulfonation with H₂SO₄ at 343 K for 10 h. The liquefied starch product (SLP) was then used to plasticize poly(vinyl alcohol) (PVA) films with various mixing ratios. The optimal 0.4 SLP/PVA blend film exhibited good mechanical properties (tensile strength 38.07 MPa, elongation at break 1199 %), good transparency, and excellent flexibility. The results highlight the possibility of using SLP/PVA films in the development of degradable packaging materials.

Improvement of Impact Strength of Polylactide Blends with a Thermoplastic Elastomer Compatibilized with Biobased Maleinized Linseed Oil for Applications in Rigid Packaging

This research work reports the potential of maleinized linseed oil (MLO) as biobased compatibilizer in polylactide (PLA) and a thermoplastic elastomer, namely, polystyrene-b-(ethylene-ran-butylene)-b-styrene (SEBS) blends (PLA/SEBS), with improved impact strength for the packaging industry. The effects of MLO are compared with a conventional polystyrene-b-poly(ethylene-ran-butylene)-b-polystyrene-graft-maleic anhydride terpolymer (SEBS-g-MA) since it is widely used in these blends. Uncompatibilized and compatibilized PLA/SEBS blends can be manufactured by extrusion and then shaped into standard samples for further characterization by mechanical, thermal, morphological, dynamical-mechanical, wetting and colour standard tests. The obtained results indicate that the uncompatibilized PLA/SEBS blend containing 20 wt.% SEBS gives improved toughness (4.8 kJ/m²) compared to neat PLA (1.3 kJ/m²). Nevertheless, the same blend compatibilized with MLO leads to an increase in impact strength up to 6.1 kJ/m², thus giving evidence of the potential of MLO to compete with other petroleum-derived compatibilizers to obtain tough PLA formulations. MLO also provides increased ductile properties, since neat PLA is a brittle polymer with an elongation at break of 7.4%, while its blend with 20 wt.% SEBS and MLO as compatibilizer offers an elongation at break of 50.2%, much higher than that provided by typical SEBS-g-MA compatibilizer (10.1%). MLO provides a slight decrease (about 3 °C lower) in the glass transition temperature (T_g) of the PLA-rich phase, thus showing some plasticization effects. Although MLO addition leads to some yellowing due to its intrinsic yellow colour, this can contribute to serving as a UV light barrier with interesting applications in the packaging industry. Therefore, MLO represents a cost-effective and sustainable solution to the use of conventional petroleum-derived compatibilizers.

Perceptions of U.S. and Canadian Cannabis Package Warnings Among U.S. Adults

BACKGROUND

Cannabis warning labels can communicate risks, but there is little research on warning perceptions and differences by product type.

METHODS

In a 2019 online survey, 1,000 U.S. adults (500 cannabis users and 500 cannabis non-users who used tobacco) were randomly assigned to view no warning or one of four U.S. or Canadian warnings displayed on images of packaging for dried flower or edible cannabis. The warnings described cannabis risks related to psychosis, addiction, lack of FDA oversight, and impaired driving. We used linear regression to examine perceptions of warnings and product harm as a function of product type (dried or edible) and warning. We examined which warning participants selected as most effective for discouraging youth use and impaired driving.

RESULTS

Participants found the addiction warning (cannabis users: B = -1.04, p < 0.001; cannabis non-users: B = 1.17, p < 0.001) and psychosis warning (users: B = -0.65, p < 0.05; non-users: B = -0.71, p < 0.05) less believable than the driving warning but indicated that they learned more from the psychosis warning than the driving warning (users: B = 0.88, p < 0.01; non-users (B = 1.60, p < 0.001). Participants viewing any warning considered smoking cannabis to be more harmful than those viewing no warning (all p < 0.05). The psychosis warning was most frequently selected as the best warning for discouraging youth use.

CONCLUSIONS

Warnings have the potential to educate consumers and impact cannabis harm perceptions. Warnings have similar effects across product types, potentially eliminating the need for product type-specific warnings. The association of cannabis use with risk for psychosis, a topic addressed in Canadian warnings, could be a useful topic of focus in U.S. warnings.

Size matters: An analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017

INTRODUCTION

The tobacco industry (TI) has used small cigarette pack sizes to encourage brand-switching and consumption, and to mitigate the impacts of tobacco tax increases. Since 2016, the European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes. We examined cigarette pack sizes in the EU and whether pack size composition differed between cheap and expensive price segments, as well as the impact of the revised TPD.

METHODS

We conducted a longitudinal analysis of pricing data from 23 EU countries between 2006-2017. We examined pack sizes over time to assess the impact of the TPD, differences in pack size composition between cheap and expensive price segments, and compared gaps in median prices between products using actual and 'expected' prices (price if all packs contained 20 sticks).

RESULTS

Cigarette pack sizes changed over time, across the EU. The distribution of pack sizes varied between price segments, with small pack sizes especially frequent in the cheap segment of the cigarette market, but this varied over time and across countries. Packs of <20 cigarettes almost disappeared from the data samples after implementation of the TPD.

CONCLUSION

Implementation of the TPD appears to have virtually eliminated packs with <20 cigarettes, restricting their use by the TI. Our analysis suggests pack sizes have been used differentially across the EU. Country-level analyses on the industry's use of pack sizes, consumer responses, and evaluations of restricting certain pack sizes are needed to confirm our findings and strengthen policy.

Cigarette Packs With URLs Leading to Tobacco Company Websites: Content Analysis

BACKGROUND

Tobacco companies include on the packaging of their products URLs directing consumers to websites that contain protobacco messages. Online media tend to be underregulated and provide the industry with an opportunity to present users with protobacco communication.

OBJECTIVE

The objective of our study was to document the content of websites that were advertised on tobacco packs in 14 low- and middle-income countries.

METHODS

We purchased tobacco packs from 14 low- and middle-income countries in 2013 and examined them for the presence of URLs. We visited unique URLs on multiple occasions between October 1, 2016 and August 9, 2017. We developed a coding checklist and used it to conduct a content analysis of active corporate websites to identify types of protobacco communication. The coding checklist included the presence of regulatory controls and warnings, engagement strategies, marketing appeals (eg, description of product popularity, luxury/quality, taste), corporate social responsibility programs, and image management. We coded brand websites separately and also described social media and other website types.

RESULTS

We identified 89 unique URLs, of which 54 were active during the search period. We assessed 26 corporate websites, 21 brand websites, 2 nontobacco websites, and 5 social media pages. We excluded 2 corporate websites and 14 brand websites due to limited accessible content or incomplete content. Corporate social responsibility was discussed on all corporate websites, and marketing appeals were also common. Corporate websites were also more likely to include more nonspecific (12/24, 50%) than specific (7/24, 29%) health warnings. Promotions (6/7, 86%) and sociability appeals (3/7, 43%) were common on brand websites. The small number of social media webpages in our sample used gendered marketing.

CONCLUSIONS

URLs appearing on tobacco packs direct consumers to websites where users are exposed to marketing that highlights the "positive" contributions of tobacco companies on corporate websites, and extensive promotions and marketing appeals on brand websites and social media pages. It is essential that marketing regulations become more comprehensive and ban all protobacco communication, a policy that is in line with articles 5.3 and 13 of the World Health Organization Framework Convention on Tobacco Control. For countries that already ban internet tobacco advertising, enforcement efforts should be strengthened. Tobacco companies' use of URLs on packs may also be compelling for plain packaging advocacy, where all branding is removed from the pack and large graphic health warning labels are the only communication on the tobacco packaging. Future research should consider including tobacco websites in marketing surveillance.

Smokers' Perceptions of Cigarette Packaging With Audio Warning Messages: A Focus Group Study in Scotland

AIMS

The use of audio pack cues or messages is a recent trend in packaging design. There is scope to use audio technology to communicate health and cessation messages via cigarette packaging. We explored how smokers responded to cigarette packs which played audio health messages.

METHODS

Twenty focus groups were conducted in Scotland in 2015 with smokers (n = 120) segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender and social grade. Perceptions of cigarette packs which played audio warnings were explored, with four messages used: (1) a cessation message with a quitline number, (2) mortality message, (3) fertility message, and (4) message about ageing skin.

RESULTS

Audio warnings were thought to increase message impact, particularly among younger smokers, as they would be hard to ignore or avoid, and repetition may lead to the messages being memorized. The warnings were considered annoying or embarrassing, and participants suggested they may discard the packs and use alternative storage. Some participants suggested that the audio warnings were off-putting and may alter their smoking behavior, with the mortality message deemed most effective and was considered relatable and felt personal. Older smokers were least likely to believe that audio warnings would affect their smoking behavior, although some thought that they may enhance cessation attempts among smokers seeking to quit, and could deter new or potential smokers, for example, young people.

CONCLUSIONS

Cigarette packs with audio messaging may have a role to play, now or in the future, as a novel way of communicating health and cessation information.

IMPLICATIONS

There is a lack of research exploring smokers' perceptions of cigarette packs which play audio health messages. This focus group study provides an understanding of smokers' immediate responses to cigarette packs which played a short health message when opened. Smokers generally viewed them as annoying or embarrassing, and some suggested the use of alternative storage. Audio warnings were thought to increase message salience, memorability, and impact, for younger smokers in particular, and some suggested that they be off-putting for themselves or others.

Trends in and Correlates of Use of Roll-Your-Own Cigarettes: A Population Study in England 2008-2017

INTRODUCTION

Understanding the use of cheaper roll-your-own (RYO) cigarettes may have implications for tobacco tax policy. We examined trends in RYO cigarette use in England between 2008 and 2017, and characterized users' sociodemographic and smoking profiles.

METHODS

We used data from 211 469 respondents to a survey representative of the adult (≥16 years) population. In current smokers across the entire study period (n = 43 389), we assessed multivariable associations between cigarette type (RYO or factory-made [FM]) and sociodemographic and smoking characteristics. Among current smokers in 2008 and 2017 (n = 7685), we tested interactions between year and cigarette type to assess the stability of each characteristic.

RESULTS

Between 2008 and 2017, FM cigarette use declined from 15.3% to 9.2% whereas RYO use increased from 6.7% to 8.1%. Greater odds of RYO use were observed among younger, male smokers from lower social grades, who were more addicted and used electronic cigarettes (ORrange = 1.28-1.86, p < .001). Lower odds of RYO use were observed among nondaily smokers, those with high motivation to stop, and higher spending on smoking (ORrange = 0.46-0.89, p ≤ .001). The RYO smoker profile was relatively stable between 2008 and 2017. However, compared with FM use, RYO use increased in younger (p < .001) and female (p = .019) smokers, and there was a relatively smaller decline in the proportion cutting down or trying to quit (p = .004).

CONCLUSION

In England, RYO use increased when overall smoking prevalence and FM use decreased. The profile of RYO smokers remained relatively stable, with users typically younger, male, more addicted, deprived, spending less on smoking, and less inclined to quit than FM smokers.

IMPLICATIONS

This population-based study provides novel insight into recent trends in RYO use in England, providing an up-to-date understanding of the profile of RYO smokers. Without the consistent application of tax across the range of combustible products, smokers who are more dependent are able to capitalize on the lower cost of RYO in order to continue smoking, undermining the potential benefit of taxation on cessation.

Changes in roll-your-own tobacco and cigarette sales volume and prices before, during and after plain packaging legislation in the UK

BACKGROUND

Plain packaging and minimum pack size legislation for tobacco products was introduced in the UK in May 2016, with a 1-year sell-off period until May 2017, during which both fully branded and plain packs of various sizes were legally available. This study investigates trends in prices of roll-your-own tobacco (RYO) before, during and after implementation of this legislation, and compares trends with those observed in the cigarette market.

METHODS

We used Nielsen Scantrack data for the period from March 2013 to June 2018 to describe trends in UK inflation-adjusted prices and volumes of both RYO and cigarettes, and linear regression to estimate changes in prices associated with the introduction of plain packaging and the minimum pack sizes of 30 g RYO and 20 cigarettes.

RESULTS

In contrast to a downward trend in cigarette sales volumes, RYO volumes rose throughout the study period. By the time plain packs accounted for 75% or more of sales, the average price of products sold in equivalent pack sizes had increased, relative to average prices in the year before implementation and with adjustment for tax changes, from 34.9 to 38.8 pence per gram for RYO (mean difference 4.26, 95% CI 3.99 to 4.53 pence, 12% increase), and from 38.6 to 41.13 pence for cigarettes (mean difference 2.53, 95% CI 2.24 to 2.83 pence, 7% increase) per cigarette.

CONCLUSIONS

New legislation resulted in higher prices for RYO and manufactured cigarettes. However, sales volumes of RYO continued to increase throughout the study period, perhaps because RYO remains a less expensive means of smoking tobacco.

Perceptions of plain cigarette packaging among smokers and non-smokers in Andalusia (Spain)

OBJECTIVES

Each year tobacco is responsible for 650,000 deaths in Europe and 55,000 in Spain. With tobacco advertising and promotion banned in Spain and most of Europe, the last bastion of marketing is the packaging. Plain tobacco packaging -which involves packs having a standardised appearance- has been proposed to counter this. The objective of this study is to research perceptions arising from the plain packaging of tobacco products.

METHODS

We employed a qualitative research methodology -focus groups- with smokers and non-smokers in in two medium-sized Andalusian towns (Spain).

RESULTS

Results show the importance of plain cigarette packaging as a form of promotion, particularly among women and young people, how pack colour influences product perceptions, and how removing full branding increases the salience of the warnings.

CONCLUSIONS

Plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking.

Plain tobacco packaging, increased graphic health warnings and adolescents' perceptions and initiation of smoking: DePICT, a French nationwide study

BACKGROUND

Plain packaging (PP) of tobacco products and increased graphic warnings may contribute to lower attractiveness of smoking, particularly among youths. In France, this policy was introduced on 1 January 2017. We examined changes in smoking-related perceptions and behaviours among a nationwide sample of French adolescents before (2016) and 1 year post (2017) implementation.

METHODS

DePICT is a two-wave cross-sectional national telephone survey of adolescents aged 12-17 years per study wave (2016: n=2046 2017: n=1999). All participants reported smoking-related perceptions, as well as ever and current tobacco use. Smokers were also asked about their perceptions of tobacco brands. Data were weighted to be representative of youths in the French population: adjusted prevalence ratios (PRs, 95% CI) estimating changes between the two study waves were calculated using multivariate log-binomial regression models.

RESULTS

In 2017, as compared with 2016, French adolescents were more likely to report fear of the consequences of smoking (PR=1.06, 95% CI 1.02 to 1.09) and that smoking is dangerous (PR=1.08, 95% CI 1.05 to 1.11). They were also less likely to report that their friends (PR=0.61, 95% CI 0.54 to 0.70) and family (PR=0.51, 95% CI 0.44 to 0.60) accept smoking. Additionally, smoking initiation significantly decreased (PR=0.96, 95% CI 0.93 to 0.98) and a non-statistically significant drop in current tobacco use was observed (PR=0.93, 95% CI 0.78 to 1.11). Smokers' attachment to their tobacco brand also decreased (PR=0.47, 95% CI 0.30 to 0.73).

CONCLUSION

Our findings suggest that PP and increased graphic warnings could contribute to changes in smoking norms and rates among adolescents.

Exploiting the "video game craze": A case study of the tobacco industry's use of video games as a marketing tool

BACKGROUND

Video games have grown in popularity since the 1970s, and tobacco imagery is present in a substantial subset of games, including those oriented to youth. Much like exposure to tobacco content in films, exposure to tobacco content in video games may influence smoking uptake and use; however, the tobacco industry's role in facilitating or promoting the use of tobacco imagery in video games is unclear. We explored the industry's interest in and use of video games to market their products to youth and young adults.

METHODS

We retrieved and analyzed archival tobacco industry documents. We supplemented information from the documents with current and archived versions of several brand and corporate websites and one website containing user-supplied information on video games.

RESULTS

Tobacco companies recognized the youth appeal and marketing potential of video games as early as 1980. Initial marketing ideas included incorporating video game themes into product packaging and design. More fully realized plans focused on incorporating video games into product promotions in bars, as a high visibility way to attract younger patrons and increase long-term marketing opportunities by generating names for tobacco company direct-marketing databases. Tobacco companies also incorporated video games into in-home product promotions, primarily as components of brand websites, in order to enhance brand image and generate repeat website traffic. A similar desire to attract and keep visitors led to discussions about the inclusion of video games on corporate youth smoking prevention websites, although only one company, Lorillard, followed through.

CONCLUSIONS

Video game players are an attractive target market for tobacco companies. Video games, as used by these companies, facilitate consumer engagement with particular tobacco brands or particular corporate messages. Eliminating the use of video games as a promotional vehicle may require limiting tobacco marketing in both physical and online environments.

Difference between recommended retail price and sales price for tobacco products in independent and convenience (small) retailers before and after the introduction of standardised tobacco packaging in the UK

AIM

Recommended retail price (RRP) is a marketing strategy used by tobacco companies to maintain competitiveness, communicate product positioning and drive sales. We explored small retailer adherence to RRP before and after the introduction of the Standardised Packaging of Tobacco Products Regulations in the UK (fully implemented on 20 May 2017) which mandated standardised packaging of cigarettes and rolling tobacco, set minimum pack/pouch sizes and prohibited price-marking.

METHOD

Monthly electronic point of sale data from 500 small retailers in England, Scotland and Wales were analysed. From May 2016 to October 2017, we monitored 20 of the best-selling fully branded tobacco products (15 factory-made cigarettes, 5 rolling tobacco) and their standardised equivalents. Adherence to RRP was measured as the average difference (%) between monthly RRPs and sales prices by pack type (fully branded vs standardised), price-marking on packaging and price segment.

RESULTS

The average difference between RRP and sales price increased from +0.36% above RRP (SD=0.72) in May 2016, when only fully branded packs were sold, to +1.37% in October 2017 (SD=0.30), when standardised packs were mandatory. Increases above RRP for fully branded packs increased as they were phased out, with deviation greater for non-price-marked packs and premium products.

DISCUSSION

Despite tobacco companies emphasising the importance of RRP, small retailers implemented small increases above RRP as standardised packaging was introduced. Consequently, any intended price changes by tobacco companies in response to the legislation (ie, to increase affordability or brand positioning) may be confounded by retailer behaviour, and such deviation may increase consumer price sensitivity.

Consumer Perceptions of Cigarette Design in France: A Comparison of Regular, Slim, Pink and Plain Cigarettes

INTRODUCTION

The cigarette, like the cigarette pack, is used by tobacco companies as a promotional tool. We explore how the cigarette could potentially be used as a dissuasive tool.

METHODS

An online survey was conducted with 15-30-year-old smokers and nonsmokers (N = 998) in France to explore their perceptions of a plain cigarette (gray with no brand name) and three branded cigarettes (regular, slim, pink). Participants were randomly assigned to view the plain cigarette and either the regular, slim, or pink cigarette. They were asked to rate the cigarettes by Appeal (tastiest, highest quality, and most expensive), Harm (most dangerous and most effective for motivating people to talk about tobacco dangers), and Perceived behavioral impact (most effective to convince teenagers not to start and to motivate smokers to reduce consumption and quit).

RESULTS

In comparison to the gray cigarette, each of the branded cigarettes were considered more appealing, less harmful, and more likely to motivate teenagers to start and less likely to motivate smokers to reduce consumption or quit.

CONCLUSIONS

The study suggests that altering the appearance of the cigarette may reduce cigarette appeal, increase harm perceptions, and deter both young people and smokers.

IMPLICATIONS

Very little research has focused on dissuasive cigarettes whereas the cigarette stick has become very important for tobacco companies for communication purposes. This is the first study to compare the effect of various branded cigarettes (regular, slim, and pink) with a plain gray cigarette on young adult smokers and nonsmokers. The findings suggest that a plain gray cigarette can reduce cigarette appeal, increase perceptions of harm, and may deter use among both smokers and nonsmokers.

Using Neuroscience to Inform Tobacco Control Policy

INTRODUCTION

Techniques employed in the field of neuroscience, such as eye tracking, electroencephalography, and functional magnetic resonance imaging, have been important in informing our understanding of the cognitive mechanisms underlying tobacco smoking. These techniques are now increasingly being used to investigate the likely impact of tobacco control policies.

AIMS AND METHODS

In this narrative review, we outline the value of these methodological approaches in answering policy-relevant tobacco control research questions, with a particular focus on their use in examining the impact of standardized cigarette packaging and health warnings. We also examine the limitations of these methodologies and provide examples of how they can be used to answer other policy-relevant questions.

RESULTS

We argue that neuroscience techniques can provide more objective evidence of the impacts of policy measures, allow investigation where it is not possible to conduct behavioral manipulations, and facilitate a deeper understanding of the cognitive mechanisms underlying the impacts of tobacco control policies such as standardized packaging, health warnings, point-of-sale displays, and mass media campaigns.

CONCLUSIONS

Rather than replacing more traditional methods of examining tobacco control measures, such as observational experiments, surveys, and questionnaires, neuroscience techniques can complement and extend these methods.

IMPLICATIONS

Neuroscience techniques facilitate objective examination of the mechanisms underlying the impacts of tobacco control measures. These techniques can therefore complement and extend other methodologies typically used in this field, such as observational experiments, surveys, and questionnaires.

Tobacco industry's elaborate attempts to control a global track and trace system and fundamentally undermine the Illicit Trade Protocol

BACKGROUND

The Illicit Trade Protocol (ITP) requires a global track and trace (T&T) system to reduce tobacco smuggling. Given the tobacco industry's (TI) historical involvement in tobacco smuggling, it stipulates that T&T 'shall not be performed by or delegated to the tobacco industry'. This paper explores the rationale for & nature of the TI's effors to influence the ITP & its T&T system.

METHODS

Analysis of leaked TI documents and publicly available data; ,investigation of front groups, trademark and patent ownership.

FINDINGS

Growing & diverse sources of evidence indicate that the TI remains involved in tobacco smuggling and that TI cigarettes account for around two-thirds of the illicit cigarette market. The TI therefore has a vested interest in controlling the global T&T system aimed to curtail this behaviour. To this end, Philip Morris International (PMI) adapted its pack marker system, Codentify, to meet T&T requirements, licensed it for free to its three major competitors who then collectively promoted it to governments using front groups and third parties including companies claiming to be independent despite clear TI links. PMI also sought to suggest Codentify was independent by selling some parts of its intellectual property on Codentify while retaining others, leaving a complex web of shared interests. In Africa, British American Tobacco used payments to obtain data suggesting its smaller competitor companies were evading taxes and secure influence with tax authorities. Regulatory capture has been enhanced by a public relations effort involving TI funding for conferences, training, research, and international police and anti-corruption organisations. Collectively this has created public messaging and a powerful network of organisations supportive of the TI's misleading postion on illicit.

CONCLUSIONS

Governments should assume the TI seeks to control T&T systems in order to avoid scrutiny and minimise excise tax payments and that any T&T system based on Codentify, on intellectual property currently or previously owned by the TI, or being promoted or implemented by companies with TI links, is incompatible with the ITP and would not serve to reduce illicit trade.

Reducing levels of medical device contamination through package redesign and opening technique

Objectives

The goal of this research was to evaluate how material curl, package structure and handling of pouches containing medical devices affect rates of contact between non-sterile surfaces and sterile devices during aseptic transfer.

Methods

One hundred and thirty-six individuals with practical experience in aseptic technique were recruited. Participants were asked to present the contents of four different pouch designs (a standard, one designed to curl in, another to curl out and one that incorporated a tab) using two transfer techniques. During the first block of trials “standard technique” was used; participants presented using their typical methods to the sterile field. Trials in the second block employed “modified technique”; participants were instructed to grab the package at the top center and present package contents using a single, fluid motion. The outside of the pouch and the backs of the participants’ hands were coated using a simulated contaminant before each trial. The simulant was undetectable in the visible spectrum, but fluoresced under a black light. The dependent variable was recorded in a binary fashion and analyzed using a generalized linear mixed model.

Results

Participants were between 20–57 and the averaged year 5.1 years of experience in aseptic technique. The data analysis was based on generalized linear mixed effects (GLMM) model, which accommodates the repeated measurements within the same participant. The effect of the pouch design was significant (P‹0.001), but the effect of aseptic technique did not suggest significance (P = 0.088). Specifically, pouches designed with the material curled outward resulted in significantly fewer contacts with non-sterile surfaces than the other styles, including the inward, tab, and standard styles; this was true regardless of the used aseptic technique, standard (P = 0.0171, P = 0.0466, P = 0.0061, respectively) or modified (P‹0.0001 for all comparisons)).

Conclusion

Results presented here contribute to a growing body of knowledge that investigates packaging as a potential route of contamination for sterile devices during aseptic presentation. Specifically, we provide insights regarding how both package design and opening technique can be informed in ways that build safety into the healthcare system.

How effective is the plain packaging of tobacco policy on rates of intention to quit smoking and changing attitudes to smoking?

BACKGROUND

The aim of this study is to critically appraise the evidence for the effectiveness of the plain packaging of tobacco products policy.

METHODS

A systematic approach to a literature review was undertaken using five databases: PubMed, MEDLINE, Google Scholar, Global Health and Legacy Tobacco Documents Library. Quantitative and qualitative studies that evaluate attitudes towards smoking, starting smoking and quitting intentions when plain packaging use is compared with standard cigarette packaging use were included.

RESULTS

A total of 1923 studies were identified. After inclusion and exclusion criteria were applied, nine studies were included in the review. The overall quality of the data was variable but a significant number of the studies had major methodological flaws. However, data analysed in the literature review suggest that exposure to plain packaging increases intention to quit amongst exposed individuals, increases negative attitudes to both smoking and starting smoking.

CONCLUSION

Although the evidence for plain packaging of tobacco is not strong, the evidence that is available indicates that it is an effective tobacco cessation policy.

The Power of Product Innovation: Smokers' Perceptions of Capsule Cigarettes

Introduction

Since being brought to market in 2007, cigarettes with capsules in the filter that can be burst to change the flavor have had remarkable global success, highlighting the importance of product innovation for tobacco companies. Very few studies have explored how these products are perceived by smokers however. This paper sought to address this gap by exploring smokers' awareness of cigarettes with one or two flavor-changing capsules in the filter and the appeal of these products.

Methods

Twenty focus groups were conducted in Glasgow and Edinburgh in 2015 with current smokers (N = 120), segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender, and social grade.

Results

Awareness, use and appeal of capsule cigarettes was greater among younger adults (16-35 years), who showed most interest in these products. Those who perceived capsules positively mentioned multiple benefits: the ability to burst the capsule, convenience of being able to share cigarettes among menthol and nonmenthol smokers, better taste, fresher breath, reduced smell, and greater discretion. It was suggested that capsule cigarettes, particularly the double capsule cigarette (which had two differently flavored capsules in the filter), would encourage nonsmokers to experiment with smoking and discourage smokers from quitting.

Conclusions

The findings offer some reasons behind the global growth of the capsule cigarette segment.

Implications

Cigarettes with flavor-changing capsules in the filter have been one of the most successful product innovations of the last decade for tobacco companies. They have received very little academic attention however. Employing focus groups with 120 smokers aged 16 and over, we found that capsule cigarettes held most appeal to, and were considered to be targeted at, younger people, with it suggested that these products would encourage initiation and discourage cessation. This study provides some understanding of how these products are viewed by smokers.

Low-Dose Irradiation With Modified Atmosphere Packaging for Mango Against the Oriental Fruit Fly (Diptera: Tephritidae)

Irradiation is used to disinfest the oriental fruit fly, Bactrocera dorsalis (Hendel) (Diptera: Tephritidae) and other pests on mango fruits before export from Thailand to foreign markets. Modified atmosphere packaging (MAP) used during export of mangoes creates a low-oxygen environment that may reduce the efficacy of quarantine irradiation treatment against B. dorsalis. 'Nam Dok Mai' mangoes infested with third-instar larvae of B. dorsalis, wrapped with three different kinds of MAP bags (CF1, FF5, and H34M) or no MAP, were treated with gamma radiation at 0 (control), 30, 60, 90, 120, and 150 Gy. The average O2 and CO2 concentrations in MAP bags with mangos were 7.2 and 8.7% in the H34M bag, 8.6 and 21.2% in the CF1 bag, and 9.6 and 26.7% in the FF5 bag, respectively. The use of MAP on infested mangoes significantly increased mortality of B. dorsalis under irradiation treatment. The estimated lethal doses to cause 99% mortality (LD99) for no MAP and MAP (CF1, FF5, and H34M bags) treatments were 58.1, 41.6, 43.8, and 47.4 Gy, respectively. Therefore, MAP acted as an additional stressor rather than providing radioprotection in irradiated B. dorsalis. Large-scale confirmatory testing of 35,000 B. dorsalis larvae treated at a radiation dose of 150 Gy in mangoes with H34M MAP bags produced no survivors to the adult stage. Commercial use of MAP producing the O2 levels that we observed for mangos in this study will not reduce the efficacy of the approved 150 Gy quarantine irradiation treatment for B. dorsalis.

Effect of Low-Oxygen Conditions Created by Modified Atmosphere Packaging on Radiation Tolerance in Drosophila suzukii (Diptera: Drosophilidae) in Sweet Cherries

Modified atmosphere packaging (MAP) creates a low-oxygen (O2) environment that can increase the shelf life of fresh produce by decreasing respiration and the growth of pathogens. Low oxygen may also increase insect tolerance to irradiation (IR), and the use of MAP with products treated by IR to control quarantine pests before export may inadvertently compromise treatment efficacy. Spotted wing drosophila, Drosophila suzukii Matsumura (Diptera: Drosophilidae) is a quarantine pest of stone and small fruits and a potential target for postharvest IR treatment. The effect of low oxygen generated by MAP at ambient temperatures on the radiation tolerance of D. suzukii infesting sweet cherries was examined. Early pupal stage D. suzukii were inserted into ripe sweet cherries and treated by 1) MAP + IR, 2) IR alone, 3) MAP alone, or 4) no MAP and no IR and held for adult emergence. Three types of commercially available MAP products were tested that produced different oxygen concentrations between 3 and 15%, and a sublethal radiation dose (60 Gy) was used to allow comparisons between the treatments. Xtend PP61 bags (3.2-4.8% O2), Xtend PP71 bags (5.4-8.6% O2), and Xtend PP53 bags (13.6-15.4% O2) did not enhance survivorship to the adult stage in D. suzukii pupae irradiated at 60 Gy in sweet cherries. MAP use should not compromise phytosanitary IR treatment against D. suzukii in exported sweet cherries or other fruit.

Adult smokers' perceptions of cigarette pack inserts promoting cessation: a focus group study

INTRODUCTION

Tobacco companies have a long tradition of including promotional material within cigarette packs, such as cigarette cards and coupons. Only in Canada are they required, by the government, to include educational material within cigarette packs, in the form of inserts highlighting the benefits of quitting or providing tips on how to do so.

METHODS

Twenty focus groups were conducted in Glasgow and Edinburgh in 2015, with smokers (n=120) segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender and social grade, to explore perceptions of the inserts used in Canada.

RESULTS

The consensus was that these inserts would capture attention and be read due to their novelty and visibility before reaching the cigarettes, and as they can be removed from the pack. While they may be ignored or discarded, and rotation was considered necessary, they were generally thought to prolong the health message. The positive style of messaging was described as refreshing, educational, encouraging, reassuring and inspirational and thought to increase message engagement. It was regarded as more sympathetic than command-style messaging, offering smokers 'a bit of hope'. The inserts were often considered preferable to the on-pack warnings, although it was felt that both were needed. Some participants suggested that inserts could encourage them to stop smoking, and they were generally viewed as having the potential to alter the behaviour of others, particularly younger people, would-be smokers and those wanting to quit.

CONCLUSIONS

Inserts are an inexpensive means of communication and offer regulators a simple way of supplementing on-pack warnings.

Surface modification of platelet concentrate bags to reduce biofilm formation and transfusion sepsis

Bacterial contamination of blood products poses a major risk in transfusion medicine, including transfusions involving platelet products. Although testing systems are in place for routine screening of platelet units, the formation of bacterial biofilms in such units may decrease the likelihood that bacteria will be detected. This work determined the surface properties of p-PVC platelet concentrate bags and investigated how these characteristics influenced biofilm formation. Serratia marcescens and Staphylococcus epidermidis, two species commonly implicated in platelet contamination, were used to study biofilm growth. The platelet concentrate bags were physically flattened to determine if reducing the surface roughness altered biofilm formation. The results demonstrated that the flattening process of the platelet bags affected the chemistry of the surface and reduced the surface hydrophobicity. Flattening of the surfaces resulted in a reduction in biofilm formation for both species after 5 days, with S. marcescens demonstrating a greater reduction. However, there was no significant difference between the smooth and flat surfaces following 7 days' incubation for S. marcescens and no significant differences between any of the surfaces following 7 days' incubation for S. epidermidis. The results suggest that flattening the p-PVC surfaces may limit potential biofilm formation for the current duration of platelet storage time of 5 days. It is hoped that this work will enhance the understanding of how surface properties influence the development of microbial biofilms in platelet concentrate bags in order to devise a solution to discourage biofilm formation.

Proteomic Investigation of Metabolic Changes of Mushroom (Flammulina velutipes) Packaged with Nanocomposite Material during Cold Storage

Metabolic changes of mushroom (Flammulina velutipes) applied with polyethylene (PE) material (Normal-PM) or nanocomposite reinforced PE packaging material (Nano-PM) were monitored using tandem mass tags (TMT) labeling combined with two-dimensional liquid chromatography-tandem mass spectrometry (2D LC-MS/MS) technique. A total of 429 proteins were investigated as differentially expressed proteins (DEPs) among treatments after a cold storage period. A total of 232 DEPs were up-regulated and 65 DEPs were down-regulated in Nano-PM packed F. velutipes compared to that of Normal-PM. The up-regulated DEPs were mainly involved in amino acid synthesis and metabolism, signal transduction, and response to stress while the down-regulated DEPs were largely located in mitochondrion and participated in carbohydrate metabolic, amino acid synthesis and metabolism, and organic acid metabolic. It was also revealed that Nano-PM could inhibit the carbohydrate and energy metabolism bioprocess, promote amino acids biosynthesis, enhance antioxidant system, and improve its resistance to stress, resulting in a further extended shelf life of F. velutipes.

Utilization of chemically treated municipal solid waste (spent coffee bean powder) as reinforcement in cellulose matrix for packaging applications

As the annual production of the solid waste generable in the form of spent coffee bean powder (SCBP) is over 6 million tons, its utilization in the generation of green energy, waste water treatment and as a filler in biocomposites is desirable. The objective of this article is to analyze the possibilities to valorize coffee bean powder as a filler in cellulose matrix. Cellulose matrix was dissolved in the relatively safer aqueous solution mixture (8% LiOH and 15% Urea) precooled to -12.5°C. To the cellulose solution (SCBP) was added in 5-25wt% and the composite films were prepared by regeneration method using ethyl alcohol as a coagulant. Some SCBP was treated with aq. 5% NaOH and the composite films were also prepared using alkali treated SCBP as a filler. The films of composites were uniform with brown in color. The cellulose/SCBP films without and with alkali treated SCBP were characterized by FTIR, XRD, optical and polarized optical microscopy, thermogravimetric analysis (TGA) and tensile tests. The maximum tensile strength of the composite films with alkali treated SCBP varied between (106-149MPa) and increased with SCBP content when compared to the composites with untreated SCBP. The thermal stability of the composite was higher at elevated temperatures when alkali treated SCBP was used. Based on the improved tensile properties and photo resistivity, the cellulose/SCBP composite films with alkali treated SCBP may be considered for packaging and wrapping of flowers and vegetables.

Influencing Eating Choices: Biological Food Cues in Advertising and Packaging Alter Trajectories of Decision Making and Behavior

From an ecological perception perspective (Gibson, 1977), the availability of perceptual information alters what behaviors are more and less likely at different times. This study examines how perceptual information delivered in food advertisements and packaging alters the time course of information processing and decision making. Participants categorized images of food that varied in information delivered in terms of color, glossiness, and texture (e.g., food cues) before and after being exposed to a set of advertisements that also varied in this way. In general, items with more direct cues enhanced appetitive motivational processes, especially if they were also advertised with direct food cues. Individuals also chose to eat products that were packaged with more available direct food cues compared to opaque packaging.

The influence of threatening visual warnings on tobacco packaging: Measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods

The first aim of this research was to assess the effectiveness, in terms of emotional and behavioral reactions, of moderately vs. highly TVWs (Threatening Visual Warnings) displayed on tobacco packs. Given the key role that emotional reactions play in explaining the effect of TVWs on behaviors, psychophysiological and self-report methods were used-for the first time in this context-to measure the emotions provoked by TVWs. The second aim of this research was to determine whether increasing the size of warnings, and their display on plain packaging (compared with branded packaging) would improve their effectiveness. A within-subjects experiment was conducted. Three variables were manipulated: health warning threat level (high vs. moderate), image size (40% vs. 75%) and pack type (plain vs. branded). A convenience sample of 48 French daily smokers participated. They were exposed to eight different packs of cigarettes in a research lab at the University of Rennes. Smokers' emotions and behavioral intentions were recorded through self-reports. Emotions were also evaluated using psychophysiological measurements: electrodermal activity and facial electromyography. The results revealed that TVWs with a high threat level are the most effective in increasing negative emotions (fear, disgust, valence, arousal) and behavioral intentions conducive to public health (desire to quit, etc.). They also highlight the appeal of increasing the size of the warnings and displaying them on plain packs, because this influences emotions, which is the first step toward behavioral change. Increasing the threat level of TVWs from moderate to high seems beneficial for public health. Our results also confirm the relevance of recent governmental decisions to adopt plain packaging and larger TVWs (in the UK, France, Ireland, Canada, New Zealand, Hungary, etc.).

Perceptions of branded and plain cigarette packaging among Mexican youth

Plain cigarette packaging, which seeks to remove all brand imagery and standardize the shape and size of cigarette packs, represents a novel policy measure to reduce the appeal of cigarettes. Plain packaging has been studied primarily in high-income countries like Australia and the UK. It is unknown whether the effects of plain packaging may differ in low-and-middle income countries with a shorter history of tobacco regulation, such as Mexico. An experimental study was conducted in Mexico City to examine perceptions of branded and plain cigarette packaging among smoking and non-smoking Mexican adolescents (n = 359). Respondents were randomly assigned to a branded or plain pack condition and rated 12 cigarette packages for appeal, taste, harm to health and smoker-image traits. As a behavioral measure of appeal, respondents were offered (although not given) four cigarette packs (either branded or plain) and asked to select one to keep. The findings indicated that branded packs were perceived to be more appealing (β = 3.40, p < 0.001) and to contain better tasting cigarettes (β = 3.53, p < 0.001), but were not perceived as less harmful than plain packs. Participants rated people who smoke the branded packs as having relatively more positive smoker-image traits overall (β = 2.10, p < 0.001), with particularly strong differences found among non-smokers for the traits 'glamorous', 'stylish', 'popular' and 'sophisticated' (p < 0.001). No statistically significant difference was found for the proportion of youth that accepted when offered branded compared with plain packs. These results suggest that plain packaging may reduce brand appeal among Mexican youth, consistent with findings in high-income countries.

Tobacco packaging design for reducing tobacco use

BACKGROUND

Tobacco use is the largest single preventable cause of death and disease worldwide. Standardised tobacco packaging is an intervention intended to reduce the promotional appeal of packs and can be defined as packaging with a uniform colour (and in some cases shape and size) with no logos or branding, apart from health warnings and other government-mandated information, and the brand name in a prescribed uniform font, colour and size. Australia was the first country to implement standardised tobacco packaging between October and December 2012, France implemented standardised tobacco packaging on 1 January 2017 and several other countries are implementing, or intending to implement, standardised tobacco packaging.

OBJECTIVES

To assess the effect of standardised tobacco packaging on tobacco use uptake, cessation and reduction.

SEARCH METHODS

We searched MEDLINE, Embase, PsycINFO and six other databases from 1980 to January 2016. We checked bibliographies and contacted study authors to identify additional peer-reviewed studies.

SELECTION CRITERIA

Primary outcomes included changes in tobacco use prevalence incorporating tobacco use uptake, cessation, consumption and relapse prevention. Secondary outcomes covered intermediate outcomes that can be measured and are relevant to tobacco use uptake, cessation or reduction. We considered multiple study designs: randomised controlled trials, quasi-experimental and experimental studies, observational cross-sectional and cohort studies. The review focused on all populations and people of any age; to be included, studies had to be published in peer-reviewed journals. We examined studies that assessed the impact of changes in tobacco packaging such as colour, design, size and type of health warnings on the packs in relation to branded packaging. In experiments, the control condition was branded tobacco packaging but could include variations of standardised packaging.

DATA COLLECTION AND ANALYSIS

Screening and data extraction followed standard Cochrane methods. We used different 'Risk of bias' domains for different study types. We have summarised findings narratively.

MAIN RESULTS

Fifty-one studies met our inclusion criteria, involving approximately 800,000 participants. The studies included were diverse, including observational studies, between- and within-participant experimental studies, cohort and cross-sectional studies, and time-series analyses. Few studies assessed behavioural outcomes in youth and non-smokers. Five studies assessed the primary outcomes: one observational study assessed smoking prevalence among 700,000 participants until one year after standardised packaging in Australia; four studies assessed consumption in 9394 participants, including a series of Australian national cross-sectional surveys of 8811 current smokers, in addition to three smaller studies. No studies assessed uptake, cessation, or relapse prevention. Two studies assessed quit attempts. Twenty studies examined other behavioural outcomes and 45 studies examined non-behavioural outcomes (e.g. appeal, perceptions of harm). In line with the challenges inherent in evaluating standardised tobacco packaging, a number of methodological imitations were apparent in the included studies and overall we judged most studies to be at high or unclear risk of bias in at least one domain. The one included study assessing the impact of standardised tobacco packaging on smoking prevalence in Australia found a 3.7% reduction in odds when comparing before to after the packaging change, or a 0.5 percentage point drop in smoking prevalence, when adjusting for confounders. Confidence in this finding is limited, due to the nature of the evidence available, and is therefore rated low by GRADE standards. Findings were mixed amongst the four studies assessing consumption, with some studies finding no difference and some studies finding evidence of a decrease; certainty in this outcome was rated very low by GRADE standards due to the limitations in study design. One national study of Australian adult smoker cohorts (5441 participants) found that quit attempts increased from 20.2% prior to the introduction of standardised packaging to 26.6% one year post-implementation. A second study of calls to quitlines provides indirect support for this finding, with a 78% increase observed in the number of calls after the implementation of standardised packaging. Here again, certainty is low. Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and reduced craving. Evidence from studies measuring eye-tracking showed increased visual attention to health warnings on standardised compared to branded packs. Corroborative evidence for the latter finding came from studies assessing non-behavioural outcomes, which in general found greater warning salience when viewing standardised, than branded packs. There was mixed evidence for quitting cognitions, whereas findings with youth generally pointed towards standardised packs being less likely to motivate smoking initiation than branded packs. We found the most consistent evidence for appeal, with standardised packs rating lower than branded packs. Tobacco in standardised packs was also generally perceived as worse-tasting and lower quality than tobacco in branded packs. Standardised packaging also appeared to reduce misperceptions that some cigarettes are less harmful than others, but only when dark colours were used for the uniform colour of the pack.

AUTHORS' CONCLUSIONS

The available evidence suggests that standardised packaging may reduce smoking prevalence. Only one country had implemented standardised packaging at the time of this review, so evidence comes from one large observational study that provides evidence for this effect. A reduction in smoking behaviour is supported by routinely collected data by the Australian government. Data on the effects of standardised packaging on non-behavioural outcomes (e.g. appeal) are clearer and provide plausible mechanisms of effect consistent with the observed decline in prevalence. As standardised packaging is implemented in different countries, research programmes should be initiated to capture long term effects on tobacco use prevalence, behaviour, and uptake. We did not find any evidence suggesting standardised packaging may increase tobacco use.

Influence of premium versus value brand names on the smoking experience in a plain packaging environment: an experimental study

OBJECTIVE

To examine the effect of branding, as indicated by brand name, on evaluation of the cigarette smoking experience.

DESIGN

Between-subjects and within-subjects experimental study. Participants were randomly allocated to smoke a cigarette from a pack featuring a premium brand name and a cigarette from a pack featuring a value brand name. Within each condition, participants unknowingly smoked two identical cigarettes (either two premium or two value cigarettes).

SETTING

Australia, October 2014, 2 years after tobacco plain packaging implementation.

PARTICIPANTS

81 current cigarette smokers aged 19-39 years. From apparently premium and value brand-name packs, 40 smokers were allocated to smoke the same actual premium cigarettes and 41 were allocated to smoke the same actual value cigarettes.

PRIMARY OUTCOME MEASURES

Experienced taste (flavour, satisfaction, enjoyment, quality, liking, mouthfeel and aftertaste), harshness, dryness, staleness, harm/strength measures (strength, tar, lightness, volume of smoke), draw effort and purchase intent.

RESULTS

Cigarettes given a premium brand name were rated as having a better taste, were less harsh and less dry than identical cigarettes given a value brand name. This pattern was observed irrespective of whether the two packs actually contained premium or value cigarettes. These effects were specific: the brand name did not influence ratings of cigarette variant attributes (strength, tar, volume of smoke, lightness and draw effort).

CONCLUSIONS

Despite the belief that brand names represent genuine differences between cigarette products, the results suggest that at least some of this perceived sensory difference is attributable to brand image.

Effect of Packaging on Shelf-life and Lutein Content of Marigold (Tagetes erecta L.) Flowers

BACKGROUND

African marigold (Tagetes erecta L.) flowers are highly valued for their ornamental appeal as well as medicinal properties. However, their short shelf lives cause high post-harvest loss and limit their export potential. The review of patents and research articles revealed that different types of packaging designs/materials have been successfully employed for extension of shelf lives of cut flowers.

OBJECTIVE

The current work focuses on designing of different packaging configurations and selection of best configuration for preservation of marigold cut flowers.

METHODS

Ten packaging configurations, composed of four different packaging materials i.e., low density polyethylene (LDPE), polyethylene terephthalate, glassine paper and cellophane paper, were designed. Each pack, consisting of 20 ± 1 g of marigold flowers along with non-packaged control set were stored at 23 ± 2°C, 80% R.H., in an environmental chamber and the flowers were evaluated for their sensory attributes, phytochemical characteristics and physicochemical parameters of senescence to determine their shelf lives.

RESULTS

Flowers packed in LDPE bag showed highest shelf life of 8 days with a lead of 4 days compared to control (shelf life - 4 days). This study also established for the first time the phenomenon of carotenogenesis in marigold cut flowers with significantly (P<0.01) higher production of lutein in LDPE packaged flowers.

CONCLUSION

LDPE pack was the best design among the ten package designs, in preserving lutein content of marigold flowers and extending their shelf lives. This economically viable packaging can not only boost the export potential of this ornamental flower, but also allow utilization of nutraceutical potency of lutein.

Sterility maintenance study: Dynamic evaluation of sterilized rigid containers and wrapped instrument trays to prevent bacterial ingress

BACKGROUND

Sterilized packaging systems are designed to maintain the sterility of surgical instruments and devices from the time of sterilization until use. This study evaluated the effectiveness of rigid containers versus wrapped instrument trays, sterilized using North American sterilization protocols, to maintain a sterile internal environment poststerilization when challenged with aerosolized bacteria under dynamic environmental conditions.

METHODS

Using a custom aerosol chamber, 111 rigid containers of various durations of use (unused, used <5 years, used 5-9 years) and 161 wrapped trays using 3 grades of sterilization wrap were challenged with ~10(2) colony-forming units per liter of air containing aerosolized Micrococcus luteus with a count median particle size of 1 μm, while simultaneously experiencing air volume exchanges due to vacuum cycles-two 1-psi cycles, three 0.7-psi cycles, and three 0.4-psi cycles-to simulate air exchange events occurring during the sterilization, transportation, and storage of sterilized instrument trays in health care facilities.

RESULTS

Of 111 rigid containers tested, 97 (87%) demonstrated bacterial ingress into the container. Of 161 wrapped trays, 0 (0%) demonstrated bacterial ingress into the tray. Contamination rates of rigid containers increased significantly with increasing duration of use.

CONCLUSIONS

In this study using a dynamic bacterial aerosol challenge, sterilized wrapped trays demonstrated significantly greater protection than sterilized rigid containers against the ingress of airborne bacteria.

The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy

BACKGROUND

Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt.

METHODS

Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18-64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n = 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave.

RESULTS

At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts.

CONCLUSIONS

HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers.