Adolescent perceptions of cigarette appearance

Article (PDF Available)inThe European Journal of Public Health 24(3) · October 2013with11 Reads
DOI: 10.1093/eurpub/ckt161 · Source: PubMed
Abstract
To reduce the possibility of cigarette appearance misleading consumers about harm caused by the product, the European Commission's draft Tobacco Products Directive proposed banning cigarettes <7.5 mm in diameter. It appears however, following a plenary vote in the European Parliament, that this will not be part of the final Tobacco Products Directive. To reduce the appeal of cigarettes, the Australian Government banned the use of branding on cigarettes and stipulated a maximum cigarette length as part of the Tobacco Plain Packaging Act. We explored the role, if any, of cigarette appearance on perceptions of appeal and harm among adolescents. Focus group research with 15-year-olds (N = 48) was conducted in Glasgow (Scotland) to explore young people's perceptions of eight cigarettes differing in length, diameter, colour and decorative design. Slim and superslim cigarettes with white filter tips and decorative features were viewed most favourably and rated most attractive across gender and socio-economic groups. The slimmer diameters of these cigarettes communicated weaker tasting and less harmful looking cigarettes. This was closely linked to appeal as thinness implied a more pleasant and palatable smoke for young smokers. A long brown cigarette was viewed as particularly unattractive and communicated a stronger and more harmful product. This exploratory study provides some support that standardising cigarette appearance could reduce the appeal of cigarettes in adolescents and reduce the opportunity for stick design to mislead young smokers in terms of harm.

Figures

27 Norberg M, Malmberg G, Ng N, Brostro
¨
m G. Who is using snus? - Time trends,
socioeconomic and geographic characteristics of snus users in the ageing Swedish
population. BMC Public Health 2011;11:929.
28 Agrawal A, Lynskey MT. Tobacco and cannabis co-occurrence: does route of
administration matter? Drug Alcohol Depend 2009;99:240–7.
29 Hamari AK, Toljamo TI, Kinnula VL, Nieminen PA. Dual use of cigarettes and
Swedish snuff (snus) among young adults in Northern Finland. Eur J Public Health
2013;23:768–71.
30 Øverland S, Tjora T, Hetland J, Aarø LE. Associations between
adolescent socioeducational status and use of snus and smoking. Tob Control 2010;
19:291–6.
31 Hansson J, Galanti MR, Magnusson C, Hergens MP. Weight gain and incident
obesity among male snus users. BMC Public Health 2011;11:371.
32 Harrison L, Hughes A. Introduction–the validity of self-reported
drug use: improving the accuracy of survey estimates. NIDA Res Monogr 1997;167:
1–16.
.........................................................................................................
European Journal of Public Health, Vol. 24, No. 3, 464–468
ß The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
doi:10.1093/eurpub/ckt161 Advance Access published on 23 October 2013
.........................................................................................................
Adolescent perceptions of cigarette appearance
Allison Ford
1,2
, Crawford Moodie
1
, Anne M. MacKintosh
1
, Gerard Hastings
1,2
1 Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirlingshire FK9 4LA, UK
2 UK Centre for Tobacco Control Studies, University of Stirling, Stirlingshire FK9 4LA, UK
Correspondence: Allison Ford, Institute for Social Marketing, University of Stirling, Stirlingshire FK9 4LA, UK, Tel: +44 (0)
1786 467390, Fax: +44 (0) 1786 467400, e-mail: a.j.ford@stir.ac.uk
Background: To reduce the possibility of cigarette appearance misleading consumers about harm caused by the
product, the European Commission’s draft Tobacco Products Directive proposed banning cigarettes <7.5 mm in
diameter. It appears however, following a plenary vote in the European Parliament, that this will not be part of
the final Tobacco Products Directive. To reduce the appeal of cigarettes, the Australian Government banned the
use of branding on cigarettes and stipulated a maximum cigarette length as part of the Tobacco Plain Packaging
Act. We explored the role, if any, of cigarette appearance on perceptions of appeal and harm among adolescents.
Methods: Focus group research with 15-year-olds (N = 48) was conducted in Glasgow (Scotland) to explore young
people’s perceptions of eight cigarettes differing in length, diameter, colour and decorative design. Results: Slim
and superslim cigarettes with white filter tips and decorative features were viewed most favourably and rated
most attractive across gender and socio-economic groups. The slimmer diameters of these cigarettes
communicated weaker tasting and less harmful looking cigarettes. This was closely linked to appeal as thinness
implied a more pleasant and palatable smoke for young smokers. A long brown cigarette was viewed as particu-
larly unattractive and communicated a stronger and more harmful product. Conclusion: This exploratory study
provides some support that standardising cigarette appearance could reduce the appeal of cigarettes in adoles-
cents and reduce the opportunity for stick design to mislead young smokers in terms of harm.
.........................................................................................................
Introduction
T
he guidelines on Article 13 of the Framework Convention on
Tobacco Control recommend that ‘individual cigarettes or
other tobacco products should carry no advertising or promotion,
including design features that make products attractive’.
1
To reduce
the appeal of cigarettes, the Australian Government stipulated partial
product standardisation as part of the Tobacco Plain Packaging Act,
which was fully implemented in December 2012. The use of
branding (including colour, brand name and decorative elements)
on cigarettes is now prohibited, a maximum length for cigarettes has
been specified and cigarettes must be white or white with an
imitation cork filter. The legislation does not, however, place any
parameters on cigarette diameter.
2
The European Commission proposed a different approach from
Australia with the draft Tobacco Products Directive (TPD)
announced in December 2012. The draft TPD did not propose a
ban on branding on cigarettes but instead a ban on cigarettes less
than 7.5 mm in diameter, on the basis that ‘cigarettes with a
diameter of less than 7.5 mm shall be deemed misleading’.
3
This
recommendation would have prohibited the sale of very slim
cigarettes, called ‘superslims’, in the European Union. However,
no research to date has examined the impact of slimmer cigarettes
on product attributes such as the perceived attractiveness or level of
harm among adolescents.
Tobacco companies increasingly offer brand variants that feature
alternative cigarette diameters, decorative designs and lengths.
4,5
Analyses of tobacco industry documents show that modifications
to the appearance of cigarettes can make them more appealing to
specific target groups, notably ‘starter’ and female smokers and can
help to boost sales and market share.
6–8
Exemplifying the potential
for product design to influence growth, sales of slim cigarettes grew
by 50% from 23 855 million sticks in 2000 to 35 673 million sticks in
2010 in Europe, despite a general decline in factory manufactured
cigarette sales.
9
This is consistent with global trends where the
superslims segment is reported to have grown 10 times faster than
the overall market in the past 5 years.
10
It has been suggested that younger people are often the target of
novel product design
11
and most vulnerable to the impact of tobacco
marketing as they are especially susceptible to tobacco brand
imagery and particularly concerned with their identity.
12,13
Recently, the public health focus on cues which influence brand
imagery and product beliefs has lain with cigarette packaging.
14–17
However, marketing literature suggests that cigarette characteristics,
such as length, diameter, colour and decorative elements, are
intrinsic product cues that are not only consumed along with the
464 European Journal of Public Health
by guest on January 9, 2016http://eurpub.oxfordjournals.org/Downloaded from
product but also contain the message of the product and infer
product attributes.
18,19
Indeed, for young adult smokers, cigarette
appearance has been found to be a method of product differenti-
ation with respect to attractiveness, quality and strength of taste.
20
Slim and white cigarette designs have also been shown to help
distance young adult female smokers from negative associations
with smoking by portraying a glamorous, slim, elegant and clean
image.
21
This study aimed to extend recent work
20,21
by exploring whether
cigarette appearance may act as a promotional and communications
tool. We examined the appeal of cigarette design and whether design
influences harm perceptions among adolescents. To our knowledge
there has been no research outside the tobacco industry, which has
explored adolescents’ perceptions of different cigarette designs.
Methods
Design
Focus groups were employed to explore how young people engage
with different cigarette designs. Exploratory research is appropriate
when there has been little prior study of the issue and the objective is
to gain general insights and an understanding of the dynamics of a
particular subject.
22,23
Focus groups provide a setting where partici-
pants can freely express beliefs and attitudes, which in turn can be
justified with meaning and interpretation.
24,25
Focus groups also
gave participants an opportunity to handle cigarettes, rather than
viewing images,
20,21
and therefore allowed a true representation of
tactility, dimension and colour.
Using purposive sampling, participants were recruited by market
research recruiters according to quota controls on gender and
socio-economic grouping. Potential participants were approached
by recruiters via door-to-door methods and in the street. To
reduce socially desirable responses and disguise the health related
aspect of this research, participants were informed that the study
purpose was to explore the marketing of a range of consumer
products to young people, including tobacco.
Informed participant and parental consent was obtained prior to
the focus groups. Both participants and parents were provided with
an information sheet, given the opportunity to ask questions and
told of their right to withdraw from the research at any time.
Participants received a small incentive (£15) for participation.
All study procedures were approved by the Institute for Socio-
Management ethics committee at the University of Stirling.
Because of potential sensitivities involved in exposing young
people to cigarettes, each session ended with a discussion to
ensure the group did not encourage participants to look
favourably on cigarettes or smoking. Participants were given an in-
formation pack, specifically developed for a youth audience, to take
away. This included information on smoking related harms, harms
associated with second hand smoke exposure, support on quitting
(for those who were smokers) and information explaining how
tobacco marketing may promote smoking among young people.
Educating young people on why and how they are a particular
target of the tobacco industry has been found to be an effective
prevention intervention.
26
The study took place in Glasgow, Scotland, in April 2011. The
groups were held in a modern community venue which provided an
informal and relaxed environment. Each group lasted approximately
90 min.
Sample
Eight focus groups, each with six participants, were conducted
with 15 year olds (N = 48). Groups were split evenly by gender
and socio-economic grouping (ABC1—middle class/C2DE—
working class). We focused on 15 year olds given the difficulty
recruiting those below this age and because of their greater in-
volvement with smoking than younger age groups, e.g. 13% of 15
year olds in Scotland are regular smokers (smoke one or more
cigarettes a week) compared with 3% of 13 year olds.
27
Within
the sample, 19% percent (N = 9) were identified as regular
smokers on a recruitment questionnaire and 81% (N = 39) as
non-smokers. It was not possible to segment groups by smoking
status, as intended, because of recruitment difficulties; however,
the smoker/non-smoker split was in line with comparative
national figures.
27
Among the 39 non-smokers, 34 had never
smoked and 5 had tried smoking in the past. All nine smokers
were from the C2DE economic grouping. Five female smokers
comprised the majority of Group 1 and four male smokers the
majority of Group 4 (see table 1).
Procedure
At the start of each group, participants were informed that there
were no right or wrong answers, and we were only interested in what
they thought. The groups started with a warm-up discussion on
general shopping habits before moving on to consumer goods
packaging, tobacco packaging
17
and then cigarette design
awareness. Participants were asked to think about cigarettes they
had seen and to describe where they saw them, what they looked
like and any differences. Eight cigarettes, which differed in length,
diameter, colour and decorative design, were then shown to partici-
pants; all were available on the UK market at the time of the study.
The eight cigarettes were: a longer length brown cigarette, a
superking size with an imitation cork tip, three narrow slims and
superslims cigarettes with white tips and decorative elements, a
standard king size cigarette with an imitation cork tip, a white-
tipped king size cigarette and a short unfiltered white cigarette
(see figure 1). To explore the messages young people infer from
cigarette design, participants were asked to group the cigarettes
together in whatever way they thought appropriate. Projective
imagery techniques such as free association, where participants
raise whatever thoughts come to mind when viewing products,
were used to assess what is communicated by cigarette design.
28
This allowed participants to link concepts with product
appearance and indicate the brand imagery projected. Participants
then ordered the items for attractiveness, strength and harm.
Photographs were taken to record the positioning of cigarettes.
The lead moderator used a semi-structured topic guide to allow
the same questions to be asked across groups while allowing flexi-
bility in the group discussions. A second moderator observed and
recorded participants’ non-verbal reactions to cigarettes including
body language, facial expressions and verbal exclamations. This
ensured that other, but no less important, responses were not
missed. Observations, recorded in a systematic way, can be useful
to give accurate accounts of responses and behaviours as they
Table 1 Sample composition
Group Gender Social grade Smoking status
1 Female C2DE Smoker
a
2 Male ABC1 Non-smoker
3 Female ABC1 Non-smoker
4 Male C2DE Smoker
b
5 Female ABC1 Non-smoker
6 Male C2DE Non-smoker
7 Female C2DE Non-smoker
8 Male ABC1 Non-smoker
a: Group 1 comprised a majority of smokers with five smokers and
one non-smoker.
b: Group 4 comprised a majority of smokers with four smokers and
two non-smokers.
Adolescent perceptions of cigarette appearance 465
by guest on January 9, 2016http://eurpub.oxfordjournals.org/Downloaded from
happen and do not rely on the eloquence of participants.
29
These
observations supplemented the data from the group discussions,
which were audio-recorded with participants’ permission and
transcribed.
Analysis
Transcripts were initially checked against recordings for accuracy.
Data from the transcripts, photographs and focus group observa-
tions were reviewed using thematic analysis to identify key and
emergent themes. The research team met to discuss and review the
themes until consensus was achieved. Transcripts were coded using
NVivo9 software and the analysis followed an inductive approach to
interpret the data.
Results
Awareness of cigarette design
When initially asked about cigarette appearance, the ‘standard’
identified was a white king-size cigarette with imitation cork filter.
As the discussion progressed, participants recalled cigarettes that
differed from the norm, suggesting that details of cigarette
appearance are noticed by adolescents. Most groups were able to
recall cigarettes with white tips, assumed to indicate menthol
flavouring, and a pink-tipped cigarette was also mentioned. One
group commented that cigarettes could be different lengths. There
was also some awareness of cigarettes displaying branding, such as
brand symbols and brand names, and other decorative features such
as gold bands.
Cigarettes as a promotional and communication tool
When shown the eight cigarettes, a small number of participants,
who had previously referred to cigarettes as disgusting, ugly and
smelly, were disinterested in them or visibly recoiled. However, for
most, the cigarettes generated interest and curiosity. Participants
were surprised with the amount of variation in cigarette
appearance and, in general, studied the cigarettes intently, with
particular attention paid to diameter and decorative elements,
including the font style of brand names. Some participants took
the time to smell them and were sometimes reluctant to pass
them on. It was highlighted in one group that a different looking
product is enough to spark their interest and one boy wanted to try
the superslims size.
You’d be interested. You’d be like ‘what’s that? Does it taste the
same?’ (Boy, C2DE).
I’d smoke it (superslims). I’d only have one but (Boy, C2DE).
There was little evidence that the smokers’ responses were any
different to those identifying as non-smokers. Irrespective of
smoking status, there was surprise at being shown cigarettes,
which differed from the ‘standard’, suggesting that the more
unusual slim, brown and filter-less cigarettes were as unfamiliar to
smokers as they were to non-smokers. There were also few group
differences in terms of gender and no apparent differences by socio-
economic grouping. Participants had no difficulty differentiating
and assigning categories and meanings to the cigarettes. The two
cigarettes with imitation cork filters were usually placed together
as ‘standard’ ones and sometimes with cigarettes of similar
diameter. The three slimmer cigarettes were grouped together
because of their size and decorative patterns or brand name font
on the filter, often described as the ‘cool’ ones, which looked ‘fancy’
and ‘expensive’. They were repeatedly called ‘skinny’, ‘cute’ and
‘feminine’ and likened to ‘sweeties’. The slims and superslims had
the most favourable reaction, leading some participants to laugh and
smile. These positive responses overshadowed the general negative
attitude to smoking among most participants—even among the two
groups with participants who identified as smokers, there was a
feeling of stigma and shame attached to smoking. Within one
group of non-smoking girls, there was a particular tension where
they found it difficult to associate the slimmer cigarettes with
something they had previously held firm negative views on. In
contrast, the brown cigarette enhanced the negative associations
most participants held with regard to smoking. It was repeatedly
likened to a ‘cigar’ and ‘twig’ and described as ‘disgusting’ and
‘old fashioned’.
Product appeal
The slims and superslims were consistently rated as most attractive.
The exception was one boy group that rated them as unattractive as
they perceived them to be feminine. For some, the novelty of these
cigarettes, that they did not resemble a ‘standard’ cigarette, enhanced
their appeal.
The patterns, they just look nicer (Girl, ABC1).
There were mixed feelings about the two more ‘standard’ looking
cigarettes: the king size and superking size with imitation cork filters.
Half the groups rated the king size attractive, while three rated the
superking size attractive. Others felt they were boring. This mixed
response was because of the perception that this style of cigarette was
common, which for some participants was a positive and for others a
negative.
Just boring.
You always see they cigarettes (Girls, C2DE).
These ones are attractive because everyone smokes them (Girl,
ABC1).
The white-tipped king-size cigarette was generally viewed as un-
attractive and described as ‘boring’, ‘cheap’ and ‘plain’. Often,
appeal was based on the perceived smoking experience. In this
regard, the brown and unfiltered cigarettes were perceived as par-
ticularly unattractive, an unpleasant smoke and smelly, while the
slimmer cigarettes were described as ‘nicer’.
There’s no bud (filter) on it. It doesn’t look like it would be
comfortable to smoke (Boy, ABC1).
They (superslims) look nice to smoke (Boy, C2DE).
Like they (superslims) don’t look like they would taste horrible
(Girl, ABC1).
Figure 1 Cigarettes used as focus group stimuli. (A) Longer
length brown cigarette with gold More brand name and band.
(B) Superking-size cigarette with imitation cork filter and
Superkings brand name and symbol. (C) Slim-size cigarette with
white tip and purple decorative design. (D) Superslim-size cigarette
with white tip and purple floral design. (E) Superslim-size cigarette
with white tip and Vogue brand name in blue decorative font.
(F) King-size cigarette with imitation cork filter and Mayfair brand
name. (G) King-size cigarette with white tip and green Mayfair
brand name. (H) Shorter filterless cigarette with Woodbine brand
name
466 European Journal of Public Health
by guest on January 9, 2016http://eurpub.oxfordjournals.org/Downloaded from
Appeal was also closely linked with strength and harm perceptions.
Young people appeared to be attracted to weaker and less harmful
looking cigarettes.
If someone hands you a stronger one or a weaker one you’d
probably take the weaker one, depending on how long you’d
been smoking for ... So they’re not doing themselves the biggest
amount of damage straight away. So they are just jumping into
the shallow end instead of the deep end kind of thing (Boy,
C2DE).
Strength and harm perceptions
From the outset and unprompted, participants associated cigarettes
with different levels of strength and harm. Judgements about
strength and harm appeared to result primarily from diameter and
to a lesser extent, colour, decoration and length. Overall, the three
slimmer cigarettes were rated weakest and least harmful because of
their small diameter. The general view was that because they contain
less tobacco, they must, therefore, be less harmful. The white tips
and longer length also helped to portray a ‘cleaner’ female image
described as ‘glamorous’ and ‘classy’ and reminded some partici-
pants of females smoking in old movies. These images helped to
soften harm perceptions.
Because it’s skinny you feel that you’re not doing so much damage
(Girl, ABC1).
...they don’t look like cigarettes so you wouldn’t think like
harmful
When you think about who smokes them you don’t think of
someone who is really ill (Girls, C2DE).
Conversely, larger diameters and imitation cork filters gave the
impression of a stronger and more harmful product as did the
longer length of the brown and cork-tipped superking-size
cigarette. The fully brown cigarette was seen as particularly strong
and harmful.
It (brown cigarette) looks really, really strong ...
Cos it’s very dark.
Overpowering, the colour (Boys C2DE).
There were mixed responses to the white-tipped king-size
cigarette. This cigarette’s white tip was associated with menthol
and perceived as weaker and less harmful. However, its diameter
sometimes produced a conundrum as the thicker size was
considered to indicate a stronger product. This suggests that adoles-
cents view cigarette design holistically when forming value
judgments.
Discussion
We found that cigarette appearance can generate significant interest
among adolescents. Intrinsic cues, such as colour, length, diameter
and decorative features, easily communicated messages and imagery
related to gender suitability, price, glamour and coolness. Appeal
was based on these characteristics. The slims and superslims with
smaller diameters, white tips and decorative elements were consist-
ently perceived as most attractive. This is in contrast with previous
findings with young adult ever-smokers, who rated an image of a
cigarette with a standard length and diameter and cork tip as most
attractive.
20
In our study, smaller diameters, in particular,
communicated weaker and less harmful looking cigarettes. This
was closely linked to the level of appeal as they implied a more
pleasant and palatable smoke for ‘starter’ smokers. These differences
may suggest that adults and adolescents prefer and place importance
on different features of cigarette designs. Alternatively, differences in
study design and the presentation of cigarettes may account for this
incongruence, with previous research showing images of cigarettes
to participants, whereas we allowed participants to handle cigarettes.
The positive imagery conjured up by slimmer cigarettes was at
odds with participants’ negative attitudes towards smoking and
smokers. These cigarettes appeared ‘cleaner’ and did not resemble
a ‘standard’ cigarette, thereby losing some of the negative associ-
ations of smoking. Similarly, the attractiveness of slim cigarettes
has been found to resolve the dissonance between the self-image
and identity young adult females wish to create and the negative
connotations of smoking.
21
Cigarette characteristics that reduce
negative perceptions and indicate smoothness and mildness have
been identified as important for young smokers in industry
documents.
30
Slim cigarettes help the tobacco industry create the
image of a safer cigarette by implying ‘ease of draw’ and less
sidestream smoke and tar.
8,31
However, importantly, recent
research suggests that while superslims may contain less tobacco
than regular-sized cigarettes, some superslims brands have higher
levels of tobacco specific nitrosamines and aromatic amines than
regular cigarettes.
32
The study has a number of limitations. Given the small sample
size, the findings cannot be considered representative, although
given the exploratory nature of the study, this was not our aim.
As real cigarettes were used as stimuli, brand names were visible
on some of the cigarettes. Therefore, it is possible that prior brand
knowledge may have played a role in influencing participants’ per-
ceptions, especially for the Mayfair cigarettes, a popular youth
brand. As the nine smokers comprised the majority of two groups,
it is unlikely that non-smoker norms would have influenced their
responses, although it is possible that the stigma the smokers
attached to smoking meant their true responses may have been
suppressed. This may account for the lack of differences between
smokers and non-smokers. In addition, we do not know whether
attractiveness of cigarette design translates into smoking behaviour
or brand choice. However, this exploratory research does suggest
that standardising cigarette appearance may reduce the potential
for cigarettes to be used as a marketing tool, particularly as
tobacco industry journals describe the cigarette as an increasingly
important advertising medium for tobacco companies.
33
Participants found a longer length brown cigarette least attractive.
This design enhanced participants’ negative associations with
smoking and supports the notion that dissuasive cigarettes could
be used to reduce the appeal of cigarettes and smoking.
21
The findings show that differences in cigarette appearance can
generate interest, provide novelty, communicate positive imagery
and mislead adolescents in respect to product harm. While
providing support for the ban on branding, colour and other
decorative elements on cigarettes in Australia, this study suggests
that standardising diameter could further reduce the opportunity
for the tobacco industry to communicate with and influence
young people. In this respect, the fact that the European
Parliament has voted against the proposed ban on cigarettes less
than 7.5 mm in diameter would appear a missed opportunity for
improving tobacco control policy in Europe.
34
Funding
This work was supported by a grant from Cancer Research UK
(C312/A8721). The UK Centre for Tobacco Control Studies
contributed to the funding of Allison Ford and Gerard Hastings.
Conflicts of interest: None declared.
Key points
This is the first study to assess adolescent response to
cigarette design.
Slim and superslim cigarettes were rated most attractive and
indicated weaker and less harmful products, while a long
Adolescent perceptions of cigarette appearance 467
by guest on January 9, 2016http://eurpub.oxfordjournals.org/Downloaded from
brown cigarette was viewed as particularly unattractive,
communicated a stronger and more harmful product and
strengthened negative associations with smoking.
These findings suggest that product standardisation may
help reduce the appeal of cigarettes and smoking in
adolescents.
References
1 World Health Organization. Guidelines for implementation of Article 13 of the WHO
Framework Convention on Tobacco Control (Tobacco advertising, promotion and
sponsorship). WHO Framework Convention on Tobacco Control, 2008. Available at:
http://www.who.int/fctc/guidelines/article_13.pdf (27 June 2013, date last accessed).
2 The Parliament of the Commonwealth of Australia. Tobacco Plain Packaging Bill.
2011. Available at: http://www.aph.gov.au/Parliamentary_Business/Bills_Legisla
tion/Bills_Search_Results/Result?bId=r4613 (27 June 2013, date last accessed).
3 European Commission. Proposal for a Directive of the European Parliament and of the
Council on the Approximation of the Laws, Regulations and Administrative Provisions
of the Member States Concerning the Manufacture, Presentation and Sale of Tobacco
and Related Products. Brussels: European Commission, 2012.
4 Moodie C, Hastings G. Making the pack the hero, tobacco industry response to
marketing restrictions in the UK: Findings from a long-term audit. Int J Ment
Health Addict 2011;9:24–38.
5 Centre for Tobacco Control Research. The Packaging of Tobacco Products. Stirling.
Centre for Tobacco Control Research, University of Stirling, 2012.
6 Cummings KM, Morley CP, Horan JK, et al. Marketing to America’s youth:
evidence from corporate documents. Tob Control 2002;11(Suppl. i):5–17.
7 Cook BL, Wayne GF, Keithly L, Connolly GN. One size does not fit all: how the
tobacco industry has altered cigarette design to target consumer groups with specific
psychological and psychosocial needs. Addiction 2003;98:1547–61.
8 Carpenter CM, Wayne GF, Connolly GN. Designing cigarettes for women: new
findings from the tobacco industry documents. Addiction 2005;100:837–51.
9 European Commission. Impact Assessment Accompanying the Document Proposal for
a Directive of the European Parliament and of the Council on the Approximation of the
Laws, Regulations and Administrative Provisions of the Member States Concerning the
Manufacture, Presentation and Sale of Tobacco and Related Products. Brussels:
European Commission, 2012.
10 Mapother J. Filters: more colour and better carbon. Tob J Int 2011;4:80–6.
11 Wray RJ, Jupka K, Berman S, et al. Young adults’ perceptions about established and
emerging tobacco products: results from eight focus groups. Nicotine Tob Res 2012;
14:184–90.
12 Scheffels J. A difference that makes a difference: young adult smokers’ accounts of
cigarette brands and package design. Tob Control 2008;17:118–22.
13 Scheffels J, Sæbø G. Perceptions of plain and branded cigarette packaging among
Norwegian youth and adults: a focus group study. Nicotine Tob Res 2013;15:450–6.
14 Wakefield M, Morley C, Horan JK, Cummings K. The cigarette pack as image: new
evidence from tobacco industry documents. Tob Control 2002;11(Suppl. i):73–80.
15 Hammond D, Dockrell M, Arnott D, et al. Cigarette pack design and perceptions of
risk among UK adults and youth. Eur J Public Health 2009;19:631–7.
16 Germain D, Wakefield MA, Durkin SJ. Adolescents’ perceptions of cigarette brand
image: does plain packaging make a difference? J Adolesc Health 2010;46:385–92.
17 Ford A, Moodie C, MacKintosh AM, Hastings G. How adolescents perceive cigarette
packaging and possible benefits of plain packaging. Educ Health 2013;31:83–8.
18 Olson JC, Jacoby J. Cue utilisation in the quality perception process. In: Venkatesan M,
editor. Proceedings of the Third Annual Conference of the Association for Consumer
Research. Chicago, IL: Association for Consumer Research, 1972: 167–79.
19 Zeithaml VA. Consumer perceptions of price, quality, and value: a means-end
model and synthesis of evidence. J Mark 1988;52:2–22.
20 Borland R, Savvas S. Effects of cigarette stick design features on perceptions of
characteristics of cigarettes. Tob Control 2013;22:331–37. doi 10.1136/
tobaccocontrol-2011-050199.
21 Hoek J, Robertson C, Hammond D, McNeill L. How do young adult women
smokers perceive dissuasive cigarette sticks? Poster presented at the World
Conference on Tobacco or Health, 22 March 2012, Singapore.
22 Kinnear TC, Taylor JR. Marketing Research: An Applied Approach, 4th edn. New
York: McGraw-Hill, 1991.
23 Parasuraman A. Marketing Research, 2nd edn. Reading, MA: Addison-Wesley
Publishing Company, 1991.
24 Morgan DL. Focus Groups as Qualitative Research. Qualitative Research. Methods
Series 16
. Newbury Park: Sage Publications Ltd, 1988.
25
Barbour RS, Kitzinger J. Developing Focus Group Research: Politics, Theory and
Practice. London: Sage, 1999.
26 Lantz PM, Jacobson PD, Warner KE, et al. Investing in youth tobacco control: a
review of smoking prevention and control strategies. Tob Control 2000;9:47–63.
27 Black C, Eunson J, Sewel K, Murray L. Scottish Schools Adolescent Lifestyle and
Substance Use Survey (SALSUS) National Report: Smoking, Drinking and Drug Use
Among 13 and 15 Year Olds in Scotland in 2010. Edinburgh: NHS National Services
Scotland, 2011.
28 Schlackman W, Chittenden D. Packaging research. In: Worchester RM, Downham J,
editors. Consumer Market Research Handbook. Amsterdam: The Netherland: Elsevier
Science, 1986: 513–36.
29 Procter T. Essentials of Marketing Research. London: Pitman Publishing, 1997.
30 Ferris Wayne G, Connolly GN. How cigarette design can affect youth initiation into
smoking: camel cigarettes 1983-93. Tob Control 2002;11(Suppl. I):32–9.
31 Bero L. Implications of the tobacco industry documents for public health and
policy. Ann Rev Public Health 2003;24:267–88.
32 Maertens R, Mladjenovic N, Soo E, White PA. Select toxicant yields and salmonella
mutagenicity of mainstream smoke emissions from Canadian ‘‘super slim’’
cigarettes. SRNT Conference. Boston, MA, Abstract POS4-25.
33 Mapother J. Putting a shine on tipping. Tob J Int 2012;2:77–83.
34 BBC. MEPs tighten anti-tobacco laws aimed at young smokers. BBC 8 October
2013. Available at: http://www.bbc.co.uk/news/world-europe-24439474 (10 October
2013, date last accessed).
468 European Journal of Public Health
by guest on January 9, 2016http://eurpub.oxfordjournals.org/Downloaded from
    • "thinking about and prioritising quitting, and quit attempts (Durkin et al., 2015; Wakefield, Hayes, Durkin, & Borland, 2013; Wakefield et al., 2015; Young et al., 2014). Plain packaging regulations in Australia, the UK, Ireland and France, also covers the appearance of cigarettes, given its importance as a communications tool (Ford, Moodie, Mackintosh, & Hastings, 2014; Moodie, Ford, Mackintosh, & Purves, 2015), and stipulates that the cigarette paper must be white and devoid of any markings except for an alphanumeric code or brand variant name printed in a small font. This provides an opportunity for these governments to include health messaging on cigarettes, as mentioned within the guidelines for Article 11 of the Framework Convention on Tobacco Control (WHO, 2008), should such messaging be found to have potential public health benefits. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: Packaging is a powerful communications tool. In this study innovative ways in which cigarette packaging could potentially be used to communicate health messages, beyond the on-pack warnings and plain packaging, were explored. Methods: Face-to-face interviews were conducted with packaging and marketing experts (N = 12) in the United Kingdom to explore novel ways of using the cigarette pack and cigarette to communicate with consumers: (1) Pack inserts, (2) A cigarette displaying a health warning, and (3) A pack playing an audio health message when opened. Participants were also asked to propose other ways, beyond those discussed, in which the pack could potentially be used to communicate health messages. Results: The on-cigarette warning was considered a powerful deterrent, thought to confront smokers, put off non-smokers, signal to youth that it is neither cool nor intelligent to smoke, and prolong the health message. Inserts were considered an appropriate supplement to the on-pack warnings, particularly if they featured gain-framed messages, and helpful for engaging smokers contemplating quitting. It was suggested that the pack with an audio health message may badger a regular smoker to the point of quitting, but the concern was that it was annoying and could lead smokers to decant their cigarettes into an alternative carrier. A number of other options for communicating with consumers were proposed. Conclusions: Pack inserts and cigarettes displaying health messages are two viable options available to regulators for supplementing the warnings on the outside of packs and thus extending health communication with consumers.
    Full-text · Article · Jul 2015
    • "Theoretically, the unattractive colours used in dissuasive (or plain) packaging give rise to cognitive dissonance that undermines the benefits smokers gain from smoking (Festinger, 1975). For many years, marketers have recognised that colours not only denote physical product attributes but create connotations that shape how consumers experience specific brands (Aslam, 2006; Agarwal and Teas, 2000). "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose Australia’s decision to introduce plain packaging has aroused international attention and stimulated interest in complementary initiatives. To date, research attention has focused on external packaging and few studies have examined the physical objects of consumption – cigarette sticks. We investigated how young adult women smokers, a group the tobacco industry has specifically targeted, interpreted dissuasive sticks. Design/methodology/approach We conducted two focus groups and 13 in-depth interviews using purposive recruitment. Data were analyzed using thematic analysis. Findings We identified three overarching themes: smoking as an act of overt and conspicuous consumption; cigarette sticks as accoutrements of social acceptability, and dissuasive colors as deconstructors of the social façade smokers construct. Dissuasive sticks challenged connotations of cleanliness participants sought, exposed smoking as “dirty”, and connoted stereotypes participants wanted to avoid. Research limitations/implications Although small-scale qualitative studies provide rich insights into participants’ responses, experimental work is required to estimate how a wider population comprising more varied smoker sub-groups responds to dissuasive sticks. Practical implications As policy makers internationally consider introducing plain packaging, they should examine whether dissuasive sticks could enhance measures regulating the external appearance of tobacco packages. Originality/value This is the first study to explore how dissuasive sticks would distance smoking from the social identity smokers seek. The findings provide a platform for experimental work that estimates the potential behavioral outcomes dissuasive sticks could stimulate.
    Article · Dec 2014
    • "The findings are also consistent with research on cigarette packaging, where pack design has a significant impact on perceptions of appeal, taste and harm [29, 30]. The slim cigarettes generally held high appeal, consistent with research with teenagers [6] and tobacco industry research with young women. For instance , research for Philip Morris found the look of superslims cigarettes a major attraction for young women, being described as dainty, feminine, stylish and cute [31]. "
    [Show abstract] [Hide abstract] ABSTRACT: Twelve focus groups in Glasgow (Scotland) were conducted with female non-smokers and occasional smokers aged 12-24 years (N = 75), with each group shown 11 cigarettes: two (standard) cigarettes with cork filters; two coloured cigarettes (pink or brown); four slim cigarettes; an aromatized black cigarette; a menthol cigarette and a cigarette with a flavour-changing rupturable capsule in the filter. Participants were asked to rank the cigarettes by appeal, taste and harm. The capsule cigarette was then discussed in depth. The pink coloured cigarette and slim cigarettes created significant interest and were generally perceived as most appealing and pleasant tasting, and least harmful. The black aromatized cigarette received a mixed response, with some disliking the dark colour and associating it with low appeal, strong taste and increased harm, whereas for others the smell helped to enhance appeal and taste perceptions and lower perceptions of harm. The novel capsule cigarette, when discussed in-depth, was viewed very positively. Just as research shows that cigarette packs can influence perceptions of appeal, harm and taste, this study suggests that the actual cigarettes can do likewise. The findings have implications for tobacco education and policy.
    Full-text · Article · Oct 2014
Show more

  • undefined · undefined
  • undefined · undefined
  • undefined · undefined