Graphic warning labels on plain cigarette packs: Will they make a difference to adolescents?

Graphic warning labels and plain cigarette packaging are two initiatives developed to increase quit behaviour among smokers. Although a little is known about how adolescents interpret graphic warning labels, very few studies have examined how plain cigarette packaging would affect adolescents' perceptions of cigarette smoking and smoking behaviour. We explored how teens interpret and respond to graphic warning labels and the plain packaging of cigarettes, to assess the potential these strategies may offer in deterring smoking initiation. Twelve focus group interviews with a sample of 80 14-16 year old students from a diverse range of schools in Auckland, New Zealand were undertaken between June and August 2009. Textual analysis revealed that graphic warning labels may influence adolescents by reiterating a negative image of smokers. Graphic warning on a plain cigarette pack increased the attention paid to graphic warning labels and the overall perceptions of harm caused by cigarette smoking, and reduced the social appeal of cigarette smoking. This research offers evidence on how adolescents are appraising and interpreting graphic warning labels, and explores how dominant appraisals may affect the role graphic warning labels play in preventing smoking. Not only would plain cigarette packaging enhance the salience and impact of graphic warning labels, but it would potentially bolster the overall message that cigarette smoking is harmful. In the context of a comprehensive tobacco control programme, graphic warning labels on plain cigarette packaging present an explicit message about the risks (to health and image) associated with cigarette smoking.     

Adolescents' Perceptions of Cigarette Brand Image: Does Plain Packaging Make a Difference?

PurposeTo examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs.MethodsWe used a 5 (degree of plain packaging and graphic health warning)× 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings.ResultsWhen brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers.ConclusionsRemoving as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced.     

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

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

Reactions of adult and teenaged smokers to the Massachusetts tobacco tax.

OBJECTIVES: This study assessed smokers' reactions to a 25 cents cigarette tax imposed in Massachusetts. METHODS: A statewide telephone survey of 1783 adult smokers and 216 teenaged smokers was conducted. RESULTS: Among adult smokers, 3.5% reported that they had stopped smoking, owing in part to the price increase; 35% had considered quitting and 19% had attempted to cut the cost of smoking by switching to cheaper brands or cutting down. Among teenagers, 21% had considered quitting and 26% had cut costs. Low-income smokers were more responsive to the price increase than more affluent smokers. CONCLUSIONS: A modest and temporary price increase promoted quitting among adult smokers and reduced cigarette consumption among low-income teenagers.     

From strength to strength: an 18-year comparison of New Zealand adolescents' self-perceived strengths

Objective: To examine whether self‐views of New Zealand (NZ) adolescents have become more positive or negative over time. Method: We compared the self‐perceptions of 609 adolescents in 1987, with 499 adolescents in 2005 using a 22‐item measure of perceived strengths. Results: The mean scores for total strengths fell by 2.4 (0.5sd) from 1987 to 2005. Endorsement of most strengths decreased over time, with especially marked decreases in perceptions of being ‘healthy’, ‘careful’, ‘good with pets’, and ‘popular’. There were increases among the girls in perceptions of being ‘attractive’ and ‘confident’ while boys showed decreases in these strengths. Boys also showed an especially marked decrease in being ‘good at sport’. Conclusions: The findings point to significant changes in self‐perceived strengths among NZ adolescents over time. An examination of changes in other critical variables suggests reasons why this may be occurring.     

College students' expectancies for light cigarettes and potential reduced exposure products

OBJECTIVES: To determine positive and negative beliefs about light cigarettes and potential reduced exposure products (PREPs) among college student smokers and non-smokers. METHODS: A web-based survey conducted in October-November 2004 among 424 students rating 5 advertisements for cigarette brands (Marlboro Red, Light, and Ultralight; Quest; Eclipse) on 28 items tapping positive and negative product expectancies. RESULTS: Marlboro Light and Ultralight were rated more positively and less negatively than their Red counterpart. PREPs showed low positive and negative ratings relative to Marlboro Light. Positive expectancies were significantly related to willingness to try each brand. CONCLUSIONS: Advertising plays a role in influencing how college students view light and PREP cigarette brands.     

Cigarette brand preferences of teenagers and adults

Individual interviews were conducted with 726 Glasgow childrenaged 6–17 years. The majority of the secondary schoolchildren made good judgements of the cigarette brands preferredby teenage and adult smokers. The young smokers were particularlygood at this. These findings add to the growing body of evidenceindicating that young people are much more aware of mattersrelating to cigarettes (such as brand names and imagery) thanadults realize, and that underage smokers are more aware ofthese matters than nonsmokers of the same age. Primary school children with parents who smoked tended to bemore aware of brand preferences than primary school childrenwhose parents did not smoke.This indicates that the childrenof smokers tend to be more attuned to brand preferences, andthat much of this early learning occurs in the home. The young smokers showed an enhanced preference for the brandmost preferred by adults. This replicates a phenomenon reportedin Australia. The preferred brand in Glasgow, Kensitas Club,is heavily advertised in the Glasgow press. The findings suggest that children are highly sensitive to theadvertising of cigarette brands, and provide further supportfor recent research indicating that cigarette advertising promotesand reinforces smoking among the young.     

Nicotine yield and measures of cigarette smoke exposure in a large population: are lower-yield cigarettes safer?

We examined the relationship of machine-estimated nicotine yield by cigarette brand with the level of cigarette consumption and two biochemical measures of smoke exposure (expired-air carbon monoxide and plasma thiocyanate) in a large, population-based sample of smokers (N = 713). The lower the nicotine yield of the cigarette, the greater the number of cigarettes smoked per day. Prior to adjusting for number of cigarettes smoked per day, nicotine yield was not related to the actual measures of smoke exposure. Smokers of ultralow-yield cigarettes had laboratory tests of smoke exposure which were not significantly different from those of smokers of higher-yield brands. Only after adjustment for number of cigarettes smoked per day did nicotine yield become significantly related to expired-air carbon monoxide and to plasma thiocyanate. In multivariate analysis, the number of cigarettes smoked per day accounted for 28 per cent and 22 per cent of the variance in observed expired-air carbon monoxide and plasma thiocyanate levels, respectively, whereas nicotine yield accounted for only 1 per cent and 2 per cent of the variance, respectively. The relative lack of an effect of nicotine yield on the biochemical measure appears to be due to the fact that smokers of lower nicotine brands smoked more cigarettes per day, thereby compensating for reduced delivery of smoke products. Our data do not support the concept that ultralow-yield cigarettes are less hazardous than others. Machine estimates suggesting low nicotine yield underrepresent actual human consumption of harmful cigarette constituents.     

Cigarette smoking behavior is strongly related to educational status: the CARDIA study

The prevalence and correlates of cigarette smoking were examined in 5,116 men and women ages 18-30 years including both blacks and whites of varied educational levels. Prevalence of smoking was approximately 30% in each race by gender subgroup after adjusting for age and education. The prevalence decreased with increasing education, from 54% among participants with less than a high school education to 12% among those with graduate degrees (P less than 0.001). Cessation rates followed a similar pattern, with former smokers twice as common among those with more education. Differences in smoking prevalence across occupational groups were largely explained by differences in educational achievement. More educated individuals smoked fewer cigarettes per day and chose brands with lower nicotine yield. Race and gender were not strongly related to smoking prevalence. However, among smokers, whites reported smoking 50% more cigarettes per day than blacks but the average nicotine and tar content of the cigarette was nearly three times higher among blacks than whites. The strong inverse relationship between education and cigarette smoking patterns has important implications for public health efforts directed at the prevention of cigarette smoking.     

Perceptions About the Impact of Cigarette Filters on the Environment and Smoking-Related Behaviors

PurposeExamine adolescents’ and young adults’ (AYAs) knowledge and perceptions about the composition and environmental harms of cigarette filters and determine how perceptions are associated with support for policy interventions.MethodsCross-sectional, convenience sample from 10 California schools. AYAs (N = 429; 70% < 21 years) were surveyed about tobacco use, perceptions of cigarette filters, their impact on the environment, and cigarette sales bans.ResultsMost agreed that filters are harmful to the environment and not biodegradable (89%, n = 383 respectively); fewer knew filters are made of plastic (43%, n = 185). AYAs who agreed that filters are harmful to the environment were more supportive of cigarette sales bans (OR = 2.78 [95% CI: 1.18, 6.58]).ConclusionsKnowledge of the environmental harms of cigarettes among AYAs may strengthen support for tobacco control. More research is needed to further understand the knowledge and attitudes about the environmental impact of tobacco and to clarify how this might add support for tobacco-related policies.     

Smoking topography and biomarkers of exposure among Japanese smokers: associations with cigarette emissions obtained using machine smoking protocols

Objectives

Although the relative risk of lung cancer due to smoking is reported to be lower in Japan than in other countries, few studies have examined the characteristics of Japanese cigarettes or potential differences in smoking patterns among Japanese smokers.

Methods

To examine tar, nicotine and carbon monoxide (TNCO) emissions from ten leading cigarettes in Japan, machine smoking tests were conducted using the International Organization for Standardization (ISO) protocol and the Health Canada Intense (HCI) protocol. Smoking topography and tobacco-related biomarkers were collected from 101 Japanese smokers to examine measures of exposure.

Results

The findings indicate considerable variability in the smoking behavior of Japanese smokers. On average, puffing behaviors observed among smokers were more similar to the parameters of the HCI protocol, and brands with greater ventilation that yielded lower machine values using the ISO protocol were smoked more intensely than brands with lower levels of ventilation. The smokers of “ultra-low/low” nicotine-yield cigarettes smoked 2.7-fold more intensively than those of “medium/high” nicotine-yield cigarette smokers to achieve the same level of salivary cotinine (p = 0.024). CO levels in expiratory breath samples were associated with puff volume and self-reported smoking intensity, but not with nominal values of nicotine-yield reported on cigarette packages.

Conclusions

Japanese smokers engaged in “compensatory smoking” to achieve their desired nicotine intake, and levels of exposure were greater than those suggested by the nominal value of nicotine and tar yields reported on cigarette packages.     

Cigarette advertising and black-white differences in brand preference

Anecdotal evidence indicates that the cigarette industry is targeting the sale of specific brands, notably menthol cigarettes, to black consumers. This paper presents data on the types of cigarettes smoked by white and black smokers. The cigarette brand preferences of two populations of smokers were examined. The first comprised 70 white and 365 black adult smokers seen at the Deaconness Family Medicine Center located in Buffalo, NY. The second population included 1,070 white and 92 black smokers who called a Stop Smoking Hotline in Buffalo. The results showed that, in both populations, blacks were twice as likely to smoke mentholated cigarettes compared with whites. In an attempt to evaluate the targeting of cigarette ads to black smokers as a possible explanation for black-white differences in brand preferences, cigarette ads appearing in magazines targeted to predominantly white or black readers were compared. Cigarette ads appearing in seven magazines were reviewed, four directed to predominantly white readers (Newsweek, Time, People, Mademoiselle) and three with wide circulation among black audiences (Jet, Ebony, Essence). The results showed that the magazines targeted to black readers contained significantly more cigarette ads and more ads for menthol brand cigarettes than magazines similar in content but targeted to white readers. The observation that a higher percentage of blacks smoke menthol cigarettes than do whites is consistent with the findings regarding differences in the type of cigarette ads appearing in magazines intended for black or white readers. However, it is not possible to determine from this study whether cigarette advertising is the cause of the differences in preference of cigarette brands between white and black smokers.(ABSTRACT TRUNCATED AT 250 WORDS)     

COMMERCE OR CON: YOUNG PEOPLE AND CIGARETTE ADVERTISING

One thousand two hundred and fifty-four adolescents in Hamilton, New Zealand, ranging in age from 10 to 16, were questioned on their awareness of, and attitudes towards, cigarette advertising, and on their image of the young smoker. Most of the respondents felt that tobacco companies advertise to encourage people to buy their brands. Smokers were less likely than non-smokers to feel that cigarette companies advertise to encourage young people to take up smoking. They were also more likely to agree that cigarette companies are generous, public spirited people. Non-smokers were more likely to feel that cigarette advertising was effective in encouraging young people to smoke. Winfield, the most popular brand among smokers, was also the most well known. Smokers had a more positive image than non-smokers of the young person who smokes.     

Heterogeneity in Smokers' Responses to Tobacco Control Policies

This paper uses unconditional quantile regression to estimate whether smokers' responses to tobacco control policies change across the distribution of smoking levels. I measure smoking behavior with the number of cigarettes smoked per day and also with serum cotinine levels, a continuous biomarker of nicotine exposure, using individual‐level repeated cross‐section data from the National Health and Nutrition Examination Surveys. I find that the cigarette taxes lead to reductions in both the number of cigarettes smoked per day and in smokers' cotinine levels. These reductions are most pronounced in the middle quantiles of both distributions in terms of marginal effects, but most pronounced in the lower quantiles in terms of tax elasticities. I do not find that higher cigarette taxes lead to statistically significant changes in the amount of nicotine smokers ingest from each cigarette. Copyright © 2015 John Wiley & Sons, Ltd.