Perceptions of cigarette pack inserts promoting cessation and dissuasive cigarettes among young adult smokers in the UK: a cross-sectional online survey

Abstract

ObjectivesTo explore young adult smokers’ perceptions of cigarette pack inserts promoting cessation and cigarettes designed to be dissuasive.DesignCross-sectional online survey.SettingUK.ParticipantsThe final sample was 1766 young adult smokers, with 50.3% male and 71.6% white British. To meet the inclusion criteria, participants had to be 16–34 years old and smoke factory-made cigarettes.Primary and secondary outcome measuresSalience of inserts, perceptions of inserts as information provision, perceptions of inserts on quitting, support for inserts and perceived appeal, harm and trial of three cigarettes (a standard cigarette, a standard cigarette displaying the warning ‘Smoking kills’ and a green cigarette).ResultsHalf the sample indicated that they would read inserts with three-fifths indicating that they are a good way to provide information about quitting (61%). Just over half indicated that inserts would make them think more about quitting (53%), help if they decided to quit (52%), are an effective way of encouraging smokers to quit (53%) and supported having them in all packs (55%). Participants who smoked factory-made cigarettes and other tobacco products (compared with exclusive factory-made cigarette smokers), had made a quit attempt within the last 6 months (compared with those that had never made a quit attempt) or were likely to make a successful quit attempt in the next 6 months (compared with those unlikely to make a quit attempt in the next 6 months) were more likely to indicate that inserts could assist with cessation. Multivariable logistic regression modelling suggested that compared with the standard cigarette, the cigarette with warning (adjusted OR=17.71; 95% CI 13.75 to 22.80) and green cigarette (adjusted OR=30.88; 95% CI 23.98 to 39.76) were much less desirable (less appealing, more harmful and less likely to be tried).ConclusionsInserts and dissuasive cigarettes offer policy makers additional ways of using the pack to reduce smoking.

Extending health messaging to the consumption experience: a focus group study exploring smokers’ perceptions of health warnings on cigarettes

“…stubbing cigarettes out early or reducing consumption), encourage or lead to quitting, or deter young people, nonsmokers and those starting to smoke. This adds to online surveys which found that the warning 'Smoking kills' on cigarettes, in comparison to regular cigarettes, were associated with a lower likelihood of perceived trial (Lund and Scheffels 2018;Moodie, Hiscock et al 2018;Moodie et al 2019), and an in-home survey in which more than half of participants thought that having this warning on cigarettes would encourage cessation and almost three-quarters that it would discourage initiation (Moodie et al 2017). These studies, collectively, suggest that warnings on cigarettes may have the potential to impact the decisions of people to start, continue or stop smoking, contrary to tobacco companies claims that there is no evidence to suggest that this would be the case (Nuthall 2019).…”

“…Twenty focus groups were conducted between January-March 2015 with 120 smokers in the two most populated cities in Scotland (Glasgow, Edinburgh) to explore their perceptions of cigarette packaging, pack inserts promoting cessation (Moodie 2018b ), and also cigarette design, which is the focus of this paper. Focus groups were employed as they are helpful for gaining insight into how a particular sample may respond to a novel concept, in this case how smokers respond to cigarettes with the warning ‘Smoking kills’.…”

“…In two online surveys, with 16-24 year old smokers and nonsmokers (n ¼ 997) in 2015 (Moodie et al 2019), and 16-34 year old smokers (n ¼ 1766) in 2016 (Moodie, Hoek et al 2018), participants were shown an image of a regular cigarette, cigarette with warning, and unattractively colored (green) cigarette, and asked to rate each on appeal, harm, and likely trial. Compared with the regular cigarette, smokers and nonsmokers rated the cigarette with warning and the green cigarette as less appealing and more harmful, and indicated that they would be less likely to try them (Moodie, Hiscock et al 2018;Moodie et al 2019). Two further studies have explored perceptions of regular (white cigarette paper with white or imitation cork filter) and dissuasive sticks (a cigarette with 'Smoking kills' on the cigarette paper, a cigarette displaying 'minutes of life lost' for each cigarette on the cigarette paper, a yellow cigarette, and a green cigarette) (Hoek et al 2016;Lund and Scheffels 2018).…”

“…Compared with the regular cigarette, smokers and nonsmokers rated the cigarette with warning and the green cigarette as less appealing and more harmful, and indicated that they would be less likely to try them (Moodie, Hiscock et al. 2018 ; Moodie et al. 2019 ).…”

Responding to health inequities in New Zealand: the potential of dissuasive cigarettes

“…[2][3][4][5][6][7] Much of this research has been led by researchers in New Zealand, [8][9][10][11][12] but further research has also been conducted in Norway 4 and the United Kingdom. 13 There are several means to portray cigarettes as repellent, including proposals to remove additives such as sugar and menthol, ensuring that cigarettes taste bitter and far less palatable to smokers. However, the current leading proposals designed to modify cigarettes to create 'dissuasive sticks' focus on two key areas.…”