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BackgroundFlavoured 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.MethodsWe 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.Results1500 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).ConclusionsColours and flavour capsule images appeal to adolescents and adults in Mexico. Mexico should consider adopting plain packaging to reduce appeal and interest.

IntroductionRaising cigarette prices, increasing graphic health warning label (HWL) coverage and requiring plain packaging could reduce cigarette smoking in Vietnam. This discrete choice experiment estimates the potential impact of these policies on smoking behaviour.MethodsIn February–May 2022, we conducted a phone-based, cross-sectional survey of 1494 Vietnamese adults who smoke. Participants were randomly assigned to view four individual cigarette pack images, varied on price (15 000 (reference group); 20 000; 30 000 or 40 000 Vietnamese dong (VND)) and packaging (branded pack with 50% graphic HWL (reference group); branded pack with 85% graphic HWL; plain pack with 50% graphic HWL or branded pack without HWL). Participants responded if they would quit or continue smoking if they could only purchase the pack shown. We used binomial logistic regressions to estimate the relative risk (RR) of price and packaging on hypothetical quitting.ResultsParticipants were more likely to report they would quit when presented with 30 000 VND (RR 1.20, 95% CI 1.07 to 1.35) and 40 000 VND packs (RR 1.40, 95% CI 1.23 to 1.58) vs the 15 000 VND pack. Participants were also more likely to report they would quit when shown the branded pack with 85% HWL (RR 1.30, 95% CI 1.18 to 1.42) and plain pack with 50% HWL (RR 1.34, 95% CI 1.21 to 1.49) vs the branded pack with 50% HWL coverage. Participants had significantly lower quit likelihood (RR 0.41, 95% CI 0.35 to 0.48) when shown the branded pack without a HWL.ConclusionsResults suggest raising cigarette prices to at least 30 000 VND, implementing larger graphic HWLs or plain packaging could decrease smoking rates in Vietnam.

Background Cigarette pack design plays a crucial role in attracting customers, especially when other marketing methods are limited by policy. University students who engage in casual smoking take the risk of developing an addiction. The objective of this study was to assess the effects of plain packaging (PP) and graphic health warnings (GHWs) on cigarette packages on three outcome variables (negative affect, avoidant responses, and intentions to quit) among ever-smoker university students in Ankara, Turkey, where youth smoking prevalence is high. Methods An online survey-based experiment was used to collect data. The respondents were randomly assigned to one of the five conditions that contained images of cigarette packs with specific design elements. Regression analyses ( n  = 623) were used to compare across conditions and to estimate the effects of combined warnings (versus text-only warnings), stronger GHWs (versus old GHWs), and PP (versus branded packages) on the outcome variables, accounting for potential confounders. Results Stronger GHWs generated more negative affect (0.31 points out of 5, p  = 0.010) and avoidant responses (0.42 points out of 5, p  = 0.002) than old warnings (when brand logos were visible). Plain packages generated more negative affect (0.48 points out of 5, p  < 0.001) and avoidant responses (0.46 points out of 5, p  = 0.001) than branded packages (with old warnings). Disentangling the effects of PP and new GHWs revealed that neither had individual differential effect on intentions to quit within 6 months. Conclusions Although no differential effect of PP or harsher GHWs was found on intentions to quit when respondents were exposed to images on screen, both design elements were found to be effective in generating negative affect and avoidant responses. More work is needed to design effective tobacco control measures among youth during critical years of tertiary education.

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

BackgroundGlobally, the tobacco industry is promoting heated tobacco products. These products may represent a strategy to promote dual use of tobacco products. One product, IQOS from Philip Morris International, is being proposed in the USA for marketing as a less harmful product. The visual design of tobacco products can influence consumers by implying product characteristics. Thus, we sought to test the impact of IQOS packaging designs on cognitive, affective and behavioural intention responses.MethodsFrom existing IQOS packages used globally, we developed three IQOS packages that decreasingly linked the product to the Marlboro brand. In September to October 2018, we assigned participants randomly to one package in an online experiment. All participants (n=954) were US adults reporting current smoking and no colour blindness. The experiment used quota sampling to ensure diversity by gender, sexual orientation, race, ethnicity and education. Measures were informed by the Context of Consumption Framework. To assess differences in ratings, we conducted non-parametric Kruskal–Wallis tests with post hoc comparisons using Dunn’s test.ResultsWe found significant differences in cognitive indicators including appeal (H=6.87, p=0.03), uniqueness (H=15.68, p<0.01), brand equity–quality (H=122.35, p<0.01) and perceived safety compared with other tobacco products (H=14.27, p<0.01). Participants rated packages similarly on affective and behavioural intention measures. All were rated low for talking to others about the product and high for interest in trying with a coupon.ConclusionLinking or separating IQOS products with a well-established cigarette brand changes how adult smokers respond to the product. Regulators should consider the visual design of packaging.

Background Perceptions of tobacco packaging may be consequential for consumption and initiation. We explored the potential effect of standardised packaging on young adults’ ratings of the appeal of brands of snus (Swedish moist snuff) and on their perceptions of typical users of these brands. We were interested in both the effects on average levels of ratings and on the within-subject variability of the ratings. The latter was used as a measure of the extent to which individuals can differentiate between brands. Methods A sample of 625 Norwegians aged 16–30 were randomly allocated to one of three between-subject conditions: Branded Packaging, Standardised Packaging, or Standardised Packaging with Health Warnings. The participants rated 10 snus brands on measures of general appeal and on their perceptions of the typical brand user (e.g., “… is sporty and active”). Results The standardised packages (without health warnings) were not rated more negatively than the branded packages, while the standardised packages with health warnings were rated slightly more negatively than the branded packages. However, in terms of within-subject standard deviations, the variability of the brand ratings across the packages was substantially lower for standardised packaging types in comparison to branded packages. Conclusions Even in cases where standardised tobacco packaging appears to have little overall effect on the valence of the average ratings, it can have a strong effect on the variability of the ratings. This suggests that standardised packaging can reduce the potential for brand differentiation.

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.

Background Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. We ran a randomised controlled trial to investigate the impact of plain packaging on smoking behaviour and attitudes. Methods In a parallel group randomised trial design, 128 daily smokers smoked cigarettes from their usual UK brand, or a plain Australian brand that was closely matched to their usual UK brand for 24 hours. Primary outcomes were number of cigarettes smoked and volume of smoke inhaled per cigarette. Secondary outcomes were self-reported ratings of motivation to quit, cigarette taste, experience of using the pack, experience of smoking, attributes of the pack, perceptions of the health warning, changes in smoking behaviour, and views on plain packaging. Results There was no evidence that pack type had an effect on either of the primary measures ( p s > 0.279). However, smokers using plain cigarette packs rated the experience of using the pack more negatively (−0.52, 95% CI −0.82 to −0.22, p  = 0.001), rated the pack attributes more negatively (−1.59, 95% CI −1.80 to −1.39, p  < 0.001), and rated the health warning as more impactful (+0.51, 95% CI 0.24 to 0.78, p  < 0.001). Conclusions Plain cigarette packs reduce ratings of the experience of using the cigarette pack, and ratings of the pack attributes, and increase the self-perceived impact of the health warning, but do not change smoking behaviour, at least in the short term. Trial registration Current Controlled Trials ISRCTN52982308 . Registered 27 June 2013.

ObjectiveTo examine the effect of branding, as indicated by brand name, on evaluation of the cigarette smoking experience.DesignBetween-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).SettingAustralia, October 2014, 2 years after tobacco plain packaging implementation.Participants81 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 measuresExperienced 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.ResultsCigarettes 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).ConclusionsDespite 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.

Background Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil. Methods A between-subjects experiment was conducted in which 640 Brazilian women aged 16–26 participated in an online survey. Participants were randomized to view 10 cigarette packages according to one of three experimental conditions: standard branded packages, the same packs without brand imagery (“plain packaging”), or the same packs without brand imagery or descriptors (e.g., flavors). Participants rated packages on perceived appeal, taste, health risk, smoothness, and smoker attributes. Finally, participants were shown a range of branded and plain packs from which they could select one as a free gift, which constituted a behavioral measure of appeal. Results Branded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. In the pack offer, participants were three times more likely to select branded packs than plain packs. Conclusions Plain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults, and consequently reduce smoking susceptibility. Overall, the findings provide support for plain packaging regulations, such as those in Australia.