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

Consumer Perceptions of Cigarette Design in France: A Comparison of Regular, Slim, Pink and Plain... Abstract 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. Introduction Article 13 of the Framework Convention for Tobacco Control (FCTC) bans all tobacco marketing and recommends plain (or standardized) tobacco packaging.1 Many countries have adopted comprehensive tobacco advertising bans and some have fully implemented plain packaging. Following Australia in December 2012, France became the second country to require plain packaging in January 2017; the United Kingdom has since followed suit in May 2017.2 Consequently, the cigarette stick has become more important for tobacco companies for brand communication,3 with promotional elements often displayed on cigarettes (eg, brand names, logos, brand descriptors, and capsule symbols) and filter innovation (eg, different shapes and colors) increasingly common.4 Tobacco companies’ use of branded cigarettes to influence audience preferences has been revealed in past research and in internal documents.5–8 For instance, slim cigarettes have been marketed at women and associated with advertising campaigns promoting the belief that smoking is an effective way of controlling weight: Philip Morris launched Virginia Slims with its advertising stressing themes of thinness, glamour, and independence.9 Industry research has found that among women smokers, irrespective of age, certain “superslims” brands and cigarettes were viewed as stylish or projected a feminine elegance.10,11 Studies have also found that certain slim brands were perceived as less harmful than other cigarettes,12 although blood cadmium levels have not been found to be lower among females who smoke slim rather than nonslim cigarettes.13 Colored and flavored cigarettes have also been developed by tobacco companies to create appeal and communicate favorable brand impressions.14,15 In the 1950s for instance, pink colored “Vanity Fair” cigarettes were advertised alongside the slogan “Be glamorous all day long”.16 Internal tobacco documents reported that colored tipping or cigarette paper could make smoking more pleasurable for women,17 with these products perceived as novel by young people.18 In addition, colored cigarettes are used to communicate flavor and taste,14 for example, black indicates chocolate flavor for the “Black devil” brand and pink indicates vanilla flavor and sweet taste for the “Pink elephant” brand. Rather surprisingly, only a few studies have explored consumer response to cigarettes. Two focus group studies were conducted in Scotland, one with 15-year-old smokers and nonsmokers and the other with 12–24-year-old female never smokers and occasional smokers, to explore perceptions of a range of cigarettes.19,20 In both studies, slimmer cigarettes were considered more appealing and less harmful than regular cigarettes with a cork filter and white cigarette paper. Color also influenced product perceptions, with a pink cigarette generating considerable interest among 12–24 female never smokers and occasional smokers, being considered appealing, pleasant tasting, and less harmful. A qualitative study with young female smokers in New Zealand found that colored cigarettes (lilac, red, silver-white, or gold) were judged to be attractive and improved smokers’ social image, with these cigarettes thought to help them look better, be seen as classy, and avoid social stigma.21 When regular cigarettes with cork or white filters and slim cigarettes were compared, there was a preference for slim and white cigarettes as participants thought that these helped distance themselves from negative associations with smoking by portraying a glamorous, slim, delicate, and feminine image. Using a face-to-face survey with a large European sample of current and former adult smokers, Agaku et al. found that colored cigarettes were thought to be sweet tasting and that flavored cigarettes were associated with first smoking experiences and reduced harm perceptions.22 Finally, an online survey in Australia compared young adult smokers’ reactions to different cigarettes, with regular cigarettes rated as more attractive and higher quality than extra-long, short, slim, or extra-slim sticks.23 Most participants indicated that they would prefer to smoke the regular stick. To reduce the appeal of the types of cigarettes on sale in most markets, researchers have begun to explore consumer response to cigarettes designed to be dissuasive. Few studies have explored the impact of plain, unattractively colored cigarettes. A qualitative study and an online survey in New Zealand both found that green or yellow-brown cigarettes were considered aversive and rated as less appealing than regular cigarettes.21,24 Focus groups in Scotland also found that young people perceived brown cigarettes as particularly strong and harmful.19,20 These findings suggest that altering the color of cigarettes may be able to influence how they are perceived, the image they convey and smoking intentions. Research has yet to compare the effect of a plain, unattractively colored cigarette with a number of different cigarette styles which are available in most countries. In this study, we explore how young adult smokers and nonsmokers perceive a plain gray colored cigarette (designed for this study) and three cigarettes (regular, slim, and brightly colored) that were on sale in France at the time of the study, in terms of appeal, harm, and behavioral impact. Methods Design and Sample An online survey was conducted in France from December 4 to 16, 2013 (before the implementation of tobacco plain packaging in 2017), with 998 smokers and nonsmokers aged 15–30 years. The sample was chosen because the prevalence of daily smoking is high in France for this population (33.4%).25 A quota sample was sought, balanced by gender, age group, socioeconomic status, geographic area (nine broad areas that cover all of France), and size of urban unit (<2000 inhabitants; 2000–20000; 20000–100000; >100000; and the Ile de France region, which includes Paris, with 12 million inhabitants), following the national percentages of the general population indicated by the National Institute of Statistics and Economics Studies (see Table 1 for sample characteristics). Almost two-fifths (38%) were smokers (of which 67% were daily smokers) and 62% were nonsmokers (of which 39% were former smokers). Table 1. Sample Characteristics (Weighted Data)   Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%          Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%        View Large Table 1. Sample Characteristics (Weighted Data)   Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%          Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%        View Large Procedure Participants were recruited by an established market research company (LH2), in collaboration with its partner “Survey Sampling International.” Members of their online panel were sent an email invitation explaining that the survey was part of a national public health study on tobacco prevention messages; the email invitation and survey were both in French. We do not have the response rate as recording contact, participation, and refusal rates is impractical when using this sampling methodology. Participants received a modest incentive, in the form of “points” which can be redeemed for vouchers, as is common with online panels. For those eligible for inclusion, they were randomly assigned to view one of three images: 333 were shown an image of a regular cigarette with the brand name “Marlboro” written on the stick and a gray plain cigarette (PC); 332 were shown an image of a slim cigarette with the brand name “Vogue” displayed on the tip and a gray cigarette; 333 were shown an image of a pink cigarette with the symbol of the brand (an elephant) displayed on the tip and a gray PC (see Figure 1: cigarettes shown to participants). These three branded cigarettes (regular, slim, and pink) were chosen because they were sold on the French market when the study was conducted: regular sticks were the most commonly sold cigarettes, with slim and pink cigarettes, targeted at women and young people, also available, (Comité National Contre le Tabagisme, unpublished report) [pp. 57–60]. Gray was selected for the PC because previous research in France found that gray tobacco packaging was perceived as unattractive compared with white and brown packs,26 with gray reported to be the color that French consumers disliked the most in a study that compared 190 color pairs.27 Participants were asked about Appeal, Harm, and Perceived behavioral impact, with the ordering of the questions randomized. The study was ethically approved by the Institut National de Prévention et d’Education pour la Santé (INPES). Figure 1. View largeDownload slide Cigarettes shown to participants. Figure 1. View largeDownload slide Cigarettes shown to participants. Measures Demographic Information Smoking status, gender, and socioeconomic status (based on occupation of the head of the household) were assessed. To assess smoking status, we used the same items employed in the European Commission’s Eurobarometer survey. Participants were asked: “Are you: 1/ a non-smoker; 2/ an occasional smoker (you do not smoke daily); 3/ a regular smoker (you smoke at least one cigarette per day).” Appeal Participants were asked in three separate questions: “of these two cigarettes, which one do you consider: the most expensive, tastiest, the highest quality.” These three items were taken from past research on plain packaging.28,29 Harm Participants were asked in two questions: “of these two cigarettes, which one do you consider: the most dangerous, the most effective to make people talk about tobacco dangers.” Perceived Behavioral Impact Participants were asked in three questions: “of these two cigarettes, which one do you consider: the most effective for convincing teenagers not to start, the most effective for motivating smokers to quit and the most effective for motivating smokers to reduce consumption.” For all questions, participants had the option to select either image, “Don’t know,” or “None.” Analysis Using Stata/SE 13.1 software, all analyses were conducted on weighted data that reflected the demographic structure of the national population. Adjusted Wald tests for weighted data were used to examine differences in the proportion of participants selecting each cigarette. Logistic regression models were run to examine differences in perceptions of the different cigarettes. For each cigarette, the dependent variables for Appeal were “most expensive,” “tastiest,” “highest quality” (where 0 = selecting the PC and 1 = selecting the branded cigarette). The dependent variables for Harm were “most dangerous” and “most effective to make people talk about tobacco dangers” (where 0 = selecting the branded cigarette and 1 = selecting the PC). For Perceived behavioral impact, the dependent variables were “most effective in convincing teenagers not to start,” “most effective for motivating smokers to quit,” and “most effective for motivating smokers to reduce consumption” (where 0 = selecting the branded cigarette and 1 = selecting the PC). Gender, age (15–20; 21–24; 25–30), smoking status (nonsmoker vs. occasional smokers vs. daily smoker), and type of cigarette (regular vs. slim vs. pink) were entered as predictor variables in each of the models. Results Perceptions of the Plain Cigarette (in Comparison With the Regular, Slim, or Pink Cigarettes) The branded regular, slim, and pink cigarettes were viewed as more appealing (the most expensive, the tastiest, and the highest quality) than the PC and less likely to have a greater impact on smoking initiation and cessation (most effective to convince teenagers not to start, and motivate smokers to reduce consumption and quit) (see Table 2: perceptions of regular, slim, pink, and PC). Although the regular and the pink cigarettes were viewed as less dangerous than the PC, there were no significant differences with respect to making people talk about the dangers of tobacco. As for the slim cigarette, it was perceived as less harmful than the PC (least dangerous, least effective in making people talk about the dangers of tobacco). Table 2. Perceptions of Regular, Slim, Pink, and Plain Cigarettes (PC) (%)   Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***    Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***  aThese responses were removed from the chi-square analysis. bns: not significant; ***p < .001. View Large Table 2. Perceptions of Regular, Slim, Pink, and Plain Cigarettes (PC) (%)   Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***    Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***  aThese responses were removed from the chi-square analysis. bns: not significant; ***p < .001. View Large Perceptions of Cigarettes According to Participants’ Profiles and Type of Cigarette Logistic regression models were conducted to examine the effect of gender (reference: male), age (reference: 15–20), smoking status (reference: nonsmoker), and type of cigarette (reference: regular cigarette) on selecting the PC or branded cigarette (see Table 3). Wald tests were computed to test the differences in odds ratios between 21–24 and 25–30 year olds, and between occasional and daily smokers. Table 3. Binary logistic regression: odds ratios for the selection of branded / plain rather than plain / branded cigarettes by gender (reference = male), age (reference = 15–20), smoking status (reference = nonsmoker), and type of branded cigarette displayed (reference = regular cigarette)   Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***    Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***  *p < .05; **p < .01; ***p < .001; ns: not significant aIt was predicted that positive attributes (“most expensive, tastiest and highest quality”) would be associated with branded cigarettes, which is why participants were asked about the likelihood of selecting branded cigarettes. bIt was predicted that negative attributes (“most dangerous, most effective to make people talk about tobacco dangers, most effective for convincing teenagers not to start, most effective for motivating smokers to quit/to reduce”) would be associated with the plain cigarette, which is why participants were asked about the likelihood of selecting plain cigarettes. View Large Table 3. Binary logistic regression: odds ratios for the selection of branded / plain rather than plain / branded cigarettes by gender (reference = male), age (reference = 15–20), smoking status (reference = nonsmoker), and type of branded cigarette displayed (reference = regular cigarette)   Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***    Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***  *p < .05; **p < .01; ***p < .001; ns: not significant aIt was predicted that positive attributes (“most expensive, tastiest and highest quality”) would be associated with branded cigarettes, which is why participants were asked about the likelihood of selecting branded cigarettes. bIt was predicted that negative attributes (“most dangerous, most effective to make people talk about tobacco dangers, most effective for convincing teenagers not to start, most effective for motivating smokers to quit/to reduce”) would be associated with the plain cigarette, which is why participants were asked about the likelihood of selecting plain cigarettes. View Large Females were significantly more likely than males to select the branded cigarette (regular, slim, or pink) as highest quality and the PC as the most effective for convincing teenagers not to start, for motivating smokers to quit and to reduce tobacco consumption. Those aged 25–30 years were significantly more likely than 15–20 year olds to report the PC as most effective for motivating smokers to quit. There was no significant difference between 21–24 and 25–30 year olds. As for smoking status, occasional smokers were more likely than nonsmokers to choose the branded cigarettes as highest quality and to select the PC as most effective for motivating teenagers not to start. Daily smokers were less likely than nonsmokers to consider the PC as most effective for motivating smokers to quit. Occasional smokers were more likely than daily smokers to select the branded cigarettes as tastiest and highest quality, and they were more likely to select the PC as most effective for convincing teenagers not to start and most effective for motivating smokers to quit. With respect to type of cigarette, participants exposed to the “pink cigarette / PC” option (compared to those exposed to “regular cigarette / PC”) were more likely to select the branded cigarette as the most expensive and less likely to choose it as the highest quality. For perceived behavioral impact, participants exposed to the “pink cigarette / PC” option were less likely to select the PC as the most effective for motivating smokers to quit and to reduce their consumption compared with those exposed to “regular cigarette / PC” option. Participants exposed to the “slim cigarette / PC” image were less likely to select the branded cigarette as tastiest compared with those exposed to the “regular cigarette / PC” option. They were also more likely to select the PC as the most dangerous and the most effective to make people talk about tobacco dangers, and they were less likely to choose the PC as the most effective for motivating smokers to quit and to reduce consumption (compared with those exposed to the “regular cigarette / PC” option). Discussion Almost three decades ago, an advertising agency suggested that Philip Morris “brand the cigarette,” proposing that “colors and designs could be carried through to the cigarette itself—a visible extension of the personality of the brand (and the user)”.30 We found that cigarettes, whether brightly colored or with a slim or regular design and with a brand name or symbol displayed on the stick, were more likely than a plain gray cigarette to influence perceptions of appeal, harm, and behavioral impact. The regular, slim, and pink cigarettes were considered the most expensive, highest quality, tastiest, and less dangerous than the PC. The PC, in contrast, was perceived as a more effective means of preventing initiation among teenagers and motivating smokers to reduce consumption and quit. These results suggest that the appearance of a cigarette, in terms of its color (bright or dull), size (slim or regular), and presence of a brand name, can influence product perceptions and perceived behavioral impact. This is also true for regular cigarettes; the white cigarette paper may help consumers distance themselves from the health risks associated with smoking.21 These findings are similar to research on plain packaging, where the use of a darker pack color can reduce the attractiveness of the pack, increase harm beliefs and motivation to quit.28,29 We found no significant differences with respect to the cigarettes being more likely to make people talk about the dangers of tobacco, except between the PC and the slim cigarette. As such, an unattractive color alone may be insufficient to provoke such reactions. Some research has revealed that displaying a warning message on cigarettes was considered a reminder of health risks. For instance, cigarettes displaying a “minutes of life lost” message have been found to increase smokers’ intentions to quit,31 and sticks displaying “minutes of life lost” or “smoking kills” warnings were rated as less appealing than regular cigarettes among smokers.24 Other studies have also found that on-cigarette message (“smoking kills”) may help to put teenagers off starting32 and would be less likely to encourage product trial among young adult smokers and nonsmokers.33 Future research could explore cigarettes combining unattractive colors and health warnings, as recommended in previous research with marketing experts.34 We identified differences in how the cigarettes were perceived by gender, age, smoking status, and cigarette type. Branded cigarettes had a stronger influence on females compared with males in conveying quality, with females more likely than males to view the PC as most effective for convincing teens not to start and for motivating smokers to reduce consumption or quit. These results are in line with research that showed that women are more likely than men to view fully branded cigarette packs as attractive compared with plain packs.35 Cigarette design also had a stronger impact on occasional smokers than nonsmokers and daily smokers, with branded cigarettes more likely to be selected as the highest quality stick (and the tastiest compared with daily smokers) than the PC. In addition, the PC was more often chosen as the most effective cigarette for convincing teens not to start among occasional smokers than among nonsmokers and as the most effective for convincing smokers to quit than among daily smokers. It may be that occasional smokers are more vulnerable to the impact of tobacco marketing (and thus the design of cigarettes) as they are more concerned with their image when they smoke.36 Participants’ reactions differed according to the type of branded cigarette they were exposed to. In the regular/PC option, the regular cigarette was more often selected as the tastiest and highest quality compared with the slim/PC and the pink/PC options, but less often chosen than the slim/PC or pink/PC options as the most effective cigarette for convincing smokers to reduce consumption and to quit. This may be explained by the fact that people are more familiar with the regular cigarette style and may consider it as reassuring regarding taste and quality, whereas slim and pink sticks may be perceived as newer products of which the taste/quality they are less able to discern. In the slim/PC option, participants less often selected the slim stick as the most dangerous, consistent with previous research that has found that slim cigarettes are perceived as less harmful, cleaner, and safer than regular cigarettes.19–21 Several conclusions can be drawn from these results. First, our study suggests that dissuasive sticks may be worth considering in countries, such as France, that have implemented plain packaging. In such markets, although smokers can hide their packs because they are unattractive, they cannot hide the cigarettes when they smoke. Second, if a pack-a-day smoker (20 cigarettes) is exposed to cigarettes approximately 70000 times per year (with around 10 puffs per cigarette),4 then removing branding from cigarettes and standardizing the color may help reduce the attractiveness of cigarettes. Third, branded cigarettes, whether regular, slim, or colored, appear to be more misleading than PC and, as such, regulation of the cigarette itself may be warranted. These regulations may be particularly important in developing countries where cigarettes are often sold by the stick.37 There are certain limitations that need to be considered. First, as the branded cigarettes we tested differed from the plain cigarette in a number of respects (color, shape, and brand name or symbol displayed on the cigarette), our research does not allow us to isolate the specific effect of each attribute on participants’ reactions. Nevertheless, should policy makers legislate for unattractively colored cigarettes without any markings, consumers will be confronted with a similar scenario to the one presented in this study, in that cigarettes on sale, which currently have brand names and/or symbols, will no longer have any of these features. Second, we assessed behavioral intentions rather than actual behavior. Third, forced exposure of our experimental design may have had an impact on responses. Fourth, although we intentionally explored young adults’ perceptions of cigarette design, given that this is a key demographic for public health, we are unable to provide any insight into the response of older smokers. In conclusion, our paper highlights that cigarettes, like cigarette packs, can be a powerful communication tool. Research could meaningfully extend this study by exploring other types of branded cigarettes, including cigarettes with flavored capsules in the filter that have been found to be particularly appealing to young people.38,39 In addition, PC colors other than gray could be examined in future research. Funding This work was supported by a grant from the INPES (Institut National de Prévention et d’Education pour la Santé) in France. CM is funded by Cancer Research UK. Declaration of Interests None declared. References 1. World Health Organisation. Guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control (Tobacco advertising, promotion and sponsorship). www.who.int/fctc/guidelines/article_13.pdf. Accessed September 25, 2017. 2. Canadian Cancer Society. Plain packaging – international overview. June 14, 2016www.smokershelp.net/wp-content/uploads/2016/07/Canadian-Cancer-Society-International-Overview.pdf. Accessed September 25, 2017. 3. Rossell S. Ready to roll. Tob Reporter . 2017; 2: 44– 45. 4. C Smith K, Washington C, Welding K, Kroart L, Osho A, Cohen JE. Cigarette stick as valuable communicative real estate: A content analysis of cigarettes from 14 low-income and middle-income countries. Tob Control . 2016; 26( 5): 604– 607. Google Scholar CrossRef Search ADS PubMed  5. Cummings KM, Morley CP, Horan JK, et al.   Marketing to America’s youth: Evidence from corporate documents. Tob Control  2002; 11( suppl 1): 5– 17. Google Scholar CrossRef Search ADS   6. Cook BL, Wayne GF, Keithly L, Connolly G. 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( 11): 1547– 1561. Google Scholar CrossRef Search ADS PubMed  7. Carpenter CM, Wayne GF, Connolly GN. Designing cigarettes for women: New findings from the tobacco industry documents. Addiction . 2005; 100( 6): 837– 851. Google Scholar CrossRef Search ADS PubMed  8. Wayne GF, Connolly GN. How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983–93. Tob Control . 2002; 11( suppl 1): 32– 39. Google Scholar CrossRef Search ADS   9. Ernster V, Kaufman N, Nichter M, Samet J, Yoon SY. Women and tobacco: Moving from policy to action. Bull World Health Organ . 2000; 78( 7): 891– 901. Google Scholar PubMed  10. Unknown. Operating plan Asia. 1995. RJ Reynolds records. Bates No. 516541768/1834. http://legacy.library.ucsf.edu/tid/jei41d00. Accessed September 25, 2017. 11. Barnewolt D, Thrane D. Review of imagery appealing to women smokers. 1986. Brown and Williamson records. Bates No. 682121192/1203. https://industrydocuments.library.ucsf.edu/tobacco/docs/#id=hgfm0132. Accessed September 25, 2017. 12. Richter P, Beistle D, Pederson L, O’Hegarty M. Small-group discussions on menthol cigarettes: Listening to adult African American smokers in Atlanta, Georgia. Ethn Health . 2008; 13( 2): 171– 182. Google Scholar CrossRef Search ADS PubMed  13. Matsunaga Y, Agaku IT, Vardavas CI. The association between cigarette rod length, slim design, and blood cadmium levels among U.S. smokers: NHANES 1999–2010. Prev Med  2014; 65( Aug): 87– 91. Google Scholar CrossRef Search ADS PubMed  14. Lewis MJ, Wackowski O. Dealing with an innovative industry: A look at flavored cigarettes promoted by mainstream brands. Am J Public Health . 2006; 96( 2): 244– 251. Google Scholar CrossRef Search ADS PubMed  15. Connolly GN. Sweet and spicy flavours: New brands for minorities and youth. Tob Control . 2004; 13( 3): 211– 212. Google Scholar CrossRef Search ADS PubMed  16. Deanna. Filter, flavor, color too with glamorous Vanity Fair cigarettes. 2012. www.kitsch-slapped.com/2012/05/filter-flavor-color-too-with-glamorous-vanity-fair-cigarettes/. Accessed September 25, 2017. 17. Idea Bank. Sharing some insights on women of today… An individual’s brainstorming. Philip Morris records. Bates No.2050901054-2050901060. 1995. www.industrydocumentslibrary.ucsf.edu/tobacco/docs/xlbk0053. Accessed September 25, 2017. 18. Opinion Research Corporation. Smoking behavior and smoker motivation - Their implications for packaging. Marketing to youth MSA collection. Bates No.1001811426-1001811544. 1961. www.industrydocumentslibrary.ucsf.edu/tobacco/docs/hqmx0045. Accessed September 25, 2017. 19. Moodie C, Ford A, Mackintosh A, Purves R. Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatized and capsule cigarettes. Health Educ Res . 2015; 30( 1): 1– 12. Google Scholar CrossRef Search ADS PubMed  20. Ford A, Moodie C, MacKintosh AM, Hastings G. Adolescent perceptions of cigarette appearance. Eur J Public Health . 2014; 24( 3): 464– 468. Google Scholar CrossRef Search ADS PubMed  21. Hoek J, Robertson C. How do young adult female smokers interpret dissuasive cigarette sticks? J Soc Mark . 2015; 5( 1): 21– 39. Google Scholar CrossRef Search ADS   22. Agaku IT, Omaduvie UT, Filippidis FT, Vardavas CI. Cigarette design and marketing features are associated with increased smoking susceptibility and perception of reduced harm among smokers in 27 EU countries. Tob Control . 2015; 24( e4): e233– e240. Google Scholar CrossRef Search ADS PubMed  23. Borland R, Savvas S. Effects of stick design features on perceptions of characteristics of cigarettes. Tob Control . 2013; 22( 5): 331– 337. Google Scholar CrossRef Search ADS PubMed  24. Hoek J, Gendall P, Eckert C, Louviere J. Dissuasive cigarette sticks: The next step in standardised (‘plain’) packaging? Tob Control . 2016; 25( 6): 699– 705. Google Scholar CrossRef Search ADS PubMed  25. INPES (Institut National de Prévention et d’Education Pour la Santé). Baromètre santé 2014. www.inpes.sante.fr/Barometres/barometre-sante-2014/index.asp. Accessed September 25, 2017. 26. Gallopel-Morvan K, Gabriel P, Le Gall-Ely M, et al.   Plain packaging to help public health. The case of tobacco control. J Bus Res . 2013; 66( 1): 133– 136. Google Scholar CrossRef Search ADS   27. Ou L-C, Luo MR, Sun P-L, et al.   A cross-cultural comparison of colour emotion for two-colour combinations. Color Res Application . 2011; 37: 23– 43. Google Scholar CrossRef Search ADS   28. Moodie C, Stead M, Bauld L, et al.   Plain Tobacco Packaging: A Systematic Review. UK Centre for Tobacco Control . Public Health Research Consortium; 2012. 29. McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J. Tobacco packaging design for reducing tobacco use. Cochrane Database Syst Rev . 2017; 4: CD011244. Google Scholar PubMed  30. Kelly Weedon Shute Advertising. Philip Morris cigarette marketing – a new perspective. Philip Morris Records . Nov 1989; Bates No. 2501057693/7719. https://www.industrydocumentslibrary.ucsf.edu/tobacco/docs/mtxc0118. Accessed June 2, 2018. 31. Hassan LM, Shiu E. No place to hide: Two pilot studies assessing the effectiveness of adding a health warning to the cigarette stick. Tob Control . 2015; 24( e1): e3– e5. Google Scholar CrossRef Search ADS PubMed  32. Moodie C, MacKintosh AM, Gallopel-Morvan K, Hastings G, Ford A. Adolescents’ perceptions of an on-cigarette health warning. Nicotine Tob Res . 2017; 19( 10): 1232– 1237. Google Scholar PubMed  33. Moodie C, Gendall P, Hoek J, et al.   The response of young adult smokers and nonsmokers in the United Kingdom to dissuasive cigarettes: An online survey. Nicot Tob Res . 2017. doi: https://doi.org/10.1093/ntr/ntx261 34. Moodie C. Novel ways of using tobacco packaging to communicate health messages: Interviews with packaging and marketing experts. Addict Res Theory  2016; 24( 1): 54– 61. Google Scholar CrossRef Search ADS   35. Moodie C, Ford A. Young adult smokers’ perceptions of cigarette pack innovation, pack colour and plain packaging. Australasian Marketing J . 2011; 19( 3): 174– 180. Google Scholar CrossRef Search ADS   36. Hines D, Fretz AC, Nollen NL. Regular and occasional smoking by college students: Personality attributions of smokers and nonsmokers. Psychol Rep . 1998; 83( 3 Pt 2): 1299– 1306. Google Scholar CrossRef Search ADS PubMed  37. de Ojeda A, Barnoya J, Thrasher JF. Availability and costs of single cigarettes in Guatemala. Nicotine Tob Res . 2013; 15( 1): 83– 87. Google Scholar CrossRef Search ADS PubMed  38. Abad-Vivero EN, Thrasher JF, Arillo-Santillán E, et al.   Recall, appeal and willingness to try cigarettes with flavour capsules: Assessing the impact of a tobacco product innovation among early adolescents. Tob Control . 2016; 25( e2): e113– e119. Google Scholar CrossRef Search ADS PubMed  39. Thrasher JF, Abad-Vivero EN, Moodie C, et al.   Cigarette brands with flavour capsules in the filter: Trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012–2014. Tob Control . 2016; 25: 275– 283. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Nicotine and Tobacco Research Oxford University Press

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

Loading next page...
 
/lp/ou_press/consumer-perceptions-of-cigarette-design-in-france-a-comparison-of-vPiMbPJem3
Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
1462-2203
eISSN
1469-994X
D.O.I.
10.1093/ntr/nty105
Publisher site
See Article on Publisher Site

Abstract

Abstract 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. Introduction Article 13 of the Framework Convention for Tobacco Control (FCTC) bans all tobacco marketing and recommends plain (or standardized) tobacco packaging.1 Many countries have adopted comprehensive tobacco advertising bans and some have fully implemented plain packaging. Following Australia in December 2012, France became the second country to require plain packaging in January 2017; the United Kingdom has since followed suit in May 2017.2 Consequently, the cigarette stick has become more important for tobacco companies for brand communication,3 with promotional elements often displayed on cigarettes (eg, brand names, logos, brand descriptors, and capsule symbols) and filter innovation (eg, different shapes and colors) increasingly common.4 Tobacco companies’ use of branded cigarettes to influence audience preferences has been revealed in past research and in internal documents.5–8 For instance, slim cigarettes have been marketed at women and associated with advertising campaigns promoting the belief that smoking is an effective way of controlling weight: Philip Morris launched Virginia Slims with its advertising stressing themes of thinness, glamour, and independence.9 Industry research has found that among women smokers, irrespective of age, certain “superslims” brands and cigarettes were viewed as stylish or projected a feminine elegance.10,11 Studies have also found that certain slim brands were perceived as less harmful than other cigarettes,12 although blood cadmium levels have not been found to be lower among females who smoke slim rather than nonslim cigarettes.13 Colored and flavored cigarettes have also been developed by tobacco companies to create appeal and communicate favorable brand impressions.14,15 In the 1950s for instance, pink colored “Vanity Fair” cigarettes were advertised alongside the slogan “Be glamorous all day long”.16 Internal tobacco documents reported that colored tipping or cigarette paper could make smoking more pleasurable for women,17 with these products perceived as novel by young people.18 In addition, colored cigarettes are used to communicate flavor and taste,14 for example, black indicates chocolate flavor for the “Black devil” brand and pink indicates vanilla flavor and sweet taste for the “Pink elephant” brand. Rather surprisingly, only a few studies have explored consumer response to cigarettes. Two focus group studies were conducted in Scotland, one with 15-year-old smokers and nonsmokers and the other with 12–24-year-old female never smokers and occasional smokers, to explore perceptions of a range of cigarettes.19,20 In both studies, slimmer cigarettes were considered more appealing and less harmful than regular cigarettes with a cork filter and white cigarette paper. Color also influenced product perceptions, with a pink cigarette generating considerable interest among 12–24 female never smokers and occasional smokers, being considered appealing, pleasant tasting, and less harmful. A qualitative study with young female smokers in New Zealand found that colored cigarettes (lilac, red, silver-white, or gold) were judged to be attractive and improved smokers’ social image, with these cigarettes thought to help them look better, be seen as classy, and avoid social stigma.21 When regular cigarettes with cork or white filters and slim cigarettes were compared, there was a preference for slim and white cigarettes as participants thought that these helped distance themselves from negative associations with smoking by portraying a glamorous, slim, delicate, and feminine image. Using a face-to-face survey with a large European sample of current and former adult smokers, Agaku et al. found that colored cigarettes were thought to be sweet tasting and that flavored cigarettes were associated with first smoking experiences and reduced harm perceptions.22 Finally, an online survey in Australia compared young adult smokers’ reactions to different cigarettes, with regular cigarettes rated as more attractive and higher quality than extra-long, short, slim, or extra-slim sticks.23 Most participants indicated that they would prefer to smoke the regular stick. To reduce the appeal of the types of cigarettes on sale in most markets, researchers have begun to explore consumer response to cigarettes designed to be dissuasive. Few studies have explored the impact of plain, unattractively colored cigarettes. A qualitative study and an online survey in New Zealand both found that green or yellow-brown cigarettes were considered aversive and rated as less appealing than regular cigarettes.21,24 Focus groups in Scotland also found that young people perceived brown cigarettes as particularly strong and harmful.19,20 These findings suggest that altering the color of cigarettes may be able to influence how they are perceived, the image they convey and smoking intentions. Research has yet to compare the effect of a plain, unattractively colored cigarette with a number of different cigarette styles which are available in most countries. In this study, we explore how young adult smokers and nonsmokers perceive a plain gray colored cigarette (designed for this study) and three cigarettes (regular, slim, and brightly colored) that were on sale in France at the time of the study, in terms of appeal, harm, and behavioral impact. Methods Design and Sample An online survey was conducted in France from December 4 to 16, 2013 (before the implementation of tobacco plain packaging in 2017), with 998 smokers and nonsmokers aged 15–30 years. The sample was chosen because the prevalence of daily smoking is high in France for this population (33.4%).25 A quota sample was sought, balanced by gender, age group, socioeconomic status, geographic area (nine broad areas that cover all of France), and size of urban unit (<2000 inhabitants; 2000–20000; 20000–100000; >100000; and the Ile de France region, which includes Paris, with 12 million inhabitants), following the national percentages of the general population indicated by the National Institute of Statistics and Economics Studies (see Table 1 for sample characteristics). Almost two-fifths (38%) were smokers (of which 67% were daily smokers) and 62% were nonsmokers (of which 39% were former smokers). Table 1. Sample Characteristics (Weighted Data)   Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%          Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%        View Large Table 1. Sample Characteristics (Weighted Data)   Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%          Smokers (n = 375)  Nonsmokers (n = 623)  Total (n = 998)  p value  Age group   15–20 years  33%  39%  37%  .185   21–24 years  26%  24%  25%   25–30 years  41%  36%  38%  Gender   Male  52%  50%  51%  .437   Female  48%  50%  49%  Cigarette consumption per day (daily smokers)   Less than 11  41%         11–20  43%         21–30  8%         31 or more  1%         It varies  8%        Tobacco most often smoked   Manufactured cigarettes  85%         Roll-Your-Own cigarettes  14%         Cigars or pipe  1%        Intention to quit   No  18%         Yes, in the next 30 days  22%         Yes, in the next 6 months  27%         Yes, but not in the next 6 months  15%         Don’t know  18%        View Large Procedure Participants were recruited by an established market research company (LH2), in collaboration with its partner “Survey Sampling International.” Members of their online panel were sent an email invitation explaining that the survey was part of a national public health study on tobacco prevention messages; the email invitation and survey were both in French. We do not have the response rate as recording contact, participation, and refusal rates is impractical when using this sampling methodology. Participants received a modest incentive, in the form of “points” which can be redeemed for vouchers, as is common with online panels. For those eligible for inclusion, they were randomly assigned to view one of three images: 333 were shown an image of a regular cigarette with the brand name “Marlboro” written on the stick and a gray plain cigarette (PC); 332 were shown an image of a slim cigarette with the brand name “Vogue” displayed on the tip and a gray cigarette; 333 were shown an image of a pink cigarette with the symbol of the brand (an elephant) displayed on the tip and a gray PC (see Figure 1: cigarettes shown to participants). These three branded cigarettes (regular, slim, and pink) were chosen because they were sold on the French market when the study was conducted: regular sticks were the most commonly sold cigarettes, with slim and pink cigarettes, targeted at women and young people, also available, (Comité National Contre le Tabagisme, unpublished report) [pp. 57–60]. Gray was selected for the PC because previous research in France found that gray tobacco packaging was perceived as unattractive compared with white and brown packs,26 with gray reported to be the color that French consumers disliked the most in a study that compared 190 color pairs.27 Participants were asked about Appeal, Harm, and Perceived behavioral impact, with the ordering of the questions randomized. The study was ethically approved by the Institut National de Prévention et d’Education pour la Santé (INPES). Figure 1. View largeDownload slide Cigarettes shown to participants. Figure 1. View largeDownload slide Cigarettes shown to participants. Measures Demographic Information Smoking status, gender, and socioeconomic status (based on occupation of the head of the household) were assessed. To assess smoking status, we used the same items employed in the European Commission’s Eurobarometer survey. Participants were asked: “Are you: 1/ a non-smoker; 2/ an occasional smoker (you do not smoke daily); 3/ a regular smoker (you smoke at least one cigarette per day).” Appeal Participants were asked in three separate questions: “of these two cigarettes, which one do you consider: the most expensive, tastiest, the highest quality.” These three items were taken from past research on plain packaging.28,29 Harm Participants were asked in two questions: “of these two cigarettes, which one do you consider: the most dangerous, the most effective to make people talk about tobacco dangers.” Perceived Behavioral Impact Participants were asked in three questions: “of these two cigarettes, which one do you consider: the most effective for convincing teenagers not to start, the most effective for motivating smokers to quit and the most effective for motivating smokers to reduce consumption.” For all questions, participants had the option to select either image, “Don’t know,” or “None.” Analysis Using Stata/SE 13.1 software, all analyses were conducted on weighted data that reflected the demographic structure of the national population. Adjusted Wald tests for weighted data were used to examine differences in the proportion of participants selecting each cigarette. Logistic regression models were run to examine differences in perceptions of the different cigarettes. For each cigarette, the dependent variables for Appeal were “most expensive,” “tastiest,” “highest quality” (where 0 = selecting the PC and 1 = selecting the branded cigarette). The dependent variables for Harm were “most dangerous” and “most effective to make people talk about tobacco dangers” (where 0 = selecting the branded cigarette and 1 = selecting the PC). For Perceived behavioral impact, the dependent variables were “most effective in convincing teenagers not to start,” “most effective for motivating smokers to quit,” and “most effective for motivating smokers to reduce consumption” (where 0 = selecting the branded cigarette and 1 = selecting the PC). Gender, age (15–20; 21–24; 25–30), smoking status (nonsmoker vs. occasional smokers vs. daily smoker), and type of cigarette (regular vs. slim vs. pink) were entered as predictor variables in each of the models. Results Perceptions of the Plain Cigarette (in Comparison With the Regular, Slim, or Pink Cigarettes) The branded regular, slim, and pink cigarettes were viewed as more appealing (the most expensive, the tastiest, and the highest quality) than the PC and less likely to have a greater impact on smoking initiation and cessation (most effective to convince teenagers not to start, and motivate smokers to reduce consumption and quit) (see Table 2: perceptions of regular, slim, pink, and PC). Although the regular and the pink cigarettes were viewed as less dangerous than the PC, there were no significant differences with respect to making people talk about the dangers of tobacco. As for the slim cigarette, it was perceived as less harmful than the PC (least dangerous, least effective in making people talk about the dangers of tobacco). Table 2. Perceptions of Regular, Slim, Pink, and Plain Cigarettes (PC) (%)   Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***    Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***  aThese responses were removed from the chi-square analysis. bns: not significant; ***p < .001. View Large Table 2. Perceptions of Regular, Slim, Pink, and Plain Cigarettes (PC) (%)   Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***    Regular cigarette (Marlboro)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  61  14  13  12  ***   Tastiest  58  6  21  15  ***   Highest quality  61  6  24  9  ***  Harm   Most dangerous  25  44  19  12  ***   Most effective to make people talk about tobacco dangers  38  29  17  16  ns  Perceived behavioral impact   Most effective for convincing teenagers not to start  13  49  29  10  ***   Most effective for motivating smokers to quit  6  52  34  8  ***   Most effective for motivating smokers to reduce consumption  7  54  30  9  ***    Slim cigarette (Vogue)  Plain Cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  67  14  7  12  ***   Tastiest  48  19  17  17  ***   Highest quality  61  11  18  11  ***  Harm             Most dangerous  14  55  17  14  ***   Most effective to make people talk about tobacco dangers  20  38  19  24  ***  Perceived behavioral impact   Most effective in convincing teenagers not to start  16  46  27  11  ***   Most effective in motivating smokers to quit  13  48  30  8  ***   Most effective in motivating smokers to reduce consumption  16  44  28  12  ***    Pink cigarette (Pink Elephant)  Plain cigarette  Nonea  Don’t knowa  p valueb  Appeal   Most expensive  69  4  12  14  ***   Tastiest  65  4  16  15  ***   Highest quality  47  13  26  14  ***  Harm   Most dangerous  23  40  23  14  ***   Most effective to make people talk about tobacco dangers  30  27  22  22  ns  Perceived behavioral impact   Most effective in convincing teenagers not to start  18  45  26  11  ***   Most effective in motivating smokers to quit  10  44  35  11  ***   Most effective in motivating smokers to reduce consumption  10  46  34  10  ***  aThese responses were removed from the chi-square analysis. bns: not significant; ***p < .001. View Large Perceptions of Cigarettes According to Participants’ Profiles and Type of Cigarette Logistic regression models were conducted to examine the effect of gender (reference: male), age (reference: 15–20), smoking status (reference: nonsmoker), and type of cigarette (reference: regular cigarette) on selecting the PC or branded cigarette (see Table 3). Wald tests were computed to test the differences in odds ratios between 21–24 and 25–30 year olds, and between occasional and daily smokers. Table 3. Binary logistic regression: odds ratios for the selection of branded / plain rather than plain / branded cigarettes by gender (reference = male), age (reference = 15–20), smoking status (reference = nonsmoker), and type of branded cigarette displayed (reference = regular cigarette)   Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***    Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***  *p < .05; **p < .01; ***p < .001; ns: not significant aIt was predicted that positive attributes (“most expensive, tastiest and highest quality”) would be associated with branded cigarettes, which is why participants were asked about the likelihood of selecting branded cigarettes. bIt was predicted that negative attributes (“most dangerous, most effective to make people talk about tobacco dangers, most effective for convincing teenagers not to start, most effective for motivating smokers to quit/to reduce”) would be associated with the plain cigarette, which is why participants were asked about the likelihood of selecting plain cigarettes. View Large Table 3. Binary logistic regression: odds ratios for the selection of branded / plain rather than plain / branded cigarettes by gender (reference = male), age (reference = 15–20), smoking status (reference = nonsmoker), and type of branded cigarette displayed (reference = regular cigarette)   Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***    Gender (female)  Age (21–24)  Age (25–30)  p value 21–24 / 25–30  Occasional smoker  Daily smoker  p value occasional / daily  Pink cigarette  Slim cigarette  Likelihood of selecting the branded cigarettesa  Most expensive  1.29  1.03  0.88  ns  1.31  0.80  ns  4.03***  1.21  Tastiest  1.36  1.14  1.16  ns  1.65  0.67  *  2.01  0.29***  Highest quality  2.24***  0.97  1.48  ns  2.65*  1.07  *  0.39**  0.64  Likelihood of selecting the plain cigarette (PC)b  Most dangerous  1.22  0.76  0.80  ns  1.31  1.47  ns  1.03  2.31***  Most effective to make people talk about tobacco dangers  1.15  0.87  1.18  ns  1.29  1.17  ns  1.09  2.44***  Most effective for convincing teenagers not to start  1.62*  0.62  0.73  ns  2.26*  0.72  **  0.69  0.78  Most effective for motivating smokers to quit  1.92**  1.32  2**  ns  1.14  0.53*  *  0.50*  0.44**  Most effective for motivating smokers to reduce consumption  1.95**  0.75  1.11  ns  0.57  0.69  ns  0.52*  0.32***  *p < .05; **p < .01; ***p < .001; ns: not significant aIt was predicted that positive attributes (“most expensive, tastiest and highest quality”) would be associated with branded cigarettes, which is why participants were asked about the likelihood of selecting branded cigarettes. bIt was predicted that negative attributes (“most dangerous, most effective to make people talk about tobacco dangers, most effective for convincing teenagers not to start, most effective for motivating smokers to quit/to reduce”) would be associated with the plain cigarette, which is why participants were asked about the likelihood of selecting plain cigarettes. View Large Females were significantly more likely than males to select the branded cigarette (regular, slim, or pink) as highest quality and the PC as the most effective for convincing teenagers not to start, for motivating smokers to quit and to reduce tobacco consumption. Those aged 25–30 years were significantly more likely than 15–20 year olds to report the PC as most effective for motivating smokers to quit. There was no significant difference between 21–24 and 25–30 year olds. As for smoking status, occasional smokers were more likely than nonsmokers to choose the branded cigarettes as highest quality and to select the PC as most effective for motivating teenagers not to start. Daily smokers were less likely than nonsmokers to consider the PC as most effective for motivating smokers to quit. Occasional smokers were more likely than daily smokers to select the branded cigarettes as tastiest and highest quality, and they were more likely to select the PC as most effective for convincing teenagers not to start and most effective for motivating smokers to quit. With respect to type of cigarette, participants exposed to the “pink cigarette / PC” option (compared to those exposed to “regular cigarette / PC”) were more likely to select the branded cigarette as the most expensive and less likely to choose it as the highest quality. For perceived behavioral impact, participants exposed to the “pink cigarette / PC” option were less likely to select the PC as the most effective for motivating smokers to quit and to reduce their consumption compared with those exposed to “regular cigarette / PC” option. Participants exposed to the “slim cigarette / PC” image were less likely to select the branded cigarette as tastiest compared with those exposed to the “regular cigarette / PC” option. They were also more likely to select the PC as the most dangerous and the most effective to make people talk about tobacco dangers, and they were less likely to choose the PC as the most effective for motivating smokers to quit and to reduce consumption (compared with those exposed to the “regular cigarette / PC” option). Discussion Almost three decades ago, an advertising agency suggested that Philip Morris “brand the cigarette,” proposing that “colors and designs could be carried through to the cigarette itself—a visible extension of the personality of the brand (and the user)”.30 We found that cigarettes, whether brightly colored or with a slim or regular design and with a brand name or symbol displayed on the stick, were more likely than a plain gray cigarette to influence perceptions of appeal, harm, and behavioral impact. The regular, slim, and pink cigarettes were considered the most expensive, highest quality, tastiest, and less dangerous than the PC. The PC, in contrast, was perceived as a more effective means of preventing initiation among teenagers and motivating smokers to reduce consumption and quit. These results suggest that the appearance of a cigarette, in terms of its color (bright or dull), size (slim or regular), and presence of a brand name, can influence product perceptions and perceived behavioral impact. This is also true for regular cigarettes; the white cigarette paper may help consumers distance themselves from the health risks associated with smoking.21 These findings are similar to research on plain packaging, where the use of a darker pack color can reduce the attractiveness of the pack, increase harm beliefs and motivation to quit.28,29 We found no significant differences with respect to the cigarettes being more likely to make people talk about the dangers of tobacco, except between the PC and the slim cigarette. As such, an unattractive color alone may be insufficient to provoke such reactions. Some research has revealed that displaying a warning message on cigarettes was considered a reminder of health risks. For instance, cigarettes displaying a “minutes of life lost” message have been found to increase smokers’ intentions to quit,31 and sticks displaying “minutes of life lost” or “smoking kills” warnings were rated as less appealing than regular cigarettes among smokers.24 Other studies have also found that on-cigarette message (“smoking kills”) may help to put teenagers off starting32 and would be less likely to encourage product trial among young adult smokers and nonsmokers.33 Future research could explore cigarettes combining unattractive colors and health warnings, as recommended in previous research with marketing experts.34 We identified differences in how the cigarettes were perceived by gender, age, smoking status, and cigarette type. Branded cigarettes had a stronger influence on females compared with males in conveying quality, with females more likely than males to view the PC as most effective for convincing teens not to start and for motivating smokers to reduce consumption or quit. These results are in line with research that showed that women are more likely than men to view fully branded cigarette packs as attractive compared with plain packs.35 Cigarette design also had a stronger impact on occasional smokers than nonsmokers and daily smokers, with branded cigarettes more likely to be selected as the highest quality stick (and the tastiest compared with daily smokers) than the PC. In addition, the PC was more often chosen as the most effective cigarette for convincing teens not to start among occasional smokers than among nonsmokers and as the most effective for convincing smokers to quit than among daily smokers. It may be that occasional smokers are more vulnerable to the impact of tobacco marketing (and thus the design of cigarettes) as they are more concerned with their image when they smoke.36 Participants’ reactions differed according to the type of branded cigarette they were exposed to. In the regular/PC option, the regular cigarette was more often selected as the tastiest and highest quality compared with the slim/PC and the pink/PC options, but less often chosen than the slim/PC or pink/PC options as the most effective cigarette for convincing smokers to reduce consumption and to quit. This may be explained by the fact that people are more familiar with the regular cigarette style and may consider it as reassuring regarding taste and quality, whereas slim and pink sticks may be perceived as newer products of which the taste/quality they are less able to discern. In the slim/PC option, participants less often selected the slim stick as the most dangerous, consistent with previous research that has found that slim cigarettes are perceived as less harmful, cleaner, and safer than regular cigarettes.19–21 Several conclusions can be drawn from these results. First, our study suggests that dissuasive sticks may be worth considering in countries, such as France, that have implemented plain packaging. In such markets, although smokers can hide their packs because they are unattractive, they cannot hide the cigarettes when they smoke. Second, if a pack-a-day smoker (20 cigarettes) is exposed to cigarettes approximately 70000 times per year (with around 10 puffs per cigarette),4 then removing branding from cigarettes and standardizing the color may help reduce the attractiveness of cigarettes. Third, branded cigarettes, whether regular, slim, or colored, appear to be more misleading than PC and, as such, regulation of the cigarette itself may be warranted. These regulations may be particularly important in developing countries where cigarettes are often sold by the stick.37 There are certain limitations that need to be considered. First, as the branded cigarettes we tested differed from the plain cigarette in a number of respects (color, shape, and brand name or symbol displayed on the cigarette), our research does not allow us to isolate the specific effect of each attribute on participants’ reactions. Nevertheless, should policy makers legislate for unattractively colored cigarettes without any markings, consumers will be confronted with a similar scenario to the one presented in this study, in that cigarettes on sale, which currently have brand names and/or symbols, will no longer have any of these features. Second, we assessed behavioral intentions rather than actual behavior. Third, forced exposure of our experimental design may have had an impact on responses. Fourth, although we intentionally explored young adults’ perceptions of cigarette design, given that this is a key demographic for public health, we are unable to provide any insight into the response of older smokers. In conclusion, our paper highlights that cigarettes, like cigarette packs, can be a powerful communication tool. Research could meaningfully extend this study by exploring other types of branded cigarettes, including cigarettes with flavored capsules in the filter that have been found to be particularly appealing to young people.38,39 In addition, PC colors other than gray could be examined in future research. Funding This work was supported by a grant from the INPES (Institut National de Prévention et d’Education pour la Santé) in France. CM is funded by Cancer Research UK. Declaration of Interests None declared. References 1. World Health Organisation. Guidelines for implementation of Article 13 of the WHO Framework Convention on Tobacco Control (Tobacco advertising, promotion and sponsorship). www.who.int/fctc/guidelines/article_13.pdf. Accessed September 25, 2017. 2. Canadian Cancer Society. Plain packaging – international overview. June 14, 2016www.smokershelp.net/wp-content/uploads/2016/07/Canadian-Cancer-Society-International-Overview.pdf. Accessed September 25, 2017. 3. Rossell S. Ready to roll. Tob Reporter . 2017; 2: 44– 45. 4. C Smith K, Washington C, Welding K, Kroart L, Osho A, Cohen JE. Cigarette stick as valuable communicative real estate: A content analysis of cigarettes from 14 low-income and middle-income countries. Tob Control . 2016; 26( 5): 604– 607. Google Scholar CrossRef Search ADS PubMed  5. Cummings KM, Morley CP, Horan JK, et al.   Marketing to America’s youth: Evidence from corporate documents. Tob Control  2002; 11( suppl 1): 5– 17. Google Scholar CrossRef Search ADS   6. Cook BL, Wayne GF, Keithly L, Connolly G. 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( 11): 1547– 1561. Google Scholar CrossRef Search ADS PubMed  7. Carpenter CM, Wayne GF, Connolly GN. Designing cigarettes for women: New findings from the tobacco industry documents. Addiction . 2005; 100( 6): 837– 851. Google Scholar CrossRef Search ADS PubMed  8. Wayne GF, Connolly GN. How cigarette design can affect youth initiation into smoking: Camel cigarettes 1983–93. Tob Control . 2002; 11( suppl 1): 32– 39. Google Scholar CrossRef Search ADS   9. Ernster V, Kaufman N, Nichter M, Samet J, Yoon SY. Women and tobacco: Moving from policy to action. Bull World Health Organ . 2000; 78( 7): 891– 901. Google Scholar PubMed  10. Unknown. Operating plan Asia. 1995. RJ Reynolds records. Bates No. 516541768/1834. http://legacy.library.ucsf.edu/tid/jei41d00. Accessed September 25, 2017. 11. Barnewolt D, Thrane D. Review of imagery appealing to women smokers. 1986. Brown and Williamson records. Bates No. 682121192/1203. https://industrydocuments.library.ucsf.edu/tobacco/docs/#id=hgfm0132. Accessed September 25, 2017. 12. Richter P, Beistle D, Pederson L, O’Hegarty M. Small-group discussions on menthol cigarettes: Listening to adult African American smokers in Atlanta, Georgia. Ethn Health . 2008; 13( 2): 171– 182. Google Scholar CrossRef Search ADS PubMed  13. Matsunaga Y, Agaku IT, Vardavas CI. The association between cigarette rod length, slim design, and blood cadmium levels among U.S. smokers: NHANES 1999–2010. Prev Med  2014; 65( Aug): 87– 91. Google Scholar CrossRef Search ADS PubMed  14. Lewis MJ, Wackowski O. Dealing with an innovative industry: A look at flavored cigarettes promoted by mainstream brands. Am J Public Health . 2006; 96( 2): 244– 251. Google Scholar CrossRef Search ADS PubMed  15. Connolly GN. Sweet and spicy flavours: New brands for minorities and youth. Tob Control . 2004; 13( 3): 211– 212. Google Scholar CrossRef Search ADS PubMed  16. Deanna. Filter, flavor, color too with glamorous Vanity Fair cigarettes. 2012. www.kitsch-slapped.com/2012/05/filter-flavor-color-too-with-glamorous-vanity-fair-cigarettes/. Accessed September 25, 2017. 17. Idea Bank. Sharing some insights on women of today… An individual’s brainstorming. Philip Morris records. Bates No.2050901054-2050901060. 1995. www.industrydocumentslibrary.ucsf.edu/tobacco/docs/xlbk0053. Accessed September 25, 2017. 18. Opinion Research Corporation. Smoking behavior and smoker motivation - Their implications for packaging. Marketing to youth MSA collection. Bates No.1001811426-1001811544. 1961. www.industrydocumentslibrary.ucsf.edu/tobacco/docs/hqmx0045. Accessed September 25, 2017. 19. Moodie C, Ford A, Mackintosh A, Purves R. Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatized and capsule cigarettes. Health Educ Res . 2015; 30( 1): 1– 12. Google Scholar CrossRef Search ADS PubMed  20. Ford A, Moodie C, MacKintosh AM, Hastings G. Adolescent perceptions of cigarette appearance. Eur J Public Health . 2014; 24( 3): 464– 468. Google Scholar CrossRef Search ADS PubMed  21. Hoek J, Robertson C. How do young adult female smokers interpret dissuasive cigarette sticks? J Soc Mark . 2015; 5( 1): 21– 39. Google Scholar CrossRef Search ADS   22. Agaku IT, Omaduvie UT, Filippidis FT, Vardavas CI. Cigarette design and marketing features are associated with increased smoking susceptibility and perception of reduced harm among smokers in 27 EU countries. Tob Control . 2015; 24( e4): e233– e240. Google Scholar CrossRef Search ADS PubMed  23. Borland R, Savvas S. Effects of stick design features on perceptions of characteristics of cigarettes. Tob Control . 2013; 22( 5): 331– 337. Google Scholar CrossRef Search ADS PubMed  24. Hoek J, Gendall P, Eckert C, Louviere J. Dissuasive cigarette sticks: The next step in standardised (‘plain’) packaging? Tob Control . 2016; 25( 6): 699– 705. Google Scholar CrossRef Search ADS PubMed  25. INPES (Institut National de Prévention et d’Education Pour la Santé). Baromètre santé 2014. www.inpes.sante.fr/Barometres/barometre-sante-2014/index.asp. Accessed September 25, 2017. 26. Gallopel-Morvan K, Gabriel P, Le Gall-Ely M, et al.   Plain packaging to help public health. The case of tobacco control. J Bus Res . 2013; 66( 1): 133– 136. Google Scholar CrossRef Search ADS   27. Ou L-C, Luo MR, Sun P-L, et al.   A cross-cultural comparison of colour emotion for two-colour combinations. Color Res Application . 2011; 37: 23– 43. Google Scholar CrossRef Search ADS   28. Moodie C, Stead M, Bauld L, et al.   Plain Tobacco Packaging: A Systematic Review. UK Centre for Tobacco Control . Public Health Research Consortium; 2012. 29. McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J. Tobacco packaging design for reducing tobacco use. Cochrane Database Syst Rev . 2017; 4: CD011244. Google Scholar PubMed  30. Kelly Weedon Shute Advertising. Philip Morris cigarette marketing – a new perspective. Philip Morris Records . Nov 1989; Bates No. 2501057693/7719. https://www.industrydocumentslibrary.ucsf.edu/tobacco/docs/mtxc0118. Accessed June 2, 2018. 31. Hassan LM, Shiu E. No place to hide: Two pilot studies assessing the effectiveness of adding a health warning to the cigarette stick. Tob Control . 2015; 24( e1): e3– e5. Google Scholar CrossRef Search ADS PubMed  32. Moodie C, MacKintosh AM, Gallopel-Morvan K, Hastings G, Ford A. Adolescents’ perceptions of an on-cigarette health warning. Nicotine Tob Res . 2017; 19( 10): 1232– 1237. Google Scholar PubMed  33. Moodie C, Gendall P, Hoek J, et al.   The response of young adult smokers and nonsmokers in the United Kingdom to dissuasive cigarettes: An online survey. Nicot Tob Res . 2017. doi: https://doi.org/10.1093/ntr/ntx261 34. Moodie C. Novel ways of using tobacco packaging to communicate health messages: Interviews with packaging and marketing experts. Addict Res Theory  2016; 24( 1): 54– 61. Google Scholar CrossRef Search ADS   35. Moodie C, Ford A. Young adult smokers’ perceptions of cigarette pack innovation, pack colour and plain packaging. Australasian Marketing J . 2011; 19( 3): 174– 180. Google Scholar CrossRef Search ADS   36. Hines D, Fretz AC, Nollen NL. Regular and occasional smoking by college students: Personality attributions of smokers and nonsmokers. Psychol Rep . 1998; 83( 3 Pt 2): 1299– 1306. Google Scholar CrossRef Search ADS PubMed  37. de Ojeda A, Barnoya J, Thrasher JF. Availability and costs of single cigarettes in Guatemala. Nicotine Tob Res . 2013; 15( 1): 83– 87. Google Scholar CrossRef Search ADS PubMed  38. Abad-Vivero EN, Thrasher JF, Arillo-Santillán E, et al.   Recall, appeal and willingness to try cigarettes with flavour capsules: Assessing the impact of a tobacco product innovation among early adolescents. Tob Control . 2016; 25( e2): e113– e119. Google Scholar CrossRef Search ADS PubMed  39. Thrasher JF, Abad-Vivero EN, Moodie C, et al.   Cigarette brands with flavour capsules in the filter: Trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012–2014. Tob Control . 2016; 25: 275– 283. Google Scholar CrossRef Search ADS PubMed  © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

Nicotine and Tobacco ResearchOxford University Press

Published: May 24, 2018

There are no references for this article.

You’re reading a free preview. Subscribe to read the entire article.


DeepDyve is your
personal research library

It’s your single place to instantly
discover and read the research
that matters to you.

Enjoy affordable access to
over 18 million articles from more than
15,000 peer-reviewed journals.

All for just $49/month

Explore the DeepDyve Library

Search

Query the DeepDyve database, plus search all of PubMed and Google Scholar seamlessly

Organize

Save any article or search result from DeepDyve, PubMed, and Google Scholar... all in one place.

Access

Get unlimited, online access to over 18 million full-text articles from more than 15,000 scientific journals.

Your journals are on DeepDyve

Read from thousands of the leading scholarly journals from SpringerNature, Elsevier, Wiley-Blackwell, Oxford University Press and more.

All the latest content is available, no embargo periods.

See the journals in your area

DeepDyve

Freelancer

DeepDyve

Pro

Price

FREE

$49/month
$360/year

Save searches from
Google Scholar,
PubMed

Create lists to
organize your research

Export lists, citations

Read DeepDyve articles

Abstract access only

Unlimited access to over
18 million full-text articles

Print

20 pages / month

PDF Discount

20% off