PI: Crawford Moodie, University of Stirling
While the UK is in the vanguard of global tobacco control, having implemented a raft of policies this century aimed at discouraging young people from starting to smoke and encouraging smokers to quit, more needs to be done to meet the 2030 smoke free target. The Khan review recommends a range of measures, including inserts inside packs with messages highlighting the benefits of quitting, and dissuasive cigarettes (i.e. cigarettes designed to be visually off-putting) to further reduce the appeal of smoking.
Health-promoting pack inserts are currently only required in Canada, although they are scheduled for introduction in Israel and are being considered in Australia. Evaluative research in Canada found that more frequent reading of inserts by smokers was associated with attempting to quit and sustained quitting. Formative research in the UK, exploring response to the inserts used in Canada, suggests that they are well-received by smokers given the positive messaging, and considered most helpful in supporting behavioural change among smokers who have attempted to quit or plan to quit. Dissuasive cigarettes are not required in any country, although warnings on cigarettes are planned in Canada. The evidence, comprising approximately 20 published studies, is consistently supportive of the potential public health benefits of warnings on cigarette sticks or cigarettes that are an unappealing colour. It suggests that dissuasive cigarettes may help to reduce the appeal of smoking, increase harm perceptions and help reduce initiation, with a smaller number of studies suggesting that it may also help to encourage cessation. While the evidence is supportive of health-promoting pack inserts and dissuasive cigarettes, there has been limited research on what designs would be most impactful.
The project aim is to explore how young people (11-17 years) and adult smokers respond to cigarette sticks/papers which display warnings and/or that are an unappealing colour, and inserts with messaging aimed at promoting quitting. The objectives are to assess:
(1) What colours and/or warnings on cigarette sticks/papers are considered most likely to reduce appeal, increase perceptions of harm, discourage trial, and encourage cessation?
(2) What inserts (and insert themes) are considered most helpful for encouraging cessation?
(3) Differences in responses to dissuasive cigarettes and inserts by key demographic and smoking and cessation-related behaviours.
The project will consist of three interlinked Work Packages.
Work Package (WP) 1: Review of relevant literature, and developments in countries with or moving towards dissuasive cigarettes or pack inserts, to identify suitable messaging and appropriate designs for inserts and warnings on cigarettes. We will work with Print and Graphics at the University of Stirling to design and produce inserts and dissuasive sticks/papers to be used in WP2.
WP2: 22 focus groups (8 in both England and Scotland, 6 in Wales) with young people aged 11-17 years and adult smokers. The six youth groups, segmented by age (11-13, 14-15, 16-17) and gender, would focus on warnings on cigarettes, as inserts are aimed at existing smokers. The 16 adult groups, segmented by age (18-24, 25-35, 36-50, >50), gender and main tobacco product used (cigarettes, rolling tobacco), would explore warnings on cigarette sticks/papers and inserts.
WP3: Two online surveys, the first with 2000 young people (11-17 years), and the second with 3000 adult smokers (18+), to identify the most effective inserts (and insert themes) and dissuasive cigarettes. The samples will be drawn from an online market research panel, with the adult survey sample representative of smokers across the UK.
Kathryn Angus, Catherine Best, Allison Ford