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Research demonstrates that tobacco packaging elements (including health warning labels, descriptive characteristics, and corporate branding) are associated with knowledge of health risks and product appeal with cigarettes. Yet, little research has assessed this with smokeless tobacco (SLT) packaging. This study evaluates the association between thr...
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... Branding and tobacco pack design play a role in consumer perceptions of product appeal and perceived harm. [25][26][27][28][29][30][31] Research from the USA and Norway found that the colour, shape and branding of existing, industry-designed SLT packs are influential factors in attracting current and never SLT users. [29][30][31] However, limited evidence is available regarding how standard SLT packaging may influence product appeal and harm perceptions, particularly in the context of a country like Bangladesh, where the use of SLT is high and compliance with HWL requirements is low. ...
... [25][26][27][28][29][30][31] Research from the USA and Norway found that the colour, shape and branding of existing, industry-designed SLT packs are influential factors in attracting current and never SLT users. [29][30][31] However, limited evidence is available regarding how standard SLT packaging may influence product appeal and harm perceptions, particularly in the context of a country like Bangladesh, where the use of SLT is high and compliance with HWL requirements is low. ...
... This aligns with prior research conducted in the USA and Norway, where colour and shape of industry-designed SLT packs increased participant interest in and attraction to products. [29][30][31] The presence of 'brand owner' portrait imagery is commonly found on SLT products sold in South Asia. 32 Our results suggest that the presence of this imagery might be particularly important in how consumers judge SLT pack attractiveness and could imply higher quality. ...
Background
In Bangladesh, smokeless tobacco (SLT) is available in a variety of pack shapes and sizes. Lack of standard packaging could limit compliance with pictorial health warning label (HWL) requirements. We explored Bangladeshi SLT users’ and non-users’ perceptions of a proposed standard pack shape for gul (tobacco powder) and zordha (chewing tobacco), including the role that HWL placement plays on harm perceptions.
Methods
We conducted 28 focus groups across three regions of Bangladesh: Dhaka, Sylhet and Khulna. Groups were stratified equally by urban/rural residence, gender and SLT use. Trained facilitators used a standardised guide to discuss perceived attractiveness, noticeability of HWLs and perceived harm of current versus standard packs.
Results
Most groups found bright colours, ‘brand owner’ portrait imagery, and strong, sturdy pack material of current packs attractive. Many of the same features increased perceived attractiveness of the standard packs. Pictorial HWLs on the standard packs appeared larger and increased the visibility and noticeability of HWLs compared with current packs. Lack of HWLs or limited visibility of HWL due to discolouration contributed to lower levels of perceived harm of the current packs. In contrast, HWL prominence and placement on both sides of the standard pack increased perceived harm of standard packs.
Conclusion
The findings suggest a standard shape and size for SLT sold in Bangladesh, coupled with proper implementation of HWLs per the law, could improve HWL noticeability and increase harm perceptions. Additional plain packaging policies that also standardise pack colour may be required to reduce attractive colours and branding.
... Participants (except for former cigarette users) then responded to six items [20][21][22][23][24] adapted to ask them to imagine they had completely switched to the new cigarettes and rate their risk of getting different diseases (referred to as "perceived risk," α = .88). All participants responded to nine adapted [25] items about the appeal of the product (α = .77) ...
... All participants responded to nine adapted [25] items about the appeal of the product (α = .77) and three adapted [20] items (α = .92) assessing intention to use the product. ...
Objectives
No studies have examined the brand context in which modified risk claims appear on tobacco products. This study examines how marketing products with modified risk claims affects risk perceptions, appeal, and intentions among own-brand, other brand, and novel brand cigarettes.
Methods
This experiment employed a 3 (claim: risk modification [RM], exposure modification [EM], control) x 3 (brand: own, other, novel) between-subjects design. A convenience sample (N = 1,557, M age = 40.28, SD age = 19.01, 71.3% female, 80.3% White) of current or former Marlboro, Camel, or Newport users was collected. Participants were assigned to view their own brand, another brand, or a novel brand, with or without a claim, and rated perceived risk after switching to this product, product appeal, and use intentions.
Results
Participants in the RM or EM conditions had lower risk perceptions (versus control). Claim did not affect appeal. Adult established cigarette users in the EM (but not RM) condition had higher intentions (versus control). Participants rated their own and another brand as more appealing than the novel brand. Interactions between brand and claim were not significant.
Conclusions
We found modified risk claims decreased risk perceptions but did not impact appeal. Whereas participants showed preference for their own brand in terms of appeal and intentions, brand did not moderate the impact of claims.
... En Argentina, la prevalencia de consumo de tabaco ha ido declinando a lo largo de los años, a la vez que se observa una tendencia ascendente en la percepción de riesgo del uso de esta sustancia (Ministerio de Salud y Desarrollo Social, 2019;SEDRONAR, 2016). Esto podría deberse a la implementación de políticas públicas específicas, como la prohibición de publicidad y la obligatoriedad de incluir advertencias sobre los peligros que comporta el consumo de esta sustancia en los paquetes de cigarrillos (Ley Nacional Argentina 26.687), que han probado ser efectivas para incrementar la percepción del riesgo asociado al uso de tabaco (Adkison et al., 2014) y la disminución de su consumo (Levy et al., 2018). Los indicadores que permitieron distinguir entre quienes consumieron, o no, tabaco, fueron los referidos a fumar una gran cantidad de cigarrillos en una misma ocasión y a consumirlo de manera diaria, aunque ambos grupos valoraron estas conductas como bastante riesgosas. ...
El consumo de alcohol, tabaco y marihuana presenta una alta prevalencia entre adultos emergentes universitarios. Una variable que incide en el consumo de estas tres sustancias psicoactivas es la percepción de riesgo asociada a dicha conducta. Este estudio examinó -en adultos emergentes universitarios argentinos- la relación bi o multivariada, entre el riesgo percibido de consumir alcohol, tabaco y marihuana, y el consumo propiamente dicho de estas sustancias. Se analizaron también variaciones en la percepción de riesgo en función del sexo y del tipo de consumo (con y sin consumo episódico excesivo de alcohol [CEEA], con y sin consumo de tabaco o marihuana). La muestra final, no probabilística y de carácter accidental, estuvo compuesta por 279 estudiantes universitarios (75.6% mujeres; M edad = 23.02; DE = 3.36) que completaron un cuestionario online. Se encontraron diferencias significativas en la percepción de riesgo (global y para indicadores individuales) en función del sexo y del tipo de consumo. A su vez, el sexo (i.e., ser hombre) y la mayor frecuencia de CEEA, de consumo de tabaco y marihuana se asociaron a la percepción de un menor riesgo atribuido al consumo de cada sustancia. Los hallazgos sugieren que las conductas de consumo frecuente e intensivo podrían ser el foco de intervenciones para corregir posibles sesgos en la interpretación o valoración del riesgo percibido.
... [22] These STPs may appear to be less harmful than conventional cigarettes, but they are associated with a higher risk of several diseases, including cardiovascular disease, pancreatic cancer, oral cancer, and esophageal cancer, among others. [23] The most hazardous ingredients in STPs are nitrosamines, which are specific to tobacco. Cancer risk is directly correlated with tobacco-specific nitrosamine levels. ...
Background: The common belief amongst the consumers of smokeless tobacco products is Smokeless Tobacco Products (STPs) are not hazardous as smoking tobacco. Any form of tobacco consumed is addictive and the nicotine absorbed from these products is manifold higher than the nicotine produced and delivered from a cigarette. Aim: The aim of this narrative review is to consolidate and summarize the data from various studies to find out whether smokeless tobacco products are less harmful than smoking tobacco products or vice-versa. Method: A comprehensive literature search was conducted using various databases like EBSCO, Google scholar, Pubmed, Embase from 1957 to 2021. The keywords used for search was 'smokeless tobacco products', 'bacterial population AND smokeless tobacco products', 'water content, pH in STP'. Result: In total, 52 articles were selected to analyze the parameters, which proved increasing carcinogenicity in smokeless tobacco products. Various parameters were analyzed which include pH, water content, manufacturing procedure of STP and microbial population in smokeless tobacco products. Conclusion: The literature search suggests that the microbial population in smokeless tobacco products acts as a cascading series of events in carcinogenesis and other opportunistic infections and concludes that smokeless tobacco products are equally harmful as smoking tobacco products.
... There has also been considerable research using discrete choice experiments (DCEs) to examine the trade-offs smokers make when considering different characteristics of cigarette packs [21][22][23][24][25]. DCEs are frequently used in health economics to address policy questions [26], and they can be used to assess tobacco-control policies [27], particularly in low-and middle-income countries [27,28]. ...
... We designed a series of choice sets to examine the impact of three attributes: warning size (30%-version 1, 70%), packaging (standardised packaging, branded packaging) and brand type (Brand A, Brand B) on preferences to try the product, taste perceptions and harm perceptions. Attribute levels were selected from previous literature [21][22][23][24][25]. ...
Aims
To measure how cigarette packaging (standardised packaging and branded packaging) and health warning size affect visual attention and pack preferences among Colombian smokers and non-smokers.
Design
To explore visual attention, we used an eye-tracking experiment where non-smokers, weekly smokers, and daily smokers were shown cigarette packs varying in warning size (30%-pictorial on top of the text, 30%-pictorial and text side-by-side, 50%, 70%) and packaging (standardised packaging, branded packaging). We used a discrete choice experiment (DCE) to examine the impact of warning size, packaging, and brand name on preferences to try, taste perceptions and perceptions of harm.
Setting
Eye-tracking laboratory, Universidad Nacional de Colombia, Bogotá, Colombia.
Participants
Participants (n=175) were aged 18-40 years.
Measurements
For the eye-tracking experiment, our primary outcome measure was the number of fixations towards the health warning compared with the branding. For the DCE, outcome measures were preferences to try, taste perceptions and harm perceptions.
Findings
We observed greater visual attention to warning labels on standardised versus branded packages (F(3,167)=22.87, p<.001) and when warnings were larger (F(9,161)=147.17, p<.001); as warning size increased, the difference in visual attention to warnings between standardised and branded packaging decreased (F(9,161)=4.44, p<.001). Non-smokers visually attended towards the warnings more than smokers, but as warning size increased these differences decreased (F(6,334)=2.92, p=.009). For the DCE, conditional trials showed that increasing the warning size from 30% to 70% reduced preferences to try (odds ratio [OR]=0.48, 95%confidence interval [CI] [0.42,0.54], p<0.001), taste perceptions (OR=0.61, 95%CI[0.54,0.68], p<0.001); and increased harm perceptions (OR=0.78, 95%CI[0.76,0.80], p<0.001). Compared with branded packaging, standardised packaging reduced our DCE outcome measures with odds ratios ranged from OR=0.25 (95% CI: 0.17,0.38; p<0.001) to OR=0.79 (95%CI: 0.67,0.93; p<0.001) across two brands. These effects were more pronounced among non-smokers, males, and younger participants. Unconditional trials showed similar results.
Conclusions
Standardised cigarette packaging and larger health warnings appear to decrease positive pack perceptions and have the potential to reduce the demand for cigarette products in Colombia.
... There is smokeless tobacco a variety of Traditional products and manufacturers (20). The popularity of products in international markets used by people in packaging and different flavors, also provide a new commercial market for their producers (21)(22)(23). However, smokeless tobacco is harmful and a major carcinogen among users and it is one of the major causes of Chronic Diseases (6,(24)(25)(26). ...
... Some cases of these beliefs about a particular brand of smoke-free tobacco come to be a more general justifiable belief (8,10,15,56). Besides, it is preferable to cigarette, because this substance is smokeless (7,15,20,21,47). ...
... Since its use is growing in family and friendly relationships, we need school and university education about the dangers and the complications. The use of this substance with different flavors, popularity of some brands among youth as well as attractive promotions from manufacturers and fashionable and attractive packages, had led to increasing numbers of consumers (8,11,21,47,48). We need qualitative studies to examine the formation of relevant beliefs about the effects of psychology such as bravery and lack of fear and increasing self-esteem as expressed by some consumers (51) as well as beliefs about physical effects such as treatment of headaches, toothache, preventing common cold, improving comfortable sleep, relaxation, eye, and nose cleansing, and eliminating bad breath (mal-smell) problems. ...
Background: Smokeless tobacco use is a public health problem in some parts of the world. The major objective of this study was to investigate the reasons and factors of consumption.
Methods: A content analysis was conducted on articles for the past thirty years (1989-2019). We reviewed and
selected 400 abstracts of original articles from PubMed databases by the search strategy, and reviewed one by
one. Among these, 45 abstracts were selected, in which the patterns of use, the reasons for using, and the determinants and predictors were described. Eleven papers were selected based on the results and related to the
research objectives. The results of these articles were evaluated precisely word by word and phrase by phrase
with content analysis method and inductive approach.
Results: The reasons for the use of smokeless tobacco fell in two main themes: socio-cultural structure; and,
beliefs, each contained Sub-themes such as "culture and living conditions", "laws", "family and peer relationships", "beliefs related to psychological" and "beliefs related to physical influences", "beliefs", "The role of
harm perceptions ".
Conclusion: There was a difference between beliefs, cultures and social conditions among the people about
using of smokeless tobacco and the association of these factors is investigated in future studies. We also suggest
for the prevention and control of smokeless tobacco use, cultural norms and beliefs will need to address adequately.
Keywords: Smokeless tobacco; Sociocultural; Beliefs; Culture; Living conditions
... Proponents claim that flavoured products mask unpleasant taste and make products more palatable. They refer to literature suggesting that flavoured smokeless tobacco (ST) products appeal to youth [16][17][18][19][20][21][22] and may increase curiosity and willingness to try snus [23]. ...
Background
Similar to the debate around e-cigarettes, an increase in snus use among Norwegian adolescents has prompted debate on whether flavour options in snus should be limited. To this end, we compared use of flavoured snus among snus users with different smoking status.
Methods
Questions about flavoured snus use were included in an online omnibus study conducted from 2015 to 2019 ( N = 65,445) that included 16,295 ever snus users (aged 15+). Current snus users ( N = 9783) were asked “Do you usually use snus that has a flavouring (liquorice, mint, wintergreen, etc.)? Adjusted predicted probabilities and 95% confidence intervals (CI) were calculated from a logistic regression model.
Results
Less than 25% of the snus users reported never having smoked. The overall probability of using flavoured snus was .45 (95% CI .44–.46), highest among daily (.51, 95% CI .47–.54) and former daily smokers (.50, 95% CI .48–.52), and lowest among never (.41, 95% CI .39–.43) and occasional smokers without any prior history of daily smoking (.41, 95% CI .38–.44). Use of flavoured products was higher among female snus users ( p = .67, 95% CI .65–.69) compared to males ( p = .35, 95% CI .34–.36), highest among the youngest age group, 15–24 years ( p = .58, 95% CI .56–.60) and decreased with increasing age.
Conclusion
Regulation that would ban or limit flavoured snus use may affect smokers—an at risk population—more than never smokers. The health authorities should be mindful of the real-world complexity governing potential harms and benefits of flavour restrictions on snus. A further assessment of flavour limitations should acknowledge that flavoured snus products also function as alternatives to cigarettes.
... 31 32 A US study reported that SLT pack appearances had a quantifiable effect on health perceptions through the use of graphic warning labels. 33 The Naswar packs used in Khyber Pakhtunkhwa province are devoid of any textual or graphic health warnings but POS vendors favoured health warning labels (if implemented), while exclusive Naswar sellers assumed it would be a useless practice. Manufacturers of Naswar deemed it an extra burden, adding to expenses. ...
Objective
To obtain insights into the perceptions of barriers and facilitators to implementation of the WHO Framework Convention on Tobacco Control (FCTC) among smokeless tobacco (SLT) supply chain actors in the Khyber Pakhtunkhwa province of Pakistan.
Methods
We conducted a qualitative study to investigate the perceptions about SLT control policy formulation and implementation among exclusive Naswar sellers and point of sale vendors. We conducted five focus group discussions in three districts of Khyber Pakhtunkhwa using combined deductive-inductive thematic analyses.
Results
We identified three central themes that potentially impact policy formulation, its implementation and application. The first theme examines the role of children in the Naswar business: as potential customers, and as potential heirs to a Naswar-selling business. A second theme targets the ‘business of Naswar’, which includes a specific identity of Naswar sellers, its potential to generate profits and the special case of Naswar regulation as a socially accepted and culturally rooted product. The third theme addresses the unusual ingredients of Naswar and its production process, making Naswar a health risk for consumers and producers. We also report conflicting views regarding SLT control among the supply chain actors.
Conclusions
This study provides insights into the perceptions of important SLT supply-side stakeholders regarding various SLT control policy options based on the FCTC. While there is some opposition to policy approaches like taxation and switching of business, implementing a ban on selling SLT to minors may be a viable option for policymakers in the short term.
... However, the present study is the first systematic attempt to analyse the variability of individual ratings. It is also the first to assess perceptions of standardised snus packaging in a country where snus use is highly prevalent (one study has been published from a U.S. context where the prevalence of snus use is low) [18]. ...
Background:
Perceptions of tobacco packaging may be consequential for consumption and initiation. We explored the potential effect of standardised packaging on young adults' ratings of the appeal of brands of snus (Swedish moist snuff) and on their perceptions of typical users of these brands. We were interested in both the effects on average levels of ratings and on the within-subject variability of the ratings. The latter was used as a measure of the extent to which individuals can differentiate between brands.
Methods:
A sample of 625 Norwegians aged 16-30 were randomly allocated to one of three between-subject conditions: Branded Packaging, Standardised Packaging, or Standardised Packaging with Health Warnings. The participants rated 10 snus brands on measures of general appeal and on their perceptions of the typical brand user (e.g., "… is sporty and active").
Results:
The standardised packages (without health warnings) were not rated more negatively than the branded packages, while the standardised packages with health warnings were rated slightly more negatively than the branded packages. However, in terms of within-subject standard deviations, the variability of the brand ratings across the packages was substantially lower for standardised packaging types in comparison to branded packages.
Conclusions:
Even in cases where standardised tobacco packaging appears to have little overall effect on the valence of the average ratings, it can have a strong effect on the variability of the ratings. This suggests that standardised packaging can reduce the potential for brand differentiation.
... In comparison, graphical warnings seem to have a greater effect in capturing attention and motivating smokers to quit [7]. One study [8] found that pictorial versions evoked more concerns about health risks compared to mere textual ones, and pictorial versions were judged as least attractive to SLT users whereas textual warnings were seen as more appealing for peers (i.e., the kind of package a peer would want to be seen using). In contrast, another study found no increase in risk perception in a sample of non-users who were shown graphic cancer warnings on snus products [9]. ...
Background:
To strengthen the risk message on snus warning labels, the European Union in 2016 removed "can" from the warning "This tobacco product (can) damages your health and is addictive." We tested how these and other textual warnings affect risk perception.
Methods:
Snus-using and non-using Norwegians aged 16-72 participated in two online survey experiments. Participants in Study 1 (N = 196) were randomized to read one of four warning labels. Outcome variables included ratings of likelihood of health damage from snus and perceived severity of such damages. Study 2 (N = 423) used similar outcome measures but added a baseline measure allowing for a pre-post comparison, as well as a control group receiving no warning label. Data were analysed using ANOVA and non-parametric tests.
Results:
Study 1 indicated that removing "can" from the EU warning increased long-term risk perception, but adding "causes cancer" had no effect on risk perception. In Study 2, risk perception increased from pre to post, regardless of label manipulation. "Causes cancer" and "damages your health" were indicated as most alarming when participants compared and ranked all warnings.
Conclusions:
Adding "causes cancer" or removing "can" from "damages your health" did not strengthen short-time (1 year) risk perception, but the latter increased long-term (10 years) risk perception in Study 1. In the pre-post design in Study 2, risk perception increased regardless of warning label.
