CIGARETTE PACKAGING IN IRELAND: THE PLAIN FUTURE

Transcription

1 CIGARETTE PACKAGING IN IRELAND: THE PLAIN FUTURE Wesley Connolly Tong and Maurice Murphy Cork Institute of Technology, Cork, Ireland. E: T: ABSTRACT Ireland has become the first country in Europe and the second in the world to pass plain packaging laws for tobacco products. Under the new Irish legislation, companies will be banned from producing branded tobacco products for the Irish market from May 2016 and banned from selling branded tobacco products in Ireland from May Australia introduced a similar ban in Packaging is an important component of the overall marketing strategy for consumer goods. The marketing value of the cigarette package increases as other forms of marketing are restricted. The package is the last and most critical link in an integrated chain of promotional communications. Packaging is the most prominent form of tobacco marketing remaining in countries such as Ireland. Since the tobacco industry has been stripped of most of its marketing mix, the cigarette package has become an increasingly important advertising tool. This paper summarises the literature with respect to six primary outcomes: health warnings, perceptions of risk, consumer appeal, measures of consumer demand and smoking behaviour, research on differences in plain packaging colours and postimplementation research from Australia. KEY WORDS Plain cigarette packaging; health; smoking; warning labels. 1

2 1. Introduction Packaging is particularly important for consumer products with a high degree of social visibility, such as cigarettes. Unlike many other consumer products, cigarettes are contained in packages that are displayed each time the product is used and are often left in public view between uses (Pollay, 2001). Koten (1980 p22) cites John Digianni, a former cigarette package designer who notes: A cigarette package is unique because the consumer carries it around with him all day It is a part of a smoker s clothing, and when he saunters into a bar and planks it down, he makes a statement about himself. Plain packaging regulations represent a form of marketing restriction. There is a large and diverse evidence base demonstrating that tobacco marketing and advertising are causally associated with youth smoking (DiFranza et al., 2006). Research suggests that plain packaging is less attractive and engaging, particularly to young people (Freeman et al., 2008). This evidence is applicable to understanding the role of packaging in that it collectively demonstrates that exposure to tobacco promotions are causally related to smoking behaviour (DiFranza et al., 2006). Packaging helps establish brand identity in competitive markets and serves as an effective form of promotion both at the point of purchase and while the product is being used (Slade, 1997). Package designs help reinforce brand imagery that is communicated through other media, and play a central role in point of purchase marketing, which now accounts for a majority of the industry s promotional spending in Canada and the USA (Dewhirst, 2004). 2. Improved Attention to Health Warnings on Plain Cigarette Packages Three qualitative studies have examined how consumer perceptions of health warnings change when displayed on plain packaging (Hammond, 2014). Qualitative research with New Zealand youth found that pictorial warnings on plain cigarette packs increased the attention paid to graphic warning labels and the overall perceptions of harm caused by cigarette smoking, and reduced the social appeal of cigarette smoking (McCool et al., 2012). A second qualitative study conducted with youth in Belgium found that health warnings catch the eye much more strongly when presented on plain, rather than branded packages (Van Hal et al., 2012). Qualitative research conducted in Australia also found that consumers felt that plain packaging would strengthen the impact of health messages (Shanahan and Elliott, 2009). These findings are consistent with a quantitative study from 1995 conducted in Canada, which found that youth reported that health warnings were easier to see and looked more serious when presented on plain packaging (Rootman and Flay, 1995). Five experimental studies have examined recall of health warnings as an outcome of plain versus branded packaging (Hammond, 2014). A 1992 study conducted with New Zealand youth found that recall of health warnings was greater when presented on plain vs. branded packaging (Beede and Lawson, 1992). A 1995 study conducted with Canadian youth produced consistent findings: when health messages were presented on plain packages, unaided recall was greater for 1 of 3 messages and aided recall was greater for 2 of 3 messages presented during the study (Goldberg et al., 1995). These results were partially replicated in a separate study involving Canadian and USA youth (Hammond, 2014). 2

3 Canadian youth smokers were more likely to recall a health warning when presented on plain packaging, with no differences among the USA sample (Rootman and Flay, 1995). A subsequent experiment conducted with Canadian youth in 1999 found that message recall increased when health messages were presented on plain white packs for two health messages, but decreased for a third message (Goldberg et al., 1999). A more recent experiment from 2013 found that Canadian university students exhibited greater recall for health warnings on plain versus branded packaging (Al-Hamdani, 2013). 3. Increased Consumer Perceptions of Risk with Cigarette Plain Packaging Tobacco packaging has played a central role in promoting the false belief that some cigarette brands are less harmful than others (Hammond, 2014). In response to the growing evidence of the health risks of smoking in the th second half of the 20 century, tobacco companies developed a low tar strategy to reassure consumers and public health authorities (Hammond, 2014). Low tar cigarettes were designed by introducing small holes in cigarette filters and marketed with light or mild packaging descriptors. Not only does filter ventilation dilute cigarette smoke to produce deceptively low tar and nicotine numbers under machine testing, but it also produces lighter tasting smoke, which reinforces the misleading descriptors on packages (Hammond, 2014). Eight experimental studies demonstrate an association between packaging and perceptions of risk (Hammond, 2014). Within-subject experiments with adult smokers and non-smokers in the USA (Bansal-Travers et al., 2011) and in France (Gallopel-Morvan et al., 2011) found that pack colour was significantly associated with ratings of reduced risk and tar, and that plain packages were associated with fewer false beliefs about the relative risk of different brands. Several recent qualitative studies in New Zealand (Peace et al., 2007) and Scotland (Moodie and Ford, 2011) have found that consumer perceptions of the relative harm and strength of cigarette brands are associated with pack colour similar to quantitative survey findings among UK youth (Moodie et al., 2012). These findings are consistent with a series of qualitative and quantitative studies commissioned by the Australian government prior to the implementation of plain packaging (Hammond, 2014). Collectively, these studies found consistent associations with colours: packs with darker colours were seen to contain cigarettes which were more harmful to health and harder to quit. Conversely, packs with lighter colours were seen to be less 'harmful to health' and easier to quit. Brown (plain) packs were perceived negatively due to the colour, the undesirable image the pack conveyed and the reaction from others (Moodie et al., 2014). The brown pack colour evoked an association of older men, elderly relatives and tramps, which is far removed from the user image that tobacco companies aim to create when investing in female orientated brands (Hammond et al., 2011; Toll and Ling, 2005). The findings highlight the importance of base colour for plain packaging. 4. Reduced Consumer Appeal and Attraction with Plain Packaging Plain cigarette packaging has been suggested to operate in three ways: increasing effectiveness of health warnings; reducing false beliefs about cigarettes and reducing brand appeal (Hammond, 2010). Qualitative research with youth and young adults in New Zealand (Beede et al., 1991), Canada (Hammond, 2014), France 3

4 (Hammond, 2014), Scotland (Hammond, 2014; Moodie and Ford, 2011) and Belgium (Van Hal et al., 2012) suggests plain packaging reduces appeal, and attraction. In general, plain packaging reduces the appeal of cigarettes among adolescents and adults in terms of the attractiveness or appeal of the cigarette (Germain et al., 2010; Hammond et al., 2013a; Hoek et al., 2012; McCool et al., 2012; Moodie et al., 2012; Scheffels and Lund, 2013; Scheffels and Sæbø, 2013; Wakefield et al., 2008; White et al., 2012) and the taste of the cigarette compared to fully branded cigarettes (Germain et al., 2010; Hammond et al., 2013; White et al., 2012). Focus groups with USA and Canadian youth also found that plain packaging was less appealing and uglier (Rootman and Flay, 1995). Approximately one third of youth in the same study believed plain packaging would make non-smokers less likely to start and approximately one quarter believed plain packaging would make young smokers smoke less. Another study conducted in Canada found that approximately half of youth surveyed believed that fewer youth would start smoking as a result of plain packaging (Goldberg et al., 1995). Qualitative research in France with youth and young adults also found that plain and standardised packaging is associated with lower levels of attraction and appeal (Hammond, 2014). Perceptions of risk can also be influenced by the brand imagery and colour of cigarette packs (Pollay, 2001; Wakefield et al., 2002). Fifteen studies have examined the impact of plain packaging on smoker image or product image (Hammond, 2014). Qualitative and survey research in New Zealand (Gendall et al., 2012; Hoek et al., 2012), Norway (Scheffels and Sæbø, 2013), Australia (Hammond, 2014), and Canada (Goldberg et al., 1995) indicate that removing brand imagery reduces positive associations with product characteristics and that smokers of plain packaged products are rated less favourably than smokers of branded products. 5. Plain Packaging and Reduced Consumer Demand and Smoking Behaviour The most important motives for young people in choosing a certain brand of cigarettes are the price of the cigarettes, the taste of the cigarette, the influence of the social environment and the recognition of the packaging (Van Hal et al., 2012). Germain et al. (2010) found that youth perceived images of progressively plainer packs, (which had branded elements, such as colour, fonts, and imagery removed) to be less appealing and also to negatively affect product taste. It is well established within the wider marketing literature that pack colour is able to influence perceptions of taste and healthiness (Hawkes, 2010; Sara, 1990). Packaging is therefore important to support the brand s market position, as it promotes recognition and according to Wakefield and Letcher (2002) it can also initiate purchase behavior. Okell (2007) contends that cigarette pack design is used to attract attention, communicate brand identity, offer symbolic meaning to the user and function as an extension of their personality and demonstrates how young adult smokers use packaging design to construct their smoker identities. It was predicted that tobacco industry investment in pack design would increase further when bans on point-of-sale tobacco displays became mandatory, as is already the case in some countries including Ireland (Freeman et al., 2008). 4

5 A growing number of studies have examined the association between plain packaging and measures of consumer demand, including smoking behaviour (Hammond, 2014). Conjoint analysis and discrete choice experiments are established methodologies for assessing consumer demand in the field of marketing. A conjoint analysis experiment was conducted among Canadian youth to examine the role of packaging as a reason for smoking (Goldberg et al., 1995). The study found that pack type was an important attribute in reasons for quitting among adults and youth smokers, particularly when paired with a pictorial warning. Discrete choice methodology was also used to assess consumer demand among young adult smokers in New Zealand (Hammond, 2014). Pack options with fewer branding elements were associated with less demand and were more likely to elicit cessation behaviour (Hoek et al., 2010). A third discrete-choice experiment was conducted in 2013 among young adult females in Canada, including smokers and non-smokers, in which plain vs. branded packaging, pack shape and size, health warnings, price, and the type of brand were tested. Plain packaging had a significant effect on intentions to try the product among smokers and non-smokers, and perceptions of risk (Kotnowski, 2013). 6. Plain Cigarette Pack Colour and Attitudes to the Cigarette Pack Colour is routinely used in package design to shape consumer perceptions of risk (Pollay, 2001; Wakefield et al., 2002). In addition to the use of colour, packaging often includes imagery and symbols to shape perceptions of risk, including images of nature scenes, physical activity, and sport (Pollay, 2001). Several studies have examined whether the background colour to which plain packs are standardized has any impact on relevant outcomes. These studies are consistent in demonstrating that darker, non-white colours are perceived as significantly less appealing and more effective (Hammond, 2014). For example, in a study conducted among UK youth and adults, plain brown packs were perceived as less appealing than plain white packs and were also associated with higher perceptions of risk (Hammond et al., 2009). Qualitative research with young adult smokers in Scotland found that dark brown plain packs were perceived as more unappealing than light brown and dark and light grey packs by all focus groups (Moodie and Ford, 2011). 7. The Impact of Plain Packaging Regulations in Australia Plain packaging regulations were implemented for the first time by Australia in December Three published studies have examined the impact of plain packaging in Australia (Hammond, 2014). The first study consisted of a survey with adult smokers in the early implementation phase of plain packaging (Wakefield et al., 2013). The study compared responses from smokers who were using plain packs (approximately three-quarters of the sample), with responses from smokers who had yet to use plain packs. Smokers using plain packs perceived their cigarettes to be lower in quality, tended to perceive their cigarettes as less satisfying than a year ago, were more likely to have thought about quitting at least once a day in the past week, and rated quitting as a higher priority in their lives (Wakefield et al., 2013). Plain pack smokers were also more likely to support the plain packaging policy than branded pack smokers. Smokers of branded and plain packs did not differ on measures of less immediate smoking intentions or the frequency of thoughts about health risks (Wakefield et al., 2013). 5

6 The second study examined rates of pack display and the number of smoking patrons in cafés, restaurants, and bars with outdoor seating (Zacher et al., 2014). Data was collected in public areas before and after the implementation of plain packaging. Smoking in outdoor areas of cafés, restaurants, and bars declined in the postimplementation period, as did number of packs that were publicly visible. The third study used a time-series analysis to compare calls to the toll-free Quitline in two Australian states between the period before and after implementation of plain packaging in Australia (Young et al., 2014). Calls to the Quitline increased 78% after plain packaging was implemented, adjusting for other factors. Quitline calls peaked 4 weeks after the implementation deadline for plain packaging, but the increase was prolonged at 6 months post-implementation. The introduction of graphic health warnings in 2006 saw the same relative increase in calls; however, the impact of plain packaging was sustained for a longer time (Hammond, 2014). There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable cause (Young et al., 2014). 8. Conclusion Given the novelty of plain packaging regulations in Australia and Worldwide, there are few studies to assess the impact of plain packaging. To date (2015), three published studies provide preliminary evidence suggesting that plain packaging has had a positive public health impact in Australia. Of the three studies, objective data indicating a significant increase in calls to the Quitline - an effective form of smoking cessation (Stead et al., 2013) - are most compelling. No studies have yet examined the impact of plain packaging within the context of smoking initiation (Hammond, 2014). References Al-Hamdani, M. (2013), "The effect of cigarette plain packaging on individuals' health warning recall", Healthcare Policy, 8(3), Bansal-Travers, M., Hammond, D., Smith, P. & Cummings, K. M. (2011), "The impact of cigarette pack design, descriptors, and warning labels on risk perception in the US", American Journal of Preventive Medicine, 40(6), Beede, P. & Lawson, R. (1992), "The effect of plain packages on the perception of cigarette health warnings", Public Health, 106(4), Beede, P., Lawson, R. & Shepherd, M. (1991), The Promotional Impact of Cigarette Packaging: A Study of Adolescent Responses to Cigarette Plain-packs, Department of Marketing, University of Otago, Dunedin, New Zealand. Dewhirst, T. (2004), "POP goes the power wall? Taking aim at tobacco promotional strategies utilised at retail", Tobacco Control, 13(3), DiFranza, J. R., Wellman, R. J., Sargent, J. D., Weitzman, M., Hipple, B. J. & Winickoff, J. P. (2006), "Tobacco promotion and the initiation of tobacco use: assessing the evidence for causality", Pediatrics, 117(6), e1237-e

7 Freeman, B., Chapman, S. & Rimmer, M. (2008), "The case for the plain packaging of tobacco products", Addiction, 103(4), Gallopel-Morvan, K., Moodie, C., Hammond, D., Eker, F., Beguinot, E. & Martinet, Y. (2011), "Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging", Tobacco Control, tobaccocontrol Gendall, P., Hoek, J., Edwards, R. & McCool, J. (2012), "A cross-sectional analysis of how young adults perceive tobacco brands: Implications for FCTC signatories", BMC Public Health, 12(1), 796. Germain, D., Wakefield, M. A. & Durkin, S. J. (2010), "Adolescents' perceptions of cigarette brand image: Does plain packaging make a difference?", Journal of Adolescent Health, 46(4), Goldberg, M. E., Liefeld, J., Madill, J. & Vredenburg, H. (1999), "The effect of plain packaging on response to health warnings", American Journal of Public Health, 89(9), Goldberg, M. E., Kindra, G., Lefebvre, J., Tribu, L., Liefeld, J. & Madillmarshall, J. (1995), "When packages can t speak: possible impacts of plain and generic packaging of tobacco products", (accessed 29 Jun 2007). Hammond, D. (2014), Standarized Packaging of Tobacco Products: Evidence Review, Prepared on behalf of the Irish Department of Health, Dublin, Ireland. Hammond, D. (2010), "Plain packaging" regulations for tobacco products: The impact of standardizing the color and design of cigarette packs", Salud publica de Mexico, 52(S226-S232). Hammond, D., Daniel, S. & White, C. M. (2013), "The effect of cigarette branding and plain packaging on female youth in the United Kingdom", Journal of Adolescent Health, 52(2), Hammond, D., Doxey, J., Daniel, S. & Bansal-Travers, M. (2011), "Impact of female-oriented cigarette packaging in the United States", Nicotine & Tobacco Research, 13(7), Hammond, D., Dockrell, M., Arnott, D., Lee, A. & McNeill, A. (2009), "Cigarette pack design and perceptions of risk among UK adults and youth", The European Journal of Public Health, 19(6), Hawkes, C. (2010), "Food packaging: the medium is the message", Public Health Nutrition, 13(02), Hoek, J., Gendall, P., Gifford, H., Pirikahu, G., McCool, J., Pene, G., Edwards, R. & Thomson, G. (2012), "Tobacco branding, plain packaging, pictorial warnings, and symbolic consumption", Qualitative Health Research, 22(5), Koten, J. (1980), "Tobacco marketer's success formula: Make cigarettes in smoker's own image", Wall Street Journal, Feb 29: p. 22. Kotnowski, K. (2013), The Impact of Standardized Cigarette Packaging Among Young Women in Canada: A Discrete Choice Experiment, A thesis presented to the University of Waterloo in fulfilment of the thesis requirement for the degree of Master of Science in Health Studies and Gerontology. McCool, J., Webb, L., Cameron, L. D. & Hoek, J. (2012), "Graphic warning labels on plain cigarette packs: Will they make a difference to adolescents?", Social Science & Medicine, 74(8), Moodie, C., Bauld, L., Ford, A. & Mackintosh, A. M. (2014), "Young women smokers' response to using plain cigarette packaging: Qualitative findings from a naturalistic study", BMC Public Health, 14(1), 812. doi: /

8 Moodie, C., Ford, A., Mackintosh, A. M. & Hastings, G. (2012), "Young people s perceptions of cigarette packaging and plain packaging: an online survey", Nicotine & Tobacco Research, 14(1), Moodie, C. & Ford, A. (2011), "Young adult smokers perceptions of cigarette pack innovation, pack colour and plain packaging", Australasian Marketing Journal (AMJ), 19(3), Okell, E. (2007), "The Anglo-American Tobacco Wars and the use of the classics to establish a global company", New Voices in Classical Reception Studies, 2, Peace, J., Wilson, N., Thomson, G. & Edwards, R. (2007), Colouring of Cigarette Packs in New Zealand - Does it Mislead Consumers, Wellington: Health Promotion and Policy Research Unit, University of Otago, New Zealand. Pollay, R. W. (2001), "The Role of Packaging seen through Industry Documents", Expert Report prepared for: JTI-MacDonald., Imperial Tobacco Canada Ltd and Rothmans, Benson & Hedges Inc. v. Attorney General of Canada and Canadian Cancer Society (intervenor). Supreme Court, Province of Quebec, District of Montreal. Defense Exhibit D-116. Rootman, I. & Flay, B. (1995), A Study on Youth Smoking, Plain Packaging, Health Warnings, Event Marketing, and Price Reductions - Key Findings, Toronto: University of Toronto, Centre for Health Promotion, Canada. Sara, R. (1990), "Packaging as a retail marketing tool", International Journal of Physical Distribution & Logistics Management, 20(8), Scheffels, J. & Lund, I. (2013), "The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey", BMJ Open, 3(12), e Scheffels, J. & Sæbø, G. (2013), "Perceptions of plain and branded cigarette packaging among Norwegian youth and adults: a focus group study", Nicotine & Tobacco Research, 15(2), Shanahan, P. & Elliott, D. (2009), Evaluation of the Effectiveness of the Graphic Health Warnings on Tobacco Product Packaging 2008, Canberra: Australian Government Department of Health and Ageing, Australia. Slade, J. (1997), "The pack as advertisement", Tobacco Control, 6(3), Stead, L. F., Hartmann-Boyce, J., Perera, R. & Lancaster, T. (2013), Telephone Counselling for Smoking Cessation, Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD DOI: / CD pub3. Toll, B. A. & Ling, P. (2005), "The Virginia Slims identity crisis: an inside look at tobacco industry marketing to women", Tobacco Control, 14(3), Van Hal, G., Van Roosbroeck, S., Vriesacker, B., Arts, M., Hoeck, S. & Fraeyman, J. (2012), "Flemish adolescents perceptions of cigarette plain packaging: a qualitative study with focus group discussions", BMJ Open, 2(6), doi: /bmjopen Wakefield, M. & Letcher, T. (2002), "My pack is cuter than your pack", Tobacco Control, 11(2), Wakefield, M. A., Hayes, L., Durkin, S. & Borland, R. (2013), "Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study", BMJ Open, 3(7), e

9 Wakefield, M. A., Germain, D. & Durkin, S. J. (2008), "How does increasingly plainer cigarette packaging influence adult smokers perceptions about brand image? An experimental study", Tobacco Control, 17(6), Wakefield, M., Morley, C., Horan, J. & Cummings, K. (2002), "The cigarette pack as image: New evidence from tobacco industry documents", Tobacco Control, 11(suppl 1), i73-i80. White, C. M., Hammond, D., Thrasher, J. F. & Fong, G. T. (2012), "The potential impact of plain packaging of cigarette products among Brazilian young women: An experimental study", BMC Public Health, 12(1), 737. doi: / Young, J. M., Stacey, I., Dobbins, T. A., Dunlop, S., Dessaix, A. L. & Currow, D. C. (2014), "Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis", Medical Journal Australia, 200(1), Zacher, M., Bayly, M., Brennan, E., Dono, J., Miller, C., Durkin, S., Scollo, M. & Wakefield, M. (2014), "Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor café strips", Addiction, 109(4),