Tobacco Packaging Research Articles

Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Background and aimIn 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive,...

Perceived efficacy of existing waterpipe tobacco warning labels versus novel enhanced generic and waterpipe-specific sets.

IntroductionSince 2008, Egypt has four existing generic bi-annually rotating warning labels (WLs) on 50% of the waterpipe tobacco packs (WTPs). The Ministry of Health Tobacco Control Unit proposed increasing WL size to 80%, removing colours and flavour imagery from WTPs, and plain packaging to help curb the rising epidemic of waterpipe tobacco smoking. Therefore, we measured the perceived efficacy of existing against novel enhanced (generic and waterpipe-specific) WTP WLs and the associated factors among Egyptian waterpipe smokers and nonsmokers.MethodsA purposive quota sample of 2014 adults was surveyed in two rounds using face interviews. At each round, participants were randomly shown one of four existing WLs, then one of four novel WLs. Participants rated the perceived efficacy of existing and novel WLs regarding the salience, depth of processing, affective reactions, credibility, relevance, perceived harm and perceived behavioural control. Data were analysed using Generalized Estimating Equations.ResultsParticipants rated novel WTP WLs with higher mean perceived efficacy scores than existing WLs for all measures, although both sets collectively scored modestly (59.7; 95% CI: 58.9–60.5 vs 53.0; 95% CI: 52.1–54.0, respectively; p<0.001). Relative to the existing WTP WLs, novel WLs were particularly able to induce higher salience, affective reactions, and depth of processing. Relative to the generic novel WTP WLs, waterpipe-specific WLs induced higher relevance, perceived harm, and affective reactions. Nonsmokers scored higher than waterpipe tobacco smokers, specifically for perceived behavioral control (65.0±32.5 vs 43.6±19.8, respectively; p<0.001). WTP WLs featuring proximal risks, such as dental effects (β = 9.70; 95% CI: 7.00–12.40), fetal harm (β = 9.42; 95% CI: 6.75–12.10), or toxic contents (β = 9.14; 95% CI: 6.58–11.70) were strongly associated with participants’ perceived efficacy scores. Among other independent factors, rural residence (β = 24.09; 95% CI: 22.21–25.97), being a nonsmoker (β = 10.51; 95% CI: 8.92–12.10), survey round 2 (β = 6.96, 95% CI: 5.73–8.19), the novel WTP WL set (β = 6.68; 95% CI: 6.19–7.17), and having higher education (β = 6.31; 95% CI: 4.34–8.27) were highly associated with participants’ perceived efficacy scores.ConclusionsWaterpipe-specific WLs on plain WTPs that feature proximal risks and address different population subgroups need to be developed in conjunction with awareness raising campaigns on WTS harms to reinforce the credibility of WTP WLs. Our findings suggest the proposed WTP WL enhancements by the Tobacco Control Unit may support a more effective WTP labelling policy within a comprehensive waterpipe-specific tobacco control framework.

Implementation of tobacco control measures in the Gulf Cooperation Council countries, 2008\u20132020

BackgroundThe World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) was developed to assist nations in reducing the demand and supply of tobacco. As of 2020, 182 nations joined the FCTC, agreeing to implement the recommended tobacco control measures. The Gulf Cooperation Council (GCC) countries, including Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates (UAE) ratified the WHO FCTC by August 2006. Given the unique political, cultural, and religious context – and known tobacco industry efforts to influence tobacco use- in these nations, a careful examination of the translation of FCTC measures into policy is needed. This study aimed to assess the implementation of FCTC tobacco control measures at the national level within the six GCC countries.MethodWe collected and coded the FCTC measures that were implemented in the GCC countries. We examined trends and variations of the implementation between 2008 and 2020.ResultsGCC countries implemented most FCTC measures targeting the demand for and supply of tobacco, with some variation among countries. Bahrain and Qatar were more comprehensively implementing FCTC measures while Kuwait and Oman implemented the least number of the FCTC measures. Implementing measures related to tobacco prices and eliminating the illicit tobacco trade has slowly progressed in GCC countries. All GCC countries entirely banned smoking in workplaces while three countries implemented a partial ban in restaurants. Only Oman has restrictions on tobacco ads shown in media. There is progress in implementing FCTC measures related to tobacco packaging, cessation, and sale to minors in most GCC countries.ConclusionsGiven the influence of the tobacco industry in the Gulf region, the findings suggest a need for ongoing surveillance to monitor the proliferation of tobacco control measures and evaluate their effectiveness. Efforts required to address tobacco use should correspond to the unique political and cultural background of the GCC countries.

Emotional impact of graphic health warnings on tobacco packages in Colombia.

Emotional impact of graphic health warnings on tobacco packages in Colombia.

Machine-assessed tar yield marketing on cigarette packages from two cities in South Korea.

INTRODUCTIONSouth Koreans continue to smoke at high rates. Tobacco manufacturers have a history of branding cigarettes with misleading descriptors including the introduction of low or ultra-low tar brand variants. The government bans traditional misleading descriptors (low, mild) but requires the presence of machine-assessed tar yields on cigarette packages. Literature suggests the presence of quantitative constituents can be misleading for smokers. We analyzed the machine-assessed tar value branding and the presence of additional branding that highlight tar levels on South Korean cigarette packs.METHODSIn August 2018, we analyzed 178 unique cigarette packs purchased in Seoul and Busan, South Korea using a systematic protocol. Cigarette packs were coded for tar levels and classified as ultra-low, low, mid, and high tar. The presence of misleading descriptors and any additional branding relating to tar or potentially indicating strength were also coded.RESULTSMachine-assessed tar yields ranged from 0.1 to 8 mg. Cigarettes with a 1 mg machine-assessed tar yield accounted for 38% of all packs purchased. A majority (80%) of packs with tar values <3 mg had additional marketing present on the pack that highlighted tar yields, compared to 45% for packs with tar values 3 mg or greater. Many (85%) of the 1 mg packs and all of the 0.1 and 0.5 mg packs had additional marketing present that referenced tar levels.CONCLUSIONSThese findings suggest that tobacco manufacturers are highlighting and reinforcing the tar yields of lower tar cigarettes by the deliberate use of tar level branding. These actions have the potential to mislead South Korean consumers that some cigarettes are less harmful than others. Strengthening of tobacco packaging regulations to prohibit references to tar yields on packs are needed to further protect consumers.

Roll-your-own smokers’ reactions to cessation-efficacy messaging integrated into tobacco packaging design: a sequential mixed-methods study

BackgroundAlthough loss-framed pictorial warning labels (PWLs) have increased knowledge of the health harms caused by smoking, they may elicit maladaptive responses among some smokers who have tried repeatedly, yet unsuccessfully,...

Performance of the EarlyCDT® Lung test in detection of lung cancer and pulmonary metastases in a high-risk cohort

ObjectivesEarly detection of lung cancer is pivotal for an optimal prognosis. CT screening is currently implemented in USA. To decrease the amount of CT scans, the application of a blood-based biomarker as part of screening criteria is desirable. Materials and methodsThe EarlyCDT® Lung test was performed in a high-risk cohort composed 246 patients referred from their GP on suspicion of lung cancer. Blood samples were taken at first visit and patients underwent diagnostic workup on suspicion of lung cancer resulting in either a malignant diagnosis or ruled out cancer. Sensitivity and specificity of the EarlyCDT® Lung were calculated in the cohort and subgroups based on age, smoking history, sex and lung cancer stage. ResultsOverall sensitivity in the cohort was 33 % for lung cancer and 31 % for primary lung cancer and lung metastases combined. Sensitivity in age groups was 11 % (60 years or below), 31 % (61−75 years) and 55 % (>75 years). In patients with at least 10 tobacco pack years, sensitivity was 33 % while the sensitivity in patients with at least 50 tobacco pack years was 44 %. The assay sensitivity in stage I-II lung cancer patients was 21 %, while this was 40 % in stage III-IV lung cancer patients.In a subgroup of patients that met current CT screening criteria (age 55–80 years and minimum 30 tobacco pack years) the sensitivity was 37 %. ConclusionThe rationale of screening for lung cancer is to find patients in an early and resectable stage. However, the EarlyCDT® Lung test performed best in elderly, late stage lung cancer patients with a heavy smoking history. Based on these results, the current study finds insufficient sensitivity of the EarlyCDT® Lung test to be used as part of inclusion criteria in a low-dose CT program for detection of lung cancer.

Examining the effect of waterpipe specific pictorial health warning labels among young adults in Lebanon and Tunisia: Protocol of a factorial experiment study design

BackgroundWaterpipe tobacco smoking (WTS) has increased substantially in the Eastern Mediterranean Region (EMR), affecting young adults who perceive waterpipe as safer than cigarette smoking. Applying pictorial health warning labels (HWLs) on tobacco products has been effective in communicating health risks associated with tobacco smoking. However, there are few experimental studies that examined pictorial HWLs specific to WTS. Methods/design: This report describes the design and protocol of the first factorial experimental study that aims to test the effectiveness of pictorial HWLs based on their placement on waterpipe device, tobacco, and charcoal packages among young adult smokers and non-smokers residing in Lebanon and Tunisia. After completing a baseline assessment, participants will be randomly assigned to 3 experimental conditions in a 3 (HWL: pictorial HWL on tobacco package vs. pictorial HWL on 3 placements [device, tobacco, and charcoal packages] vs. text-only HWL on tobacco package) x 4 (pictorial HWLs) x 2 (waterpipe smokers vs. non-smokers) factorial design. We will use a within/between-subject design, where pictorial HWLs and time (pre vs. post-exposure) are the within-subject factors and waterpipe smoking status as the between-subjects factor. Participants will complete post-exposure measures that include attention, perceived harm, intention to quit (smokers) or initiate smoking (non-smokers). Discussion: This is the first international study examining the placements of pictorial HWLs using efficient within/between subject design. Findings will provide additional evidence to convince policymakers to consider three placements of HWLs specific to WTS as a promising regulatory target to curb WTS.

Characteristics of flavored and non-flavored waterpipe tobacco users: a real-world setting study.

We aimed to compare sociodemographic characteristics, smoking patterns, beliefs and perceptions, nicotine dependence, and psychological indicators between flavored waterpipe (WP) tobacco (FWT) and non-flavored WP tobacco (non-FWT) smokers in Iran. A cross-sectional study was conducted in 94 WP-serving venues surrounding Tehran and Ardabil metropolitans in Iran. Convenience sampling was applied to select 900 current WP smokers [508 (56%) FWT-only and 392 (44%) non-FWT-only smokers] aged 18 years and older. Multivariable logistic regression was used to examine the independent characteristics of FWT and non-FWT smokers. Compared to non-FWT smokers, FWT smokers were younger (adjusted odds ratio [AOR]=0.88, 95% confidence interval [CI]: 0.87–0.90) and more likely to have ≥ 1 sibling who smoked WP (AOR=1.54, 95% CI: 1.06–2.24), share WP with others (AOR=2.52, 95% CI: 1.68–3.77), report current cigarette smoking (AOR=2.05, 95% CI: 1.23–3.42), and report confidence in quitting at any time (AOR=3.64, 95% CI: 2.45–5.39). FWT smokers were less likely to have seen (AOR=0.40, 95% CI: 0.27–0.60) or read (AOR=0.44, 95% CI: 0.24–0.80) warning messages on WP tobacco packages relative to non-FTW smokers. The most common self-reported reason for smoking WP was entertainment for both groups, followed by stress relief for non-FWT smokers and the escape from loneliness for FWT smokers. FWT-only smokers differ from non-FWT-only smokers in several aspects including being younger, having more positive beliefs and perceptions regarding WP use, and having higher cigarette smoking prevalence. These findings will help in developing more effective and targeted policies and cessation interventions for WP smokers according to flavor type they use, especially in the Middle East.

Saborizantes y caracteres de diseño en cigarrillos y productos de tabaco disponibles próximos a centros educativos en Montevideo, Uruguay

Introduction: tobacco products are designed to be attractive, and recently, flavour additives have been introduced in the market. In Uruguay, regulations in force prohibit all forms of publicity for these products. For this reason, attracting consumers to tobacco products by means of flavour and design constitutes an important factor in smokers’ choice, in particular the young. Learning about products available in our market and those that are close to educational centers is relevant.Method: descriptive, observational, prospective and transversal study. The field work protocol was adapted from the Johns Hopkins University Tobacco Pack Surveillance System Project.Results: 23 varieties were identified. 34.78% of the products were flavoured, and they were available in 86,67% points of sale. All flavoured products’ packs included a reference to its condition. In 50% of them, the brand suggested the presence or activation of flavour. 87.5% of filters referred to flavor activation and 37.5% added technological traits. 75% were mint flavoured and 24% were double-flavoured. Only 39.1% included minor protection information.Conclusions: there is great availability of flavoured tobacco products, the variety being greater in recent years, although lower in Uruguay if compared to other countries. In the absence of specific regulations on additives and flavouring substances, countries could reduce the offer by implementing a single presentation by brand and the complete banning of publicity.

Knowledge and Beliefs about the Inclusion of Health Warnings on Waterpipe Tobacco Packaging in Jordan

BACKGROUND: Article 11 of WHO-FCTC strategies emphasize the need for countries to include health warnings on packages of tobacco products. This study aims to assess Jordanian people, aged 13 years and above knowledge and beliefs about the inclusion of health warning labels on waterpipe tobacco packages. &#x0D; &#x0D; METHODS: A descriptive cross-sectional approach was conducted among youth and adults aged 13 years and above. The sample was recruited from public schools, universities, and a governmental public service agency. Data collection was done through an electronic survey using Tablets. &#x0D; &#x0D; RESULTS: A total of 1067 participated in the study, with ages ranging between 13&amp;ndash; 63 years old with a mean (20.9, SD= &amp;plusmn; 6.1). Study participants mainly consisted of students making (86.7%) of the total sample. These students were in secondary education school (19.3%) or attending university (67.4%). Findings indicated that participants tobacco smoking status were non-smokers, single type smoker, dual smoker, and triple smokers (67.8%, 21.6%, 6.8%, and 3.7% respectively). In comparison the prevalence of smoking single tobacco type, dual smoking, and triple smokers tobacco products was statistically higher among males than females (11.1%-10.6%, 5.1%-1.8%, and 3.1%-0.7% respectively). Eighty-seven percent knew that waterpipe smoking is harmful and would support the inclusion of health warnings on the tobacco packet. Thirty percent indicated that the inclusion of health warnings will greatly improve their knowledge of the harmful effects of tobacco smoking. &#x0D; &#x0D; CONCLUSION: The current study shows that participants believe including health warnings on waterpipe tobacco package would help smokers to think about quitting.

Reporting of Differences in Taste Between Branded and Unbranded Cigarettes by Smokers Blinded to Cigarette Branding: Within-Person, Randomized Crossover Study.

BackgroundSaudi Arabia implemented a plain tobacco packaging regulation, one of the World Health Organization’s recommended initiatives to help reduce smoking rates, in August 2019. A few weeks after implementation, a large number of smokers complained via various media channels, especially social media (eg, Twitter), that an extreme change in cigarette taste had occurred, frequency of coughing had increased, and for some, shortness of breath had led to hospitalization.ObjectiveThe main objective is to determine whether smokers blinded to cigarette branding report differences in taste between branded and unbranded cigarettes. The secondary objective is to observe the frequency of immediate cough or shortness of breath.MethodsThis study employed a within-person, randomized crossover design that recruited current smokers 18 years and older who were cleared upon physical assessment before the experiment. Participants received 6 sequences of different random exposures (3 puffs) to 3 plain-packaged cigarettes (2 from their favorite brand and 1 from another brand as a control) and 3 branded cigarettes (2 from the favorite brand and 1 from another brand as a control). Participants wore virtual reality goggles accompanied by special software to alter visual reality and gloves to alter the touch sensation.ResultsThis study recruited 18 participants, measured at 6 time points, to produce 108 experiments. Participants were not able to identify the correct type of cigarettes (plain or branded, estimate of fixed effect=−0.01, P=.79). Moreover, there were no differences in the ability of the participants to identify their favorite brand (t107=−0.63, mean 0.47, P=.53). In terms of immediate coughing, out of the 108 experiments, 1 episode of short coughing was observed, which was attributed to the branded cigarette, not the plain-packaged cigarette.ConclusionsAfter controlling the visual and touch sensations, participants were not able to differentiate between branded and plain-packaged cigarettes in terms of taste or inducing immediate shortness of breath or cough. Interestingly, participants were not able to identify their favorite brand.

Tobacco industry marketing adaptations to Singapore plain packaging

BackgroundSingapore has implemented plain packaging, a measure that strips all colours, logos and branding elements from tobacco packs. In other countries, tobacco companies responded to plain packaging with a variety...

Visual detection of tobacco packaging film based on apparent features

The main purpose of this article is to study the detection of transparent film on the surface of tobacco packs. Tobacco production line needs an industrial robot to remove the transparent film in the process of unpacking. Therefore, after the industrial robot removes the transparent film, it is necessary to use machine vision technology to determine whether there is transparent film residue on the surface of tobacco packaging. In this article, based on the study of the optical features of semitransparent objects, an algorithm for detecting the residue of transparent film in tobacco packs based on surface features is proposed. According to the difference of surface features between tobacco and film, a probability distribution model considering highlights, saturation, and texture density is designed. Because the probability distribution model integrates many features of tobacco and film, it is more reasonable to distinguish the tobacco film regions. In this article, an appropriate foreground box with a trapezoidal mask and image segmentation algorithm GrabCut is used to segment the foreground area of tobacco pack more accurately, and the possible film area is obtained by image differential and morphological processing. Finally, on the basis of comparing the effect of various machine learning algorithms on the image classification of possible film regions, support vector machine based on color features is used to judge the possible film region. Application results of the system show that the method proposed in this article can effectively detect whether there is film residue on the surface of tobacco pack.

Shock and awe or incentive-compatible harm reduction? Graphic health warnings on tobacco packages

BackgroundGraphic Health Warnings (GHWs) on cigarette packages were first introduced in Canada in 2001 and will become mandatory in the US as of January 2022. While previous studies have evaluated the impacts of GHWs, the data used in these studies have several shortcomings. The objective of this paper was to investigate the likely impact of such warnings in the US based upon the experience of Canada using hitherto unexplored monthly cigarette sales data, and to explore if alternative approaches involving risk-reduced products might be more successful in reducing smoking.MethodsWe used quasi-experimental segmented regression and difference-in-differences analyses. Data on monthly sales (i.e., shipments) of cigarettes from Canadian manufacturers to Canadian retailers during 1995–2005 were obtained from Statistics Canada.ResultsWe found that GHWs did not have a significant impact on the sales of cigarettes in Canada. We propose an alternative type of graphical health messaging that actively combines information on how to quit with the legally required messaging. The novelty of the proposal is that it is incentive compatible for the supply side of the market and if adopted in several states, the measure could be tested by using a suitable treatment–control design.ConclusionsOur findings imply that we should not expect any notable decline in sales or consumption as a result of implementation of GHWs in the US. The main impact of GHWs will be to add to the anti-smoking culture that has grown steadily over several decades, and this may impact smoking in the longer term.

What are the effects of standardized tobacco packaging design in reducing tobacco use among adults?

What are the effects of standardized tobacco packaging design in reducing tobacco use among adults?

Youth Exposure to Warnings on Cigar, E-Cigarette, and Waterpipe Tobacco Packages

Studies of tobacco product warnings have focused primarily on the reach and effectiveness of cigarette warnings for adult smokers, whereas few observational studies have examined noncigarette tobacco product warnings among youth. High school students from the 2019 National Youth Tobacco Survey (n=10,094) reported the frequency of exposure to warnings on cigar, e-cigarette, and waterpipe tobacco packages and the perceived harm of occasionally using e-cigarettes and waterpipe tobacco. In 2020, results were analyzed for the entire sample and among subgroups, including never users, ever users, youth susceptible to using tobacco, and current users. Reported high exposure to warnings was highest for cigars (22.3%), followed by that for e-cigarettes (20.8%) and that for waterpipe tobacco (7.0%). Youth who were susceptible to using cigars (AOR=1.53, 95% CI=1.29, 1.82), who ever used cigars (AOR=4.32, 95% CI=3.57, 5.22), or who currently used cigars (AOR=8.90, 95% CI=6.95, 11.39) were more likely to report high exposure to cigar warnings than youth who never used cigars. Similar findings were observed for e-cigarette and waterpipe tobacco warnings. For youth who ever used e-cigarettes, high exposure to warnings was associated with higher odds of perceiving e-cigarettes as harmful for occasional product use (AOR=1.50, 95% CI=1.05, 2.15), and high exposure to waterpipe tobacco warnings was associated with higher odds of perceiving waterpipe tobacco as harmful (AOR=1.21, 95% CI=1.00, 1.45). Warnings on noncigarette tobacco products reach some youth at risk for using these products, but these warnings may need to be strengthened to further reduce their use.

Illicit tobacco trade: empty pack survey in eight Argentinean cities

ObjectiveTo estimate the prevalence of illicit tobacco trade (ITT) and different ITT modes—tax stamp counterfeiting and smuggling—in Argentina.DesignCross-sectional study using an empty tobacco pack survey with a simple random cluster...

Consumer Response to Standardized Tobacco Packaging in the United Kingdom: A Synthesis of Evidence from Two Systematic Reviews.

Standardized packaging of tobacco products has now been fully implemented in 15 countries. However, there is limited evidence, apart from in Australia, on how consumers have responded to the policy. Two systematic reviews explored consumer, tobacco industry and retailer response to standardized packaging in the United Kingdom (UK), which became mandatory for cigarettes (factory-made and hand-rolled) from May 2017, following a twelve-month transition period. In the first review, electronic databases were searched for published primary research from January 2016 to February 2019. The second review used the same methods, with searches conducted between February 2019 and September 2020. The current study conducted a narrative synthesis of the findings exploring consumer response from these two systematic reviews. Eleven studies met the inclusion criteria. Studies examined consumer response to on-pack warnings (n=7 studies), appeal of packs and smoking (n=4), perceptions of harm (n=5), and behavioral responses (n=8). There was consistent evidence that standardized packaging was associated with increased warning salience and effectiveness, and reduced appeal. Findings were mixed with respect to whether standardized packs were associated with increased perceptions of harm. Standardized packaging was generally thought to deter never or occasional smokers. Standardized packaging was associated with increased thoughts of quitting during the transition period, but no study directly explored cessation or relapse prevention. Some smokers switched to cheaper cigarettes. Standardized packaging in the UK seems to be reducing the appeal of packaging and smoking and making warnings more salient, but the behavioral impact is unclear. More consumer research is needed to assess longer-term behavioral response.

Awareness and utilisation of quitline among current tobacco users in a district in southern india

Background: Tobacco use not only increases mortality, but also causes enormous burden to the Nation’s health and economy. The WHO -Framework Convention on Tobacco Control implemented “MPOWER”, comprising of an important entity of ‘offering help to tobacco users’ to quit. Quitline provides evidence-based treatment services to tobacco users and advertising those services has the potential to increase their utilisation. Objectives: Our objective was to assess the awareness and utilisation of the newly introduced quitline on tobacco packs among tobacco users. Materials and Methods: After obtaining Ethics Committee approval, this cross-sectional study was conducted from March-June 2019 in a purposive sample of tobacco users aged 18 years and above at the point of sale with prior informed consent. The questionnaire included questions on the users’ knowledge and utilisation of the quitline. Results: Most of the tobacco users (84.6 %) had not observed the quitline on tobacco pack. Amongst those who observed the quitline, 65.5% were smokers, while the smokeless tobacco users who comprised half of the study population were unaware of the quitline. More than 97% of illiterates were unaware of the quitline. Only three tobacco users who were aware of quitline had tried using it. Conclusion: Most of the tobacco users had basic education but were not aware of the quitline on the tobacco packs and only a very few of them used the services, highlighting the need to increase its awareness for effective tobacco control.