Abstract

Objectives

Each year tobacco is responsible for 650,000 deaths in Europe and 55,000 in Spain. With tobacco advertising and promotion banned in Spain and most of Europe, the last bastion of marketing is the packaging. Plain tobacco packaging -which involves packs having a standardised appearance- has been proposed to counter this. The objective of this study is to research perceptions arising from the plain packaging of tobacco products.

Methods

We employed a qualitative research methodology -focus groups with smokers and nonsmokers in in two medium-sized Andalusian towns (Spain).

Results

Results show the importance of plain cigarette packaging as a form of promotion, particularly among women and young people, how pack colour influences product perceptions, and how removing full branding increases the salience of the warnings.

Conclusions

Plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking.

Keywords:
Tobacco; Plain packaging; Social marketing; Qualitative research

Resumen

Objetivos

El tabaco es causa de aproximadamente 650.000 muertes en Europa, y de ellas, unas 55.000 en España. Debido a las prohibiciones de realizar actividades de publicidad y promoción, el envase está considerado como el último bastión de comunicación para la industria tabacalera. El envase neutro -un aspecto uniforme del envase para toda marca comercializada- ha sido propuesto como forma de combatirlo. El objetivo de este trabajo se centra en estudiar las percepciones que suscita el diseño neutro del envase.

Métodos

Se ha realizado una investigación cualitativa, a través de grupos focales en dos ciudades de tamaño medio con personas fumadoras y no fumadoras en dos ciudades de tamaño medio de Andalucía (España).

Resultados

Los resultados señalan la importancia que tendría el envase de tabaco neutro como estrategia de desnormalización del tabaco, en especial en las mujeres y las personas jóvenes, como el color del envase neutro influye en las percepciones que el consumidor tiene del producto, y como incrementa la visibilidad de las esquelas sanitarias insertadas en el envase.

Conclusiones

El envase neutro, unido a las advertencias sanitarias combinadas, podrían reducir la capacidad distintiva del envase. La desaparición de los rasgos estéticos del envase, de esta manera, añadiría una dificultad más a las compañías para presentar sus marcas de forma favorable, y ayudaría a proteger a la población de los peligros del tabaco.

Palabras clave:
Tabaco; Envase neutro; Marketing social; Investigación cualitativa

Introduction

Tobacco is a major global health problem, being a risk factor in six of the eight leading causes of death globally and responsible for seven million deaths per year. ¹1. World Health Organization. WHO global report on trends in prevalence of tobacco smoking 2015. World Health Organization. 2015. (Accessed 15/02/2017.) Available at: http://apps.who.int/iris/bitstream/10665/156262/1/9789241564922eng.pdf
http://apps.who.int/iris/bitstream/10665... Tobacco is responsible for approximately a quarter (27%) of all deaths in Spain each year.²2. Eriksen M, Mackay J, Ross H. The tobacco atlas. 5th ed. Atlanta: The American Cancer Society; 2015. p. 88. Public health policy makers face two important challenges: to reduce consumption and prevalence among smokers and discourage non-smokers from starting. The World Health Organisation's Framework Convention on Tobacco Control recommends a range of measures to protect citizens; one of these concerns the packaging and labelling of tobacco products. Article 11 of the Framework Convention on Tobacco Control recommends pictorial health warnings on packaging, which are now mandatory in more than 100 countries,³3. Canadian Cancer Society. Cigarette package health warnings: international status report. 2014 (accessed 14/02/2015). Available at http://global.tobaccofreekids.org/files/pdfs/en/WLstatusreporten.pdf
http://global.tobaccofreekids.org/files/... and also plain (or standardised) packaging -the standardisation of pack appearance so that all cigarettes must come in drab colour packs with pictorial health warnings but without any branding, except for the brand name.

Packaging is a multipurpose marketing tool and crucial for tobacco products, particularly in countries where other communication tools are banned. In Spain, for instance, since tobacco advertising, promotion and sponsorship is no longer permitted, the packaging is extremely important. There are numerous examples of innovative pack design in Spain, such as novel pack shapes and ways of opening, slimmer packs for female-oriented brands, and also textured packs, which create a distinctive tactile sensation -touch is important in developing emotional or affective connections with brands.⁴4. Spence C, Gallace A. Multisensory design: reaching out to touch the consumer. Psychol Mark. 2011;28:267-308. Further innovation seems likely.

While the importance of fully-branded packaging as a marketing tool for tobacco is well established, the impact of plain packaging is not well understood in Spain. Indeed, a systematic review of research on plain packaging found that most studies were conducted in five countries (Australia, Canada, France, New Zealand, United Kingdom),⁵5. Moodie C, Stead M, Bauld L, et al. Plain tobacco packaging: a systematic review. Stirling: University of Stirling; 2012. all with stringent tobacco control policy. It may be that reactions to plain packs will differ in other countries, as cultural differences have been found in response to anti-tobacco media campaigns,⁶6. Laroche M, Toffoli R, Zhang Q, et al. A cross-cultural study of the persuasive effect of fear appeal messages in cigarette advertising: China and Canada. Int J Advert. 2001;20:297-317. pictorial warnings,⁷7. Sabbane LI, Lowrey TM, Chebat J-C. The effectiveness of cigarette warning label threats on nonsmoking adolescents. J Consum Aff. 2009;43:332-45. perceptions of branding and colour preference and meaning.⁸8. Grimes A, Doole I. Exploring the relationships between colour and international branding: a cross cultural comparison of the UK and Taiwan. J Mark Manag. 1998;14:799-817.

9. Madden TJ, Hewett K, Roth MS. Managing images in different cultures: a cross-national study of color meanings and preferences. J Int Mark. 2000;8: 90-107.^-1010. Roullet B, Droulers O. Pharmaceutical packaging color and drug expectancy. ACR North Am Adv. 2005;32:164-71. The main aims of plain packaging are to reduce the appeal of the pack and product; increase the salience of the health warnings; and reduce misperceptions of product harm as a result of pack design.¹¹11. Stead M, Moodie C, Angus K, et al. Is consumer response to plain/standardised tobacco packaging consistent with Framework Convention on Tobacco Control Guidelines? A systematic review of quantitative studies. PLoS One. 2013;8:e75919. Australia was the first country to implement plain packaging in December 2012, followed by France and the United Kingdom in 2017. Norway, New Zealand and Ireland will fully implement plain packaging in 2018 and a number of other countries are considering this measure.

The aim of this study is to gauge smokers and non-smokers' perceptions of plain tobacco packaging in comparison to fully-branded packaging, their response to different plain pack colours, and what impact, if any, plain packaging has on the salience of the health warnings.

Methods

Design and sample

Given that plain packs are not available on the Spanish market, we employed a qualitative methodology to fully explore participants' attitudes, perceptions and reactions to plain packaging. Eight focus groups (5-8 participants per group; n = 59) were conducted in two Spanish medium sized towns (Granada and Cádiz). The sample was segmented by gender, age and smoking status, following criterion of homogeneity for intra-groups characteristics and heterogeneity for between-groups characteristics. People aged 15 to 45 years were interviewed because they are a key target group for Spanish health practitioners, and male and female smokers and non-smokers were included given that plain packaging is intended to encourage smokers to quit and discourage non-smokers from starting (see Table 1 for sample characteristics).

In order to determine the number of focus groups we established a minimum of two groups per considered category of the segmentation variables, combining categories for not having an excessive number of groups that would not add new information for the analysis,¹²12. Callejo J. Investigar las audiencias: un análisis cualitativo. Barcelona: Paidós Ibérica; 2001. with a bigger number of groups for the young people categories, that are supposed to be a main target for the tobacco industry, as well as the fact that at this early stages people start to smoke. ¹³13. MacFadyen L, Hastings G, MacKintosh AM. Cross sectional study of young people's awareness of and involvement with tobacco marketing. BMJ. 2001;322:513-7.^-1414. Shafey O, Eriksen M, Ross H, et al. The tobacco atlas. Atlanta Am Cancer Soc. 2009;3:38-9.

Materials and procedure

To explore the impact of pack design, participants were presented with fully-branded and plain packs with cigarettes inside. The brands chosen for the study were those on the Spanish market that were most popular with each group. Mock-up plain packs were produced so as to look as realistic as possible for participants. The plain packs were presented in three different colours (brown, white and grey), with these colours the most frequently explored in plain packaging research.⁵5. Moodie C, Stead M, Bauld L, et al. Plain tobacco packaging: a systematic review. Stirling: University of Stirling; 2012.^,1515. Gallopel-Morvan K, Jacques O, Mathias W, et al. Demarketing tobacco products: the influence of plain packs on smokers and non-smokers perceptions and behavioural intentions. Journale d'Economie Medicale. 2012;30: 322-31.^-1616. Gallopel-Morvan K, Gabriel P, Le Gall-Ely M, et al. Plain packaging and public health: the case of tobacco. J Bus Res. 2013;66:133-6.

Each focus group was conducted by two researchers, one male and one female, with one leading as moderator and the other assisting as co-moderator and ensuring that the groups were recorded. Groups were conducted in quiet rooms with a round table to help participants interact, with the group discussions video and audio recorded for transcription and analysis. All groups were first shown a set of fully-branded cigarette packs and asked their opinion of these. They were then shown the differently coloured plain packs and asked their thoughts and feelings on these. Participants were compensated with a gift voucher (25 D) at the end of the session to encourage recruitment.

Each focus group discussion was transcribed and analysed using NVivo 10 software, which involves a semantic categorization of participants' comments and a frequency analysis of the appearance of each category by the creation of nodes. Coding resources -focus groups transcripts- and categorization references -gender, age and smoking status- were used for the frequency analysis. Semantic categorisation was undertaken in three stages¹⁷17. Kvale S. Doing interviews. Thousand Oaks: Sage; 2008. p. 160.:

Quality of data collection and analysis

We followed a rigorous process to increase the reliability of the results. Firstly, a semi-structured topic guide was developed by the research team to ensure that all relevant topics were discussed in each group. Secondly, given the importance of the stimuli we only used actual packs of cigarettes, rather than images. Thirdly, we recruited participants who were not known to each other¹⁸18. Krueger RA. El grupo de discusión: guía práctica para la investigación aplicada. Madrid: Pirámide; 1991. and ensured homogeneity within each group. ¹⁹19. Murgado E. Teoría y práctica del grupo de discusión en la investigación de mercados: un modelo normativo. Jaén: Universidad de Jaen; 2011. Fourthly, extensive field notes were taken during the groups and these were used in conjunction with the video and audio recording to analyze participants' comments, discussions and behaviors. The coding and analysis was performed by two of the researchers who moderated the groups, thus helping triangulate the findings. Finally, we comprehensively reviewed the literature prior to the groups being conducted in order to fully understand the topic and to allow us to compare our findings with past research.

Results

Role of fully-branded packaging

The aesthetic appeal of current, fully-branded cigarette packaging was mentioned frequently. Women were more aware of, and interested in, pack aesthetics than men. With regard to the different pack elements, most comments related to pack colour, particularly for women, who said that colour influenced their perceptions of the pack and product. For instance, the cream colour of one of the fully-branded packs was viewed as feminine, thought to make the pack look more elegant, and suggestive of smooth tasting cigarettes.

In terms of which element of the pack participants reported seeing first on fully-branded packs, non-smokers said the health warnings whereas smokers, women and young adults said the branding. Another frequent answer, irrespective of smoking status, was the colour of the pack.

Perceived impact of plain packaging on smoking-related behavior

In all groups, although particularly among young men, plain packaging was considered something that could help reduce cigarette consumption. Participants suggested that removing full branding from cigarette packs would be effective, a strong deterrent for those susceptible to smoking and those who have recently started smoking.

They suggested that plain packaging, i.e. packs without different colours and designs, would essentially convert the product into something vulgar. Few felt it would have any impact on adult smokers however, although it may help to reduce consumption for some, and some young women smokers doubted the efficacy of plain packs in stopping people from starting to smoke.

Effect of plain packs on warning salience

Participants commented that the warnings were more visible on plain packs, as the branding no longer distracted from them, and that this would make people more aware of them. The absence of branding (aside from brand name) was also thought to make brand identification more difficult.

Perceptions of plain pack colour

While the three plain packs had a similar appearance, the different colour of each significantly influenced how they were perceived. Two of the three plain pack colours (grey and brown) were considered much more negatively than the white pack. Participants referred to the grey pack as ugly, associating it with dirtiness, something bad or diseased lungs. The cigarettes within this pack were also considered to be poorer quality.

The brown plain pack generated mixed perceptions, being more frequent the positive ones. It was considered ugly and dirty by some participants, and was associated with illness and death. It was also considered to have lower quality cigarettes. However, others thought it looked attractive and flashy, or like chocolates or cigars. Results reveal that this colour can be as appropriate as the grey one when the target is young people.

Finally, the white pack reminded participants of a pharmacy product, being seen as less harmful.

Discussion

Packaging is a crucial marketing tool which can influence consumers in myriad ways.²⁰20. Chapman S. Public health advocacy and tobacco control: making smoking history. Oxford: Blackwell; 2007. p. 328. It can appeal to consumers, generate interest, communicate information about the product and its benefits, and add value by increasing the quality of experiences related to its use.²¹21. Becker L, van Rompay TJL, Schifferstein HNJ, et al. Tough package, strong taste: the influence of packaging design on taste impressions and product evaluations. Food Qual Prefer. 2011;22:17-23.^-2222. Rey-Pino JM, Nerín I, Lacave-García MB. El envase neutro de los productos de tabaco: una nueva estrategia para el control del tabaquismo. Gac Sanit. 2017;31:62-5. It has a key function at the point-of-sale but importantly can function post-purchase.²³23. Ford A, Moodie C, Hastings G. The role of packaging for consumer products: understanding the move towards "plain" tobacco packaging. Addict Res Theory. 2012;20:339-47.

24. Lindsay D. Shaped to sell. Beverage World. 1997;116:91-2.^-2525. Peters M. Good packaging gets through to fickle buyers. London: Marketing; 1994. p. 10. For tobacco products, packaging is often considered a badge product given its high social visibility, and it can enhance positive perceptions of smoking as well as confer a positive image of the smoker.⁵5. Moodie C, Stead M, Bauld L, et al. Plain tobacco packaging: a systematic review. Stirling: University of Stirling; 2012.^,2626. Hastings G, Gallopel-Morvan K, Rey JM. The plain truth about tobacco packaging. Tob Control. 2008;17:361-2.

Our findings suggest that package design can significantly influence pack and product perceptions. The appearance of fullybranded packaging was viewed as important by women, with some packs considered elegant and the product perceived as smoother; smoother cigarettes are often thought to be less harmful.²⁷27. Mutti S, Hammond D, Borland R, et al. Beyond light and mild: cigarette brand descriptors and perceptions of risk in the International Tobacco Control (ITC) Four Country Survey. Addiction. 2011;106:1166-75. That pack design appeared more pronounced for women than men may reflect the importance attached to the aesthetic characteristics of packaging by women, as identified in tobacco industry marketing documents²⁸28. Carpenter CM, Wayne GF, Connolly GN. Designing cigarettes for women: new findings from the tobacco industry documents. Addiction. 2005;100: 837-51. and previous academic research.²⁹29. Moodie C, Ford A. Young adult smokers' perceptions of cigarette pack innovation, pack colour and plain packaging. Australas Mark J. 2011;19:174-80.

The results suggest that plain packaging may have a role to play in combating smoking by discouraging younger people from starting to smoke or new smokers from continuing, although consistent with past research the impact on adult smokers was considered marginal.³⁰30. Mcneill A, Gravely S, Hitchman SC, et al. Tobacco packaging design for reducing tobacco use. Cochrane Database Syst Rev. 2017. CD011244. With the branding removed participants also felt that this would make the warnings stand out more, which is one of the core aims of plain packaging, and also that it would be more difficult for them or others to form a strong connection with brands.

People are known to attach meanings to particular colours,⁹9. Madden TJ, Hewett K, Roth MS. Managing images in different cultures: a cross-national study of color meanings and preferences. J Int Mark. 2000;8: 90-107. as was found with the different coloured plain packs. The brown and grey plain packs (especially the grey) were more likely than the white pack to have negative associations, being considered ugly, dirty and like diseased lungs. It is well established in the marketing literature that pack appearance influences product evaluation,²³23. Ford A, Moodie C, Hastings G. The role of packaging for consumer products: understanding the move towards "plain" tobacco packaging. Addict Res Theory. 2012;20:339-47. with the cigarettes considered higher quality in fullybranded packs and poorer quality in the brown and grey plain packs.

In terms of limitations of the study, the use of qualitative research means that the findings cannot be generalised to the wider population, and possible biases may have occurred during the focus group discussions, e.g., some influencing from researchers to participants. With respect to the stimuli, the brands we chose may have also created some bias among participants, depending on their attitudes to these brands. The brown plain pack we used differs from the darker pack used in countries which have implemented plain packaging (Australia, United Kingdom, France), which likely resulted in this pack being viewed slightly more positively, given that research has found that darker plain pack colours are perceived as more off-putting.²⁹29. Moodie C, Ford A. Young adult smokers' perceptions of cigarette pack innovation, pack colour and plain packaging. Australas Mark J. 2011;19:174-80. The study also provides no insight into the impact of plain packaging on actual smoking behaviour.

The main strength of this research is that it offers an understanding of how smokers and non-smokers in Andalusia (Spain) perceive a measure that could extend tobacco control policy, but that has not been yet considered by Spanish policy makers. In addition, while there are limitations with focus groups, they are an appropriate methodology for exploring consumers' views of plain packaging, given that these packs are not available for sale in Spain. They allow for in-depth responses on the possible impact that plain packaging may have, and the impact of pack colour.

In conclusion, the findings suggest that plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands, and may help to reinforce the ability of some consumers to protect themselves from the dangers of smoking. Finally, as we found some differences with past research in other countries in how different packs colors were perceived, this suggests that it may be beneficial to explore the suitability of particular plain pack colors in each country before implementing this measure.

References

Publication Dates

History