A systematic review of smoker and non-smoker perceptions of visually unappealing cigarette sticks
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College of Medicine and Dentistry, James Cook University, Townsville, Australia
Aaron Drovandi   

College of Medicine and Dentistry, James Cook University, 1 James Cook Drive, 4814, Townsville, QLD, Australia
Publish date: 2018-01-31
Tob. Induc. Dis. 2018;16(January):2
Cigarette stick appearance can significantly contribute to perceptions of cigarette taste, harm, and appeal, and may be modified to reduce positive perceptions of cigarettes and other tobacco products. A systematic review was conducted to investigate how smokers and non-smokers identify cigarettes as being attractive or unattractive, and the resulting perceptions of cigarette appeal, perceived harm, and impact on quit intentions.

Eligible articles were identified using database searches conducted with a date range of January 1990 to May 2017 in PubMed, CINAHL, PsycINFO, Google Scholar and Web of Science. Articles were included if they evaluated participant (any smoking status) perceptions of visual cigarette stick attributes. We identified studies describing visual attributes of cigarette sticks and the resulting perceptions of participants. Changes or differences in quitting intentions, cigarette appeal, perceptions of taste, and cigarette harm, and the likelihood of smoking uptake were recorded. Data were grouped into two main categories: those of physical cigarette design, and those including health messages on cigarette sticks.

Of the 950 identified non-duplicated records, 9 matched the eligibility criteria. These studies were all conducted in developed countries, and largely enrolled adolescent and young adult smokers and non-smokers. Slim, lighter coloured and branded cigarettes were favoured over longer, broader, or darker coloured cigarettes, and those without any branding or embellishments. Health warnings including ‘Minutes of life lost’, ‘Smoking kills’, and the names of carcinogenic constituents in cigarettes, reduced cigarette attractiveness and increased participant quit intentions.

Cigarette appeal and resulting smoking behaviours can be influenced by several visual attributes of individual cigarettes. Unappealing visual attributes of cigarette sticks, including modifications to the size and colour of cigarettes, and the inclusion of health warnings on cigarette sticks may serve as an effective tobacco control method, potentially leading to a reduction in tobacco use.

World Health Organisation. Elaboration of guidelines for implementation of Article 11 of the Convention. In Third session of the Conference of the Parties to the WHO Framework Convention on Tobacco Control. Durban, South Africa, 17-22 November 2008. Accessed July, 2017.
Canadian Cancer Society. Cigarette Package Health Warnings: International Status Report. 5th ed. 2016.
Hammond D. Health warning messages on tobacco products: a review. Tob Control. 2011;20(5):327-337. doi:10.1136/tc.2010.037630
Noar SM, Francis DB, Bridges C, Sontag JM, Ribisl KM, Brewer NT. The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies. Soc Sci Med. 2016;164:118-129. doi:10.1016/j.socscimed.2016.06.011
Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT. Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob Control. 2016;25:341-354. doi:10.1136/tobaccocontrol-2014-051978
Australian Government Department of Health. Post-Implementation Review of Tobacco Plain Packaging 2016. Accessed May 3, 2017.
Australian Commonwealth Government. Tobacco Plain Packaging Act 2011 (No. 148, 2011). 2011.
McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J. Tobacco packaging design for reducing tobacco use. Cochrane Database Syst Rev 2017;4:CD0011244. doi:10.1002/14651858.cd011244.pub2
Hammond D, Doxey J, Daniel S, Bansal-Travers M. Impact of female-oriented cigarette packaging in the United States. Nicotine Tob Res. 2011;13(7):579-588. doi:10.1093/ntr/ntr045
Hoek J, Wong C, Gendall P, Louviere J, Cong K. Effects of dissuasive packaging on young adult smokers. Tob Control. 2011;20(3):183-188. doi:10.1136/tc.2010.037861
Gallopel-Morvan K, Moodie C, Hammond D, Eker F, Beguinot E, Martinet Y. Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging. Tob Control. 2012;21(5):502-506. doi:10.1136/tobaccocontrol-2011-050079
Babineau K, Clancy L. Young people's perceptions of tobacco packaging: a comparison of EU Tobacco Products Directive & Ireland's Standardisation of Tobacco Act. BMJ Open. 2015;5(6): e007352. doi:10.1136/bmjopen-2014-007352
Al-Hamdani M. The effect of cigarette plain packaging on individuals’ health warning recall. Health Policy. 2013;8(3):68-77. doi:10.12927/hcpol.2013.23210
Australian Commonwealth Government. Tobacco Plain Packaging Regulations 2011 (No. 263, 2011). 2011.
UK Department of Health. The Standardised Packaging of Tobacco Products Regulations 2015. Accessed September 25, 2017.
French Ministry of Social Affairs and Health. Decree No. 2016-334 of 21 March 2016 on the neutral packaging of cigarettes and certain tobacco products. https://www.tobaccocontrollaws.... Accessed December 14, 2017.
Wakefield M, Morley C, Horan JK, Cummings KM. The cigarette pack as image: new evidence from tobacco industry documents. Tob Control. 2002;11(Supp 1):i73-i80. doi:10.1136/tc.11.suppl_1.i73
Cook BL, Wayne GF, Keithly L, Connolly G. One size does not fit all: how the tobacco industry has altered cigarette design to target consumer groups with specific psychological and psychosocial needs. Addiction. 2003;98(11):1547-1561. doi:10.1046/j.1360-0443.2003.00563.x
Carpenter CM, Wayne GF, Connolly GN. Designing cigarettes for women: new findings from the tobacco industry documents. Addiction. 2005;100(6):837-851. doi:10.1111/j.1360-0443.2005.01072.x
Moher D, Liberati A, Tetzlaff J, Altman DG, PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLοS Medicine. 2009;6(7):e1000097. doi:10.1371/journal.pmed.1000097
Critical Appraisal Skills Programme (CASP): Making sense of evidence. Accessed November 4, 2016.
University of Adelaide Australia. Joanna Briggs Institute Checklist for Qualitative Research. Accessed November 4, 2016.
Borland R, Savvas S. Effects of stick design features on perceptions of characteristics of cigarettes. Tob Control. 2013;22(5):331-337. doi:10.1136/tobaccocontrol-2011-050199
Ford A, Moodie C, MacKintosh AM, Hastings G. Adolescent perceptions of cigarette appearance. Eur J Public Health. 2014;24(3):464-468. doi:10.1093/eurpub/ckt161
Hoek J, Robertson C. How do young adult female smokers interpret dissuasive cigarette sticks? A qualitative analysis. J Soc Mark. 2015;5(1):21-39. doi:10.1108/jsocm-01-2014-0003
Moodie C, Ford A, Mackintosh A, Purves R. Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatized and capsule cigarettes. Health Educ Res. 2015;30(1):1-12. doi:10.1093/her/cyu063
O’Connor RJ, Bansal-Travers M, Cummings KM, Hammond D, Thrasher JF, Tworek C. Filter presence and tipping paper color influence consumer perceptions of cigarettes. BMC Public Health. 2015;15(1):1279. doi:10.1186/s12889-015-2643-z
Hoek J, Gendall P, Eckert C, Louviere J. Dissuasive cigarette sticks: the next step in standardised (‘plain’) packaging? Tob Control. 2015;25(6):699-705. doi:10.1136/tobaccocontrol-2015-052533
Hassan LM, Shiu E. No place to hide: two pilot studies assessing the effectiveness of adding a health warning to the cigarette stick. Tob Control. 2015;24:e3-e5. doi:10.1136/tobaccocontrol-2013-051238
Moodie C, Purves R, Mckell J, de Andrade M. Novel Means of Using Cigarette Packaging and Cigarettes to Communicate Health Risk and Cessation Messages: A Qualitative Study. Int J Ment Health and Addict. 2015;13(3):333-344. doi:10.1007/s11469-014-9530-1
Moodie C, Mackintosh AM, Gallopel-Morvan K, Hastings G, Ford A. Adolescents’ perceptions of an on-cigarette health warning. Nicotine Tob Res. 2016:ntw165. doi:10.1093/ntr/ntw165
Hammond D, Fong GT, McNeill A, Borland R, Cummings KM. Effectiveness of cigarette warning labels in informing smokers about the risks of smoking: findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(Supp 3):iii19-25. doi:10.1136/tc.2005.012294
Ayo-Yusuf OA, Agaku IT. The association between smokers’ perceived importance of the appearance of cigarettes/cigarette packs and smoking sensory experience: a structural equation model. Nicotine Tob Res. 2015;17:91-97. doi:10.1093/ntr/ntu135
Ferris RP. The influence of brand identification and imagery on subjective evaluation of cigarettes. Rep No RD.1752-C. Bates 102375094. https://industrydocuments.libr.... Published 1980. Accessed September 21, 2016.
Johnston ME Jr. Special Report No. 248. Market Potential of a health Cigarette. Phillip Morris. Bates No. 2040452500–2040452523. https://industrydocuments.libr.... Accessed September 21, 2016.
Fitzmaurice RA. Memorandum to H. Cullman and S. Pollack: Marlboro Red 100s. Philip Morris. Bates No. 2024984161–2024984163. https://industrydocuments.libr.... Published August 2, 1979. Accessed September 21, 2016.
Phillip Morris International. Marlboro Lights. https://industrydocuments.libr.... Accessed September 21, 2016.
Smith KC, Washington C, Welding K, Kroart L, Osho A, Cohen JE. Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries. Tob Control. 2016. doi:10.1136/tobaccocontrol-2016-053148
Agaku IT, Omaduvie UT, Filippidis FT, Vardavas CI. Cigarette design and marketing features are associated with increased smoking susceptibility and perception of reduced harm among smokers in 27 EU countries. Tob Control. 2015;24:e223-e240. doi:10.1136/tobaccocontrol-2014-051922
Agaku IT, Vardavas CI, Ayo-Yusuf OA, Alpert HR, Connolly GN. Gender and racial differences in smoking of long/ultra-long and king size cigarettes among U.S. adult smokers, NHANES 1999-2012. Drug Alcohol Depend. 2014;136:28-35. doi:10.1016/j.drugalcdep.2013.12.004
Carpenter CM, Wayne GF, Connolly GN. The role of sensory perception in the development and targeting of tobacco products. Addiction. 2007;102:136-147. doi:10.1111/j.1360-0443.2006.01649.x
Agaku IT, Vardavas CI, Connolly GN. Cigarette Rod Length and Its Impact on Serum Cotinine and Urinary Total NNAL Levels, NHANES 2007-2010. Nicotine Tob Res. 2014;16(1):100-107. doi:10.1093/ntr/ntt140
Matsunaga Y, Agaku IT, Vardavas C. The association between cigarette rod length, slim design, and blood cadmium levels among U.S. smokers: NHANES 1999-2010. Prev Med. 2014;65:87-91. doi:10.1016/j.ypmed.2014.04.021
Moodie C. Novel ways of using tobacco packaging to communicate health messages: Interviews with packaging and marketing experts. Addict Res Theory. 2016;24(1):54-61. doi:10.3109/16066359.2015.1064905
Siahpush M, McNeill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Tob Control. 2006;15(Supplement 3):iii65-70. doi:10.1136/tc.2005.013276
Morgan JC, Byron MJ, Baig SA, Stepanov I, Brewer NT. How people think about the chemicals in cigarette smoke: a systematic review. J Behav Med. 2017:1-12.
Thrasher JF, Osman A, Abad-Vivero EN, Hammond D, Bansal-Travers M, Cummings M, et al. The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy. Nicotine Tob Res. 2014:ntu246.
Moodie C. Adult smokers’ perceptions of cigarette pack inserts promoting cessation: a focus group study. Tob Control. 2016:tobaccocontrol-2016.
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