Culturally specific health-related features on cigarette packs sold in China

Abstract

BackgroundChina is the country with the highest burden of tobacco-caused disease. We characterised the extent to which cigarette pack marketing features (eg, imagery, text, pack color) could potentially mislead consumers by suggesting products are healthy.MethodsWe used two methods: group concept mapping and content analysis. First, we used a group concept mapping approach to generate and sort Chinese consumer responses to an open-ended prompt asking what marketing features suggest a product is ‘healthy’ or ‘good for you’. Second, based on the concept mapping results, we developed a codebook of health-related features on cigarette packs that were relevant to the unique cultural context of product marketing in China. Two trained coders who were native Chinese speakers double-coded a sample of 1023 cigarette packs purchased in 2013 (wave 1) and 2017 (wave 2). We examined differences in the presence of features overall and over time.ResultsOverall, 83.5% (n=854) of Chinese cigarette packs in our sample contained at least one ‘healthy’ or ‘good for you’ feature, and the presence of health-related features on packs remained constant between wave 1 (83.5%, n=354) and wave 2 (83.5%, n=500; p=1.00). Across both waves, the most common categories of culturally specific health features present related to recycling symbols, rare animal imagery, bright colours (eg, bright yellow) and botanical imagery (eg, bamboo, mint).ConclusionHealth-related features on cigarette packs sold in China are common. Enhanced policies to address tobacco packaging, labelling and branding could support and facilitate a reduction in the high tobacco burden in China.

The problematic use of cultural symbols on Chinese cigarette packs

“…The World Health Organization and Campaign for Tobacco-Free Kids 19 , 24 have briefly noted the usage of famous Chinese icons and occasion-related symbols on Chinese tobacco packs that brand them for gift-giving. Literature also exists examining cultural appeals on Chinese cigarette packs relating to ceremonial weddings and health symbols 25 , 26 . However, there exists a gap in literature examining the nature and extent of Chinese cultural appeals on cigarette packs.…”