The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy

Thrasher, James F.; Osman, Amira; Abad-Vivero, Erika N.; Hammond, David; Bansal-Travers, Maansi; Cummings, K. Michael; Hardin, James W.; Moodie, Crawford

doi:10.1093/ntr/ntu246

Cited by 42 publications

(47 citation statements)

References 8 publications

(10 reference statements)

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“…In Canada, for instance, pack inserts with positive messages about quitting or tips on how to quit are used to supplement the on-pack warnings. In June 2012, eight rotating pack inserts with coloured graphics were introduced, replacing the previous set of 16 text-only inserts used since 2000 11. Few studies however have explored how smokers respond to pack inserts, and none in middle-income countries.…”

Section: Introductionmentioning

confidence: 99%

Young adult smokers’ perceptions of plain packs, numbered packs and pack inserts in Turkey: a focus group study

Mucan

Moodie

2017

Tob Control

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Introduction:The Turkish Government's 'National Tobacco Control Program 2015-2018' included plans to introduce plain packaging and also a ban on brand names on cigarette packs, allowing only assigned numbers on packs. We explored perceptions of these proposed measures, and also pack inserts with cessation messages, another novel way of using the packaging to communicate with consumers. Methods: Eight focus groups were conducted with 47 young adult smokers in Manisa and Kutahya (Turkey) in December 2016. Participants were shown three straight-edged plain cigarette packs, as required in Australia, and then three bevelled-edged plain packs, as permitted in the United Kingdom. They were then shown plain packs with numbers rather than brand names, and finally three pack inserts with messages encouraging quitting or offering tips on how to do so. Participants were asked about their perceptions of each. Results: Plain packs were considered unappealing and off-putting, although the bevellededged packs were viewed more favourably than the straight-edged packs. Numbered packs were thought by some to diminish the appeal created by the brand name and potentially decrease interest among never smokers and newer smokers. Pack inserts were thought to have less of an impact than the on-pack warnings, but could potentially help discourage initiation and encourage cessation. Conclusions: That bevelled-edged plain packs were perceived more positively than straightedged plain packs is relevant to countries planning to introduce plain packaging. The study provides a first insight into smokers' perceptions of a ban on brand names, which was perceived to reduce appeal among young people.

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Section: Introductionmentioning

confidence: 99%

Young adult smokers’ perceptions of plain packs, numbered packs and pack inserts in Turkey: a focus group study

Mucan

Moodie

2017

Tob Control

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“…1 Countries print HWLs on package exteriors; however, package inserts (i.e., small leaflets inside of packs) remain underutilized, even though tobacco companies have long used them for promotions. 2 Canada is the only country to use inserts to supplement HWLs, 3 providing an important case study for understanding whether inserts can help enhance pictorial HWL effects.…”

Section: Introductionmentioning

confidence: 99%

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

Thrasher

Swayampakala

Cummings

et al. 2016

Preventive Medicine

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Background In June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers’ attention towards warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up. Methods Data were analysed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models assessed associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30 days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects. Results Over the study period, reading warnings significantly decreased (p<0.0001) while reading inserts increased (p=0.004). More frequent reading of warnings was associated independently with stronger response efficacy (Boften/very often vs never=0.28, 95% CI: 0.11–0.46) and risk perceptions at follow-up (Boften/very often vs never=0.31, 95% CI: 0.06–0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (Btwice or more vs none=0.30, 95% CI: 0.14–0.47), quit attempts (ORtwice or more vs none= 1.68, 95% CI: 1.28–2.19), and quit attempts lasting 30 days or longer (ORtwice or more vs none=1.48, 95% CI: 1.01 – 2.17). Conclusions More frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs.

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“…Approximately a quarter of smokers at each wave reported having read the inserts at least once in the prior month, with younger smokers and those intending to quit or having recently tried to quit significantly more likely to have read them. Smokers who read the inserts a few times or more in the previous month were more likely to have made a quit attempt at the subsequent wave compared with smokers who had not read the inserts 3. In addition, while reading on-pack health warnings significantly decreased across waves, reading inserts significantly increased, with more frequent reading of inserts associated with self-efficacy to quit, quit attempts and sustained quitting at follow-up 8…”

Section: Introductionmentioning

confidence: 97%

Adult smokers’ perceptions of cigarette pack inserts promoting cessation: a focus group study

Moodie

2017

Tob Control

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Introduction Tobacco companies have a long tradition of including promotional material within cigarette packs, such as cigarette cards and coupons. Only in Canada are they required, by government, to include educational material within cigarette packs, in the form of inserts highlighting the benefits of quitting or providing tips on how to do so. Methods Twenty focus groups were conducted in Glasgow and Edinburgh in 2015 with smokers (N=120) segmented by age (16-17, 18-24, 25-35, 36-50, >50), gender and social grade, to explore perceptions of the inserts used in Canada. Results The consensus was that these inserts would capture attention and be read due to their novelty, visibility before reaching the cigarettes, and as they can be removed from the pack. While they may be ignored or discarded, and rotation was considered necessary, they were generally thought to prolong the health message. The positive style of messaging was described as refreshing, educational, encouraging, reassuring and inspirational, and thought to increase message engagement. It was regarded as more sympathetic than command-style messaging, offering smokers 'a bit of hope'. The inserts were often considered preferable to the on-pack warnings, although it was felt that both were needed. Some participants suggested that inserts could encourage them to stop smoking, and they were generally viewed as having the potential to alter the behaviour of others, particularly younger people, would-be smokers and those wanting to quit. Conclusions Inserts are an inexpensive means of communication and offer regulators a simple way of supplementing on-pack warnings.

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The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy

Abstract: HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers.

Cited by 42 publications

References 8 publications

Young adult smokers’ perceptions of plain packs, numbered packs and pack inserts in Turkey: a focus group study

Young adult smokers’ perceptions of plain packs, numbered packs and pack inserts in Turkey: a focus group study

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

Adult smokers’ perceptions of cigarette pack inserts promoting cessation: a focus group study

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