PT  - JOURNAL ARTICLE
AU  - Matthew Stone
AU  - David Strong
AU  - Claudiu Dimofte
AU  - Elizabeth Brighton
AU  - Jesica Oratowski
AU  - Tingyi Yang
AU  - Manar Alkuzweny
AU  - Atean Asslani
AU  - Katherine Velasco
AU  - Michael Skipworth
AU  - Noe C Crespo
AU  - Samantha Hurst
AU  - Eric C Leas
AU  - Kim Pulvers
AU  - John P Pierce
TI  - Role of affective reactivity induced by cigarette packaging including graphic warning labels: the CASA Study
AID  - 10.1136/tobaccocontrol-2021-056650
DP  - 2023 May 01
TA  - Tobacco Control
PG  - 315--322
VI  - 32
IP  - 3
4099  - http://tobaccocontrol.bmj.com/content/32/3/315.short
4100  - http://tobaccocontrol.bmj.com/content/32/3/315.full
SO  - Tob Control2023 May 01; 32
AB  - Objective To identify whether three types of cigarette pack designs, including three versions of graphic warning label (GWL) plain packs, one GWL absent and branding absent pack (blank) and the smoker’s own GWL absent and branding present pack (US), elicit different valence, type and levels of affect.Design US daily smokers (n=324) were asked to handle each of the five pack types and ‘think aloud’ their reactions. To avoid a muted familiarity response, exposure to their own US pack followed exposure to at least one GWL plain pack. Reactions were scored on a reactivity scale (−3 to +3) and the text was coded for speech polarity (−1 to +1) and emotive word frequency.Results Reactivity scores had excellent inter-rater reliability (agreement ≥86%; intraclass correlation coefficient ≥0.89) and were correlated with speech polarity (r=0.21–0.37, p<0.001). When considering their US pack, approximately two-thirds of smokers had a low (31.5%) to medium (34.6%) positive response (reactivity=1.29; polarity=0.14) with expressed feelings of joy and trust. Blank packaging prompted a largely (65.4%) neutral response (reactivity=0.03; polarity=0.00). The gangrenous foot GWL provoked mostly medium (46.9%) to high (48.1%) negative responses (reactivity=−2.44; polarity=−0.20), followed by neonatal baby (reactivity=−1.85; polarity=−0.10) and throat cancer (reactivity=−1.76; polarity=−0.08) warnings. GWLs varied in their elicitation of disgust, anger, fear and sadness.Conclusion Initial reactions to GWL packs, a blank pack, and smokers’ current US pack reflected negative, neutral, and positive affect, respectively. Different versions of the GWL pack elicited different levels and types of immediate negative affect.Data are available upon reasonable request. Deidentified data and a measures codebook will be made available on request.