Discussion

The results from this study show that all sets of pack-label variant descriptors systematically affected respondents’ judgements of the cigarettes associated with them, and this is so even when presented on plain, standardised packs. This is not surprising; however, it is of concern when it leads to erroneous inferences about relative harm.

For the most part, rankings were intercorrelated with stronger taste, higher quality, higher tar and higher harm all related. The exception, where it was studied, was for the colour variants, where Gold was seen by many as the highest in quality, but Red the strongest in taste. This undoubtedly related to broader conceptual meanings, where gold is highly valued as a commodity, and by inference, things coloured gold are good. Furthermore, in Australia, two of the premium brands, Dunhill and Benson & Hedges both use gold in their packaging. Clearly, strong cultural preconceptions can shape these judgements, undoubtedly in interaction with use by the companies of these cultural preconceptions to position their products in the market.

It is notable that stronger cigarettes are rated as being higher in quality even though they are seen to be higher in harm, an attribute not normally associated with high quality. Unfortunately, we did not have any direct comparisons of quality and harm, so cannot be certain that harm and quality are positively associated, but tar level and quality are, as are tar level and harm.

While responding is consistent with what we know about human behaviour, it is useful to demonstrate that this is happening or can happen with cigarette brand variants.

We suspect the implicit positive association between strength, which is seen as an indicator of quality, and harmfulness is unique to products where there is a risk associated with use that is linked to the experiences sought from use. Thus, whisky is a stronger alcoholic beverage than beer, and we guess it would generally be seen as potentially more harmful. That smokers are acknowledging some harm is hardly surprising, Australian smokers have been educated for decades about the harms, and the current sample would have been exposed to such information all their lives. However, this should not be taken to show that these smokers are adequately informed. Smokers underestimate the magnitude of the harms,18 ,19 thus, while they are accepting some risk, they are underestimating the magnitude of this risk.

The most compelling conclusion, although hardly a surprising one from this study, is that given any set of attributes, people try to find order among them, and that some of this order is socially shared (ie, they come up with similar judgements). For variant sets that are currently used, some of the commonality is likely due to some combination of industry communications and taste differences between the variants. For those that are novel, it is clear that more universal heuristics are being used: for instance, a higher number means more of something than a low one. However, the nature of the comparison can affect this, with highly vented being seen as weaker, and less harmful than unvented. Whether this is due to understanding of how filter venting works, or relies on a more universal understanding that ventilation is something that ‘lets in air’, is uncertain.

There were two sets of ratings where responses were inconsistent with the science. The charcoal filter was seen as one of the filter descriptors delivering the most tar/nicotine, and being the most harmful. Charcoal is, in fact, a very good filter, but it is a dirty product, and thus, a heuristic of similarity would lead to the assumption that it was a more harmful product.

For the style descriptors, Oriental blend was rated as equally weakest in taste even though it is generally considered to be a very strong-tasting blend. This suggests that in both this case and with the filters, few respondents have had experience with these products and were relying on broader heuristics to make their judgements.

Currently, filter venting is the main engineering feature that affects the performance of cigarettes and, thus, the experiences of use.3 Highly vented filters are, erroneously,8 seen as lower in harm.5 As we have shown with the impacts of bans on misleading descriptors like ‘light’, ‘mild’ and ‘low tar’,10 ,11 just removing the descriptors has little impact when the engineering features that create the experiences of difference remain. The only viable solution is to prohibit engineering features that contribute to increased product attractiveness particularly of rated strength, especially when they do not actually reduce actual exposures, and thus, do not affect product harmfulness. While it might be possible to sustain some product differentiation solely on the basis of differential variant names, where physical differences exist, it is likely to be far easier to create strong product preferences for specific variants. This analysis suggests that merely considering names in isolation of product differentiation will be a less effective strategy than regulating both together.

There are a number of limitations to this study. Respondents were drawn from an internet panel, and though the sample is not representative, it was unselected on any aspect related to the study aims. Therefore, responses are unlikely to be much different than a more representative sample. That said, some caution should be taken in drawing conclusions about the absolute magnitude of effects, but this is of minor importance and does not threaten the conclusion that variant descriptors influence perceptions. It should also be stressed that these judgements were made in an experimental context, and we did not assess smokers’ prior experiences with different variants within each set, so cannot know what effects experience may have had for those descriptors that have been used. However, that we obtained similar effects for descriptor sets that are currently used, as well as novel ones, suggests that experience is not a critical feature of these judgements, although it may affect the magnitude of effects.

There are also a number of strengths with this study. First, we targeted younger smokers and ex-smokers (aged 18–29 years old), a group at an age more brand conscious.20 As such, they would be more affected (in their choices) by the characteristics we explored than older and more dependent smokers. Research has shown that loyalty to a cigarette brand, once fostered, is hard to break.21 ,22 We do not know to what extent these judgements would be shared by older smokers, but can see no reason why the same overall pattern would not occur. Second, the use of a within-subject design to explore key comparisons means that the study has considerable power, even with the relatively small sample size.

In summary, these results show that smokers impute differentiable characteristics to cigarettes based on variant labels. As such, variant descriptors on plain packaging can be used as a powerful branding tool. This role of variant descriptors will be even more important than it has been, as most other aspects of cigarette differentiation were removed from Australian packs from December 2012. While variant descriptors are allowed, it seems to us inevitable that smokers will try to make value judgements between them. If those differences are real and the judgements appropriate, this is a good thing. However, if these judgements lead to systematic misunderstandings, then they are a problem. It is particularly a problem when the incorrect attributions are around risk and harm, as is the case for many variants sets. Indeed we suspect any variant set that induces inferences about relative strength is likely to also result in inappropriate inferences about harmfulness. We believe that variants should only be allowed where the differences are meaningful, and can be shown not to unduly create misleading perceptions of risk. This is doubly the case for products like cigarettes which are apparently so benign, but which prematurely kill around half of all long-term users.