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Research paper
Perceptions of plain packaging among young adult roll-your-own smokers in France: a naturalistic approach
  1. Karine Gallopel-Morvan1,
  2. Crawford Moodie2,
  3. Figen Eker3,
  4. Emmanuelle Beguinot3,
  5. Yves Martinet4
  1. 1EHESP School of Public Health, EA MOS (Equipe d'Accueil en Management des Organisations de Santé), Rennes Cx, France
  2. 2Centre for Tobacco Control Research, University of Stirling, Scotland, UK
  3. 3French National Committee Against Tobacco (CNCT), Paris, France
  4. 4Unité de Coordination de Tabacologie, Centre Hospitalier Universitaire and University Henri Poincaré, Nancy, France
  1. Correspondence to Professor Karine Gallopel-Morvan, EHESP School of Public Health, EA MOS (Equipe d'Accueil en Management des Organisations de Santé), Av. du Professeur Léon-Bernard, CS 74312, Rennes Cx 35043, France; karine.gallopel-morvan{at}ehesp.fr

Abstract

Background We explored, for the first time, young adult roll-your-own smokers’ response to using plain packaging in real-world settings.

Methods Naturalistic research was employed, where 133 French young adult smokers (18–25 years of age) used plain roll-your-own packs for 10 days; the plain packs they were provided with contained their usual brand of rolling tobacco and displayed the name of their usual brand. Participants were recruited in five cities in France (Paris, Marseille, Metz, Nantes, Toulouse) and completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, brand attachment, product perceptions (eg, taste, quality, natural), feelings about smoking (satisfying, pleasurable), feelings when using the pack in front of others (embarrassment, image), warning response (credibility, awareness of risks) and smoking-related behaviour (eg, consumption, quitting).

Results Compared to their own fully branded packs, plain packs were associated with less positive pack and product perceptions, lower brand attachment and less positive feelings about smoking and feelings when using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like missing out on rolling a cigarette. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar.

Conclusions The study suggests that the impacts of plain packaging for roll-your-own cigarette smokers are the same as for smokers of factory-made cigarettes.

  • Hand-rolled/RYO tobacco
  • Packaging and Labelling
  • Prevention

https://doi.org/10.1136/tobaccocontrol-2013-051513

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    Introduction

    In France, a third (33.7%) of the adult population smoke,1 with 73 000 deaths annually due to smoking-related illness.2 France was one of the first countries in Europe to introduce a comprehensive ban on tobacco advertising with the Loi Evin in 1991.3 However, tobacco companies remain free to use packaging to promote their brands. While the Framework Convention on Tobacco Control recommends plain packaging for tobacco products,4 Australia remains the only country to have implemented plain packaging in December 2012. In 2013, the governments of New Zealand, Ireland and Scotland announced plans to follow suit. In France, the Minister for Health, Marisol Touraine, acknowledged the potential merits of plain packaging, but the French government intends to wait for findings from Australia before deciding on whether to implement it.5

    With respect to the evidence concerning plain packaging, a review of the literature, which included 37 studies, suggests that it may help reduce the appeal of tobacco products to consumers; increase the salience and effectiveness of health warnings and reduce the ability of packaging to mislead consumers about the harmful effects of smoking.6 A number of approaches to exploring plain packaging have been used, including surveys, eye-tracking research, experimental auctions, focus groups, interviews and mixed-methods designs.7 Only two studies have assessed the potential impact of plain packaging using a naturalistic approach, in an attempt to imitate the experience of using plain packs in a country where it has not been introduced. In both studies, young adult smokers in Scotland transferred cigarettes from their own packs into plain brown cigarette packs provided and used these for a period of 1 or 2 weeks.8 ,9 Both studies found that compared to smoker's own branded packs, plain packs were associated with more negative perceptions and feelings about the pack and about smoking. Participants were also more likely to report hiding and covering the plain pack, foregoing cigarettes, smoking less around others and thinking about quitting when using the plain packs. To date, only one published study has assessed smokers’ response to plain packaging in Australia.10 Conducted in November 2012, when plain and branded packs were on sale, the study found that smokers using plain packs, compared with smokers using branded packs, perceived their cigarettes to be less satisfying and poorer quality, were more supportive of plain packaging, and were more likely to think about and prioritise quitting. There was no significant difference in harm perceptions.

    There remain gaps in the literature, however. Only one study has considered the potential impact of plain packaging for roll-your-own (RYO) tobacco. While an Australian study included RYO and smokers of factory-made cigarettes, only 6.2% of the sample smoked RYO, and findings were not presented separately for factory-made and hand-rolled cigarettes smokers.10 As such, the impact of plain packaging on RYO smokers remains unclear. The inclusion of a question in the UK Government's consultation on plain packaging, asking whether plain packaging should apply to cigarettes only, or to cigarettes and hand-rolling tobacco, highlights the need for research. So too does the growth of RYO in a number of markets. For instance, in the European Union (EU) in 2012, 46% of smokers reported smoking hand-rolled cigarettes at least some of the time, and 20% on a daily basis.11 In France, 34% of adult smokers report using RYO tobacco at least once a month.11 RYO is popular due to its lower price, particularly among lower income groups and younger people.12

    Another gap in the literature is the absence of research exploring the impact of plain packaging on brand attachment. In the marketing literature, brand attachment is defined as the strength of the bond connecting the brand with the consumer's self. This bond is exemplified by a rich and accessible memory network (or mental representation) that involves thoughts and feelings about the brand and the brand's relationship to the self.13 Research has found that brand attachment is a stronger predictor of actual consumer behaviour than brand attitude strength and that the greater the brand attachment the greater the brand loyalty and behavioural commitment, for example, more money spent on the brand and greater personal resources to maintain an on-going relationship with that brand.13

    To address these gaps in the literature, a naturalistic approach was employed where young adult RYO smokers used plain packs for 10 days. They were given plain packs featuring the name of the brand they smoke most often, allowing us to assess level of brand attachment and whether this was impacted by plain packaging. We also explored pack and product perceptions, feelings about smoking, feelings when using the pack in front of others, response to the health warnings and cessation-related behaviour.

    Methods

    Design and sample

    In April 2013, young adult RYO smokers aged 18–25 years were recruited from five cities in France (Paris, Marseille, Metz, Nantes, Toulouse) by LH2, a leading market research company in France (http://www.lh2.fr). LH2 were fully briefed on study protocol but were not informed about the purpose of the study. We focused on young adults as smoking prevalence in France is particularly high for younger people, with 44% of 15–30-year-old smokers, an increase from 41% in 2005.1 Cities were chosen to represent different geographical areas in France and different population sizes. Between 35 and 40 young adult RYO smokers were recruited in the centre of each city, segmented by gender, age (18–21, 22–25) and smoking status (regular smokers, occasional smokers). Regular smokers smoked daily and occasional smokers smoked less than daily but at least once a week.

    Market recruiters were instructed to intercept people in the street and inform them that the study was concerned with smokers’ opinions of tobacco and packaging. For those willing to participate and available for the duration of the 10-day study, a recruitment questionnaire was used to determine eligibility. Questions included type of tobacco smoked most often (if not RYO tobacco, then no more questions were asked), age, sex, motivation to quit, number of cigarettes smoked per day or per week, the RYO brand they smoke most often, occupation and Fagerström Test for Nicotine Dependence.14

    Recruiters explained to eligible participants that a requirement of participation was that they would need to buy enough RYO tobacco to last for the 10 days of the study. The recruiters also explained to participants that they would need to visit their home within the next week or so, on a day and at a time suitable for them, in order to transfer the rolling tobacco they had purchased into different packs. The participants would then be required to use the (plain) packs they had been given for the next 10 days. Of the 200 RYO smokers who agreed to this, 198 purchased a 10-day supply of rolling tobacco and allowed market recruiters into their homes; two smokers indicated that they were no longer available for the study duration. When market recruiters visited the homes of each participant, they asked to see the RYO packs and asked a series of questions related to this pack. Using a pair of gloves, they transferred the tobacco from the branded packs purchased by participants into plain packs, which featured the name of their brand. The number of plain packs they were given and the brand name on the packs were tailored for each participant using their responses to the recruitment questionnaire. Participants were instructed to retain and reuse the RYO plain packs if they ran out of tobacco.

    Participants provided informed consent before participating and were asked to mail the used RYO plain packs to LH2 or destroy them after study completion. They were also asked to complete an internet questionnaire that would be emailed to them after they had used the plain RYO packs for 10 days (only participants with internet access, which was measured during recruitment, were included within the study). This questionnaire included the same questions that participants had been asked in their homes in the presence of the market recruiters, with an additional question concerning the taste of tobacco. Participants received a voucher for 30 euros upon study completion. Ethical approval for the study was provided by the French Health Ministry (Direction Générale de la Santé).

    Materials

    The RYO plain packs were the same dark brown-green colour as those used in Australia (Pantone 448C), with the brand name in the same typeface (Lucida Sans) and font size and colour (Pantone Cool Gray 2C). Pictorial health warnings featured on 75% of both sides of packs, consistent with the warning size proposed in the draft Tobacco Products Directive (TPD) in 2012.15 The warning size specified in the final TPD, announced following study completion, is 65% on both sides of packs. In terms of warning content, an image of rotten teeth was displayed on the front of each pack, and an image of a child in an incubator on the back of each pack. Previous research in France has found these images to be effective in terms of communicating the risks associated with smoking.16 These two warnings are among the 14 pictorial warnings which have been used on the back of packs in France since April 2011, covering 40% of the pack surface.

    Measures

    Brand attachment and brand attitude

    To measure brand attachment, a five-item scale (table 1) that has been validated in France and tested on a range of brands was used.17 For brand attitude, participants were asked about the extent to which they liked the tobacco brand. Response options for all items were: completely agree (5), slightly agree (4), neither agree nor disagree (3), slightly disagree (2), completely disagree (1).

    View this table:
    Table 1

    Brand attachment and attitude scores for the fully branded pack and plain pack after 10 days

    Pack perceptions and pack attitude

    Five items were used to assess pack perceptions in terms of desirability, attractiveness, style, fashion and coolness (table 2). For pack attitude, participants were asked about the extent to which they liked/disliked the pack. All items were measured with an Osgood scale (eg, undesirable=1 vs very desirable=5, etc.).

    View this table:
    Table 2

    Pack perceptions and attitude for fully branded pack and plain pack after 10 days

    Product perceptions

    Five items were used to assess whether the tobacco tasted good, tasted natural, tasted light, was good quality, and had high levels of tar (table 3). Within the internet questionnaire only, completed after 10 days of using the plain packs, participants were also asked if they felt that they had smoked their usual tobacco. Response options for all items were: completely agree (5), slightly agree (4), neither agree nor disagree (3), slightly disagree (2), completely disagree (1).

    View this table:
    Table 3

    Product and health warnings perceptions for fully branded pack and plain pack after 10 days

    Warning response

    Two items were used to measure the credibility of warnings, and whether they made participants more aware of tobacco dangers (table 3). Response options were: completely agree (5), slightly agree (4), neither agree nor disagree (3), slightly disagree (2), completely disagree (1).

    Feelings when smoking and when using the pack in the company of others

    Two items were used to assess feelings when smoking (satisfaction, pleasure), and two items assessed feelings when using the pack in front of others (embarrassment, image) (table 4). Responses were measured with an Osgood scale (eg, unsatisfying=1 vs very satisfying=5).

    View this table:
    Table 4

    Feelings when smoking and when using the pack in the company of others for fully branded pack and plain pack after 10 days

    Purchase and smoking-related behaviour

    Seven items asked about whether participants felt like buying the pack, rolling a cigarette, crushing a cigarette, reducing consumption, quitting, smoking less in front of people and hiding the pack (table 5). Response options were: yes totally (5), slightly yes (4), neither yes or no (3), slightly no (2), completely no (1).

    View this table:
    Table 5

    Purchase and smoking-related behaviour for fully branded pack and plain pack after 10 days

    Analysis

    All analyses were conducted on weighted data using SPSS software. To compare the mean scores for participants’ own packs and the plain packs, t test for paired samples was used. The brand attachment items were aggregated in one component (the mean of the five items) as the scale had a good reliability (Cronbach values were 0.88 for their own pack and 0.90 for the plain pack).

    Results

    Sample characteristics

    Of the 198 eligible participants, 133 completed the questionnaires and reported using only the plain pack for the duration of the study. The 27 participants who reported using the plain packs provided and also fully branded packs were excluded from the analysis, as were the 38 who failed to return the final (internet) questionnaire.

    The average participant age was 21.77 years (SD 2.20), with 71 females (53.4%), 65 regular smokers (48.9%) and 68 occasional smokers (51.1%). Occasional smokers smoked, on average, 15.19 rolled cigarettes (SD 15.16) in the last 10 days. Regular smokers smoked an average of 12.03 rolled cigarettes per day (SD 7.58), with 37 smoking less than 10 cigarettes per day and 28 more than 10 a day. One smoker wanted to quit in the next 6 months, 12 (9.0%) later than in the next 6 months and 120 (90.2%) were pre-contemplators, who did not want to quit at all. According to the Fagerström test, of the 65 regular smokers, 49 (75.4%) had a light/moderate dependence (defined as a score of 0–5) and 16 (24.6%) a high dependence (defined as a score of 6–10). The most commonly smoked RYO brands were Camel, Marlboro, Fleur du Pays, Pall Mall and Interval.

    Brand attachment and brand attitude

    Participants had significantly less attachment toward their brand for the plain pack compared to their own fully branded pack, with the mean overall brand attachment score 3.61 for their own pack and 3.40 for the plain pack; lower scores indicate lower brand attachment. Of the five brand attachment items, two were significantly lower for the plain pack compared to their own pack; ‘Purchasing this brand gives me a lot of pleasure’ (3.36 vs 3.76) and ‘I am very attracted to this brand’ (3.55 vs 3.74) (table 1). Liking of the brand (brand attitude) was also significantly lower for the plain pack compared to their own pack (4.02 vs 4.41).

    Pack perceptions and pack attitude

    On average, participants rated the plain pack negatively on all pack perception items (desirable, attractive, stylish, fashionable, cool), with mean scores ranging from 1.89 to 2.05 for the plain pack compared to 3.06–3.44 for their own fully branded packs (table 2). Liking of the pack (pack attitude) was also significantly lower for the plain pack (2.13) compared to their own pack (3.60).

    Product and health warnings perceptions

    Product perceptions were lower for the plain pack compared to their own pack. Ratings for the items concerning tobacco tasting good, tasting light, being of good quality and being natural were lower for the plain pack (respectively, 3.93; 3.04; 3.78; 2.62) than for their own pack (respectively, 4.26; 3.29; 4.20; 3.25) (table 3). There were no perceived differences between the pack types in terms of delivering high levels of tar (3.08 for the plain pack vs 2.95 for their own pack; p=0.18). In relation to whether the taste of tobacco was the same when in the plain pack, asked only at the end of the study, 25.6% agreed (completely or slightly) that they did not feel that the tobacco tasted the same as usual, 35.4% disagreed (completely or slightly) and 39.1% had no opinion.

    For the health warnings, there was no significant difference between the plain pack and their own pack for credibility (3.80 vs 3.66; p=0.226), although thoughts of the dangers associated with tobacco were higher for the plain pack (3.23 for own pack vs 3.78 for plain pack).

    Feelings when smoking and when using the pack in the company of others

    Participants reported less pleasure and less satisfaction when smoking for the plain pack than for their own pack (table 4). For their own pack, mean scores were 3.81 for satisfaction and 3.91 for pleasure, whereas they were 2.96 and 3.19, respectively, for the plain pack. Participants also indicated that they felt more embarrassed when using the plain pack than their own pack (2.35 vs 1.35), and felt that they were spreading a bad image of themselves when they used the plain pack (3.09 vs 2.57).

    Purchase and smoking behaviour

    Participants were more likely to report feeling like smoking less in front of others, and hiding the pack more in front of others, when using the plain pack in comparison to their own pack (1.78 and 1.48, respectively, for the plain pack vs 2.37 and 2.22, respectively, for their own pack). Participants reported feeling less inclined to buy the plain pack in comparison to their own pack (2.80 vs 4.04), less desire to roll a cigarette with the plain pack (2.83 vs 4.19) and feel more like stubbing out a cigarette early with the plain pack (2.03 vs 1.76). Participants also reported that the plain pack made them feel more like quitting (2.23) and reducing consumption (2.50) in comparison with their own pack (1.93 and 2.09, respectively) (table 5).

    Discussion

    Given the exponential growth in sales of RYO tobacco in Europe and other markets, we explored the response of young adult RYO smokers to using plain RYO packaging in naturalistic settings. The findings are similar to past naturalistic research,8 ,9 research from Australia where plain and fully branded packs were on sale,10 and indeed the growing plain packaging literature.6 We found that in comparison to participant's own fully branded packs, plain packaging featuring large pictorial health warnings was associated with more negative perceptions of the pack and also the product (eg, poorer taste, less satisfying), as well as more negative feelings about smoking and increased avoidant (hiding the pack, smoking less in front of others) and cessation-related smoking behaviours (eg, greater feelings of reducing consumption and quitting). We also found that plain packaging was associated with lower brand attachment, more negative feelings when smoking in front of others and lower purchase intention.

    That plain RYO packaging was perceived less positively than fully branded RYO packaging is consistent with the literature. However, while research has explored the impact of plain packaging on brand appeal, brand image and brand satisfaction,18–21 no study has considered brand attachment. Brand attachment is of critical importance in marketing and,22 unsurprisingly, research with smokers from all EU member states has found the brand itself to be a key factor in determining why smokers select a particular cigarette brand.11 By incorporating the name of the brand that participants used onto the plain packs, this allowed us to gauge the impact, if any, that plain packaging had on brand attachment. Just as past research has found plain packaging to lower brand appeal, image and satisfaction, we found that it lowered brand attachment.

    Participants perceived the product differently depending on pack type, with the tobacco rated as less ‘natural’ and of poorer quality when in the plain pack. Similarly, the tobacco was not considered to taste as good, or as light, when in a plain pack. Indeed, a quarter of the sample did not think the tobacco tasted the same as usual—even though they had observed the recruiters place their tobacco in the plain packs in their homes—highlighting the interplay between the pack and gustatory sensations.23 While it is well established within the marketing literature that pack appearance influences product evaluation,24 interestingly, participants also reported feeling less pleasure and satisfaction when smoking from the plain pack.

    Consistent with the two naturalistic studies in Scotland, we found that warning credibility did not differ by pack type, even though the warnings featured on the plain RYO packs used in this study were larger than those currently on sale in France. They were, however, found to increase awareness of the dangers of tobacco. We are unable to determine whether the increased warning size, the absence of competing branding or a combination of both resulted in this increase in awareness of the dangers of tobacco. Future research could attempt to tease this out. However, the findings are important as RYO smokers often think that RYO tobacco is safer than factory-made cigarettes because it contains less chemicals,25 even though epidemiological evidence shows that this is not the case.26

    With respect to avoidant and cessation-related behaviours, when using the plain packs, participants were more likely to report feeling like hiding the pack, smoking less in front of others, stubbing out cigarettes, missing out on rolling cigarettes, and reducing consumption. These findings are similar to that of past naturalistic research with factory-made smokers of cigarettes, but are interesting given that most of our sample (90%) indicated that they did not want to quit. It is generally accepted that branding is more important for younger people. The fact that plain packaging appeared to encourage cessation-related behaviour among a group of young adults with low motivation to quit lends support to this.

    Our findings must be considered in light of a number of limitations. The brief study period allows an insight into the short-term response of RYO smokers to plain packaging, but fails to provide a longer-term assessment. That participants used plain packs, at a time when they were not available on the French market, may have influenced their responses; although we see no way of avoiding this prior to plain packaging being introduced. Additionally, the different mode of questionnaire collection (face-to-face and email) may have impacted upon the responses given, although the findings are consistent with past research. As smokers were exposed to plain packaging with large health warnings, we are unable to disentangle the individual impact of the warnings and of removing the branding, and how each of these may have influenced responses.

    Despite these limitations, this study adds to, and extends, what is known about the potential impacts of plain packaging. Our findings allow some insight into the possible public health benefits of plain RYO packaging, and support the inclusion of hand-rolled cigarettes within any plain packaging legislation.

    What this paper adds

    • We explored, for the first time, young adult roll-your-own smokers’ response to using roll-your-own plain packaging in real-world settings.

    • Compared with fully branded packs, plain packs were associated with less positive pack and product perceptions, lower brand attachment, less positive feelings about smoking and less positive feelings when using the pack in front of others.

    • Compared to fully branded packs, participants were more likely to report feeling like reducing consumption, missing out on rolling a cigarette and quitting when using the plain packs.

    • The findings are consistent with past research with smokers of factory-made cigarettes.

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    Footnotes

    • Contributors KG-M devised the study, conducted the analyses and drafted the paper. CM helped draft and revise the paper. KG-M, FE, EB and YM designed data collection tools. All authors read and approved the final manuscript.

    • Funding The study was funded by the French Health Ministry. Crawford Moodie is funded by Cancer Research UK.

    • Competing interests None.

    • Ethics approval French health ministry.

    • Provenance and peer review Not commissioned; externally peer reviewed.