Smoking Susceptibility and Tobacco Media Engagement Among Youth Never Smokers

Abstract Introduction From May 20, 2017, cigarettes in the United Kingdom must be sold in standardized (plain) packaging. We explore postimplementation reactions to standardized cigarette packaging among never-smokers in Scotland, whether reactions vary in relation to permitted variations in pack structure, and whether reactions are associated with susceptibility. Aims and Methods A cross-sectional survey with 12–17-year-old never-smokers (n = 507) in Scotland, conducted November 2017–November 2018. Participants were shown one “regular” standardized cigarette pack (flip-top lid and straight-edged pack, similar to designs in Australia) and three standardized packs with varied pack structures (beveled-edges, slim pack, and shoulder box), which are permitted postimplementation in the United Kingdom. Participants rated each pack on eight five-point reaction measures (eg, attractiveness). Participants also indicated which pack, if any, they would choose. Smoking susceptibility was the outcome. Results The mean reaction scores for all four packs were mostly negative, however the shoulder box was consistently rated less negatively than the regular, slim, or beveled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than nonsusceptible participants (25% vs. 7%; χ 2 = 29.70; p < .001). For all four packs, not finding them off-putting was associated with susceptibility (Adjusted Odds Ratio range: 2.73–3.69), albeit only a minority of adolescents did not find each pack off-putting. Conclusions Adolescents have negative reactions to the standardized cigarette packs implemented in the United Kingdom, albeit permitted variations in structure can reduce the extent of negativity. Most reactions to standardized packaging had no association with susceptibility. Implications We provide the first empirical evidence that adolescents find the standardized cigarette packs implemented in the United Kingdom unappealing and that most pack reactions have no association with susceptibility among never-smokers, with the exception of the minority who did not think that they would put them off smoking. This suggests that the legislation is achieving one of its primary aims, to reduce the appeal of packaging. That permitted variations in pack structure (eg, shoulder boxes) somewhat reduce negative reactions suggests that the United Kingdom, and other countries introducing similar legislation, should ensure that all aspects of pack design are fully standardized.

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Impact of a ban on the open display of tobacco products in retail outlets on never smoking youth in the UK: findings from a repeat cross-sectional survey before, during and after implementation

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054831 ◽

2019 ◽

pp. tobaccocontrol-2018-054831 ◽

Cited By ~ 1

Author(s):

Allison Ford ◽

Anne Marie MacKintosh ◽

Crawford Moodie ◽

Mirte A G Kuipers ◽

Gerard B Hastings ◽

...

Keyword(s):

Brand Awareness ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Tobacco Products ◽

Point Of Sale ◽

Cigarette Brand ◽

The Mean ◽

Never Smokers ◽

The Uk ◽

Smoking Susceptibility

BackgroundIn the UK, a ban on the open display of tobacco products at the point of sale (POS) was phased in between 2012 and 2015. We explored any impact of the ban on youth before, during and after implementation.MethodsA repeat cross-sectional in-home survey with young people aged 11–16 years old in the UK was conducted preban (2011, n=1373), mid-ban (2014, n=1205) and postban (2016, n=1213). The analysis focuses on the never-smokers in the sample (n=2953 in total). Preban, we quantified the associations of noticing cigarettes displayed at POS and cigarette brand awareness with smoking susceptibility. We measured any change in noticing cigarettes displayed at POS, cigarette brand awareness and smoking susceptibility between preban, mid-ban and postban. Postban, we assessed support for a display ban, perceived appeal of cigarettes and perceived acceptability of smoking as a result of closed displays.ResultsPreban, noticing cigarettes displayed at POS (adjusted OR [AOR]=1.97, 95% CI 1.30 to 2.98) and higher brand awareness (AOR=1.15, 95% CI 1.03 to 1.29) were positively associated with smoking susceptibility. The mean number of brands recalled declined from 0.97 preban to 0.69 postban (p<0.001). Smoking susceptibility decreased from 28% preban to 23% mid-ban and 18% postban (p for trend <0.001). Postban, 90% of never-smokers supported the display ban and indicated that it made cigarettes seem unappealing (77%) and made smoking seem unacceptable (87%).ConclusionsBoth partial and full implementation of a display ban were followed by a reduction in smoking susceptibility among adolescents, which may be driven by decreases in brand awareness.

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Relationship between trying an electronic cigarette and subsequent cigarette experimentation in Scottish adolescents: a cohort study

Tobacco Control ◽

10.1136/tobaccocontrol-2017-053691 ◽

2017 ◽

Vol 27 (4) ◽

pp. 373-378 ◽

Cited By ~ 45

Author(s):

Catherine Best ◽

Farhana Haseen ◽

Dorothy Currie ◽

Gozde Ozakinci ◽

Anne Marie MacKintosh ◽

...

Keyword(s):

Young People ◽

Smoking Status ◽

Close Monitoring ◽

Cigarette Use ◽

Survey Analysis ◽

Original Cohort ◽

Friendship Group ◽

Never Smokers ◽

Smoking Susceptibility

BackgroundThis study examines whether young never smokers in Scotland, UK, who have tried an e-cigarette are more likely than those who have not, to try a cigarette during the following year.MethodsProspective cohort survey conducted in four high schools in Scotland, UK during February/March 2015 (n=3807) with follow-up 1 year later. All pupils (age 11–18) were surveyed. Response rates were high in both years (87% in 2015) and 2680/3807 (70.4%) of the original cohort completed the follow-up survey. Analysis was restricted to baseline ‘never smokers’ (n=3001/3807), 2125 of whom were available to follow-up (70.8%).ResultsAt baseline, 183 of 2125 (8.6%) never smokers had tried an e-cigarette and 1942 had not. Of the young people who had not tried an e-cigarette at baseline, 249 (12.8%) went on to try smoking a cigarette by follow-up. This compares with 74 (40.4%) of those who had tried an e-cigarette at baseline. This effect remained significant in a logistic regression model adjusted for smoking susceptibility, having friends who smoke, family members’ smoking status, age, sex, family affluence score, ethnic group and school (adjusted OR 2.42 (95% CI 1.63 to 3.60)). There was a significant interaction between e-cigarette use and smoking susceptibility and between e-cigarette use and smoking within the friendship group.ConclusionsYoung never smokers are more likely to experiment with cigarettes if they have tried an e-cigarette. Causality cannot be inferred, but continued close monitoring of e-cigarette use in young people is warranted.

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Smoking Susceptibility Among Never-Smokers: Data From the 2006–07 National Youth Smoking Survey

Can J Public Health ◽

10.1007/bf03404043 ◽

2011 ◽

Vol 102 (4) ◽

pp. 254-257 ◽

Cited By ~ 7

Author(s):

Wiworn Sae Yang ◽

Scott T. Leatherdale ◽

Rashid Ahmed

Keyword(s):

Youth Smoking ◽

Youth Smoking Survey ◽

Never Smokers ◽

Smoking Susceptibility

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The Influence and Interaction of Tobacco-Related Information Exposure on Youth Smoking Behavior and Smoking Susceptibility: Sex and School Type Difference

10.20944/preprints201905.0288.v1 ◽

2019 ◽

Author(s):

Jingfen Zhu ◽

Jiahui Li ◽

Yaping He ◽

Na Li ◽

Gang Xu ◽

...

Keyword(s):

Tobacco Control ◽

School Type ◽

Exposure Level ◽

Youth Smoking ◽

Current Smoking ◽

Control Information ◽

Control Message ◽

Never Smokers ◽

And Control ◽

Smoking Susceptibility

This study investigated the influence and interaction of tobacco promotional and control information with adolescents’ current smoking and smoking susceptibility. 12,278 students were recruited from junior, senior and vocational high schools located in Shanghai, China. The exposure to tobacco promotional and control message of participants over the past 30 days were examined, as well as current smoking and never smokers’ initiation susceptibility. Complex sample analysis was applied. Descriptive and multivariate logistic regressions were conducted. 89.3% and 91.5% of adolescents investigated were exposed to tobacco promotional and control message respectively, which separately increased and decreased the risk of current smoking and never-smokers’ smoking susceptibility, especially among males and junior high school students. The risk changed in consistency with the exposure level（Ptrend < 0.001）. Tobacco control message seemed to mitigate the influence of tobacco promotions in the risk of both current smoking (OR = 0.64, 95%CI: 0.41–0.99) and smoking susceptibility (OR = 0.65, 95%CI: 0.46–0.93). Tobacco-related message exposure was highly prevalent and associated with youth smoking risk and smoking susceptibility. It is important to enhance the comprehensiveness and enforcement of promotion bans. Given the improvement of tobacco control message on smoking risk brought by tobacco promotions, the publicity and dissemination of tobacco control information need to be consistently strengthened.

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Association between the display of cigarette packs at the point of sale and smoking susceptibility among adolescents in Brazil

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000331 ◽

2018 ◽

Vol 44 (1) ◽

pp. 49-51

Author(s):

Ana Luiza Curi Hallal ◽

Andreza Madeira Macario ◽

Roberto Hess de Souza ◽

Antônio Fernando Boing ◽

Lúcio Botelho ◽

...

Keyword(s):

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Point Of Sale ◽

Susceptibility To Smoking ◽

Never Smokers ◽

Smoking Susceptibility ◽

Cigarette Packs

ABSTRACT This was a cross-sectional study aimed at determining the association between exposure to tobacco displays at the point of sale and susceptibility to smoking in schoolchildren in the 14- to 17-year age bracket. Of the participating students, 69.0%, 21.3%, and 9.7% were classified as never smokers, experimenters, and smokers, respectively. Of the participants who were classified as being exposed to smoking, 18.9% were susceptible to smoking. Of the participants who were classified as being unexposed to smoking, 12.9% were susceptible to smoking (OR = 1.56; 95% CI: 1.04 -2.35; p = 0.029). Exposure to point-of-sale tobacco displays is associated with smoking susceptibility in Brazilian adolescents.

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Reactions to, and trial intentions for, three dissuasive cigarette designs: a cross-sectional survey of adolescents in Scotland

Tobacco Control ◽

10.1136/tobaccocontrol-2020-055842 ◽

2020 ◽

pp. tobaccocontrol-2020-055842

Author(s):

Danielle Mitchell ◽

Nathan Critchlow ◽

Crawford Moodie ◽

Linda Bauld

Keyword(s):

Smoking Status ◽

White Paper ◽

Cross Sectional Survey ◽

Chi Square ◽

Cross Sectional ◽

Health Warning ◽

Older Adolescents ◽

Never Smokers ◽

Dark Green ◽

Smoking Susceptibility

ObjectivesThere has been growing academic and policy interest in opportunities to decrease the appeal of cigarette sticks, such as making them an unattractive colour or requiring them to display a health warning. We therefore explored reactions to, and trial intentions for, three ‘dissuasive’ cigarette designs among adolescents in Scotland.MethodsA cross-sectional survey with 12–17 year olds in Scotland (n=594) was conducted between November 2017 and November 2018. Participants were shown one ‘standard’ cigarette (imitation cork filter with white paper casing) and three dissuasive cigarettes: (1) a cigarette with the warning ‘smoking kills’; (2) a cigarette with the warning ‘toxic’ and a skull and cross-bones image and (3) a dark green cigarette. Participants rated each cigarette on nine five-point reaction measures (eg, appealing/unappealing or attractive/unattractive). A composite reaction score was computed for each cigarette, which was binary coded (overall negative reactions vs neutral/positive reactions). Participants also indicated whether they would try each cigarette (coded: Yes/No). Demographics, smoking status and smoking susceptibility were also measured.ResultsMore participants had negative reactions to the dark green (93% of adolescents), ‘smoking kills’ (94%) and ‘toxic’ (96%) cigarettes, compared with the standard cigarette (85%). For all three dissuasive designs, Chi-square tests found that negative reactions were more likely among younger adolescents (vs older adolescents), never-smokers (vs ever smokers) and non-susceptible never-smokers (vs susceptible never-smokers). Most participants indicated that they would not try any of the cigarettes (range: 84%–91%).ConclusionDissuasive cigarettes present an opportunity to further reduce the appeal of smoking among adolescents.

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