Adolescents’ perceptions of standardised cigarette packaging and other cigarette packaging measures intended to be dissuasive: A mixed method study in Britain

Background: This thesis had two main aims. First, to understand how adolescents responded to standardised cigarette packaging. Second, to explore how adolescents perceived novel ways of using the packaging to attempt to deter smoking, specifically cigarette packs that played audio health messages when opened, cigarette packs where the brand variant name was replaced by a number (‘numbered packs’), and cigarette sticks which were an unappealing colour or displayed a warning (‘dissuasive cigarettes’). Methods: A mixed methods design was used, with three interlinked studies with adolescents. First, focus groups were employed with 16-17 year-olds (n=41) in Scotland to explore awareness of, and responses to, standardised packaging, and perceptions of cigarette packs that played audio health warning messages and dissuasive cigarettes. Second, a cross-sectional survey with 12-17 year-olds in Scotland (n=594) examined perceptions of, and responses to, standardised packaging and dissuasive cigarettes. Third, focus groups with 11-16 year-olds (n=89) across Britain assessed reactions to brand variant names and numbered packs. Findings: The findings suggest that standardised packaging is viewed unfavourably by adolescents, with the warnings on packs prominent and off-putting and the appeal of the pack, the user and smoking greatly diminished. Standardised packs with different structures from the traditional straight-edged flip top pack were viewed less negatively however. While some adolescents viewed the packs playing audio health messages as a deterrent, and thought that the numbered packs, which caused some confusion, would make it more difficult to form attachments with brands, dissuasive cigarettes appear to have the greatest potential to discourage young people from smoking. Conclusion: Standardised packaging appears to be protecting adolescents by making cigarette packaging and smoking less appealing, and the on-pack warnings more salient and effective. However, as adolescents are not necessarily exposed to packs at the point of consumption, dissuasive cigarettes may help to extend this protection