Reducing tobacco-attributable illness in the U.S. and worldwide relies on effective tobacco control efforts, which includes adequately informing consumers about the dangers associated with tobacco use, especially vulnerable and susceptible youth. Research demonstrates that tobacco packaging elements (including health warning labels, descriptive characteristics, and corporate branding) are associated with knowledge of health risks and product appeal with cigarettes. Results from the current research suggest that package design characteristics are associated with perceptions of health risk and product appeal with smokeless tobacco packaging as well.
The current research found that graphic health warning labels were associated with lower ratings of product appeal and elicit greater concern for health risks than text warnings alone, consistent with previous research testing warning labels for cigarettes . Furthermore, the impact of graphic warnings was strongest among the youth and young adults in our sample (14-25 year olds). Youth in our study reported that the products with graphic warnings would likely taste worse and pose more harm to a user, perceptions which may be linked with a lower likelihood of product use. A systematic review of literature on health warning labels conducted in 2011 indicated that health warning labels on cigarette packs can discourage youth uptake of tobacco, yet the impact of such warning labels is dependent upon the presence of imagery, location, size, and text of the warnings . Research to date has focused on health warning labels on cigarette packs; the findings from this study suggest that this may also be true for warnings on SLT products.
Smokeless tobacco packaging with the flavor descriptor was not associated with conveying information regarding health risks associated with product use. This is consistent with previous findings with cigarettes – characterizing flavors do not necessarily alter risk perceptions around the product [37, 38]. Future research should continue to evaluate how flavorings in smokeless tobacco products may be related to perceptions of health risks and appeal.
The branded pack was more appealing and more likely to grab respondents’ attention, while plain packaging was perceived as delivering more chemicals and making respondents consider the health risks associated with SLT use. Corporate branding on the packaging appeared to diminish perceptions of harm and increase positive perceptions of product quality compared to products in plain packaging. These findings are consistent with what other studies on combustible tobacco products have shown with regard to the influence of product packaging on consumer perceptions of the product [14, 17, 20, 21, 31]. In December 2012 plain packaging legislation was passed in Australia with the intent to reduce the appeal of packaging to consumers and increase the noticeability and salience of health warnings, among others (see Tobacco Plain Packaging Act 2011 for more detail: http://www.comlaw.gov.au/Details/C2011A00148). The real life effects of plain packaging on initiation, cessation, and relapse remain to be seen.
While this research illustrated that, among all age groups, SLT packaging elements were associated with product-related beliefs, a key finding was that youth and young adults were often more likely than older respondents to indicate that these elements would have an effect on their perceptions in each of the product conditions. This is of particular importance because, according to the most recent U.S. Surgeon General’s report, the majority of new smokeless tobacco users are youth and young adults . If packaging elements are effective in conveying messages to young people, incorporating components that accurately convey the risk associated with use and reduce product appeal may result in a reduction in uptake among non-users.
Respondents overwhelmingly selected the new dissolvable tobacco products, Camel Strips and Camel Orbs, as the most appealing, accounting for over half of selections (62%). This product was only available in two test markets in the country at the time of this survey. Therefore, respondents found this product appealing simply by looking at the package and reading a one sentence description about how each product is used. Furthermore, when presented with the branded packaging condition, those who had selected the Strips and Orbs also selected the branded pack as particularly appealing to those their age and as the one they would want to be seen using. These tobacco products have packaging that closely resembles nontobacco products like breath strips or candy and may be alluring to youth. Further research should examine how these products are perceived after trial and how integrated corporate branding with other tobacco products (such as use of the Camel brand) influences perceptions and intention to try these products.
Several limitations should be considered. First, this was a web-based survey with an internet panel that was strategically designed to assess particular age groups, and does not reflect a representative sample of the US population. Because this survey was web-based, only those with access to a computer were able to participate, potentially underrepresenting individuals from lower socioeconomic classes. Additionally, because this was an opt-in internet panel, it is possible that there is some confounding present between internet access and panel composition.
Also, because this was a cross-sectional survey, we are unable to draw conclusions regarding the causation between packaging elements and perceptions of appeal and harm. The current data speak only to associations between packaging elements and perceptions. Another limitation is that tobacco use rates in this survey were markedly high and not reflective of the general population. Half of our sample had smoked daily at some point and three-quarters and smoked at some point in their lifetime. In addition, 17% of participants had used SLT in the past 30 days, though use in the general population among adults is 3.5%. Future research should apply these methods to a more broadly generalizable population. Despite these limitations, these findings highlight the importance of smokeless tobacco packaging in conveying information to consumers or creating impressions, and have important implications for future studies and tobacco control policy efforts.