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Smokers ignore health warnings

31 May 2011

No one would drink a glass of poison if it was emblazoned with large letters warning that it would kill them. But millions of people every day ignore similar warnings on cigarette packets. Do seasoned smokers ignore the stark health warnings that declare “smoking kills”, “smoking seriously harms you and others around you” and “smokers die younger”, or are their eyes trained not to see them? That’s what academics at the UK Centre for Tobacco Studies – based at Bath and Bristol universities – decided to investigate using eye-tracking technology. Their aim was to find out whether the government’s introduction of health labels – which began in the 1970s with the message, “Warning by HM Government. Smoking can damage your health” – was effective at preventing the habit or encouraging addicts to stop.

What they discovered won’t please the tobacco giants. The academics’ findings suggest that the best way to stop non-smokers from picking up the habit is to force cigarette-makers to box up their fags in plain packets devoid of any branding whatsoever. The work was carried out by Marcus Munafò, professor of biological psychology at Bristol University, and Linda Bauld, professor of socio-management at the University of Stirling, who noticed that tobacco firms had enjoyed significant surges in sales after jazzing up their packet designs.

The academics point out that, as governments around the world bought in increasingly strict restrictions on cigarette adverts on billboards, TV, cinema and more, tobacco firms began spending more time and money investigating new ways to attract customers. And, slowly but surely, their cigarette packaging became increasingly imaginative.

Munafò points to an example of when Sterling introduced price-marked packs to emphasise their value in 2008. “Its market share increased from 5% to 6.1% in four months,” he says, before going on to flag up a limited edition “Celebration” pack of Lambert & Butler in 2004, which included pictures marking the brand’s 25th anniversary. That, say the academics, helped to increase Lambert & Butler’s market share by 0.4% – or some £60m – during four months on sale. Munafò points out that a couple of years later, Benson & Hedges Silver introduced a new “slide pack”, which opened via a side panel rather than flip-top, and saw sales rocket 25% over six months, then a further 32.5% (or more than £74m) after a year. “In the latter two cases, spokespeople for the producers, Imperial Tobacco and Gallaher, explicitly attributed sales success to the packs,” Munafò adds. “And an industry paper, Tobacco Journal International, pointed out that ‘tobacco packaging is no longer the silent salesman it once was – it now shouts.’ Thetobacco industry clearly acknowledges that the pack is a marketing tool.”

So Munafò and Bauld called in 43 non-smokers, light smokers and daily smokers to look at both plain and branded cigarette packets to help them to work out the different effects. All of their research packs featured health warnings, but while the branded packets were samples from 10 of the UK’s most popular cigarette-makers, the others were simple, unadorned white packets, with their brand name and number of cigarettes displayed only nominally in a standard font. The academics then fitted their volunteers with eye-tracking technology to see how they responded to the packets.

“We measured the number of times each person viewed the top half of the pack, which contained the brand information, and the bottom half of the pack, containing the health warning information,” explains Munafò, who as an experimental psychologist specialises in investigating the cognitive and biological basis of addictive behaviours. After analysing their findings, the researchers found that non-smokers and light smokers paid more attention to the stark health warnings on plain packs than on those adorned with names like Marlborough. By contrast, the frequent smokers did not – Bauld and Munafò believe they might have conditioned themselves to ignore them.

It might not sound surprising that stark health warning stood out more, and had a more significant impact, on plain packets, but the researchers say their evidence adds support to the idea that the government should force the tobacco industry to dump decorative packaging. Munafò reckons if the likes of British American Tobacco, maker of Dunhill, Kent, Lucky Strike and Pall Mall, amongst others, were forced to standardise the colour and design of cigarette packaging – with all branding removed apart from a standard typeface including the name, relevant legal markings, and health warnings – it would boost the effectiveness of warnings. He adds that previous research suggests that the deterrent of plain packaging would be most powerful among children and young people, or those who believe they are smoking “healthier” cigarettes.

“Studies with teenagers – those not yet smoking or not smoking regularly – have found that they are brand-aware, including awareness by cigarette pack colour and design alone,” says Munafò. “And smokers can believe that some brands of cigarettes are less harmful than others due to packaging, for example substantial false beliefs about the relative risks as a result of terms such as ‘light’ or ‘mild’, brand descriptors of ‘taste’ or lighter colours being used on packaging. Plain packaging reduces levels of these false beliefs.”

The government has committed to consulting on the idea of introducing plain packaging. Bauld and Munafò have sent their findings to the Department of Health for discussion with its tobacco policy team. But other countries are ahead of us: in January next year, Australia will be the first to introduce plain packaging for cigarettes.

In the meantime, Bauld and Munafò are furthering their research, including using brain imaging to look at how the brain responds to plain and branded packs. But Munafò is clear about what he thinks the health secretary, Andrew Lansley, should do. “The government should introduce plain packaging of tobacco products and maintain text and visual health labels on packs,” he says. “There is good independent evidence on the impact of visual warnings on attitudes to smoking and smoking behaviour.”

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