Despite bans on tobacco advertising in many countries, the tobacco industry has shown both remarkable resilience and marketing ingenuity to continue promoting their wares, and offset the loss of prohibited marketing channels by creatively exploiting unregulated marketing channels; most notably packaging. Plain tobacco packaging, which involves removing all branding (including logos, trademarks, colours) from tobacco packs, would perform three key functions according to research in this area: (1) prevent the use of misleading colours, which consumers often equate to product safety; (2) remove the promotional appeal of the pack; and, (3) prevent health warnings being undermined. In this study we will explore adult smokers' perceptions of packaging and plain packaging using a mixed methods approach, comprising focus groups, interviews and, for the first time, ecological research - that is smokers using plain cigarette packs rather than their normal branded packs in everyday settings, for a period of two weeks. The study is due to be finished in September 2010.

CTCR Staff: Crawford Moodie, Anne Marie MacKintosh and Gerard Hastings

This project aims to develop and share knowledge and learning in relation to smoking cessation in prisons and broadening this out to other organisations across the criminal justice system that also have the potential to contribute to quitting and to generic services. It will encompass broad target groups such as offenders, families and staff within the criminal justice system. It aims to develop functioning systems for provision of support and care pathways, in prisons, on release, across the CJS, and into the community, which will result in enhanced engagement and quit rates. A Regional Criminal Justice System (CJS) Tobacco Control Coordinator will be appointed to look toward the organisational/systems perspectives across prisons, probation services, police and courts in relation to tobacco control and stop smoking support and treatment, and full process and outcomes evaluation will be conducted. This is part of an overall bid coordinated by UKCTCS covering six settings in all.

CTCR Staff: Susan MacAskill and Douglas Eadie

The Institute for Social Marketing (ISM) is acting as an advisor to the UK Centre for Tobacco Control Studies to evaluate the development and impact of a complex community initiative, ‘The North of England Tackling Illicit Tobacco for Better Health' Programme, which aims to reduce smoking prevalence in the North East, North West, and Yorkshire and Humber regions by reducing demand and availability of illicit tobacco (both cigarettes and loose). The 18 month evaluation employs a mixed methods approach, combining quantitative, qualitative research exercises as well as review and analysis of secondary data and materials. ISM has a specific interest in advising on the social marketing components of the programme.

CTCR Staff: Douglas Eadie

The aim of this project was to produce a report which reviewed the evidence base on plain packaging, does it support a move to plain packaging, and what are the gaps in the literature and areas where research could be improved? According to the literature there are three ways in which plain packaging might be expected to deliver health benefits: (1) by making health warnings more prominent and therefore stronger; (2) by reducing the promotional power of the pack (and therefore the amount of tobacco promotion); and, (3) by preventing the use of colour to deceive consumers and potential consumers about the dangers of smoking. Although there are some areas where research could be improved, the consistency of findings from many countries point to the potential benefits of plain packaging. This document was used to help inform the Department of Health's tobacco control strategy.

CTCR Staff: Crawford Moodie and Gerard Hastings

This project aimed to assess the potential for recruiting independent and local retailers to assist public health manage tobacco sales decline in the UK. The study comprised three stages: (1) a literature and market review clarifying the current state of knowledge regarding local and convenience retailing, focussing specifically on tobacco, and covering possible retail-focused solutions to aid decline and enhance health promotion; (2) interviews conducted with a range of retailers (n=14 across the UK) to understand the possibilities for change; and (3), from these two data collection exercises, ideas were developed for working with retailers via an iterative process within the project team.

CTCR Staff: Douglas Eadie, Kathryn Angus and Gerard Hastings; and Leigh Sparks from the Institute of Retail Studies, Stirling University

The Centre is a strategic partnership of nine UK universities in England and Scotland (Nottingham, Bath, Birmingham, Edinburgh, Stirling, Queen Mary, UCL, York and Bristol) involving leading tobacco control researchers from a range of disciplines.

Each institution will work together to deliver a programme of original research, policy development, advocacy, teaching and training.

UKCTCS is part of a £20 million investment into public health research, funded by the UK Clinical Research Collaboration (UKCRC) comprising the Economic & Social Research Council, The British Heart Foundation, Cancer Research UK, the National Institute for Health Research and the Medical Research Council.

CTCR Staff: Gerard Hastings and Abraham Brown

This report considers the effect of smoking imagery on young people (under 25 years) in the UK. It begins by examining trends in smoking prevalence and initiation, goes on to review the different forms of pro-smoking imagery and the evidence for how they can affect behaviours and attitudes among young people. It concludes by exploring effective ways of reducing young people's exposure to positive images of smoking – and increasing their exposure to positive images of health. A number of recommendations for reducing the influence of pro-smoking imagery on young people are given.

Report available

CTCR Staff: Gerard Hastings and Kathryn Angus

Enormous progress has been made in European tobacco control over the last 20 years: pack warnings; the curtailment of tobacco advertising; restrictions on smoking in public places; rising prices; smuggling is being addressed; and initial attempts have been made to tackle harm minimisation. Yet well over half a million Europeans are still being killed every year by tobacco and smoking remains by far the biggest threat to our public health. The ASPECT (Analysis of the Science and Policy for European Control of Tobacco) Consortium's report drew together analysis of tobacco control policy in the European Union from the past 20 years, the present and provided a set of recommendations to feed into and inform policy discussions to define a European tobacco-control strategy for the future.

As part of the Consortium's Expert Committee, we co-ordinated Chapter 6 "The Influence of the Tobacco Industry on European Tobacco-Control Policy" which demonstrated the lengths to which the tobacco industry had gone to undermine and influence policy making at all levels, and the considerable success it had achieved over the last couple of decades. Presented as the tobacco industry's 'stakeholder marketing plan', the evidence was collected from industry documents, with input from a network of European and International tobacco control experts, and the findings of a number of expert workshops and international conferences.

CTCR Staff: Gerard Hastings and Kathryn Angus

Download the full report - pdf ASPECT publication [Warning: large file!]

In 1999, the House of Commons Health Select Committee acquired access to internal documents of the main advertising agencies of the UK tobacco industry as part of its investigation into the conduct of the tobacco industry. Previously only accessible to the public through the House of Commons library, this fully searchable database is now available to a global audience. Launched in December 2003 the site has attracted a huge amount of interest with over 350,000 hits and 8,500 downloads in its first week.

The resource provides some fascinating insights into the strategies used by the UK tobacco industry. A series of marketing Case Studies examining issues such as tobacco sponsorship and tobacco marketing and young people have been developed using relevant search terms. Each Case Study contains many extracts from the internal documents demonstrating how the UK tobacco industry and their advertising agencies market their products.

CTCR Staff: Douglas Eadie, Elinor Devlin (left 2005) and Kathryn Angus

Publications:
Devlin E, Hastings GB, Eadie DR, Angus, K and Stead M (2004). Smoking prevention: where social and critical marketing meet. Presentation to the Academy of Marketing conference, Cheltenham, UK 7-9th July.

URL: http://www.tobaccopapers.com

The Framework Convention on Tobacco Control is a public health landmark: it sets down for the first time agreed international standards for protecting public health. ITCPS has been established to ensure that it is backed by a rigorous evidence base. It will greatly enhance our understanding of the impact and mechanisms of national level policy interventions such as advertising bans or public places smoking controls. The study uses a prospective cohort design, and a random sample of 8,000 smokers were recruited in four countries (UK, Canada, Australia, USA). This has provided vital feedback on such tobacco control policies as: (a) the introduction of graphic tobacco package warning labels; (b) the elimination of "light" or "mild" as descriptors of cigarette brands; (c) the elimination of advertising and promotion of tobacco products.

The project was also expanded to cover Ireland, which introduced comprehensive controls on smoking in public places, and Thailand. Other countries around the world are considering joining the study.

The research team includes internationally recognized experts in tobacco control in each of the four countries that are working together to design and conduct this international tobacco control policy survey. The CTCR and Dr Ann McNeill form the UK arm of the project.

CTCR Staff: Gerard Hastings, Susan Anderson (left 2005), Anne Marie MacKintosh and Elinor Devlin (left 2005)

Publications:
Tobacco Control Supplement 2007

Cigarette on-pack messages are one of the principal vehicles for informing smokers about the risks of smoking and research has highlighted their role as a valid health communication tool. Furthermore, they have the potential to disrupt the powerful cigarette brand imagery associated with tobacco packaging. Responding to concerns within Europe that the old style on-pack messages were ineffective and the introduction of new tobacco product legislation across Europe (EU Directive 2001/37/EC), this study was conducted to explore European smokers' response to the changes. The research drew upon two main areas of health communication: the need to pre-test messages to ensure they are appropriate for their intended audience; and the increased effectiveness of targeting messages to specific segments of the population. Two main research areas were addressed. First, the extent to which the new messages were appropriate for smokers in Europe and second, the potential to provide targeted and personally relevant messages to smokers via tobacco packs.

Fifty-six focus groups were conducted across 7 European countries (Finland, France, Germany, Greece, Spain, Sweden and the UK) with 16-64 year old smokers, half of whom were not thinking about quitting (pre-contemplators) and half of whom were thinking of quitting in the next six months (contemplators and preparers).

The research confirmed that the EU labelling format for tobacco packs, introduced in the EU Directive 2001/37/EC, was more noticeable than the one it replaced and had the potential to help smokers who wished to quit. It was also clear that the novelty of the new format had an impact.

CTCR Staff: Susan Anderson (left 2005), Elinor Devlin (left 2005), Gerard Hastings and Lynn MacFadyen

Publications:
Devlin E, Hastings G, Eadie D and Anderson S (2002). Research into the labelling of tobacco products in Europe. Proceeding of the 3rd European Conference on Tobacco or Health, Warsaw, June.

Devlin E, Anderson S, Hastings GB, Rautalahti M, Ratte S, Beck V, Kordiolis N, Marin-Tuya D, Tomson T (2003). Targeting on-pack messages: European smokers' response. Proceedings of the 12th World Conference on Tobacco or Health, Helsinki, August.

Devlin E, Anderson S, Hastings GB and MacFadyen L (2005). Targeting smokers via tobacco product labelling: Opportunities and challenges for Pan European health promotion. Health Promotion International, 20 (1): 41-49.

This research was conducted to examine young smokers' engagement with cigarette packaging and responses to current UK cigarette warnings labels, and to identify potential improvements in the content and design of labels. The manner in which young people engaged with health warnings, the effects of this on smoking attitudes, behaviour and brand image were also explored.

Sixteen mini-focus groups were conducted with young people aged 12-17 years. The groups were purposively sampled according to: gender, socio-economic group and smoking experience. The research was conducted in two stages. The first stage examined young people's responses to packaging concepts in general and explored how they engaged with packaging and used on-pack information. Their responses to cigarette warnings labels were examined in this context. The second stage examined their responses to cigarette warnings labels in more detail, and their response to potential improvements in content and design explored.

The research found that current health warnings are not very visible, credible or influential. Furthermore, that they lack novelty and sympathy with young people's needs. However, young people do notice health warnings and have genuine concerns for the health consequences of smoking. Health warnings, when improved, can be more visible, credible and effective and encourage greater processing of the health risks, particularly when pictorial warnings are included.

CTCR Staff: Lynn MacFadyen, Anne Marie Mackintosh, Elinor Devlin (left 2005) and Gerard Hastings

Tobacco Control on Public Transport (2000)
(Commissioned by Argyll and Clyde Health Board)

Research was conducted to inform the development of a local initiative to reduce exposure to environmental tobacco smoke on public transport. Research was conducted with the management and drivers of local bus companies (primary mode of transport in the study area). An initiative was launched in May 2000 to raise public awareness and to support local companies in responding to ETS issues.

CTCR Staff: Lynn MacFadyen and Douglas Eadie

A Monitor of the Tobacco Advertising Ban in the UK (1999-ongoing)
(Funded by Cancer Research UK)

In February 2003, a comprehensive ban on tobacco promotion came into effect in the United Kingdom, which prohibited tobacco marketing through print and broadcast media, billboards, the Internet, direct mail, product placement, promotions, free gifts, coupons and sponsorship. This study, initiated in 1999, monitors young people's awareness and involvement with tobacco marketing, alongside their smoking knowledge, attitudes and behaviour before, during and after the implementation of these controls on tobacco advertising and promotion. It represents a shift away from the reliance upon econometric models to assess the impact of implementing controls on tobacco marketing. This research involves repeat cross-sectional surveys administered to adolescents in Scotland, England, Wales and Northern Ireland. Measures are taken approximately every two years and the first two surveys, conducted in 1999 and 2002 provide baseline measures, collected prior to the new regulations on tobacco advertising and promotions. Surveys have been conducted in 2004 (18 months after the first stage of the ban), 2006 and again in 2008. Key measures within the surveys include, awareness of a range of forms of tobacco marketing, awareness of cigarette brands, perceptions of prevalence of smoking, smoking behaviour and smoking intentions.

A second strand to the research is an audit of the industry's marketing activities which takes place on an ongoing basis. It aims to identify and detail any innovations or changes in tobacco industry marketing to both consumers and retailers.

CTCR Staff: Anne Marie MacKintosh, Gayle Tait (left 2009), Louise Hassan (left 2007), Gerard Hastings, Susan Anderson (left 2005) and Elinor Devlin (left 2005)

Related p ublications:
Devlin E, Anderson S, Borland R, MacKintosh AM and Hastings GB (2006). Development of a research tool to monitor point-of-sale promotions. Social Marketing Quarterly, XII (1): 29-39.

Brown A, MacKintosh AM, Hastings G and Hassan L (2006). Monitoring the impact on adolescents of the UK tobacco marketing ban. Presentation at the 13 th World Conference on Tobacco or Health, Washington DC, 12th -15th July.

"Keep Smiling, No-one's Going to Die": A Review of Internal Documents from UK Tobacco Advertisers (1999-2000)

In 1999, the House of Commons Health Select Committee required disclosure of internal documents from the UK tobacco industry's main advertising agencies as part of their investigation into tobacco. The documents are unique because they come from ad agencies rather than the tobacco companies themselves, as is the norm with disclosed tobacco documents. They are particularly revealing because the ad agencies are not nearly so circumspect as their tobacco clients.

As special advisor to the Committee, Gerard Hastings was asked to review and report back on their contents. The results of this analysis are damning (BMJ 2000; Vol 321:366-371). They show that tobacco advertising is deliberately used to increase consumption as well as brand share, and that marketing - advertising combined with new product development, pricing and distribution - has a powerful effect on young people. Shockingly the documents also reveal calculated attempts to exploit the smuggled tobacco market and down play the health consequences of smoking. However, perhaps the most chilling aspect of the documents is their gung ho, flippant tone that raises not the slightest qualm about the consequences of their actions. "Keep Smiling, No-one's Going to Die" was how one creative director signed off his letter to a tobacco client; it also the title of the report we produced on these shameful documents:

http://www.tobaccopapers.com/keepsmiling/KeepSmilingReport.pdf

CTCR Staff: Douglas Eadie, Elinor Devlin (left 2005) and Kathryn Angus

Publications:
Hastings GB and MacFadyen L (2000). A day in the life of an advertising man: Review of internal documents from the UK tobacco industry's principal advertising agencies. British Medical Journal, 321(5 August): 366-371. Article

Tobacco Marketing and Young People (1998-1999)
(Funded by Cancer Research UK)

The tobacco industry uses a range of communications and promotional techniques to reach its key target groups with relevant and credible messages about smoking. Enduring brand images are a result of a carefully balanced mix of advertising, couponing, sampling, brand-stretching, packaging, point-of-sale communications, product placement and the internet. Research was conducted between January 1998 and December 1999 to investigate the impact of tobacco related marketing communications on young smokers in the UK. Observational, qualitative and quantitative methodologies were used.

CTCR Staff: Lynn MacFadyen, Gerard Hastings and Anne Marie MacKintosh

Related publication:
MacFadyen L, Hastings GB and MacKintosh AM (2001). Cross sectional study of young people's awareness of and involvement with tobacco marketing. British Medical Journal, 322(3 March): 513-517. Article