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Health Promotion International, Vol. 20 No. 1 © The Author 2005. Published by Oxford University Press. All rights reserved. doi:10.1093/heapro/dah506 For Permissions, please email: [email protected] Advance access publication 28 January 2005 Targeting smokers via tobacco product labelling: opportunities and challenges for Pan European health promotion Downloaded from ELINOR DEVLIN, SUSAN ANDERSON, GERARD HASTINGS and LYNN MACFADYEN Cancer Research UK Centre for Tobacco Control Research, University of Stirling, http://heapro.oxfordjournals.org Department of Marketing, Stirling, FK9 4LA, UK SUMMARY Cigarette on-pack messages are one of the principal increased effectiveness of targeting messages to specific vehicles for informing smokers about the risks of smoking segments of the population. Two main research areas were and research has highlighted their role as a valid health addressed. First, the extent to which the new messages were communication tool. Furthermore, they have the potential appropriate for smokers in Europe and second, the to disrupt the powerful cigarette brand imagery associated potential to provide targeted and personally relevant with tobacco packaging. Responding to concerns within messages to smokers via tobacco packs. Fifty-six focus Europe that the old style on-pack messages were ineffective groups were conducted across seven European countries and the introduction of new tobacco product legislation (Finland, France, Germany, Greece, Spain, Sweden and the at World Health Organization on May 21, 2010 across Europe (EU Directive 2001/37/EC), this study was UK) with 17–64-year-old smokers, half of whom were not conducted to explore European smokers’ response to the thinking about quitting (pre-contemplators) and half of changes. The research draws upon two main areas of health whom were thinking of quitting in the next 6 months communication: the need to pre-test messages to ensure (contemplators and preparers). Implications for future they are appropriate for their intended audience; and the labelling practices within Europe are discussed. Key words: Europe; targeting; tobacco labelling INTRODUCTION Tobacco consumption is responsible for 1.2 products is an integral element of this strategy million deaths in Europe [Word Health (Kaiserman, 1993) with many countries such as Organisation (WHO), 1999]. This figure is Australia, Poland and Canada introducing estimated to rise to 2 million and account for one tougher legislation in this area (Borland, 1997; in five of all deaths in the European region by Przewozniak and Zatonski, 2002; Health the year 2020 (Haglund, 2000). A comprehensive Canada, 2003). tobacco control strategy including policy on taxa- On-pack messages are a valid health commu- tion, tobacco promotion, nicotine replacement nication tool. Research in Australia (Borland, therapies, smoke-free public places and health 1997) found that new, more prominent informa- promotion is vital to persuade current smokers to tion on tobacco packs (covering at least the top quit and encourage young people not to start 25% of the front and the top third of the back of (World Bank, 2003). The labelling of tobacco the pack) resulted in: increased noticing of the 41 42 E. Devlin et al. warnings; more potent stimulation of negative Table 1: EU Directive on tobacco product thoughts about smoking; and the premature regulation (2001/37/EC): content of warnings stubbing out of cigarettes already lit. Research Location on pack Statement also supports design enhancements. The effec- tiveness of on-pack information can be increased Front Smoking kills by: being made more prominent (Kaiserman, Front Smoking seriously harms you and 1993); being printed in contrasting colours (Ross, others around you 1981); varying the design and content (Bhalla Back Smokers die younger Back Smoking clogs the arteries and and Lastovieka, 1984); and by being developed causes heart attacks and strokes for a target audience and informed by creative Back Smoking causes fatal lung cancer Downloaded from input and market research (Jacoby et al., 1982; Back Smoking when pregnant harms Fischer et al., 1993). Cigarette packaging is your baby Back Protect children: do not make them known to play an important role in honing and breathe your smoke supporting the imagery associated with powerful Back Your doctor or your pharmacist can cigarette brands (Carr-Gregg and Gray, 1993). help you stop smoking Research has shown that on-pack messages have Back Smoking is highly addictive, do not the ability to disrupt this brand imagery by start http://heapro.oxfordjournals.org Back Stopping smoking reduces the risk disrupting the available space on packs to of fatal heart and lung diseases communicate brand values and by undermining Back Smoking can cause a slow and the influence of commercial communication painful death (MacFadyen et al., 2001). Furthermore, Mahood Back Get help to stop smoking: (telephone, postal address, internet address, (1999) argues that an effective warning system consult your doctor/pharmacist) will create a situation of informed consent Back Smoking may reduce the blood flow regarding the nature of the risks, the magnitude and causes impotence of the dangers and the probability of occurrence Back Smoking causes ageing of the skin among smokers regarding the risks of tobacco Back Smoking can damage the sperm and decrease fertility smoke. Back Smoke contains benzene, nitrosamines, Within Europe, until recently, the labelling of formaldehyde and hydrogen cyanide at World Health Organization on May 21, 2010 tobacco products was governed by the 1992 EU Labelling Directive (EU Directive 1992/41/EC), which required a general message to be present on the most visible surface covering at least 4% As a communication device, on-pack messages (6% for countries with two languages) and an should follow the principles of communication alternating specific warning on the back of the theory and practice. It is recognized that good pack covering around 5%. The messages were communication involves the active participation required to be clear and legible, printed in bold of both the sender and the receiver (Lannon letters and printed on a contrasting background. and Cooper, 1983; Meadows, 1983; Buttle, 1991). Research in the UK and across Europe found Effective health communications must therefore that the information provided fell short of be designed in consultation with the target group, informed consent (Health Education Authority, taking account of their needs and wants (Eadie 1998) and that the messages were barely visible and Smith, 1995). Audience research is generally and not noticed by smokers (ASH, 1998). conducted to formulate, develop and evaluate EU legislation has begun to address these health communications (Atkin and Freimuth, shortcomings with the introduction of the EU 1989; Nowak and Siska, 1995). It follows that Directive on Tobacco Product Regulation (EU messages on tobacco packs, designed under this Directive 2001/37/EC). The Directive standard- process, will be more effective in achieving their izes the design and content of messages across desired objective (Ross, 1981; Kaiserman, 1993; Europe and requires messages to be printed in Eadie and Kitchen, 1999). Furthermore, careful black on a white background covering at least targeting of messages will increase their 30% of the front and 40% of the back of the pack, effectiveness (Ross, 1981; Kaiserman, 1993) and with a 5-mm black border. The Directive also it is argued that on-pack health information prescribes a list of 16 messages (two for the front should be specific and targeted to certain segments and 14 for the back), which are to be randomly of the population (Krugman et al., 1994; Mahood, rotated by member states (see Table 1). 1999). Research was therefore conducted to Targeting smokers via tobacco product labelling 43 examine the extent to which the new measures Table 2: Profile of focus group sample per country meet the needs of smokers in Europe and to explore the potential for labels to provide Gender Age Smoking status targeted and personally relevant messages. 1 Male 17–24 Contemplator/preparer The ‘Stages of Change’ model (Prochaska and 2 Male 25–34 Pre-contemplator DiClemente, 1983) was used to segment the 3 Male 35–44 Pre-contemplator target market. Prochaska and DiClemente’s 4 Male 45–64 Contemplator/preparer 5 Female 17–24 Pre-contemplator ‘Stages of Change’ model posits that behaviour 6 Female 25–34 Contemplator/preparer change involves the progression through five 7 Female 35–44 Contemplator/preparer stages: pre-contemplation, contemplation, pre- 8 Female 45–64 Pre-contemplator Downloaded from paration, action and maintenance. The model forms the basis of effective segmentation and allows messages to be designed that are tailored (those who are not thinking of quitting) and to the specific needs of the individual (Werch and ‘contemplators/preparers’ (those who are thinking DiClemente, 1994). The EU has identified those of quitting in the next 6 months). Throughout who want to quit as a priority group (Commis- this report, descriptions and analysis of sion Report, 1999). However, as the majority of ‘contemplators/preparers’ is simplified to http://heapro.oxfordjournals.org smokers are in the pre-contemplation stage it is ‘contemplators’. The sample profile for each vital to consider their views and ensure that any country is summarized in Table 2. strategy developed does not alienate them. This In order to ensure consistency across the