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Original research
Role of affective reactivity induced by cigarette packaging including graphic warning labels: the CASA Study
  1. Matthew Stone1,2,
  2. David Strong1,3,
  3. Claudiu Dimofte4,
  4. Elizabeth Brighton1,
  5. Jesica Oratowski1,
  6. Tingyi Yang1,
  7. Manar Alkuzweny1,
  8. Atean Asslani1,
  9. Katherine Velasco1,
  10. Michael Skipworth1,
  11. Noe C Crespo2,
  12. Samantha Hurst1,3,
  13. Eric C Leas1,3,
  14. Kim Pulvers5,
  15. John P Pierce1,3
  1. 1 Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
  2. 2 School of Public Health, San Diego State University, San Diego, California, USA
  3. 3 Cancer Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
  4. 4 Marketing Department, San Diego State University, San Diego, California, USA
  5. 5 Department of Psychology, California State University San Marcos, San Marcos, California, USA
  1. Correspondence to Dr Matthew Stone, Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA 92093, USA; m3stone{at}health.ucsd.edu

Abstract

Objective To identify whether three types of cigarette pack designs, including three versions of graphic warning label (GWL) plain packs, one GWL absent and branding absent pack (blank) and the smoker’s own GWL absent and branding present pack (US), elicit different valence, type and levels of affect.

Design US daily smokers (n=324) were asked to handle each of the five pack types and ‘think aloud’ their reactions. To avoid a muted familiarity response, exposure to their own US pack followed exposure to at least one GWL plain pack. Reactions were scored on a reactivity scale (−3 to +3) and the text was coded for speech polarity (−1 to +1) and emotive word frequency.

Results Reactivity scores had excellent inter-rater reliability (agreement ≥86%; intraclass correlation coefficient ≥0.89) and were correlated with speech polarity (r=0.21–0.37, p<0.001). When considering their US pack, approximately two-thirds of smokers had a low (31.5%) to medium (34.6%) positive response (reactivity=1.29; polarity=0.14) with expressed feelings of joy and trust. Blank packaging prompted a largely (65.4%) neutral response (reactivity=0.03; polarity=0.00). The gangrenous foot GWL provoked mostly medium (46.9%) to high (48.1%) negative responses (reactivity=−2.44; polarity=−0.20), followed by neonatal baby (reactivity=−1.85; polarity=−0.10) and throat cancer (reactivity=−1.76; polarity=−0.08) warnings. GWLs varied in their elicitation of disgust, anger, fear and sadness.

Conclusion Initial reactions to GWL packs, a blank pack, and smokers’ current US pack reflected negative, neutral, and positive affect, respectively. Different versions of the GWL pack elicited different levels and types of immediate negative affect.

  • packaging and labelling
  • prevention
  • public policy

Data availability statement

Data are available upon reasonable request. Deidentified data and a measures codebook will be made available on request.

https://doi.org/10.1136/tobaccocontrol-2021-056650

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    Data availability statement

    Data are available upon reasonable request. Deidentified data and a measures codebook will be made available on request.

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    Footnotes

    • Twitter @MatthewDavStone

    • Contributors DS and JPP were co-principal investigators responsible for the study and data collection. KP was co-investigator responsible for data collection. MS, SH, DS and JPP helped to conceptualise the study. MS conducted the analyses, prepared the tables and figures, and wrote the majority of the manuscript with the help of JPP and DS. All coauthors aided in interpreting the analysis and critically reviewed and revised the manuscript. DS and MS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the manuscript.

    • Funding This project was supported in part by National Cancer Institute Grant: R01-DA033296 and the Tobacco-Related Disease Research Program Grant: 28DT-0005.

    • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of NCI or TRDRP.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.