Tobacco Packaging and Labeling Policies: Expanding the Evidence on Novel Policies

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The primary goal of Project 2 is to build the evidence base in the area of tobacco packaging and labeling policies (Article 11 of the FCTC), in low, middle, and high income countries. Project 2 will complement the survey data described in Project 1 by collecting information directly from tobacco packages and by conducting experimental studies in "high-burden" ITC countries. Project 2 includes 4 sub-studies, each with a specific aim. Specific Aim 1 is to examine consumer perceptions of cigarette packaging design among youth and adults in 7 "high-burden" ITC countries: China, India, Bangladesh, Mexico, Republic of Korea, the United States, and Germany. Parallel experimental studies will be conducted in each of the 7 countries to examine the impact of brand descriptors (e.g., light, mild, smooth, slims) and brand imagery (e.g., colors and design) on perceptions of risk and brand appeal. Overall, the study seeks to identify potentially misleading information on cigarette packages and to evaluate the potential impact of "plain" packaging regulations. In Specific Aim 2, parallel experimental studies will be conducted with youth adults in the same 7 high-burden ITC countries to evaluate the impact of health warnings on tobacco packages. The study will examine the impact of three types of health warnings on health beliefs, message recall, and smoking susceptibility: text- only health warnings, pictorial warnings with graphic depictions of health effects, and pictorial warnings with personal testimonials. Specific Aim 3 will attempt to replicate the findings from the experimental studies in Aims 1 and 2 by integrating key measures from these studies into the population-based surveys in 7 low and middle-income ITC countries: Thailand, Malaysia, Uruguay, India, China, Mexico, and Bangladesh. Specific Aim 4 will document industry practices in cigarette packaging and their association with tobacco labeling policies. This study will systematically collect and analyze package design and descriptors from 50 leading cigarette brands in each of 20 countries, including all ITC countries. Each of the studies in Project 2 will focus upon potential similarities and differences between low,middle, and high income countries in industry practice and the effectiveness of labeling policiesa primary theme of this P01 application.