Are all cigarettes just the same? Female’s perceptions of slim, coloured, aromatized and capsule cigarettes

Abstract

Twelve focus groups in Glasgow (Scotland) were conducted with female non-smokers and occasional smokers aged 12–24 years (N = 75), with each group shown 11 cigarettes: two (standard) cigarettes with cork filters; two coloured cigarettes (pink or brown); four slim cigarettes; an aromatized black cigarette; a menthol cigarette and a cigarette with a flavour-changing rupturable capsule in the filter. Participants were asked to rank the cigarettes by appeal, taste and harm. The capsule cigarette was then discussed in depth. The pink coloured cigarette and slim cigarettes created significant interest and were generally perceived as most appealing and pleasant tasting, and least harmful. The black aromatized cigarette received a mixed response, with some disliking the dark colour and associating it with low appeal, strong taste and increased harm, whereas for others the smell helped to enhance appeal and taste perceptions and lower perceptions of harm. The novel capsule cigarette, when discussed in-depth, was viewed very positively. Just as research shows that cigarette packs can influence perceptions of appeal, harm and taste, this study suggests that the actual cigarettes can do likewise. The findings have implications for tobacco education and policy.

Introduction

The Framework Convention on Tobacco Control, a global health treaty that seeks to protect consumers from the potential harms of tobacco consumption and exposure to tobacco smoke [1], includes a number of provisions for reducing the supply and demand for tobacco. One provision for reducing demand is a ban on tobacco advertizing, promotion and sponsorship. While a growing number of countries have implemented comprehensive bans [2], tobacco companies have adapted to these changes and now give more prominence to the packaging and also the product. Indeed, tobacco industry journals describe the cigarette as an increasingly important advertizing medium for tobacco companies [3].

With coloured, patterned and capsuled filters, tactile and aromatic tipping papers, and striking designs on the cigarette paper becoming more common, the cigarette is and will continue to be fully exploited as a promotional tool [3]. However, only a few studies have explored how consumers respond to cigarette appearance [4, 5], and only one has used a youth sample and allowed participants to handle products [6]. Ford et al. [6] found that among a sample of 15 year olds the circumference, length and colour of cigarettes influenced product appeal and also harm perceptions, with the smaller circumference of slims and superslims cigarettes perceived to be less harmful. As most people begin smoking before the age of 18, and few begin after the age of 24 [7], further research gauging how young people respond to cigarette design is necessary. In this study, we focus on young females given that many non-conventional cigarettes designs, e.g. slim, aromatized, coloured and capsuled, are designed for a female audience.

Slim cigarettes were first brought to market almost half a century ago, targeted specifically at women. Virginia Slims, introduced in the 1960s, was reported to be ‘the first cigarette for women only … designed slimmer for a woman’s slimmer hands and lips’ [8]. Similarly, when Virginia Slims Superslims was launched approximately two decades later they were positioned as ‘the first low-smoke cigarette ever marketed exclusively to women. So the product, the packaging and the promotion are all designed with a decidedly feminine touch’ [9]. The slim cigarette range has further expanded and now includes slims, superslims, demislims and microslims, all with a different-sized circumference from each other and a smaller circumference than king-sized cigarettes. The latest edition to the slim cigarette range is microslims, introduced in 2013, which have a smaller circumference than superslims cigarettes (4.7 mm versus 5.0 mm) and are the thinnest factory-made cigarettes currently available in the world. Although the slim range of cigarettes has experienced exponential growth since the start of the 21st century [10, 11], only a few studies have explored consumer perceptions of these types of cigarettes [4–6].

Research has also failed to explore perceptions of cigarettes with capsules in the filters. Capsule cigarettes date back to the 1960s, when the American Tobacco Company introduced Waterford cigarettes. These cigarettes had tiny rupturable capsules of water in the filter which could be pinched to release moisture and give a fresh new flavour [12]. More recently, cigarettes containing menthol capsules within the filter appeared on the Japanese market in 2007. Brand variants featuring menthol capsules, which can be pinched to change the taste of the cigarette, are now available in most markets [13, 14]. In the UK, for instance, the first capsule cigarette, Silk Cut Choice, was brought to market in December 2011, with an additional eight capsule brand variants introduced by March 2014. These products have been an important driver of growth for tobacco companies, with the capsule cigarette segment experiencing triple digit growth globally [15] and being worth £139.7 million in 2013 in the UK, up 561% from £21.1 million in 2012 [16]. According to Imperial Tobacco, flavour-changing cigarettes now account for 2.2% of the UK cigarette market [17]. Highlighting how important these innovative products are perceived to be by tobacco companies, British American Tobacco (BAT) introduced capsule cigarettes for the entire Pall Mall brand family in the UK [18]; Pall Mall is one of BATs global flagship brands.

Just as slim cigarettes are primarily targeted at females [19], as it would appear are cigarettes with menthol capsules given the popularity of menthol cigarettes among women [20], so too are aromatized cigarettes according to tobacco industry documents [21]. Scented cigarettes are popular among women as they help address female sensitivity to unpleasant odour [22] and research has found higher use of aromatized cigarettes by females, as well as younger people, those aware of smoking-related health risks and those who perceive some cigarettes to be less harmful than others [23, 24]. Tobacco industry research suggests that cigarettes which have cigarette or tipping paper that differs from the standard cork or white may also appeal to women smokers [25]. Research on behalf of Philip Morris, sharing insights into women and smoking, suggested that ‘colored cigarette paper or tipping’ could act as an enhancement to the pleasure of female smoking [26].

Given the paucity of research exploring consumer perceptions of cigarettes, our main objective was to explore how both teenage girls and young women perceived a range of cigarettes, including slim, capsule, aromatized and coloured cigarettes. Due to the exploratory nature of the research focus groups were used, which offer participants the opportunity to freely express their attitudes and beliefs, encourage interaction and discussion, and can provide rich insights into how and why participants respond the way they do [27, 28].

Methods

Design and sample

Twelve focus groups were conducted with 12–24-year-old females (N = 75) in Greater Glasgow (Scotland), segmented by age (12–14, 15–17, 18–24) and social grade (ABC1, C2DE); social grade was determined by the occupation of the chief income earner within the household, where social grades A, B and C1 signify higher income groups while social grades C2, D and E signify lower income groups. We focused on 12–24 year olds because although most smokers (66%) start smoking before 18, many (29%) begin between the ages of 18–24 [7]. We had intended to also segment groups by smoking status (non-smokers [NS] and occasional smokers [OS]); however, there were difficulties recruiting OS for 12–14-year olds. As such, all 12- to 14-year old groups comprised only NS; see Table I for sample composition. We targeted only NS and OS, defined as those who smoked less than daily, as understanding how those yet to start smoking, or yet to become regular (daily) smokers, perceive cigarette appearance may help inform tobacco education and policy.

Participants were recruited using convenience sampling by market research recruiters during October and November 2013. Market recruiters were instructed to intercept potential participants in the street, in the Greater Glasgow area, and explain that the study was concerned with what young females think about the different ways that tobacco products are marketed. A recruitment questionnaire was used to capture information about age, social grade and smoking behaviour to determine eligibility for inclusion. Response rates were not recorded, however. The groups took place between November and December 2013, in community centres in Greater Glasgow. Within each group, we gauged perceptions of packaging and cigarettes, with a focus on superslims packaging (not presented here) and slim, capsule, aromatized and coloured cigarettes; these types of cigarettes are available in most markets.

Procedure

Informed participant consent, and parental consent for those aged 12–17, was obtained prior to study onset. Those agreeing to participate were given an information sheet explaining what the study involved and that it would be audio-recorded. Both the information sheet, and a consent form completed prior to study onset, explained that participation was voluntary; participants could withdraw at any time without providing a reason; participants did not have to respond to any questions, which made them feel uncomfortable; and that anything said would be confidential.

At the end of each group, participants were debriefed about the harms associated with tobacco use, the addictive nature of cigarettes, and that tobacco companies target young women with pack and cigarette design. Those within the 12–14 and 15–17-year-old groups, i.e. below the legal age limit for the purchase of tobacco products, were also given an age appropriate take home pack including information on smoking-related harms and how tobacco marketing may promote smoking among youth. The study received ethical approval from the Management Department Ethics Committee in the University of Stirling.

Results

Appeal

In general, NS viewed cigarettes as less appealing than OS. Nevertheless, the pink (Sobranie Cocktails) cigarette generated a favourable reaction and was ranked as or among the most appealing in 11 of the 12 groups, described as ‘lovely’, ‘pretty’, ‘young’ and ‘fun’ and likened to makeup and sweets, e.g. ‘It looks like colourful and nice sweets’ (15–17, NS). The pink cigarette was viewed as ‘quite exciting’ (15–17, OS) and repeatedly said to be unrecognizable as a cigarette, which added to its appeal, e.g. ‘I think the pink one looks really nice and girly. It doesn’t look like a cigarette’ (12–14, NS).

That pink one is my favourite. It looks like my lip liner (18–24, NS)

I can’t believe there is a pink fag, I am so fascinated (18–24, NS)

Some participants within the two 18–24-year-old occasional smoking groups were enthused by the pink colour, which appeared to bring an element of fun into smoking. One said they wanted to try it and others said that if their usual brand gave the option of a pink variant they would choose that one.

I think you would want to smoke it just for the fun of it (18–24, OS)

The pink one looks alright. I’d smoke that (18–24, OS)

Like the pink cigarette, the four slim cigarettes tended to be considered appealing, often said to look nicer than the other cigarettes and with more interesting design elements, e.g. ‘That one looks quite pretty cos it’s got a wee design’ (15–17, OS). They were described as ‘petite’, ‘cute’ and ‘cool’ and thought to look more like ‘candy sticks’ (18–24, OS) than cigarettes. They also were associated with discretion, e.g. ‘You could hide that so your parents don’t find out’ (12–14, NS). Some participants were aware of slim cigarettes, particularly in the 18–24 age groups, and one participant said she had bought superslims before.

One of the girls was smoking them (superslims) on her break and she gave me it to try … I nearly died when I seen the price of them but I bought them anyway because they looked nice, the packet was beautiful and I felt as if I wasn’t doing much harm to myself (18–24, OS)

While eight groups placed all four slim cigarettes together when they ranked them by appeal, four differentiated them by size. In the four groups which differentiated them by size the thinnest cigarette, the microslim, was generally considered less appealing than the others and described as ‘weird’, ‘stupid’ and ‘too thin’. The stability of the microslim was also questioned: ‘It looks like you would break it as soon as you would touch it’ (12–14, NS). Some participants were also critical of the potential smoking experience with the microslim, although for others this criticism extended to the entire slim range. Interestingly, the participant who had previously smoked superslims said that she would smoke two at a time.

I used to smoke two of them … Just one after the other … like kind of airy fairy, it wasn’t really like smoking a cigarette (18–24, OS)

They just look pointless. I don’t think there would be any point in smoking them. They wee skinny ones (18–24, NS)

Participants who liked the design of the slim cigarettes thought they may provide an appealing option for people who do not really want to smoke, want to quit, or are just starting, e.g. ‘I think if you were like starting, that would be like the one you would go for cos it’s the smallest’ (12–14, NS)

I would smoke that because of the wee flowers, and it wouldn’t look disgusting in my ashtray (18–24, OS)

I think the slimmer ones look, just like I said before, they look as if you don’t really want to smoke, you are just smoking cos other people are. They are so flimsy kind of looking (15–17, NS)

The black aromatized cigarette generated a mixed response, with four groups, mostly OS, ranking it among the most appealing and seven groups as among the least appealing; one group positioned it in the middle. Those who found it unappealing tended to associate it with a strong taste and increased harm. Those rating it as appealing said that, like the pink one, it was an unusual colour, and also that it looked ‘classy’, ‘expensive’ and ‘high-end’. The gold band on the filter added to these perceptions. The scent, thought to smell like an ‘air freshener’, ‘candle’ or ‘liquorice’, helped enhance appeal, e.g. ‘It’s a bit perfumed so it might not be as noticeable as like the other ones, so if someone doesn’t want to smell of smoke they might want that’ (12–14, NS). One group of NS suggested the scent was added to make smokers feel better: ‘It’s like they’re trying to take away the badness of it by putting in a scent’ (18–24, NS). Indeed, after rating the black cigarette as harmful, one OS commented: ‘See now that I’ve smelled it, it doesn’t look so bad’ (18–24, OS).

I would smoke the black one. It smells really nice and it looks quite cute (18–24, OS)

I think it smells quite nice so I think if I was smoking it I wouldn’t be put off by the smell (18–24, NS)

The capsule and menthol cigarettes were, for the most part, placed together and ranked in the middle in terms of appeal, being considered ‘cleaner’ and ‘fresher’ than the standard cork-filtered cigarettes. Where separated, the capsule cigarette was ranked as more appealing than the menthol cigarette because of the innovative ‘bursting’ function. The two standard cork-filtered cigarettes (hereafter, referred to as ‘standard’ cigarettes) were referred to as ‘plain’, ‘boring’, ‘ugly’ and ‘dirty’ and generally had low appeal. In all but one group, the brown cigarette was perceived as least appealing, described as ‘disgusting’ and looking like a ‘cigar’ or ‘cinnamon stick’.

Taste

When ranked in order of taste, the slim, pink, capsule and menthol cigarettes were generally perceived to be more pleasant tasting than the ‘standard’ cigarettes. The four slim cigarettes were typically grouped together and always considered among the ‘most pleasant’ tasting or in the middle. Their slimmer dimensions and more feminine, ‘delicate’ and ‘fancy’ designs, such as purple graphics or white tips, were thought to communicate a weaker taste.

The purple ones, the kind of skinnier ones would taste nicer than that one with the grey tip because they are like more feminine …They won’t be as strong (15–17, OS)

One group ranked the superslim cigarette with its floral design as ‘most pleasant’ tasting, with a more pleasant taste being associated with the perceived effort put into the cigarette design. Three groups differentiated the microslim, perceived to be the weakest tasting out of all the cigarettes. For two of these groups, both OS, this resulted in a more pleasant taste perception, but a less pleasant taste perception for the other, non-smoking, group.

I actually think that (microslim) would be quite pleasant because you wouldn’t really get much out of it, it would just be a wee oh, and then that’s it (18–24, OS)

While two groups positioned the pink cigarette as ‘unpleasant’ tasting, this cigarette was generally considered among the ‘most pleasant’ tasting. The pink colour was repeatedly said to be indicative of a nicer taste and there was often the expectation that it might be flavoured. Strawberry flavour was a common suggestion, while others said that it might taste like ‘sweets’, ‘yogurt’ or ‘bubblegum’.

The pink one looks as if it would taste of something nice and sweet … It’s like pink, it’s like a girly colour and like sweets and stuff (12–14, NS)

The black cigarette again received a mixed response. Groups which ranked it as pleasant tasting asked if it tasted like it smelled or assumed that it did, e.g. ‘I think because of the way it smells it probably tastes a bit better’ (18–24, NS). Similar to the pink cigarette, some participants expected a more unusual taste from the black cigarette, such as ‘liquorice’ or ‘vanilla’. Those that ranked the black cigarette as unpleasant tasting said the colour reminded them of ‘tar’ and ‘cigars’, and because of the colour they expected the cigarette to have a very strong taste.

The menthol and capsule cigarettes tended to be ranked as pleasant tasting or in the middle. Participants inferred menthol flavouring from the pale tips and green design elements. These cues indicated a ‘mintier’ and more ‘refreshing’ taste than the standard cigarettes: ‘They look good to taste because the green’ (12–14, NS). It was unusual for groups to rank the standard cigarettes as more or equally pleasant tasting as the slim, pink or menthol flavoured cigarettes. When they were ranked similarly, mostly by non-smoking groups, the reasoning given was that these are the norm and the preferred choice of most smokers and must, therefore, be good: ‘Everyone smokes them so you think those must taste nice’ (12–14, NS). The standard cigarettes were, however, viewed more positively than the long brown cigarette, considered unpleasant tasting by all groups.

Harm

The general view was that all cigarettes were harmful, although some were considered less harmful than others. The four slim cigarettes were usually placed together and considered among the least harmful in 10 groups: ‘They don’t seem dangerous’ (15–17, NS). Their size was the key reason for this: ‘They look better for you cos they are quite thin and that tiny one’s really short as well’ (12–14, NS). There was a perception that the smaller diameters of these cigarettes imply that they contain less harmful ingredients and are ultimately less harmful, e.g. ‘You’d have to smoke thousands to do something bad to you’ (18–24, NS). It was also suggested that these cigarettes would take less time to smoke than a standard cigarette, thus reducing the level of exposure to harm and helping the concerned smoker feel better about smoking. Two groups differentiated the microslim from the other three slim cigarettes and ranked it as less harmful due to its smaller size.

They won’t feel as bad about it if it’s like if you’re smoking it quicker you’re not doing as much damage as having a normal cigarette (18–24, NS)

The smaller ones look less harmful …

Because there is probably less tobacco in it

Less things in it (12–14, NS)

Like the slim cigarettes, the pink cigarette was generally ranked as among the least harmful, due to the colour rather than the size. That the pink cigarette looked ‘pretty’, ‘delicate’ and ‘happier’ also influenced harm perceptions, as did the fact that it did not look like a cigarette.

It just looks like it would be less harmful, but obviously they all are, but it just looks like it (12–14, NS)

It just doesn’t look like a cigarette so that just makes it look less harmful (12–14, NS)

Interestingly, one non-smoking group ranked the pink cigarette as most harmful, suggesting that the pink colour was perhaps masking a higher level of harm: ‘It just seems like they are trying to cover something up … they are trying to compensate for something by having it pretty’ (12–14, NS). It was also suggested that there might be additives in the pink dye which may be harmful.

The black cigarette was consistently considered among the most harmful, except for one non-smoking and one occasional smoking group who thought it may be less harmful because of the pleasant smell. The high perceived level of harm of the black cigarette was related to the perception that it was strong tasting, with the dark colour implying a high tar level and serving as a reminder of the health risks associated with smoking. Within a 12–14-year-old group, it was suggested that because this cigarette looked harmful it would not be the ones people their age would choose.

That (black) is so scary looking (18–24, OS)

The black one would be at the very bottom because it makes you like, that’s what, that’s what you are doing to your body, making it go black (12–14, NS)

The capsule and menthol cigarettes tended to be placed together and ranked as less harmful, positioned either alongside the four slim and pink cigarettes or as slightly more harmful than these cigarettes. The capsule and menthol cigarettes were, however, usually ranked less harmful than the two standard cigarettes. The prevailing view was that menthol flavouring implied a safer cigarette.

I’d put the menthol as the least harmful … Cos they’re mints, so you widnae (would not) think mints would hurt you (15–17, NS)

It’s like you associate mint with like tasting nice and stuff and so really if you had a cigarette you wouldn’t think it would be doing you harm because you are tasting mint (12–14, NS)

The standard cigarettes were typically considered more harmful than the slim and pink cigarettes but less harmful than the brown and black cigarettes. Two of the 12–14-year-old non-smoking groups did, however, view these cigarettes as less harmful because they are popular, e.g. ‘Because everyone smokes them, so you would think, if everyone smokes them, they are going to be less harmful’ (12–14, NS). The brown cigarette was rated as the most harmful in every group, due to the colour, and was not considered a cigarette that others their age would use.

Capsule cigarettes

After the ranking exercises, the capsule cigarette was discussed in more detail, with groups shown the menthol capsule inside the filter. Within three occasional smoking groups, several participants said they had tried smoking this type of cigarette, it being the preferred product type for one smoker: ‘I can smoke normal fags, but sometimes I like a menthol fag so I can just smoke it and, if I feel like a menthol fag, I just press it’ (18–24, OS). Having the choice of smoking with or without menthol flavouring was seen as a positive, providing the ‘Best of both worlds’ (18–24, NS).

The capsule design was referred to as ‘cool’, ‘funky’ and ‘high-tech’ and every group saw advantages in this type of cigarette. The ‘click’ design was thought to offer novelty and hold appeal to children, people keen to try something different or smokers bored of their regular brand. Several participants spoke of their desire to want to press the capsule, while others said they would consider trying or buying this type of cigarette.

If you weren’t to hear that smoking was bad for you or anything and you were to see that then all children would want to try it (12–14, NS)

I just think it’s quite cool personally, the fact it clicks

And it changes flavour and all, whether you like it or not, you just click it and that’s it

… I’d buy them (18–24, OS)

Many participants thought the cigarette would be less smelly than a standard cigarette, provide fresher breath, be gentler on the throat, and would make it less obvious that somebody had been smoking, e.g. ‘They would make your breath fresh wouldn’t they at the end of your fag’ (18–24, NS). Several likened it to finishing off a cigarette with a chewing gum, e.g. ‘Because you’re smoking a cigarette and then all of a sudden it’s like chewing gum’ (15–17, NS). As such it was considered a cigarette for occasions such as a ‘party’, ‘wedding’, ‘prom’, or ‘night out’, and for somebody who worried about the smell of smoking cigarettes or who had a sore throat.

Within all the 12–14 groups, and two of the 15–17 groups, participants spoke of this being a cigarette for young people: those starting smoking but not yet used to the taste of cigarettes or who were trying to hide smoking from their parents.

Like someone might be feeling left out because they don’t like the taste of a cigarette. They might, like, try that one so you can change the taste of it (12–14, NS)

I’m thinking like if you are like a teenager like your parents don’t know you smoke, that would come in more handy cos they wouldn’t be able to smell it off you (12–14, NS)

While in the harm ranking activity, the capsule cigarette was placed alongside the menthol cigarette and towards the least harmful, perceptions of harm were less clear after participants were shown the capsule inside the filter. While the perception that the capsule cigarette would be less harmful persisted, some participants recognized that the cigarette was just the same as a standard cigarette but with a different flavouring. Others thought it would be more harmful. These participants were surprised at the capsule’s appearance, likened it to chemicals and became concerned about the extra ingredients needed to change the taste.

Less harmful, because it’s got a wee button, this wee cool invention (18–24, NS)

That looks more dangerous … once you open it … It’s a good idea, but that just looks like something you would put in your laundry,

It’s just extra chemicals isn’t it? (18–24, OS)

Discussion

Our findings are consistent with the few studies which have explored consumer response to cigarette appearance in showing that cigarette appearance can influence perceptions of harm, appeal and taste [4–6]. The findings are also consistent with research on cigarette packaging, where pack design has a significant impact on perceptions of appeal, taste and harm [29, 30].

The slim cigarettes generally held high appeal, consistent with research with teenagers [6] and tobacco industry research with young women. For instance, research for Philip Morris found the look of superslims cigarettes a major attraction for young women, being described as dainty, feminine, stylish and cute [31]. In this study, slim cigarettes were described as lovely, pretty, fun, cool and cute. The slimness of these cigarettes, and thus lower tobacco weight, was also viewed as an indicator of reduced harm. Research has found, however, that while a superslims cigarette had lower yields of carbon monoxide, carbonyls, volatiles and aromatic amines in comparison to a Canadian Benchmark cigarette, the reduced circumference significantly increased the yields of formaldehyde, ammonia and phenols in mainstream smoke emissions [32]. The authors conclude that superslims cigarettes are not less harmful than other cigarettes. Interestingly, the one former superslims smoker, in this study, commented that she felt she was doing herself less harm when smoking superslims, and reported smoking two superslims cigarettes at a time, one after the other, because she did not feel like she was smoking a standard cigarette. If smokers of slim cigarettes are engaging in compensatory smoking behaviour because they believe these products to carry a reduced health risk, this has significant implications for public health. Future research with smokers of slimmer cigarettes is needed to explore this further.

The pink cigarette was considered appealing, pleasant tasting and having a lower level of harm than the other cigarettes participants were shown. Terms such as ‘happier’ and ‘fun’ were associated with the pink cigarette, with this positive evaluation linked to its lack of prototypicality, consistent with research on other consumer products [33]. Similarly, for those who considered the black aromatized cigarette positively, this was primarily due to the fact that it did not smell like a cigarette. Fragrances are important for marketers because they instantly connect to emotions, mood and memory, and can subconsciously affect product perceptions and also purchase decisions [34]. This finding highlights how the sensory appeal of tobacco products extends beyond how they look.

Capsule technology is one the most important innovations in the tobacco sector in recent times [35], with a BAT spokesperson going as far as to call them the ‘biggest innovation in cigarettes since the filter’ [36]. The global growth of the capsule cigarette market is likely to continue, particularly as the number of capsule brand variants continues to increase and tobacco companies replace existing brand variants, and even entire brand families, with capsule cigarettes [18]. Participants clearly appreciated the novelty of these products, described as a ‘cool invention’; the desire among young people for something ‘new’ is recognized within tobacco industry documents [37]. Indeed, highlighting how positively these products are perceived, there was a desire to try and ‘click’ the filter to change the taste, and some participants mentioned product trial or purchase, consistent with tobacco industry research [38].

That some NS and OS within our sample were receptive to certain cigarettes, particularly the slim, pink, aromatic and capsule cigarettes, is a potential concern as receptivity to a range of tobacco marketing practices has been found to be associated with susceptibility to start smoking [39–41] and progression to regular smoking among young people [42–44]. Whether cigarette design and appearance does have any influence on smoking uptake and progression to regular smoking is beyond the scope of this study, and future research should explore whether this is the case. The findings are nevertheless important as they suggest that some cigarettes can generate interest and appeal among young people and some, particularly slimmer cigarettes, communicate misleading messages about harm.

Tobacco education within schools has the potential to play an important role in encouraging young people to resist wider pressures from the social environment, including pressures from the tobacco industry. A ‘social influence resistance model’ is often used in tobacco education with the aim of teaching children to recognize marketing tactics used to promote smoking among young people, which could also include cigarette appearance, and there is some evidence that this is an effective school-based education intervention [45]. A review of the literature suggests that programmes teaching young people to resist social influences, which could include tobacco marketing, and also to be socially competent, have been found to be most effective [46].

An alternative approach to education, and one which would prevent exposure to these products in the first instance, would be to standardize cigarette appearance. Australia remains the only country to have done so, at least in terms of banning the use of branding on the cigarette and stipulating the colour of the tipping and cigarette paper, although slim and capsule cigarettes are still permitted. Within the European Union, the new Tobacco Products Directive (TPD) will ban aromatized cigarettes and capsule cigarettes from May 2016, but it will not prohibit slim or coloured cigarettes. The European Commission did propose a ban on slim cigarettes (<7.5 mm in diameter) in December 2012 [47], with the draft TPD, which was approved by the European Parliament’s Public Health Committee in July 2013, but this recommendation was not included within the final TPD. As such, no country places any restrictions on cigarette diameter, even though slim cigarettes may mislead consumers in respect to how harmful they are. Although there have been attempts in Australia and the EU to control the design and appearance of cigarettes, globally tobacco companies continue to have a great deal of freedom in respect to this increasingly important advertizing medium.

In respect to limitations, like all qualitative research the findings are not generalizable to the wider population. Furthermore, while we deliberately selected teenage girls and young women as our sample, the study provides no insight into the response from older women or males. Given that our entire sample was white British, we were also unable to explore ethnic or cultural differences, which would be a fruitful area of future research. In addition, while our findings show that perceptions can be influenced by the design of a cigarette, they provide no insight into the potential impact, if any, on subsequent trial. Finally, the novelty of some of the cigarettes, particularly the aromatized cigarette and microslim, which were not available for sale in Scotland at the time of the study, may have influenced how they were perceived.

Qualitative research for RJ Reynolds in the 1980s suggested that product development that could capture the 18–24-year-old female market could be made along three dimensions: visual (length; filter tip colour other than white or cork; cigarette paper colour; diameter); taste (via flavours); and aroma [25]. Over 30 years on and these products are available for sale across the world, influencing perceptions among not only young adult women (18–24) but also teenage girls as well.

Funding

This study was funded by Cancer Research UK.

Conflict of interest statement

None declared.

References