E-cigarette use in global digital youth culture. A qualitative study of the social practices and meaning of vaping among 15-20-year-olds in Denmark, Finland, and Norway.

BACKGROUND: The introduction of e-cigarettes on the tobacco market has brought new regulatory challenges, and particular concerns relate to e-cigarette uptake among young people. The aim of this study was to explore the use and social meaning of e-cigarettes among Nordic young people and to discuss this in the context of current legislation. METHODS: Thirteen focus groups were conducted with 46 Danish, Finnish, and Norwegian young people (24 boys) with vaping experience aged 15-20 years (mean age 17 years). RESULTS: Young people's vaping stood out as an inherently social practice that was commonly interlinked with experimental use patterns. Relative to smoking, vaping was seen as socially acceptable and less harmful to health. Product innovations like flavour additives and nicotine-free liquid options added to perceptions of low harm, and innovative device design features facilitated new and playful user practices. Finally, digital markets eased the young people's access to e-cigarettes, and the digital world also represented an arena for e-cigarette exposure and self-presentation. They commonly viewed vaping-related content in their social media feeds and also produced such content themselves. CONCLUSION: Young people's vaping is a social practice interwoven in contemporary digital and global youth culture. Transnational regulations are needed to support individual countries in preventing e-cigarette use and exposure among young people.

Towards Tobacco-Free Generation: implementation of preventive tobacco policies in the Nordic countries.

AIMS: Europe's Beating Cancer Plan set a goal of creating a Tobacco-Free Generation in Europe by 2040. Prevention is important for achieving this goal. We compare the Nordic countries' preventive tobacco policies, discuss the possible determinants for similarities and differences in policy implementation, and provide strategies for strengthening tobacco prevention. METHODS: We used the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) to identify the key policies for this narrative review. We focused on Articles 6, 8, 9, 11, 13 and 16 of the WHO FCTC, and assessed the status of the required (core) and recommended (advanced) policies and their application to novel tobacco and nicotine products. Information on the implementation of strategies, acts and regulations were searched from global and national tobacco control databases, websites and scientific articles via PubMed and MEDLINE. RESULTS: The WHO FCTC and European regulations have ensured that the core policies are mostly in place, but also contributed to the shared deficiencies that are seen especially in the regulations on smokeless tobacco and novel products. Strong national tobacco control actors have facilitated countries to implement some advanced policies - even as the first countries in the world: point-of-sale display bans (Iceland), outdoor smoking bans (Sweden), flavour bans on electronic cigarettes (Finland), plain packaging (Norway), and plain packaging on electronic cigarettes (Denmark). CONCLUSIONS: Collaboration and participation in reinforcing the European regulations, resources for national networking between tobacco control actors, and national regulations to provide protection from the tobacco industry's interference are needed to strengthen comprehensive implementation of tobacco policies in the Nordic countries.

Single, Dual, and Triple Use of Cigarettes, e-Cigarettes, and Snus among Adolescents in the Nordic Countries.

New tobacco and nicotine products have emerged on the market in recent years. Most research has concerned only one product at a time, usually e-cigarettes, while little is known about the multiple use of tobacco and nicotine products among adolescents. We examined single, dual, and triple use of cigarettes, e-cigarettes, and snus among Nordic adolescents, using data of 15-16-year-olds (n = 16,125) from the European School Survey Project on Alcohol and other Drugs (ESPAD) collected in 2015 and 2019 from Denmark, Finland, Iceland, Norway, Sweden, and the Faroe Islands. Country-specific lifetime use of any of these products ranged between 40% and 50%, and current use between 17% and 31%. Cigarettes were the most common product in all countries except for Iceland, where e-cigarettes were remarkably more common. The proportion of dual and triple users was unexpectedly high among both experimental (24%-49%) and current users (31-42%). Triple use was less common than dual use. The users' patterns varied somewhat between the countries, and Iceland differed substantially from the other countries, with a high proportion of single e-cigarette users. More knowledge on the patterns of multiple use of tobacco and nicotine products and on the potential risk and protective factors is needed for targeted intervention and prevention efforts.

The Response of Smokers to Health Warnings on Packs in the United Kingdom and Norway Following the Introduction of Standardized Packaging.

INTRODUCTION: Standardized packaging was phased in between May 2016 and May 2017 in the United Kingdom and July 2017 and July 2018 in Norway. In both countries, the health warnings on packs prior to standardized packaging being implemented were from the former Tobacco Products Directive library of warnings (text warnings covering 43% of the pack front and pictorial warnings covering 53% of the pack reverse). The warnings on packs, postimplementation, were from the current Tobacco Products Directive library of warnings (novel pictorial warnings covering 65% of the pack front and reverse) for the United Kingdom but unchanged in Norway. AIMS AND METHODS: Longitudinal online surveys were conducted prior to standardized packaging (United Kingdom: April-May 2016; Norway: May-June 2017) and postimplementation (United Kingdom: September-November 2017 and May-July 2019; Norway: August-September 2018). We explored smokers' response to the on-pack warnings (salience, cognitive reactions, and behavioral reactions). RESULTS: In the United Kingdom, noticing warnings on packs, reading or looking closely at them, thinking about them, thinking about the health risks, avoidant behaviors, forgoing cigarettes, and being more likely to quit due to the warnings significantly increased from waves 1 to 2, and then decreased from waves 2 to 3, but remained higher than at wave 1. In Norway, noticing warnings, reading or looking closely at them, thinking about them, thinking about the health risks, and being more likely to quit due to the warnings significantly decreased from waves 1 to 2; avoidant behaviors and forgoing cigarettes remained unchanged. CONCLUSIONS: The inclusion of large novel pictorial warnings on standardized packs increases warning salience and effectiveness. IMPLICATIONS: Two longitudinal online surveys in the United Kingdom and Norway explored the impact of standardized packaging on warning salience and effectiveness. That warning salience and effectiveness only increased in the UK postimplementation, where standardized packaging was implemented alongside new larger pictorial warnings on the pack front and reverse, and not in Norway, where standardized packaging was introduced but older smaller text warnings (pack front) and pictorial warnings (pack reverse) were retained, highlights the importance of removing full branding and introducing stronger warnings simultaneously.

Normalisation of non-drinking? 15-16-year-olds' accounts of refraining from alcohol.

INTRODUCTION AND AIMS: In many countries, adolescents' drinking has decreased substantially over recent years. This study aims to explore Norwegian adolescents' accounts of refraining from drinking alcohol and how their explanations are contextualised. DESIGN AND METHODS: Semi-structured qualitative interviews were conducted with 95 adolescents aged 15-16 years (50 females), recruited from six schools in Norway. Interviews examined perceptions and experience of alcohol use, and how non-drinking was reasoned for. RESULTS: The adolescents' accounts of refraining from alcohol were sorted into three categories: (i) influence from non-drinking peers and negative social norms towards alcohol use: non-drinking was described as the norm in their age group; (ii) legal age and relationship to parents: age limits and parents' disapproval of drinking was perceived as justifiable; and (iii) non-drinking to sustain control: alcohol use was perceived as implying loss of control of self-presentation in specific situations, and risk of negative exposure on social media. It was also seen as implying risk of loss of control of future achievement in school or sports. DISCUSSION AND CONCLUSIONS: The adolescents' explanations for non-drinking indicated a devaluation in the social position of alcohol among younger adolescents. Non-drinking was described as majority behaviour and fitting in with a life orientation towards both present-day and future achievement. Their accounts pointed towards a normative effect of age limits on buying alcohol and highlighted the significance of emotional closeness and open communication about alcohol with parents. The results indicate a differentiated normalisation of non-drinking in this age group.

Frightening or Foolish? Gendered Perceptions of Public Intoxication Among Youths and Adults in Norway and Finland.

Background: What people define as acceptable alcohol use may differ between social situations and depend upon on who is drinking as well as who is evaluating the situation. Objective: The aim of the study was to explore how Norwegian and Finnish youth and adults perceived the acceptability of situations involving public intoxication and how gender and alcohol's harm to others were made relevant in their reflections. Methods: We conducted eight focus groups among adolescents (N = 44) and eight among adults (N = 38), using photos and stories of drinking situations as stimuli for the discussions. Results: Youths' and adults' perceptions of public intoxication were characterized by ambivalence: negative evaluations were often nuanced and negotiated while positive evaluations typically were followed up with reservations. To some extent, their evaluations depended upon the gender and age of the drinker. Although a norm of gender equality was emphasized, women were typically criticized for their looks and for foolish behavior when drunk, while drunk men were often perceived as frightening. Age was a prominent dimension in evaluations of the acceptability of women's alcohol use, while it was seldom mentioned when discussing intoxicated men. Youths seemed to have somewhat more restrictive attitudes towards public intoxication than adults, reflecting perhaps how they related to the situations with more general conceptions of drinking and harms from drinking, picked up from public debate or from school. Conclusion: Perceptions of alcohol's harm to others were clearly gendered, in that intoxicated men were seen as frightening while women were seen as foolish.

Monitoring young lifestyles (MyLife) - a prospective longitudinal quantitative and qualitative study of youth development and substance use in Norway.

PURPOSE: The Monitoring Young Lifestyles (MyLife) project was initiated as an integrated quantitative and qualitative prospective investigation of correlates, causes, and consequences of adolescent substance use and other addictive behaviours in Norway. PARTICIPANTS: The MyLife cohort was recruited from middle schools in Norway, which were selected from low, medium and high standard of living areas in both rural and urban regions of the country. A total of 3512 eighth, ninth and tenth graders (55% girls) from 33 schools were enrolled in the quantitative project arm (QT), while a total of 120 eighth graders (52% girls) from six schools were enrolled in the qualitative project arm (QL). FINDINGS TO DATE: QT baseline was conducted in the fall of 2017, when 2975 adolescents completed an online questionnaire at school during a regular class time. A total of 2857 adolescents participated in the first QT follow-up 1 year later. QL baseline was conducted across the fall semesters of 2014 (one class) and 2015 (five classes), when a total of 118 eighth graders completed face-to-face interviews. QL follow-ups were conducted in the spring of 2015 and fall of 2017 (n=98) for group interviews, and in the spring of 2017 and 2018 (n=95) for individual interviews. In terms of additional data sources, a total of 3035 parents consented to own participation, of which 1899 completed a brief online questionnaire at QT baseline in late 2017. School principals completed brief surveys at the same time. FUTURE PLANS: Both QT and QL arms have planned follow-ups through 2021. Consents were obtained for individual-level linkages of adolescent and parental quantitative surveys to each other, as well as to the information available in multiple national registries and databases. These supplemental data sources will provide key information on additional putative exposures as well as on the long-term health, educational, and social outcomes of the MyLife participants.

Standardised snus packaging reduces brand differentiation: a web-based between-subject experiment.

BACKGROUND: Perceptions of tobacco packaging may be consequential for consumption and initiation. We explored the potential effect of standardised packaging on young adults' ratings of the appeal of brands of snus (Swedish moist snuff) and on their perceptions of typical users of these brands. We were interested in both the effects on average levels of ratings and on the within-subject variability of the ratings. The latter was used as a measure of the extent to which individuals can differentiate between brands. METHODS: A sample of 625 Norwegians aged 16-30 were randomly allocated to one of three between-subject conditions: Branded Packaging, Standardised Packaging, or Standardised Packaging with Health Warnings. The participants rated 10 snus brands on measures of general appeal and on their perceptions of the typical brand user (e.g., "… is sporty and active"). RESULTS: The standardised packages (without health warnings) were not rated more negatively than the branded packages, while the standardised packages with health warnings were rated slightly more negatively than the branded packages. However, in terms of within-subject standard deviations, the variability of the brand ratings across the packages was substantially lower for standardised packaging types in comparison to branded packages. CONCLUSIONS: Even in cases where standardised tobacco packaging appears to have little overall effect on the valence of the average ratings, it can have a strong effect on the variability of the ratings. This suggests that standardised packaging can reduce the potential for brand differentiation.

Plain packaging: legislative differences in Australia, France, the UK, New Zealand and Norway, and options for strengthening regulations.

By July 2018, five countries (Australia, France, the UK, New Zealand and Norway) had fully implemented plain (standardised) packaging. Using government documents, we reviewed the key legislative differences between these five countries to identify best practice measures and potential lacuna. We then discuss how governments planning to introduce plain packaging could strengthen their legislation. Differences between countries include the terminology used (either 'plain', 'standardised' or 'plain and standardised'), products covered and transition times (ranging from 2 to 12 months). Myriad differences exist with respect to the packaging, including the dimensions (explicitly stated for height, width and depth vs minimum dimensions for the health warnings only), structure (straight-edged flip-top packs vs straight, rounded and bevelled-edged flip-top packs and shoulder boxes) and size (minimum number of cigarettes and weight of tobacco vs fixed amounts) and warning content (eg, inclusion of a stop-smoking web address and/or quitline displayed on warnings on one or both principal display areas). Future options that merit further analysis include banning colour descriptors in brand and variant names, allowing pack inserts promoting cessation and permitting cigarettes that are designed to be dissuasive. Plain packaging legislation and regulations are divergent. Countries moving towards plain packaging should consider incorporating the strengths of existing policies and review opportunities for extending these. While plain packaging represents a milestone in tobacco-control policy, future legislation need not simply reflect the past but could set new benchmarks to maximise the potential benefits of this policy.

15-year-old tobacco and alcohol abstainers in a drier generation: Characteristics and lifestyle factors in a Norwegian cross-sectional sample.

AIMS: Norwegian adolescents currently drink and smoke less on average than previous cohorts. Based on cross-sectional survey data, the individual and familial characteristics of 15-year-old non-users and users of alcohol and tobacco were compared to identify correlates to abstinence. METHODS: The survey was approved by the Norwegian Social Science Service. The sample consisted of 3107 adolescents from a 2011 school-based survey, of which 848 (27.3%) did not drink alcohol nor use tobacco. Associations with leisure time activities, risk perceptions, parenting style and social factors were analysed by logistic regression. RESULTS: Most of the non-drinkers were also non-users of tobacco. Abstainers (neither alcohol nor tobacco use) tended to have less unorganized and more hobby-related leisure time activities, higher risk perceptions for smoking, and monitoring or emotionally supportive parents. They more rarely reported close relationships with their best friend and were more likely to report lower occurrences of drinking and smoking among friends or siblings. CONCLUSIONS: Differences in perceived parenting styles and a lower degree of unorganized leisure in the abstainer group points to monitoring and closer emotional ties between parents and children as important factors in adolescent abstinence. An implication of these results is that promoting hobby-based activities might be a useful strategy for preventing alcohol and tobacco use in young people.

Adolescent perceptions of dissuasive sticks: a web survey among 16-20 year olds in Norway.

BACKGROUND: While increasingly stringent rules for cigarette pack design restrict the advertising potential of cigarette packs, the cigarette stick itself remains a potential medium for marketing. Common design features are filters, slim cigarettes and capsule cigarettes. Recent research indicates lower general appeal, more negative perceptions of taste, and greater harm for cigarettes designed to be unappealing (dissuasive sticks), and the aim for the current study was to investigate perceptions of dissuasive cigarette sticks among Norwegian adolescents, and learn about factors that might make cigarettes unappealing to them. METHODS: Two hundred eighty-one adolescents, 16-20 years old, smokers and non-smokers, assessed the appeal, taste, harmfulness, and which one they would most likely want to try, of 6 different cigarette sticks in a web survey. The cigarette sticks included two standard designs: cork and white filter sticks, and 4 dissuasive designs: green sticks, yellow sticks, and two white sticks with a health warning printed on the side. RESULTS: All dissuasive designs were perceived as less appealing, worse tasting, more harmful than the standard cork tip and white tip cigarettes. The dissuasive sticks were less often chosen as a cigarette one would want to try. The evaluations of designs were relatively similar across gender, smoking and snus use status, and smoking susceptibility. In multinomial regressions, perceptions of taste and harm differences were associated with perceived product trial. CONCLUSIONS: This study supports earlier findings, and suggest that the use of unpleasant colours and warnings printed directly on cigarette sticks could increase perceived harmfulness, reduce notions of good taste, and possibly reduce desires to experiment with cigarettes in adolescence.

Assessing notions of denormalization and renormalization of smoking in light of e-cigarette regulation.

The rationale for 'denormalization' of smoking in tobacco policies has been challenged by the emergence of e-cigarettes and the need to regulate e-cigarette use and promotion. Our aim is to assess the research status on e-cigarettes' contribution to 'renormalization' of smoking and to clarify how renormalization of smoking can be appraised at the conceptual and empirical level. Combining conceptual analysis and narrative review, the paper brings out three dimensions of denormalization/renormalization of smoking ('unacceptability/acceptability'; 'invisibility/visibility'; 'phasing out behaviour/maintaining behaviour') and an inherent duality of the e-cigarette as a smoking-like device and a smoking alternative. These analytical dimensions are applied qualitatively to consider the literature identified by searching the Web of Science database for 'e-cigarettes AND renormalization' (and variants thereof). Theoretically, normative changes in smoking acceptability, increased visibility of e-cigarettes and use, and observations of actual use (prevalence, dual use, gateway) can all be applied to illustrate processes of renormalization. However, only acceptability measures and user measures can be said to be empirical tests of renormalization effects. Visibility measures are only based on logical assumptions of a possible renormalization; they are not in themselves indicative of any "real" renormalization effects and can just as well be understood as possible consequences of normalization of e-cigarettes. Just as a downward trend in smoking prevalence is the litmus test of whether denormalization policy works, stagnating or rising smoking prevalence should be the main empirical indicator of renormalization.

Cute as candy: a qualitative study of perceptions of snus branding and package design among youth in Norway.

OBJECTIVES: Snus use has increased among youth in Norway in recent years and is now more prevalent than smoking. Concurrently, a range of new products and package designs have been introduced to the market. The aim of this study was to explore how youth perceive snus branding and package design, and the role, if any, of snus packaging on perceptions of appeal and harm of snus among youth. PARTICIPANTS: Adolescent tobacco users and non-users (N=35) ages 15-17 years. DESIGN: We conducted interviews among 6 focus groups (each with 4-7 participants). Participants were shown snus packages with a variety of designs and with different product qualities (flavour additives, slim, regular, white and brown sachets) and group discussions focused on how they perceived packages and products. The focus group discussions were semistructured using a standard guide, and analysed thematically. RESULTS: The participants in the focus groups narrated distinct images of snus brands and associated user identities. Package design elements such as shapes, colours, images and fonts were described as guiding these perceptions. Packaging elements and flavour additives were associated with perceptions of product harm. The appeal of flavoured snus products and new types of snus sachets seemed to blend in with these processes, reinforcing positive attitudes and contributing to the creation of particular identities for products and their users. CONCLUSIONS: The findings indicate that packaging is vital to consumer's identification with, and differentiation between, snus brands. In view of this, snus branding and packaging can be seen as fulfilling a similar promotional role as advertising messages: generating preferences and appeal.

"It looks kind of cool when cool people smoke, but " Norwegian adolescents' decoding of smoking scenes in films.

AIMS: Exposure to smoking scenes in films is seen as contributing to smoking initiation among young people. This has triggered calls to include depictions of smoking as a criterion in film ratings. All the same time, little is known about how adolescents interpret different smoking scenes. This study analyses how young people decode smoking scenes by contextualising identification with, and evaluation of, various characters who smoke, as well as the significance of film genres. DESIGN: In order to explore how adolescents conceptualize smoking scenes in different film genres, we conducted eight focus-group interviews with adolescents aged 13-17 years (n = 54), using purposive sampling. The discussions were semi-structured with a standard guide, and we used clips from eight films containing various positive and negative moods and character types as stimuli for the discussions. To analyse interpretations qualitatively, thematic coding was applied. RESULTS: The adolescents acknowledged that smoking is a narrative ingredient designed to illustrate and amplify character traits and situational moods. Characters who smoked were usually interpreted in terms of smoking stereotypes: stress relief, romantic seduction, social interaction between equals, habitual smoking, and as a symbol of "bad guys". The adolescents identified more strongly with elegant, positive, and self-assured smoking characters than with negative, anxious, or ambiguous characters. CONCLUSIONS: Adolescents interpret smoking scenes in accordance with encoded meanings: they tend to get the messages inscribed by the filmmakers. As positive and glamorous representations are more likely to stimulate smoking experimentation and initiation among adolescents than negative representations, future research should distinguish more clearly between exposure to positive and to negative representations.

Adolescent tobacco use practices and user profiles in a mature Swedish moist snuff (snus) market: Results from a school-based cross-sectional study.

AIMS: The aim of this work was to study the diversity of tobacco use among Norwegian adolescent tobacco users and to investigate how different user groups compared with each other in terms of lifestyle and risk correlates. Swedish moist snuff (snus) use has increased dramatically in Norway over the last few years and is now more prevalent than smoking in younger age groups. METHODS: The participants were 736 15-year-old tobacco users obtained from a large school-based cross-sectional survey (response rate 73%). Leisure time activity and risk behaviour factors were extracted by principal components analysis. Associations between tobacco use, leisure activities, risk behaviours, alcohol use and sex were studied bivariately and by logistic regression. RESULTS: In total, 41.5% of the tobacco users were dual users (smokers and snus users). Problem behaviour and risk-taking lifestyles were associated with tobacco use frequency and high-frequency dual use, with a low risk profile for all types of occasional users (snus, cigarettes or dual users), a medium risk profile for all types of daily single-product users, including those who occasionally used the other product (i.e. dual users) and a high-risk profile for those who used both products daily (daily dual users). CONCLUSIONS: Fragmented use patterns in adolescence undermine the dichotomy often applied between smokers and snus users. For associations with lifestyle and risk correlates, use frequency and high-frequency dual use seem to be more important than the choice of product.

Smoking and snus use onset: exploring the influence of snus debut age on the risk for smoking uptake with cross-sectional survey data.

INTRODUCTION: Snus use has become increasingly prevalent among young people in Norway, while smoking has declined. Little is known about the transitions between snus and other tobacco products, particularly among younger users. A major concern involves the association between snus initiation and future smoking uptake. METHODS: A total of 409 lifetime snus users who had started with snus before cigarettes or were never-smokers were selected from a national sample of participants in annually repeated cross-sectional surveys (2005-2011) of Norwegian men and women aged 15-74 years. About 30% of them were lifetime smokers, 84% were men, and the mean age was 29.4 years. Logistic regression was applied to investigate the association between age of snus uptake and the risk for becoming a smoker later on. RESULTS: Respondents who started using snus before the age of 16 years had an odds ratio of 3.1 (confidence interval = 1.98-4.76) of being lifetime smokers compared with those who initiated snus later. The prevalence of current smoking among early snus initiators (22.9%) was comparable to that found among never-snus-users (29.6%). Among late snus initiators, current smoking prevalence was 5.9%. CONCLUSION: In this study, snus debut age was an important factor for the association between snus use and smoking.

[Occasional smoking in Norway]. / Av-og-til-røyking i Norge.

BACKGROUND: In recent decades, daily smoking has become less common, while occasional smoking has stayed at the same level. The purpose of the study is to describe occasional smokers on the basis of their smoking behaviour and socio-demographic characteristics. MATERIAL AND METHOD: Data from Statistics Norway's quarterly surveys of tobacco use in 2010 and 2011 were used. Information on smoking habits, smoking-related behaviour and the respondents' attitudes to their own smoking was collected in telephone interviews. RESULTS: Of the 8,700 men and women aged 16-74 (response rate 57%) who were included, altogether 1,583 were daily smokers and 907 occasional smokers. The occasional smokers were younger, more frequently lived in large cities and had a higher level of education and income than the daily smokers. Twenty-nine of 174 (17%) occasional smokers used snus on a daily basis, compared to 10 of 394 (3%) of the daily smokers. The occasional smokers had great confidence in their ability to quit: 95% responded that they would be smoke-free in five years, compared to 55% of the daily smokers (n = 2,158). Fifty-five (35%) of the occasional smokers lit up several times weekly (16 cigarettes per week on average), while the remaining (65%) smoked only once per week as a maximum (five cigarettes per week on average). Those who smoked several times each week had attitudes to their own smoking and usage pattern for tobacco that were similar to those of the daily smokers. Nearly half of the occasional smokers defined themselves as non-smokers. INTERPRETATION: Norwegian occasional smokers are a heterogeneous group in terms of their smoking pattern and frequency, and many define themselves as non-smokers.

Perceptions of relative risk of disease and addiction from cigarettes and snus.

The public is largely unaware of the lower global risk associated with snus compared with that of cigarettes, but little is known of perceptions of relative risks for specific diseases. Inveterate, daily, and nondaily smokers' perceptions of the relative snus/cigarette risk of cardiovascular disease, and of cancer of the lung, stomach, and oral cavity, and perceptions among smokers, snus users, and dual users of the relative risk of nicotine addiction, was studied in a pooled sample from annual national surveys (2008-2011) performed by Statistics Norway. The total sample included 2,661 ever smokers and snus users aged 15-79 years old. Fifty-three percent were men, and the average age was 46.1 year. Compared with medical consensus, all smoker groups overestimated the relative risks of diseases from snus use, and inveterate smokers overestimated them significantly more than other groups. For all diseases except lung cancer, the majority of smokers thought snus users were running a higher or equal risk. For lung cancer, 22% believed that snus use gave a higher or equal risk. Smokers, snus users, and dual users tended to think that snus and cigarettes were equally addictive products, while a somewhat higher proportion of those who had quit both products thought that cigarettes were more addictive. Increased knowledge of the relative health risks might give smokers an incitement to switch to snus and prompt current dual users to stop smoking completely. Awareness could be improved by tailoring information at targeted groups, for example via the health care system.

The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey.

OBJECTIVES: This study examined the perceptions of cigarette packaging and the potential impact of plain packaging regulations. The hypothesis was that the branded cigarette packages would be rated more positively than the corresponding plain packs with and without descriptors. DESIGN: Between-subjects experimental online survey. Male and female participants were separately randomised to one of the three experimental conditions: fully branded cigarette packs, plain packs with descriptors and plain packs without descriptors; participants were asked to evaluate 12 individual cigarette packages. The participants were also asked to compare five pairs of packs from the same brand family. SETTING: Norway. PARTICIPANTS: 1010 youths and adults aged 15-22. PRIMARY OUTCOME MEASURES: Ratings of appeal, taste and harmfulness for individual packages. Ratings of taste, harm, quality, 'would rather try' and 'easier to quit' for pairs of packages. RESULTS: Plain with and without descriptors packs were rated less positively than the branded packs on appeal (index score 1.63/1.61 vs 2.42, p<0.001), taste (index score 1.21/1.12 vs 1.70, p<0.001) and as less harmful (index score 1.0.34/0.36 vs 0.82, p<0.001) among females. Among males, the difference between the plain with and without descriptors versus branded condition was significant for appeal (index score 2.08/1.92 vs 2.58, p<0.005) and between the plain without descriptors versus branded condition for taste (index score 1.18 vs 1.70, p<0.00). The pack comparison task showed that the packs with descriptors suggesting a lower content of harmful substances, together with lighter colours, were more positively rated in the branded compared with the plain condition on dimensions less harmful (ß -0.77, 95% CI -0.97 to -0.56), would rather try (ß -0.32, 95% CI -0.50 to -0.14) and easier to quit (ß -0.58, 95% CI -0.76 to -0.39). CONCLUSIONS: The results indicate that a shift from branded to plain cigarette packaging could lead to a reduction in positive perceptions of cigarettes among young people.