Cigarette design and marketing features are associated with increased smoking susceptibility and perception of reduced harm among smokers in 27 EU countries.

Background: This study assessed the role of cigarette design and marketing characteristics in initial smoking, cigarette brand choice and the perception of reduced harm of cigarette brands among adults in the European Union in 2012.

Methods: Data were from the Eurobarometer 385 (V.77.1) survey conducted in 2012 (n=26 566). Multivariate logistic regression was used to assess associations between cigarette design/marketing features with aspects of initial smoking (among current and former smokers), cigarette brand choice and perception of reduced harm of cigarette brands (among current smokers; p<0.05).

Results: Respondents aged ≥55 years had lower OR than 15-24-year-olds of reporting initial smoking because of the presence of menthol flavour (adjusted OR (AOR)=0.42; 95% CI 0.24 to 0.72) or a specific sweet, fruity or spicy flavour (AOR=0.38; 95% CI 0.20 to 0.73). Females had higher OR than males of reporting initial smoking because of the presence of menthol flavour (AOR=2.89; 95% CI 2.07 to 4.02). Furthermore, female smokers were more likely to choose a cigarette brand based on specific tastes such as menthol or spicy, fruity or sweet flavours (AOR=1.33; 95% CI 1.14 to 1.56), or on the levels of tar, nicotine and carbon monoxide (AOR=1.30; 95% CI 1.11 to 1.52). Characteristics such as light-coloured packaging, the shape and size of cigarettes and the pack, the use of terms in the brand name such as 'silver' or 'blue' or descriptors such as 'natural' or 'organic' were all associated with perceptions of reduced harm among specific demographic groups.

Conclusions: These findings call for a stronger regulation of tobacco ingredients, packaging features and other marketing strategies that may increase the attractiveness of tobacco products or promote perceptions of harm reduction.