Perceptions of plain cigarette packaging among smokers and non-smokers in Andalusia (Spain)

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=> "Juan Miguel" "apellidos" => "Rey-Pino" "email" => array:1 [ 0 => "jrey@ugr.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Karine" "apellidos" => "Gallopel-Morvan" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Crawford" "apellidos" => "Moodie" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] ] ] 4 => array:3 [ "nombre" => "Esteve" "apellidos" => "Fernández" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "e" "identificador" => "aff0030" ] ] ] 5 => array:3 [ "nombre" => "Isabel" "apellidos" => "Nerín" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "f" "identificador" => "aff0035" ] ] ] ] "afiliaciones" => array:6 [ 0 => array:3 [ "entidad" => "Department of Marketing and Communication, University of Cádiz, Cádiz, España" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Marketing Management and Research, University of Granada, Granada, España" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "EHESP Scool of Public Health, EA 7348 MOS, Rennes, France" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Institute for Social Marketing, University of Stirling, Stirling, United Kingdom" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Tobacco Control Unit, Institut Català d’Oncologia (ICO-IDIBELL); School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain" "etiqueta" => "e" "identificador" => "aff0030" ] 5 => array:3 [ "entidad" => "Tobacco Control Unit, Department of Medicine, Psychiatry and Dermatology, School of Medicine, University of Zaragoza, Zaragoza, España" "etiqueta" => "f" "identificador" => "aff0035" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Percepciones del envase neutro del tabaco entre fumadores y no fumadores en Andalucía (España)" ] ] "textoCompleto" => "IntroductionTobacco is a major global health problem, being a risk factor in six of the eight leading causes of death globally and responsible for seven million deaths per year.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> Tobacco is responsible for approximately a quarter (27%) of all deaths in Spain each year.<a class="elsevierStyleCrossRef" href="#bib0160">2</a> Public health policy makers face two important challenges: to reduce consumption and prevalence among smokers and discourage non-smokers from starting. The World Health Organisation's Framework Convention on Tobacco Control recommends a range of measures to protect citizens; one of these concerns the packaging and labelling of tobacco products. Article 11 of the Framework Convention on Tobacco Control recommends pictorial health warnings on packaging, which are now mandatory in more than 100 countries,<a class="elsevierStyleCrossRef" href="#bib0165">3</a> and also plain (or standardised) packaging —the standardisation of pack appearance so that all cigarettes must come in drab colour packs with pictorial health warnings but without any branding, except for the brand name.Packaging is a multipurpose marketing tool and crucial for tobacco products, particularly in countries where other communication tools are banned. In Spain, for instance, since tobacco advertising, promotion and sponsorship is no longer permitted, the packaging is extremely important. There are numerous examples of innovative pack design in Spain, such as novel pack shapes and ways of opening, slimmer packs for female-oriented brands, and also textured packs, which create a distinctive tactile sensation —touch is important in developing emotional or affective connections with brands.<a class="elsevierStyleCrossRef" href="#bib0170">4</a> Further innovation seems likely.While the importance of fully-branded packaging as a marketing tool for tobacco is well established, the impact of plain packaging is not well understood in Spain. Indeed, a systematic review of research on plain packaging found that most studies were conducted in five countries (Australia, Canada, France, New Zealand, United Kingdom),<a class="elsevierStyleCrossRef" href="#bib0175">5</a> all with stringent tobacco control policy. It may be that reactions to plain packs will differ in other countries, as cultural differences have been found in response to anti-tobacco media campaigns,<a class="elsevierStyleCrossRef" href="#bib0180">6</a> pictorial warnings,<a class="elsevierStyleCrossRef" href="#bib0185">7</a> perceptions of branding and colour preference and meaning.<a class="elsevierStyleCrossRefs" href="#bib0190">8–10</a> The main aims of plain packaging are to reduce the appeal of the pack and product; increase the salience of the health warnings; and reduce misperceptions of product harm as a result of pack design.<a class="elsevierStyleCrossRef" href="#bib0205">11</a> Australia was the first country to implement plain packaging in December 2012, followed by France and the United Kingdom in 2017. Norway, New Zealand and Ireland will fully implement plain packaging in 2018 and a number of other countries are considering this measure.The aim of this study is to gauge smokers and non-smokers’ perceptions of plain tobacco packaging in comparison to fully-branded packaging, their response to different plain pack colours, and what impact, if any, plain packaging has on the salience of the health warnings.MethodsDesign and sampleGiven that plain packs are not available on the Spanish market, we employed a qualitative methodology to fully explore participants’ attitudes, perceptions and reactions to plain packaging. Eight focus groups (5-8 participants per group; n = 59) were conducted in two Spanish medium sized towns (Granada and Cádiz). The sample was segmented by gender, age and smoking status, following criterion of homogeneity for intra-groups characteristics and heterogeneity for between-groups characteristics. People aged 15 to 45 years were interviewed because they are a key target group for Spanish health practitioners, and male and female smokers and non-smokers were included given that plain packaging is intended to encourage smokers to quit and discourage non-smokers from starting (see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> for sample characteristics).<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>In order to determine the number of focus groups we established a minimum of two groups per considered category of the segmentation variables, combining categories for not having an excessive number of groups that would not add new information for the analysis,<a class="elsevierStyleCrossRef" href="#bib0210">12</a> with a bigger number of groups for the young people categories, that are supposed to be a main target for the tobacco industry, as well as the fact that at this early stages people start to smoke.<a class="elsevierStyleCrossRefs" href="#bib0215">13,14</a>Materials and procedureTo explore the impact of pack design, participants were presented with fully-branded and plain packs with cigarettes inside. The brands chosen for the study were those on the Spanish market that were most popular with each group. Mock-up plain packs were produced so as to look as realistic as possible for participants. The plain packs were presented in three different colours (brown, white and grey), with these colours the most frequently explored in plain packaging research.<a class="elsevierStyleCrossRefs" href="#bib0175">5,15,16</a>Each focus group was conducted by two researchers, one male and one female, with one leading as moderator and the other assisting as co-moderator and ensuring that the groups were recorded. Groups were conducted in quiet rooms with a round table to help participants interact, with the group discussions video and audio recorded for transcription and analysis. All groups were first shown a set of fully-branded cigarette packs and asked their opinion of these. They were then shown the differently coloured plain packs and asked their thoughts and feelings on these. Participants were compensated with a gift voucher (25 €) at the end of the session to encourage recruitment.Each focus group discussion was transcribed and analysed using NVivo 10 software, which involves a semantic categorization of participants’ comments and a frequency analysis of the appearance of each category by the creation of nodes. Coding resources —focus groups transcripts— and categorization references —gender, age and smoking status— were used for the frequency analysis. Semantic categorisation was undertaken in three stages<a class="elsevierStyleCrossRef" href="#bib0235">17</a>:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">•Reducing chunks of text from transcripts into common meanings, following an initial read-through, and undertaking a more advanced reading of the texts.</li><li class="elsevierStyleListItem" id="lsti0010">•Assuming a complete read-through of all transcripts, repeated several times.</li><li class="elsevierStyleListItem" id="lsti0015">•Extracting literal chunks of text from the transcripts to illustrate the results.</li></ul>Quality of data collection and analysisWe followed a rigorous process to increase the reliability of the results. Firstly, a semi-structured topic guide was developed by the research team to ensure that all relevant topics were discussed in each group. Secondly, given the importance of the stimuli we only used actual packs of cigarettes, rather than images. Thirdly, we recruited participants who were not known to each other<a class="elsevierStyleCrossRef" href="#bib0245">18</a> and ensured homogeneity within each group.<a class="elsevierStyleCrossRef" href="#bib0305">19</a> Fourthly, extensive field notes were taken during the groups and these were used in conjunction with the video and audio recording to analyze participants’ comments, discussions and behaviors. The coding and analysis was performed by two of the researchers who moderated the groups, thus helping triangulate the findings. Finally, we comprehensively reviewed the literature prior to the groups being conducted in order to fully understand the topic and to allow us to compare our findings with past research.ResultsRole of fully-branded packagingThe aesthetic appeal of current, fully-branded cigarette packaging was mentioned frequently. Women were more aware of, and interested in, pack aesthetics than men. With regard to the different pack elements, most comments related to pack colour, particularly for women, who said that colour influenced their perceptions of the pack and product. For instance, the cream colour of one of the fully-branded packs was viewed as feminine, thought to make the pack look more elegant, and suggestive of smooth tasting cigarettes.<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020">•“It's feminine, no, more than this, it is really feminine” (female, smoker, 35-45 years old).</li><li class="elsevierStyleListItem" id="lsti0025">•“Maybe it could have some relation, the outer design (the pack) with the fact of you smoking a cigarette, it's soft… I don’t know, maybe it's because of this” (female, smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0030">•“It's elegant, for wealthy people” (female, non-smoker, 25-34 years old).</li></ul>In terms of which element of the pack participants reported seeing first on fully-branded packs, non-smokers said the health warnings whereas smokers, women and young adults said the branding. Another frequent answer, irrespective of smoking status, was the colour of the pack.<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035">•“I have directly seen’smoking kills”’ (female, non-smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0040">•“The red colour” (male, non-smoker, 35-45 years old).</li><li class="elsevierStyleListItem" id="lsti0045">•“So, I have seen directly the brand… I’ve seen the brand and I have said to myself, huh!” (female, smoker, 15-24 years old).</li></ul>Perceived impact of plain packaging on smoking-related behaviorIn all groups, although particularly among young men, plain packaging was considered something that could help reduce cigarette consumption. Participants suggested that removing full branding from cigarette packs would be effective, a strong deterrent for those susceptible to smoking and those who have recently started smoking.<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0050">•“Young people search for the best, the coolest thing; then, when they see this, this does not catch their attention” (male, smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0055">•“If you see something so insipid, so dull, something that is somewhere at home, I even do not know that it is a tobacco pack. I see this thing white (the plain pack) and I say to myself: what is this? I do not even pick it up, they do not recall my attention. And if children see these sad colours, so subdued colours, so dulled, children will never recall tobacco products” (female, smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0060">•“If all packs have the same colour, with the name of the brand and that picture, I am sure that consumption will be reduced” (male, smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0065">•“Because of the design, I think that it would be better (…) to search for all brands and make all of them be the same, that is, all packs the same; so, you see them and you do not like them” (male, non-smoker, 35-45 years old).</li></ul>They suggested that plain packaging, i.e. packs without different colours and designs, would essentially convert the product into something vulgar. Few felt it would have any impact on adult smokers however, although it may help to reduce consumption for some, and some young women smokers doubted the efficacy of plain packs in stopping people from starting to smoke.<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0070">•“It is obvious, then, maybe I see this (fully-branded pack), and I know perfectly that it is tobacco and the company, and then I see this other one (plain pack) and I do not know what it is, it is a box, and it can contain bolts, earphones… And it does not impact me in any way. It is clear to me that it is less easy to distinguish that it is tobacco” (male, smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0075">•“They would arrive to something if they make all brands exactly the same, all grey, especially for people that have never smoked” (male, non-smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0080">•“It's not a question of a single model, I do not think that a lot of people that began to smoke did it because of the pack being this way… It is more a question of friendship, of your circle of friends” (female, non-smoker, 15-24 years old).</li></ul>Effect of plain packs on warning salienceParticipants commented that the warnings were more visible on plain packs, as the branding no longer distracted from them, and that this would make people more aware of them. The absence of branding (aside from brand name) was also thought to make brand identification more difficult.<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0085">•“I think that it is much easier to get used to the current pack of the brand with a picture on it, than getting used to the grey one with a picture on it. The picture on this pack (plain pack), you see it all the time. And in this (fully-branded pack) you can distract this vision a bit, you can get distracted with the logo, the red colour” (male, smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0090">•“That's right, it does not distract you from seeing it, it is simply the picture” (female, non-smokers, 35-45 years old).</li><li class="elsevierStyleListItem" id="lsti0095">•“The pack, being so simple, it does not have anything that capture your attention except the picture, your eyes always will go to the picture, the pack does not have anything but the picture” (female, smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0100">•“It is clear to me, you see this one (plain pack) and see immediately the picture, not the brand, nothing…” (male, smoker, 15-24 years old).</li></ul>Perceptions of plain pack colourWhile the three plain packs had a similar appearance, the different colour of each significantly influenced how they were perceived. Two of the three plain pack colours (grey and brown) were considered much more negatively than the white pack. Participants referred to the grey pack as ugly, associating it with dirtiness, something bad or diseased lungs. The cigarettes within this pack were also considered to be poorer quality.<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0105">•“The grey pack does not capture my attention, it's not flashy; if you have it in your pocket, or if you see somebody with it, you won’t like to try. It is not the same, I don’t know, the brown is what you say, it looks like a cigar with cinnamon flavour that I have sometimes bought (…) and the white… the white, it does capture more the attention” (male, smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0110">•“The one I dislike more is the grey and the one I like more, the white” (female, non-smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0115">•“The grey looks like if it has more smoke, death, obscurity, the two other ones are more easy to advertise, more classic and they are more noticeable… This (the grey) is like not having anything, except the pictures” (male, smoker, 15-24 years old).</li></ul>The brown plain pack generated mixed perceptions, being more frequent the positive ones. It was considered ugly and dirty by some participants, and was associated with illness and death. It was also considered to have lower quality cigarettes. However, others thought it looked attractive and flashy, or like chocolates or cigars. Results reveal that this colour can be as appropriate as the grey one when the target is young people.<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0120">•“The brown one looks sadder and that the tobacco is poorer quality” (male, smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0125">•“The brown, because I see this colour… like if my lungs are already like this colour, or the teeth” (male, smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0130">•“The chocolate, I like more the brown colour” (female, smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0135">•“The brown one capture my attention, but because it looks like this, a pack of condoms, or a pack of cigars, or…, I don’t know, any other thing” (male, smoker, 25-34 years old).</li></ul>Finally, the white pack reminded participants of a pharmacy product, being seen as less harmful.<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0140">•“It looks even fancy… the idea is that if you want, you can choose, and I can choose, I might prefer the white one, because it looks like a medicine, you know, you always can think that a medicine can be good, but if you see it in brown or grey…” (male, smoker, 25-34 years old).</li><li class="elsevierStyleListItem" id="lsti0145">•“It looks cleaner” (female, non-smoker, 15-24 years old).</li><li class="elsevierStyleListItem" id="lsti0150">•“The white colour looks light tobacco” (male, smoker, 25-34 years old).</li></ul>DiscussionPackaging is a crucial marketing tool which can influence consumers in myriad ways.<a class="elsevierStyleCrossRef" href="#bib0250">20</a> It can appeal to consumers, generate interest, communicate information about the product and its benefits, and add value by increasing the quality of experiences related to its use.<a class="elsevierStyleCrossRefs" href="#bib0255">21,22</a> It has a key function at the point-of-sale but importantly can function post-purchase.<a class="elsevierStyleCrossRefs" href="#bib0265">23–25</a> For tobacco products, packaging is often considered a badge product given its high social visibility, and it can enhance positive perceptions of smoking as well as confer a positive image of the smoker.<a class="elsevierStyleCrossRefs" href="#bib0175">5,26</a>Our findings suggest that package design can significantly influence pack and product perceptions. The appearance of fully-branded packaging was viewed as important by women, with some packs considered elegant and the product perceived as smoother; smoother cigarettes are often thought to be less harmful.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> That pack design appeared more pronounced for women than men may reflect the importance attached to the aesthetic characteristics of packaging by women, as identified in tobacco industry marketing documents<a class="elsevierStyleCrossRef" href="#bib0290">28</a> and previous academic research.<a class="elsevierStyleCrossRef" href="#bib0295">29</a>The results suggest that plain packaging may have a role to play in combating smoking by discouraging younger people from starting to smoke or new smokers from continuing, although consistent with past research the impact on adult smokers was considered marginal.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> With the branding removed participants also felt that this would make the warnings stand out more, which is one of the core aims of plain packaging, and also that it would be more difficult for them or others to form a strong connection with brands.People are known to attach meanings to particular colours,<a class="elsevierStyleCrossRef" href="#bib0195">9</a> as was found with the different coloured plain packs. The brown and grey plain packs (especially the grey) were more likely than the white pack to have negative associations, being considered ugly, dirty and like diseased lungs. It is well established in the marketing literature that pack appearance influences product evaluation,<a class="elsevierStyleCrossRef" href="#bib0265">23</a> with the cigarettes considered higher quality in fully-branded packs and poorer quality in the brown and grey plain packs.In terms of limitations of the study, the use of qualitative research means that the findings cannot be generalised to the wider population, and possible biases may have occurred during the focus group discussions, e.g., some influencing from researchers to participants. With respect to the stimuli, the brands we chose may have also created some bias among participants, depending on their attitudes to these brands. The brown plain pack we used differs from the darker pack used in countries which have implemented plain packaging (Australia, United Kingdom, France), which likely resulted in this pack being viewed slightly more positively, given that research has found that darker plain pack colours are perceived as more off-putting.<a class="elsevierStyleCrossRef" href="#bib0295">29</a> The study also provides no insight into the impact of plain packaging on actual smoking behaviour.The main strength of this research is that it offers an understanding of how smokers and non-smokers in Andalusia (Spain) perceive a measure that could extend tobacco control policy, but that has not been yet considered by Spanish policy makers. In addition, while there are limitations with focus groups, they are an appropriate methodology for exploring consumers’ views of plain packaging, given that these packs are not available for sale in Spain. They allow for in-depth responses on the possible impact that plain packaging may have, and the impact of pack colour.In conclusion, the findings suggest that plain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands, and may help to reinforce the ability of some consumers to protect themselves from the dangers of smoking. Finally, as we found some differences with past research in other countries in how different packs colors were perceived, this suggests that it may be beneficial to explore the suitability of particular plain pack colors in each country before implementing this measure.Editor in chargeCarlos Álvarez-Dardet.Transparency declarationThe corresponding author on behalf of the other authors guarantee the accuracy, transparency and honesty of the data and information contained in the study, that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described.<elsevierMultimedia ident="tb0005"></elsevierMultimedia>Authorship contributionsB. Lacave-Garcia is responsible for the article and contributed to the conception and management of the work, to the analysis and interpretation of data, the critical review and the final writing of the manuscript, with important intellectual contributions. J.M. Rey-Pino contributed to the conception of the work, to the data collection and their analysis and data interpretation, as well as the data initial writing of the manuscript. K. Gallopel-Morvan contributed to the conception of the work, to the analysis and interpretation of data, and to the critical review of the article with relevant intellectual insights. C. Moodie contributed to the conception of the work, to the interpretation of data, and to the critical review of the article with relevant intellectual insights. E. Fernández contributed to the conception of the work, to the interpretation of data, and to the critical review of the article with relevant intellectual contributions. I. Nerín contributed to the conception of the work, to the interpretation of data, the initial writing of the article and to the critical review of the article with relevant intellectual contributions. All authors approved the final version of the article when it was sent. All authors are responsible for having reviewed all aspects of the manuscript and for having discussed all of it for having an integer version of it.FundingB. Lacave-García and J.M. Garcia have been financially supported by the Andalusian Government, health department, with the project “effects of plain packaging of tobacco products and visual warnings on the fall of the demand of tobacco products: a research from the social marketing perspective” (code 49/08).C. Moodie is supported by Cancer Research UK.E. Fernández is partly supported by Ministry of Universities and Research, Government of Catalonia (grant 2017SGR319) and by the Instituto de Salud Carlos III, Government of Spain, co-funded by the European Regional Development Fund (FEDER) (grants INT16/00211 and INT17/00103).Conflicts of interestNone." "textoCompletoSecciones" => array:1 [ "secciones" => array:14 [ 0 => array:3 [ "identificador" => "xres1286236" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1188692" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres1286235" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1188691" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Design and sample" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Materials and procedure" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Quality of data collection and analysis" ] ] ] 6 => array:3 [ "identificador" => "sec0030" "titulo" => "Results" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0035" "titulo" => "Role of fully-branded packaging" ] 1 => array:2 [ "identificador" => "sec0040" "titulo" => "Perceived impact of plain packaging on smoking-related behavior" ] 2 => array:2 [ "identificador" => "sec0045" "titulo" => "Effect of plain packs on warning salience" ] 3 => array:2 [ "identificador" => "sec0050" "titulo" => "Perceptions of plain pack colour" ] ] ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0060" "titulo" => "Editor in charge" ] 9 => array:2 [ "identificador" => "sec0065" "titulo" => "Transparency declaration" ] 10 => array:2 [ "identificador" => "sec0080" "titulo" => "Authorship contributions" ] 11 => array:2 [ "identificador" => "sec0085" "titulo" => "Funding" ] 12 => array:2 [ "identificador" => "sec0090" "titulo" => "Conflicts of interest" ] 13 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2018-02-15" "fechaAceptado" => "2018-04-24" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1188692" "palabras" => array:4 [ 0 => "Tobacco" 1 => "Plain packaging" 2 => "Social marketing" 3 => "Qualitative research" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1188691" "palabras" => array:4 [ 0 => "Tabaco" 1 => "Envase neutro" 2 => "Marketing social" 3 => "Investigación cualitativa" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "ObjectivesEach year tobacco is responsible for 650,000 deaths in Europe and 55,000 in Spain. With tobacco advertising and promotion banned in Spain and most of Europe, the last bastion of marketing is the packaging. Plain tobacco packaging —which involves packs having a standardised appearance— has been proposed to counter this. The objective of this study is to research perceptions arising from the plain packaging of tobacco products. MethodsWe employed a qualitative research methodology -focus groups- with smokers and non-smokers in in two medium-sized Andalusian towns (Spain). ResultsResults show the importance of plain cigarette packaging as a form of promotion, particularly among women and young people, how pack colour influences product perceptions, and how removing full branding increases the salience of the warnings. ConclusionsPlain packaging, combined with pictorial health warnings, may reduce the capacity of packaging to be distinctive and a badge product. Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Objectives" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "ObjetivosEl tabaco es causa de aproximadamente 650.000 muertes en Europa, y de ellas, unas 55.000 en España. Debido a las prohibiciones de realizar actividades de publicidad y promoción, el envase está considerado como el último bastión de comunicación para la industria tabacalera. El envase neutro —un aspecto uniforme del envase para toda marca comercializada— ha sido propuesto como forma de combatirlo. El objetivo de este trabajo se centra en estudiar las percepciones que suscita el diseño neutro del envase. MétodosSe ha realizado una investigación cualitativa, a través de grupos focales en dos ciudades de tamaño medio con personas fumadoras y no fumadoras en dos ciudades de tamaño medio de Andalucía (España). ResultadosLos resultados señalan la importancia que tendría el envase de tabaco neutro como estrategia de desnormalización del tabaco, en especial en las mujeres y las personas jóvenes, como el color del envase neutro influye en las percepciones que el consumidor tiene del producto, y como incrementa la visibilidad de las esquelas sanitarias insertadas en el envase. ConclusionesEl envase neutro, unido a las advertencias sanitarias combinadas, podrían reducir la capacidad distintiva del envase. La desaparición de los rasgos estéticos del envase, de esta manera, añadiría una dificultad más a las compañías para presentar sus marcas de forma favorable, y ayudaría a proteger a la población de los peligros del tabaco." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Objetivos" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:2 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:1 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age group (years)</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Women</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " colspan="2" align="center" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Men</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " rowspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Smoker \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-smoker \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Smoker \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-smoker \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15-24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">29 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">25-34 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">35-45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">- \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Total \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">16 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">59 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2203251.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Number of participants by gender, age and smoker status." ] ] 1 => array:5 [ "identificador" => "tb0005" "tipo" => "MULTIMEDIATEXTO" "mostrarFloat" => false "mostrarDisplay" => true "texto" => array:1 [ "textoCompleto" => "What is known about the topic?There is a growing evidence base about plain packaging for tobacco products, which is recommended by the Framework Convention on Tobacco Control. This measure has now been fully implemented in Australia, France, the United Kingdom and New Zealand. Studies suggest that plain tobacco packaging may diminish the positive image that fully-branded packaging can create and elicit more negative perceptions about the product. Other research suggests that this measure can increase the visibility of the health warnings on packs and reduce misperceptions of harm as a consequence of pack design. Nevertheless, less research has looked at perceptions of specific attributes of plain packaging, like colour.What does this study add to the literature?This research explores perceptions of plain tobacco packaging among smokers and non-smokers in Spain, as well as plain pack colour. This study provides an insight into this measure in Spain, which will be of interest to public health and policy makers given the potential of plain tobacco packaging to be used to help tackle tobacco-related harm." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "WHO global report on trends in prevalence of tobacco smoking 2015" "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "World Health Organization" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "World Health Organization" "fecha" => "2015" ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The tobacco atlas" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "M. Eriksen" 1 => "J. Mackay" 2 => "H. Ross" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Libro" => array:5 [ "edicion" => "5th ed." "fecha" => "2015" "paginaInicial" => "88" "editorial" => "The American Cancer Society" "editorialLocalizacion" => "Atlanta" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "autores" => array:1 [ 0 => array:2 [ "colaboracion" => "Canadian Cancer Society" "etal" => false ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:2 [ "tituloSerie" => "Cigarette package health warnings: international status report." "fecha" => "2014" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multisensory design: reaching out to touch the consumer" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "C. 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Original article

Perceptions of plain cigarette packaging among smokers and non-smokers in Andalusia (Spain)

Percepciones del envase neutro del tabaco entre fumadores y no fumadores en Andalucía (España)

Blanca Lacave-Garcíaa, Juan Miguel Rey-Pinob,

Autor para correspondencia

jrey@ugr.es

Corresponding author.

, Karine Gallopel-Morvanc, Crawford Moodied, Esteve Fernándeze, Isabel Nerínf

a Department of Marketing and Communication, University of Cádiz, Cádiz, España

b Department of Marketing Management and Research, University of Granada, Granada, España

c EHESP Scool of Public Health, EA 7348 MOS, Rennes, France

d Institute for Social Marketing, University of Stirling, Stirling, United Kingdom

e Tobacco Control Unit, Institut Català d’Oncologia (ICO-IDIBELL); School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain

f Tobacco Control Unit, Department of Medicine, Psychiatry and Dermatology, School of Medicine, University of Zaragoza, Zaragoza, España

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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Tobacco is a major global health problem&#44; being a risk factor in six of the eight leading causes of death globally and responsible for seven million deaths per year&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> Tobacco is responsible for approximately a quarter &#40;27&#37;&#41; of all deaths in Spain each year&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> Public health policy makers face two important challenges&#58; to reduce consumption and prevalence among smokers and discourage non-smokers from starting&#46; The World Health Organisation&#39;s Framework Convention on Tobacco Control recommends a range of measures to protect citizens&#59; one of these concerns the packaging and labelling of tobacco products&#46; Article 11 of the Framework Convention on Tobacco Control recommends pictorial health warnings on packaging&#44; which are now mandatory in more than 100 countries&#44;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a> and also plain &#40;or standardised&#41; packaging &#8212;the standardisation of pack appearance so that all cigarettes must come in drab colour packs with pictorial health warnings but without any branding&#44; except for the brand name&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Packaging is a multipurpose marketing tool and crucial for tobacco products&#44; particularly in countries where other communication tools are banned&#46; In Spain&#44; for instance&#44; since tobacco advertising&#44; promotion and sponsorship is no longer permitted&#44; the packaging is extremely important&#46; There are numerous examples of innovative pack design in Spain&#44; such as novel pack shapes and ways of opening&#44; slimmer packs for female-oriented brands&#44; and also textured packs&#44; which create a distinctive tactile sensation &#8212;touch is important in developing emotional or affective connections with brands&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a> Further innovation seems likely&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">While the importance of fully-branded packaging as a marketing tool for tobacco is well established&#44; the impact of plain packaging is not well understood in Spain&#46; Indeed&#44; a systematic review of research on plain packaging found that most studies were conducted in five countries &#40;Australia&#44; Canada&#44; France&#44; New Zealand&#44; United Kingdom&#41;&#44;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">5</span></a> all with stringent tobacco control policy&#46; It may be that reactions to plain packs will differ in other countries&#44; as cultural differences have been found in response to anti-tobacco media campaigns&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">6</span></a> pictorial warnings&#44;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a> perceptions of branding and colour preference and meaning&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">8&#8211;10</span></a> The main aims of plain packaging are to reduce the appeal of the pack and product&#59; increase the salience of the health warnings&#59; and reduce misperceptions of product harm as a result of pack design&#46;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a> Australia was the first country to implement plain packaging in December 2012&#44; followed by France and the United Kingdom in 2017&#46; Norway&#44; New Zealand and Ireland will fully implement plain packaging in 2018 and a number of other countries are considering this measure&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The aim of this study is to gauge smokers and non-smokers&#8217; perceptions of plain tobacco packaging in comparison to fully-branded packaging&#44; their response to different plain pack colours&#44; and what impact&#44; if any&#44; plain packaging has on the salience of the health warnings&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Design and sample</span><p id="par0025" class="elsevierStylePara elsevierViewall">Given that plain packs are not available on the Spanish market&#44; we employed a qualitative methodology to fully explore participants&#8217; attitudes&#44; perceptions and reactions to plain packaging&#46; Eight focus groups &#40;5-8 participants per group&#59; n &#61; 59&#41; were conducted in two Spanish medium sized towns &#40;Granada and C&#225;diz&#41;&#46; The sample was segmented by gender&#44; age and smoking status&#44; following criterion of homogeneity for intra-groups characteristics and heterogeneity for between-groups characteristics&#46; People aged 15 to 45 years were interviewed because they are a key target group for Spanish health practitioners&#44; and male and female smokers and non-smokers were included given that plain packaging is intended to encourage smokers to quit and discourage non-smokers from starting &#40;see <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> for sample characteristics&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">In order to determine the number of focus groups we established a minimum of two groups per considered category of the segmentation variables&#44; combining categories for not having an excessive number of groups that would not add new information for the analysis&#44;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> with a bigger number of groups for the young people categories&#44; that are supposed to be a main target for the tobacco industry&#44; as well as the fact that at this early stages people start to smoke&#46;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Materials and procedure</span><p id="par0035" class="elsevierStylePara elsevierViewall">To explore the impact of pack design&#44; participants were presented with fully-branded and plain packs with cigarettes inside&#46; The brands chosen for the study were those on the Spanish market that were most popular with each group&#46; Mock-up plain packs were produced so as to look as realistic as possible for participants&#46; The plain packs were presented in three different colours &#40;brown&#44; white and grey&#41;&#44; with these colours the most frequently explored in plain packaging research&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;15&#44;16</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">Each focus group was conducted by two researchers&#44; one male and one female&#44; with one leading as moderator and the other assisting as co-moderator and ensuring that the groups were recorded&#46; Groups were conducted in quiet rooms with a round table to help participants interact&#44; with the group discussions video and audio recorded for transcription and analysis&#46; All groups were first shown a set of fully-branded cigarette packs and asked their opinion of these&#46; They were then shown the differently coloured plain packs and asked their thoughts and feelings on these&#46;&#160;Participants were compensated with a gift voucher &#40;25 &#8364;&#41; at the end of the session to encourage recruitment&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">Each focus group discussion was transcribed and analysed using NVivo 10 software&#44; which involves a semantic categorization of participants&#8217; comments and a frequency analysis of the appearance of each category by the creation of nodes&#46; Coding resources &#8212;focus groups transcripts&#8212; and categorization references &#8212;gender&#44; age and smoking status&#8212; were used for the frequency analysis&#46; Semantic categorisation was undertaken in three stages<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">17</span></a>&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">&#8226;</span><p id="par0050" class="elsevierStylePara elsevierViewall">Reducing chunks of text from transcripts into common meanings&#44; following an initial read-through&#44; and undertaking a more advanced reading of the texts&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">&#8226;</span><p id="par0055" class="elsevierStylePara elsevierViewall">Assuming a complete read-through of all transcripts&#44; repeated several times&#46;</p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">&#8226;</span><p id="par0060" class="elsevierStylePara elsevierViewall">Extracting literal chunks of text from the transcripts to illustrate the results&#46;</p></li></ul></p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Quality of data collection and analysis</span><p id="par0065" class="elsevierStylePara elsevierViewall">We followed a rigorous process to increase the reliability of the results&#46; Firstly&#44; a semi-structured topic guide was developed by the research team to ensure that all relevant topics were discussed in each group&#46; Secondly&#44; given the importance of the stimuli we only used actual packs of cigarettes&#44; rather than images&#46; Thirdly&#44; we recruited participants who were not known to each other<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">18</span></a> and ensured homogeneity within each group&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">19</span></a> Fourthly&#44; extensive field notes were taken during the groups and these were used in conjunction with the video and audio recording to analyze participants&#8217; comments&#44; discussions and behaviors&#46; The coding and analysis was performed by two of the researchers who moderated the groups&#44; thus helping triangulate the findings&#46; Finally&#44; we comprehensively reviewed the literature prior to the groups being conducted in order to fully understand the topic and to allow us to compare our findings with past research&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Role of fully-branded packaging</span><p id="par0070" class="elsevierStylePara elsevierViewall">The aesthetic appeal of current&#44; fully-branded cigarette packaging was mentioned frequently&#46; Women were more aware of&#44; and interested in&#44; pack aesthetics than men&#46; With regard to the different pack elements&#44; most comments related to pack colour&#44; particularly for women&#44; who said that colour influenced their perceptions of the pack and product&#46; For instance&#44; the cream colour of one of the fully-branded packs was viewed as feminine&#44; thought to make the pack look more elegant&#44; and suggestive of smooth tasting cigarettes&#46;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">&#8226;</span><p id="par0075" class="elsevierStylePara elsevierViewall">&#8220;It&#39;s feminine&#44; no&#44; more than this&#44; it is really feminine&#8221; &#40;female&#44; smoker&#44; 35-45 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">&#8226;</span><p id="par0080" class="elsevierStylePara elsevierViewall">&#8220;Maybe it could have some relation&#44; the outer design &#40;the pack&#41; with the fact of you smoking a cigarette&#44; it&#39;s soft&#8230; I don&#8217;t know&#44; maybe it&#39;s because of this&#8221; &#40;female&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">&#8226;</span><p id="par0085" class="elsevierStylePara elsevierViewall">&#8220;It&#39;s elegant&#44; for wealthy people&#8221; &#40;female&#44; non-smoker&#44; 25-34 years old&#41;&#46;</p></li></ul></p><p id="par0090" class="elsevierStylePara elsevierViewall">In terms of which element of the pack participants reported seeing first on fully-branded packs&#44; non-smokers said the health warnings whereas smokers&#44; women and young adults said the branding&#46; Another frequent answer&#44; irrespective of smoking status&#44; was the colour of the pack&#46;<ul class="elsevierStyleList" id="lis0015"><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">&#8226;</span><p id="par0095" class="elsevierStylePara elsevierViewall">&#8220;I have directly seen&#8217;smoking kills&#8221;&#8217; &#40;female&#44; non-smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0040"><span class="elsevierStyleLabel">&#8226;</span><p id="par0100" class="elsevierStylePara elsevierViewall">&#8220;The red colour&#8221; &#40;male&#44; non-smoker&#44; 35-45 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0045"><span class="elsevierStyleLabel">&#8226;</span><p id="par0105" class="elsevierStylePara elsevierViewall">&#8220;So&#44; I have seen directly the brand&#8230; I&#8217;ve seen the brand and I have said to myself&#44; huh&#33;&#8221; &#40;female&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li></ul></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Perceived impact of plain packaging on smoking-related behavior</span><p id="par0110" class="elsevierStylePara elsevierViewall">In all groups&#44; although particularly among young men&#44; plain packaging was considered something that could help reduce cigarette consumption&#46; Participants suggested that removing full branding from cigarette packs would be effective&#44; a strong deterrent for those susceptible to smoking and those who have recently started smoking&#46;<ul class="elsevierStyleList" id="lis0020"><li class="elsevierStyleListItem" id="lsti0050"><span class="elsevierStyleLabel">&#8226;</span><p id="par0115" class="elsevierStylePara elsevierViewall">&#8220;Young people search for the best&#44; the coolest thing&#59; then&#44; when they see this&#44; this does not catch their attention&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0055"><span class="elsevierStyleLabel">&#8226;</span><p id="par0120" class="elsevierStylePara elsevierViewall">&#8220;If you see something so insipid&#44; so dull&#44; something that is somewhere at home&#44; I even do not know that it is a tobacco pack&#46; I see this thing white &#40;the plain pack&#41; and I say to myself&#58; what is this&#63; I do not even pick it up&#44; they do not recall my attention&#46; And if children see these sad colours&#44; so subdued colours&#44; so dulled&#44; children will never recall tobacco products&#8221; &#40;female&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0060"><span class="elsevierStyleLabel">&#8226;</span><p id="par0125" class="elsevierStylePara elsevierViewall">&#8220;If all packs have the same colour&#44; with the name of the brand and that picture&#44; I am sure that consumption will be reduced&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0065"><span class="elsevierStyleLabel">&#8226;</span><p id="par0130" class="elsevierStylePara elsevierViewall">&#8220;Because of the design&#44; I think that it would be better &#40;&#8230;&#41; to search for all brands and make all of them be the same&#44; that is&#44; all packs the same&#59; so&#44; you see them and you do not like them&#8221; &#40;male&#44; non-smoker&#44; 35-45 years old&#41;&#46;</p></li></ul></p><p id="par0135" class="elsevierStylePara elsevierViewall">They suggested that plain packaging&#44; i&#46;e&#46; packs without different colours and designs&#44; would essentially convert the product into something vulgar&#46; Few felt it would have any impact on adult smokers however&#44; although it may help to reduce consumption for some&#44; and some young women smokers doubted the efficacy of plain packs in stopping people from starting to smoke&#46;<ul class="elsevierStyleList" id="lis0025"><li class="elsevierStyleListItem" id="lsti0070"><span class="elsevierStyleLabel">&#8226;</span><p id="par0140" class="elsevierStylePara elsevierViewall">&#8220;It is obvious&#44; then&#44; maybe I see this &#40;fully-branded pack&#41;&#44; and I know perfectly that it is tobacco and the company&#44; and then I see this other one &#40;plain pack&#41; and I do not know what it is&#44; it is a box&#44; and it can contain bolts&#44; earphones&#8230; And it does not impact me in any way&#46; It is clear to me that it is less easy to distinguish that it is tobacco&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0075"><span class="elsevierStyleLabel">&#8226;</span><p id="par0145" class="elsevierStylePara elsevierViewall">&#8220;They would arrive to something if they make all brands exactly the same&#44; all grey&#44; especially for people that have never smoked&#8221; &#40;male&#44; non-smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0080"><span class="elsevierStyleLabel">&#8226;</span><p id="par0150" class="elsevierStylePara elsevierViewall">&#8220;It&#39;s not a question of a single model&#44; I do not think that a lot of people that began to smoke did it because of the pack being this way&#8230; It is more a question of friendship&#44; of your circle of friends&#8221; &#40;female&#44; non-smoker&#44; 15-24 years old&#41;&#46;</p></li></ul></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Effect of plain packs on warning salience</span><p id="par0155" class="elsevierStylePara elsevierViewall">Participants commented that the warnings were more visible on plain packs&#44; as the branding no longer distracted from them&#44; and that this would make people more aware of them&#46; The absence of branding &#40;aside from brand name&#41; was also thought to make brand identification more difficult&#46;<ul class="elsevierStyleList" id="lis0030"><li class="elsevierStyleListItem" id="lsti0085"><span class="elsevierStyleLabel">&#8226;</span><p id="par0160" class="elsevierStylePara elsevierViewall">&#8220;I think that it is much easier to get used to the current pack of the brand with a picture on it&#44; than getting used to the grey one with a picture on it&#46; The picture on this pack &#40;plain pack&#41;&#44; you see it all the time&#46; And in this &#40;fully-branded pack&#41; you can distract this vision a bit&#44; you can get distracted with the logo&#44; the red colour&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0090"><span class="elsevierStyleLabel">&#8226;</span><p id="par0165" class="elsevierStylePara elsevierViewall">&#8220;That&#39;s right&#44; it does not distract you from seeing it&#44; it is simply the picture&#8221; &#40;female&#44; non-smokers&#44; 35-45 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0095"><span class="elsevierStyleLabel">&#8226;</span><p id="par0170" class="elsevierStylePara elsevierViewall">&#8220;The pack&#44; being so simple&#44; it does not have anything that capture your attention except the picture&#44; your eyes always will go to the picture&#44; the pack does not have anything but the picture&#8221; &#40;female&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0100"><span class="elsevierStyleLabel">&#8226;</span><p id="par0175" class="elsevierStylePara elsevierViewall">&#8220;It is clear to me&#44; you see this one &#40;plain pack&#41; and see immediately the picture&#44; not the brand&#44; nothing&#8230;&#8221; &#40;male&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li></ul></p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Perceptions of plain pack colour</span><p id="par0180" class="elsevierStylePara elsevierViewall">While the three plain packs had a similar appearance&#44; the different colour of each significantly influenced how they were perceived&#46; Two of the three plain pack colours &#40;grey and brown&#41; were considered much more negatively than the white pack&#46; Participants referred to the grey pack as ugly&#44; associating it with dirtiness&#44; something bad or diseased lungs&#46; The cigarettes within this pack were also considered to be poorer quality&#46;<ul class="elsevierStyleList" id="lis0035"><li class="elsevierStyleListItem" id="lsti0105"><span class="elsevierStyleLabel">&#8226;</span><p id="par0185" class="elsevierStylePara elsevierViewall">&#8220;The grey pack does not capture my attention&#44; it&#39;s not flashy&#59; if you have it in your pocket&#44; or if you see somebody with it&#44; you won&#8217;t like to try&#46; It is not the same&#44; I don&#8217;t know&#44; the brown is what you say&#44; it looks like a cigar with cinnamon flavour that I have sometimes bought &#40;&#8230;&#41; and the white&#8230; the white&#44; it does capture more the attention&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0110"><span class="elsevierStyleLabel">&#8226;</span><p id="par0190" class="elsevierStylePara elsevierViewall">&#8220;The one I dislike more is the grey and the one I like more&#44; the white&#8221; &#40;female&#44; non-smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0115"><span class="elsevierStyleLabel">&#8226;</span><p id="par0195" class="elsevierStylePara elsevierViewall">&#8220;The grey looks like if it has more smoke&#44; death&#44; obscurity&#44; the two other ones are more easy to advertise&#44; more classic and they are more noticeable&#8230; This &#40;the grey&#41; is like not having anything&#44; except the pictures&#8221; &#40;male&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li></ul></p><p id="par0200" class="elsevierStylePara elsevierViewall">The brown plain pack generated mixed perceptions&#44; being more frequent the positive ones&#46; It was considered ugly and dirty by some participants&#44; and was associated with illness and death&#46; It was also considered to have lower quality cigarettes&#46; However&#44; others thought it looked attractive and flashy&#44; or like chocolates or cigars&#46;&#160;Results reveal that this colour can be as appropriate as the grey one when the target is young people&#46;<ul class="elsevierStyleList" id="lis0040"><li class="elsevierStyleListItem" id="lsti0120"><span class="elsevierStyleLabel">&#8226;</span><p id="par0205" class="elsevierStylePara elsevierViewall">&#8220;The brown one looks sadder and that the tobacco is poorer quality&#8221; &#40;male&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0125"><span class="elsevierStyleLabel">&#8226;</span><p id="par0210" class="elsevierStylePara elsevierViewall">&#8220;The brown&#44; because I see this colour&#8230; like if my lungs are already like this colour&#44; or the teeth&#8221; &#40;male&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0130"><span class="elsevierStyleLabel">&#8226;</span><p id="par0215" class="elsevierStylePara elsevierViewall">&#8220;The chocolate&#44; I like more the brown colour&#8221; &#40;female&#44; smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0135"><span class="elsevierStyleLabel">&#8226;</span><p id="par0220" class="elsevierStylePara elsevierViewall">&#8220;The brown one capture my attention&#44; but because it looks like this&#44; a pack of condoms&#44; or a pack of cigars&#44; or&#8230;&#44; I don&#8217;t know&#44; any other thing&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li></ul></p><p id="par0225" class="elsevierStylePara elsevierViewall">Finally&#44; the white pack reminded participants of a pharmacy product&#44; being seen as less harmful&#46;<ul class="elsevierStyleList" id="lis0045"><li class="elsevierStyleListItem" id="lsti0140"><span class="elsevierStyleLabel">&#8226;</span><p id="par0230" class="elsevierStylePara elsevierViewall">&#8220;It looks even fancy&#8230; the idea is that if you want&#44; you can choose&#44; and I can choose&#44; I might prefer the white one&#44; because it looks like a medicine&#44; you know&#44; you always can think that a medicine can be good&#44; but if you see it in brown or grey&#8230;&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0145"><span class="elsevierStyleLabel">&#8226;</span><p id="par0235" class="elsevierStylePara elsevierViewall">&#8220;It looks cleaner&#8221; &#40;female&#44; non-smoker&#44; 15-24 years old&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0150"><span class="elsevierStyleLabel">&#8226;</span><p id="par0240" class="elsevierStylePara elsevierViewall">&#8220;The white colour looks light tobacco&#8221; &#40;male&#44; smoker&#44; 25-34 years old&#41;&#46;</p></li></ul></p></span></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0245" class="elsevierStylePara elsevierViewall">Packaging is a crucial marketing tool which can influence consumers in myriad ways&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a> It can appeal to consumers&#44; generate interest&#44; communicate information about the product and its benefits&#44; and add value by increasing the quality of experiences related to its use&#46;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;22</span></a> It has a key function at the point-of-sale but importantly can function post-purchase&#46;<a class="elsevierStyleCrossRefs" href="#bib0265"><span class="elsevierStyleSup">23&#8211;25</span></a> For tobacco products&#44; packaging is often considered a badge product given its high social visibility&#44; and it can enhance positive perceptions of smoking as well as confer a positive image of the smoker&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;26</span></a></p><p id="par0250" class="elsevierStylePara elsevierViewall">Our findings suggest that package design can significantly influence pack and product perceptions&#46; The appearance of fully-branded packaging was viewed as important by women&#44; with some packs considered elegant and the product perceived as smoother&#59; smoother cigarettes are often thought to be less harmful&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> That pack design appeared more pronounced for women than men may reflect the importance attached to the aesthetic characteristics of packaging by women&#44; as identified in tobacco industry marketing documents<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">28</span></a> and previous academic research&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a></p><p id="par0255" class="elsevierStylePara elsevierViewall">The results suggest that plain packaging may have a role to play in combating smoking by discouraging younger people from starting to smoke or new smokers from continuing&#44; although consistent with past research the impact on adult smokers was considered marginal&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> With the branding removed participants also felt that this would make the warnings stand out more&#44; which is one of the core aims of plain packaging&#44; and also that it would be more difficult for them or others to form a strong connection with brands&#46;</p><p id="par0260" class="elsevierStylePara elsevierViewall">People are known to attach meanings to particular colours&#44;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> as was found with the different coloured plain packs&#46; The brown and grey plain packs &#40;especially the grey&#41; were more likely than the white pack to have negative associations&#44; being considered ugly&#44; dirty and like diseased lungs&#46; It is well established in the marketing literature that pack appearance influences product evaluation&#44;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">23</span></a> with the cigarettes considered higher quality in fully-branded packs and poorer quality in the brown and grey plain packs&#46;</p><p id="par0265" class="elsevierStylePara elsevierViewall">In terms of limitations of the study&#44; the use of qualitative research means that the findings cannot be generalised to the wider population&#44; and possible biases may have occurred during the focus group discussions&#44; e&#46;g&#46;&#44; some influencing from researchers to participants&#46; With respect to the stimuli&#44; the brands we chose may have also created some bias among participants&#44; depending on their attitudes to these brands&#46; The brown plain pack we used differs from the darker pack used in countries which have implemented plain packaging &#40;Australia&#44; United Kingdom&#44; France&#41;&#44; which likely resulted in this pack being viewed slightly more positively&#44; given that research has found that darker plain pack colours are perceived as more off-putting&#46;<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">29</span></a> The study also provides no insight into the impact of plain packaging on actual smoking behaviour&#46;</p><p id="par0270" class="elsevierStylePara elsevierViewall">The main strength of this research is that it offers an understanding of how smokers and non-smokers in Andalusia &#40;Spain&#41; perceive a measure that could extend tobacco control policy&#44; but that has not been yet considered by Spanish policy makers&#46; In addition&#44; while there are limitations with focus groups&#44; they are an appropriate methodology for exploring consumers&#8217; views of plain packaging&#44; given that these packs are not available for sale in Spain&#46; They allow for in-depth responses on the possible impact that plain packaging may have&#44; and the impact of pack colour&#46;</p><p id="par0275" class="elsevierStylePara elsevierViewall">In conclusion&#44; the findings suggest that plain packaging&#44; combined with pictorial health warnings&#44; may reduce the capacity of packaging to be distinctive and a badge product&#46; Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands&#44; and may help to reinforce the ability of some consumers to protect themselves from the dangers of smoking&#46; Finally&#44; as we found some differences with past research in other countries in how different packs colors were perceived&#44; this suggests that it may be beneficial to explore the suitability of particular plain pack colors in each country before implementing this measure&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Editor in charge</span><p id="par0280" class="elsevierStylePara elsevierViewall">Carlos &#193;lvarez-Dardet&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Transparency declaration</span><p id="par0285" class="elsevierStylePara elsevierViewall">The corresponding author on behalf of the other authors guarantee the accuracy&#44; transparency and honesty of the data and information contained in the study&#44; that no relevant information has been omitted and that all discrepancies between authors have been adequately resolved and described&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0080" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0140">Authorship contributions</span><p id="par0300" class="elsevierStylePara elsevierViewall">B&#46; Lacave-Garcia is responsible for the article and contributed to the conception and management of the work&#44; to the analysis and interpretation of data&#44; the critical review and the final writing of the manuscript&#44; with important intellectual contributions&#46; J&#46;M&#46; Rey-Pino contributed to the conception of the work&#44; to the data collection and their analysis and data interpretation&#44; as well as the data initial writing of the manuscript&#46; K&#46; Gallopel-Morvan contributed to the conception of the work&#44; to the analysis and interpretation of data&#44; and to the critical review of the article with relevant intellectual insights&#46; C&#46; Moodie contributed to the conception of the work&#44; to the interpretation of data&#44; and to the critical review of the article with relevant intellectual insights&#46; E&#46; Fern&#225;ndez contributed to the conception of the work&#44; to the interpretation of data&#44; and to the critical review of the article with relevant intellectual contributions&#46; I&#46; Ner&#237;n contributed to the conception of the work&#44; to the interpretation of data&#44; the initial writing of the article and to the critical review of the article with relevant intellectual contributions&#46; All authors approved the final version of the article when it was sent&#46; All authors are responsible for having reviewed all aspects of the manuscript and for having discussed all of it for having an integer version of it&#46;</p></span><span id="sec0085" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0145">Funding</span><p id="par0325" class="elsevierStylePara elsevierViewall">B&#46; Lacave-Garc&#237;a and J&#46;M&#46; Garcia have been financially supported by the Andalusian Government&#44; health department&#44; with the project &#8220;effects of plain packaging of tobacco products and visual warnings on the fall of the demand of tobacco products&#58; a research from the social marketing perspective&#8221; &#40;code 49&#47;08&#41;&#46;</p><p id="par0330" class="elsevierStylePara elsevierViewall">C&#46; Moodie is supported by Cancer Research UK&#46;</p><p id="par0335" class="elsevierStylePara elsevierViewall">E&#46; Ferna&#769;ndez is partly supported by Ministry of Universities and Research&#44; Government of Catalonia &#40;grant 2017SGR319&#41; and by the Instituto de Salud Carlos III&#44; Government of Spain&#44; co-funded by the European Regional Development Fund &#40;FEDER&#41; &#40;grants INT16&#47;00211&#160;and INT17&#47;00103&#41;&#46;</p></span><span id="sec0090" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0150">Conflicts of interest</span><p id="par0315" class="elsevierStylePara elsevierViewall">None&#46;</p></span></span>"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Objectives</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Each year tobacco is responsible for 650&#44;000 deaths in Europe and 55&#44;000 in Spain&#46; With tobacco advertising and promotion banned in Spain and most of Europe&#44; the last bastion of marketing is the packaging&#46; Plain tobacco packaging &#8212;which involves packs having a standardised appearance&#8212; has been proposed to counter this&#46; The objective of this study is to research perceptions arising from the plain packaging of tobacco products&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">We employed a qualitative research methodology -focus groups- with smokers and non-smokers in in two medium-sized Andalusian towns &#40;Spain&#41;&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Results show the importance of plain cigarette packaging as a form of promotion&#44; particularly among women and young people&#44; how pack colour influences product perceptions&#44; and how removing full branding increases the salience of the warnings&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Plain packaging&#44; combined with pictorial health warnings&#44; may reduce the capacity of packaging to be distinctive and a badge product&#46; Altering pack design in such a way would make it more difficult for tobacco companies to create a favourable image of their brands and may help to reinforce the ability of the population to protect themselves from the dangers of smoking&#46;</p></span>"
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        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">El tabaco es causa de aproximadamente 650&#46;000 muertes en Europa&#44; y de ellas&#44; unas 55&#46;000 en Espa&#241;a&#46; Debido a las prohibiciones de realizar actividades de publicidad y promoci&#243;n&#44; el envase est&#225; considerado como el &#250;ltimo basti&#243;n de comunicaci&#243;n para la industria tabacalera&#46; El envase neutro &#8212;un aspecto uniforme del envase para toda marca comercializada&#8212; ha sido propuesto como forma de combatirlo&#46; El objetivo de este trabajo se centra en estudiar las percepciones que suscita el dise&#241;o neutro del envase&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Se ha realizado una investigaci&#243;n cualitativa&#44; a trav&#233;s de grupos focales en dos ciudades de tama&#241;o medio con personas fumadoras y no fumadoras en dos ciudades de tama&#241;o medio de Andaluc&#237;a &#40;Espa&#241;a&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Los resultados se&#241;alan la importancia que tendr&#237;a el envase de tabaco neutro como estrategia de desnormalizacio&#769;n del tabaco&#44; en especial en las mujeres y las personas j&#243;venes&#44; como el color del envase neutro influye en las percepciones que el consumidor tiene del producto&#44; y como incrementa la visibilidad de las esquelas sanitarias insertadas en el envase&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">El envase neutro&#44; unido a las advertencias sanitarias combinadas&#44; podr&#237;an reducir la capacidad distintiva del envase&#46; La desaparici&#243;n de los rasgos est&#233;ticos del envase&#44; de esta manera&#44; a&#241;adir&#237;a una dificultad m&#225;s a las compa&#241;&#237;as para presentar sus marcas de forma favorable&#44; y ayudar&#237;a a proteger a la poblaci&#243;n de los peligros del tabaco&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0025"
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          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "M&#233;todos"
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          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "multimedia" => array:2 [
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        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
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          ]
        ]
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " rowspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Age group &#40;years&#41;</th><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Women</th><th class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Men</th><th class="td" title="\n
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                  \t\t\t\t  " rowspan="2" align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total</th></tr><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Smoker&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Non-smoker&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">15-24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">29&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25-34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35-45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Total&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">59&nbsp;\t\t\t\t\t\t\n
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          "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Number of participants by gender&#44; age and smoker status&#46;</p>"
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          "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">What is known about the topic&#63;</span><p id="par0290" class="elsevierStylePara elsevierViewall">There is a growing evidence base about plain packaging for tobacco products&#44; which is recommended by the Framework Convention on Tobacco Control&#46; This measure has now been fully implemented in Australia&#44; France&#44; the United Kingdom and New Zealand&#46; Studies suggest that plain tobacco packaging may diminish the positive image that fully-branded packaging can create and elicit more negative perceptions about the product&#46; Other research suggests that this measure can increase the visibility of the health warnings on packs and reduce misperceptions of harm as a consequence of pack design&#46; Nevertheless&#44; less research has looked at perceptions of specific attributes of plain packaging&#44; like colour&#46;</p></span><span id="sec0075" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">What does this study add to the literature&#63;</span><p id="par0295" class="elsevierStylePara elsevierViewall">This research explores perceptions of plain tobacco packaging among smokers and non-smokers in Spain&#44; as well as plain pack colour&#46; This study provides an insight into this measure in Spain&#44; which will be of interest to public health and policy makers given the potential of plain tobacco packaging to be used to help tackle tobacco-related harm&#46;</p></span></span>"
        ]
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    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "WHO global report on trends in prevalence of tobacco smoking 2015"
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                          "colaboracion" => "World Health Organization"
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            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The tobacco atlas"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "M&#46; Eriksen"
                            1 => "J&#46; Mackay"
                            2 => "H&#46; Ross"
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:5 [
                        "edicion" => "5th ed&#46;"
                        "fecha" => "2015"
                        "paginaInicial" => "88"
                        "editorial" => "The American Cancer Society"
                        "editorialLocalizacion" => "Atlanta"
                      ]
                    ]
                  ]
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              ]
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            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:1 [
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Canadian Cancer Society"
                          "etal" => false
                        ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:2 [
                        "tituloSerie" => "Cigarette package health warnings&#58; international status report&#46;"
                        "fecha" => "2014"
                      ]
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              ]
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            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multisensory design&#58; reaching out to touch the consumer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "C&#46; Spence"
                            1 => "A&#46; Gallace"
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                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Psychol Mark&#46;"
                        "fecha" => "2011"
                        "volumen" => "28"
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                        "paginaFinal" => "308"
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            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Plain tobacco packaging&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "C&#46; Moodie"
                            1 => "M&#46; Stead"
                            2 => "L&#46; Bauld"
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                      ]
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                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2012"
                        "editorial" => "University of Stirling"
                        "editorialLocalizacion" => "Stirling"
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            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A cross-cultural study of the persuasive effect of fear appeal messages in cigarette advertising&#58; China and Canada"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:3 [
                            0 => "M&#46; Laroche"
                            1 => "R&#46; Toffoli"
                            2 => "Q&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Int J Advert&#46;"
                        "fecha" => "2001"
                        "volumen" => "20"
                        "paginaInicial" => "297"
                        "paginaFinal" => "317"
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            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The effectiveness of cigarette warning label threats on nonsmoking adolescents"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "L&#46;I&#46; Sabbane"
                            1 => "T&#46;M&#46; Lowrey"
                            2 => "J-C&#46; Chebat"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Consum Aff"
                        "fecha" => "2009"
                        "volumen" => "43"
                        "paginaInicial" => "332"
                        "paginaFinal" => "345"
                      ]
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            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Exploring the relationships between colour and international branding&#58; a cross cultural comparison of the UK and Taiwan"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "A&#46; Grimes"
                            1 => "I&#46; Doole"
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                        ]
                      ]
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                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Mark Manag&#46;"
                        "fecha" => "1998"
                        "volumen" => "14"
                        "paginaInicial" => "799"
                        "paginaFinal" => "817"
                      ]
                    ]
                  ]
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              ]
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            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Managing images in different cultures&#58; a cross-national study of color meanings and preferences"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T&#46;J&#46; Madden"
                            1 => "K&#46; Hewett"
                            2 => "M&#46;S&#46; Roth"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Int Mark&#46;"
                        "fecha" => "2000"
                        "volumen" => "8"
                        "paginaInicial" => "90"
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Información del artículo

ISSN: 02139111
Idioma original: Inglés

DOI:10.1016/j.gaceta.2018.04.009

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2022 Agosto	187	68	255
2022 Julio	143	77	220
2022 Junio	136	60	196
2022 Mayo	146	55	201
2022 Abril	149	66	215
2022 Marzo	126	88	214
2022 Febrero	111	52	163
2022 Enero	107	60	167
2021 Diciembre	87	50	137
2021 Noviembre	105	76	181
2021 Octubre	106	76	182
2021 Septiembre	69	79	148
2021 Agosto	71	74	145
2021 Julio	53	47	100
2021 Junio	94	47	141
2021 Mayo	108	71	179
2021 Abril	234	144	378
2021 Marzo	139	59	198
2021 Febrero	94	41	135
2021 Enero	71	52	123
2020 Diciembre	93	48	141
2020 Noviembre	71	27	98
2020 Octubre	51	36	87
2020 Septiembre	142	40	182
2020 Agosto	115	40	155
2020 Julio	123	33	156
2020 Junio	63	45	108
2020 Mayo	106	42	148
2020 Abril	164	45	209
2020 Marzo	161	62	223
2020 Febrero	504	149	653
2020 Enero	343	89	432
2019 Diciembre	95	39	134
2019 Noviembre	70	12	82
2019 Octubre	84	34	118
2019 Septiembre	65	15	80
2019 Agosto	84	28	112
2019 Julio	58	18	76
2019 Junio	65	29	94
2019 Mayo	74	29	103
2019 Abril	52	12	64
2019 Marzo	46	26	72
2019 Febrero	44	29	73
2019 Enero	25	12	37
2018 Diciembre	30	20	50
2018 Noviembre	81	26	107
2018 Octubre	65	53	118
2018 Septiembre	2	20	22
2018 Agosto	0	102	102
2018 Julio	0	19	19

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