Guillaumier 2014.
| Methods | Country: Australia Setting: large Social and Community Welfare Organisation in Western Sydney, New South Wales Date: March ‐ December 2012 Design: Between‐participants 2×2 factorial design trial embedded within a cross‐sectional computer touchscreen survey |
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| Participants | 354 socially disadvantaged welfare aid adult recipients (aged 18+) who were current smokers were recruited. The sample was drawn from a service outlet of a large, national non‐government, social and community service organisation (SCSO). The service provides ‘emergency relief’ welfare such as food vouchers, grocery items and financial aid to individuals experiencing various forms of social and financial hardship across a large catchment area of Western Sydney. The client profile of SCSOs includes an over‐representation of disadvantaged groups including Aboriginal and Torres Strait Islanders, single parents, long‐term unemployed and those whose primary income is a government benefit. Participants were introduced to the study when they attended the SCSO for their emergency relief appointment. Staff explained that there was a study about smoking. If interested, they were led to a private room where a research assistant provided more detailed info and assistance to complete the survey if needed. Participation was assumed to be consent. Participants received a AUD 20 gift voucher for participating 138 men (39%) Average age not available |
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| Interventions | IV: The 4 pack conditions were: (1) branded Winfield Blue 25; (2) standardised Winfield Blue 25; (3) branded B&H Smooth 25 and (4) Standardised B&H Smooth 25. Within each pack condition, respondents were presented with a standard set of items to rate their assigned pack. Plain pack digital images were created using specifications outlined in the Australian Government’s Tobacco Plain Packaging Act 2011, while images of branded packs were supplied by the Centre for Behavioural Research in Cancer, Victoria, Australia Branded = Branded pack conditions replicated cigarette packs available for purchase at the time of survey. 2 of the most popular brand variants in the Australian mainstream: branded Winfield blue and branded premium Benson and Hedges Smooth 25 Standardised (plain) = Australian: dark brown‐green colour (Pantone 448C), with the brand name in the same typeface (Lucida Sans) and font size and colour (Pantone Cool Gray 2C) All pack conditions featured the same graphic image and text HW: ‘smoking causes peripheral vascular disease’ that first appeared on Australian cigarette packs in 2006. These were pre‐ and post‐real packages in Australia – so 30% front‐of‐pack warnings increased to 75% of the pack face, and 90% back‐of‐pack warnings remained |
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| Outcomes |
[Secondary non‐behavioural]: Participants were asked to rate their assigned pack on measures of brand appeal and purchase intentions. Brand appeal: rated packs on brand appeal scales (1 ‐ 7) Purchase Intentions: Participants were presented with images of the 2 brand name options (Winfield and B&H) on a single screen and asked: “If you ran out of cigarettes and only the packs below were available in the store you went to, which would you be most tempted to buy?” Participants could choose between the 2 brand name images or select "I would not buy any". Analysis summary: Participants were randomly allocated to 1 of the 4 cigarette pack conditions by Digivey’s randomise function, which uses a pseudo‐random number generator provided by the underlying programming language. Participants who had previously viewed and rated a standardised packaging image, received standardised image response options, and those who had previously rated a branded packaging image (i.e. pack A or C) received branded image response options at this question; Pairwise comparisons using the Wilcoxon rank sum test were undertaken to compare median scores between branded packaging and standardised packaging for each of the 2 brand names. OR analyses were used to assess the effect of packaging type (branded vs standardised) on purchase intention |
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| Funding source | “This study was part of a project funded by a grant from the Hunter Medical Research Institute (G1101150).” | |
| Conflicts of interest | “AG was supported by an Australian Postgraduate Award PhD scholarship administered through the University of Newcastle. BB was supported by a Cancer Institute NSW Career Development Fellowship. CP was supported by Cancer Control Collaboration funding.” | |
| Notes | ||
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Selective reporting (reporting bias) | Low risk | Comment: in line with objectives |
| Sampling Method | Unclear risk | Quote: "The primary limitation of the study is its reliance on a convenience sample limiting its external validity and generalisability. However, socially disadvantaged groups are notoriously difficult to recruit and retain in health research.(33 34) Recruitment challenges were overcome by accessing community services as recruitment sites and using convenience samples." Comment: A convenience sample but as the authors state it is very difficult to access a random sample of socially disadvantaged groups |
| Measurement of independent variable | Low risk | Comment: packs shown were easily distinguishable |
| Measurement of dependent variable | Low risk | Quote: "The outcome measures used in this study pose an additional limitation. Although they were selected for the purpose of comparing results with previous plain pack research,(19 20) they have not been evaluated for validity or reliability and this should be assessed in the future." Comment: The measures used had good face vaildity although the authors have commented on the need for further research in this area, they were comparable with measures used in ohter studies |
| Control for confounding | Low risk | Quote: "Sociodemographic characteristics were similar across the four intervention groups" Comment: Groups appeared similar |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | Quote: "A total of 787 clients were approached by SCSO staff during the study period and 608 were eligible to be approached to participate by the RA. Of those, 581 (96%) completed the survey and 362 (62%) of them were identified as current smokers (daily and occasional). Eight smokers were excluded as they primarily used something other than manufactured or roll‐your‐own tobacco." Comment: High response rate and few exclusions |
| Statistical methods | Low risk | Comment: Appropriate |