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Does the hand that controls the cigarette packet rule the smoker? : findings from ethnographic interviews… Bell, Kirsten; Dennis, Simone; Robinson, Jude; Moore, Roland 2015

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ewSKirsten Bell , Simone Dennis , Jude Robinson , Roland MooreHope Building #14, Australian National University, ACT, 0200, AustraliaiminologUniversity of Liverpool, Liverpool, L69 3GB, United Kingd Prevention Research Center, Pacific Institute for Reseaer the CC BY-NC-NDnses/by-nc-nd/4.0/).‘Gold’ brand to the rugged masculine appeal of Marlboros and thefeminine refinement of Virginia Slims. Clearly evident in accountsabout the industry and industry accounts themselves is the pow-erdthe ‘charisma’dof branding (Pottage, 2013). The marketing‘guru’ Louis Cheskin, responsible for the iconic Marlboro Man,hich occurs whenre translated intoge, 2013, p. 544).attests, the ciga-) focus of industrytings et al., 2008).The tobacco industry maintained complete control over ciga-rette packaging until 1965, when the USA Federal Cigarette Label-ing Act required cigarette cartons and packets to carry the textualwarning “Caution: Cigarette smoking may be hazardous to yourhealth”. Following the US lead, in subsequent decades many othercountries introduced requirements that cigarette packets carrywarning labels. However, a decisive shift occurred in 2001, whenCanada became the first country in the world to introduce graphic(text- and picture-based) warning labels on cigarette packets.* Corresponding author.E-mail addresses: kibell@mail.ubc.ca (K. Bell), simone.dennis@anu.edu.auContents lists available at ScienceDirectSocial ScienceseSocial Science & Medicine 142 (2015) 136e144(S. Dennis), j.e.robinson@liverpool.ac.uk (J. Robinson), roland@prev.org (R. Moore).© 2015 The Authors. Published by Elsevier Ltd. This is an open access article undlicense (http://creativecommons.org/lice1. Introduction1.1. Branding cigarette packetsThe cigarette packet has long been a cultivated element of itsalluredfrom the gleaming case of Benson and Hedges' premiumlabeled this effect “sensation transference”, w“the auratic effects of the branded package ainnate qualities of the product” (cited in PottaThus, as the Legacy Tobacco Documents Libraryrette packet formed an intensive (and fetishizedresearch throughout the twentieth century (HasComparative study packets when asked to do so on a purely intellectual or aesthetic level reflects how they engage withpackets as they are enfolded into their everyday lives.a r t i c l e i n f oArticle history:Received 16 June 2015Received in revised form6 August 2015Accepted 13 August 2015Available online 15 August 2015Keywords:CanadaAustraliaUnited KingdomUSACigarette packagingTobacco controlEthnographic interviewshttp://dx.doi.org/10.1016/j.socscimed.2015.08.0210277-9536/© 2015 The Authors. Published by Elsevierdomrch and Evaluation, 180 Grand Avenue, Suite 1200, Oakland, CA 94612-3749, USAa b s t r a c tThroughout the twentieth century, packaging was a carefully cultivated element of the appeal of thecigarette. However, the tobacco industry's control over cigarette packaging has been steadily erodedthrough legislation that aims to rebrand the packet from a desirable to a dangerous commoditydepi-tomized in Australia's introduction of plain packaging in 2012. Evident in both the enactment of cigarettepackaging legislation and industry efforts to overturn it is the assumption that packets do thingsdi.e.that they have a critical role to play in either promoting or discouraging the habit. Drawing on 175ethnographic interviews conducted with people smoking in public spaces in Vancouver, Canada; Can-berra, Australia; Liverpool, England; and San Francisco, USA, we produce a ‘thick description’ of smokers'engagements with cigarette packets. We illustrate that despite the very different types of cigarettepackaging legislation in place in the four countries, there are marked similarities in the ways smokersengage with their packets. In particular, they are not treated as a purely visual sign; instead, a primarymeans through which one's own cigarette packet is apprehended is by touch rather than by sight.Smokers perceive cigarette packets largely through the operations of their handsdthrough their‘handiness’. Thus, our study findings problematize the assumption that how smokers engage withb School of Archaeology and Anthropology, ADc Department of Sociology, Social Policy and Cr y, School of Law and Social Justice, Room 1.16, Eleanor Rathbone Building, Bedford Street South,a Department of Anthropology, University of British Columbia, 6303 NW Marine Drive, Vancouver, BC, V6T 1Z1, CanadaDoes the hand that controls the cigarettFindings from ethnographic interviewsAustralia, the United Kingdom and the Ua, * b cjournal homepage: www.elLtd. This is an open access article upacket rule the smoker?ith smokers in Canada,Ad& Medicinevier .com/locate/socscimednder the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).& MAlthough the legislation was ostensibly designed to informsmokers about the health effects of smoking, its purpose wasclearly persuasive as well as informational. In other words, HealthCanada explicitly recognized the potential of graphic warning la-bels to market the concept of reducing tobacco consumption, aswell as promulgating factual information about the health effects ofsmoking (Health Canada, 2000).In conjunction with an array of other countries, Australia fol-lowed suit in implementing graphic warning labels in 2006 and theUK in 2008. However, such efforts subsequently stalled in the USA,after the Food and Drug Administration announced its intendedgraphic warning labels in 2011. A legal challenge by the tobaccoindustry was mounted, centering on precisely the issue of the‘informational’ versus ‘advertising’ dimensions of the proposedlabels, and was instrumental to the ruling in its favor. According tothe presiding District Judge, Richard Leon: “It is abundantly clearfrom viewing these images that the emotional response they werecrafted to induce is calculated to provoke the viewer to quit, ornever to start smokingdan objective wholly apart from dissemi-nating purely factual and uncontroversial information” (Reinberg,2012). Although the Court of Appeals has since overturned theruling, the legislation is currently in limbo.The notion that packets could be enrolled into the service of ananti-tobacco agenda in much the same way that they had previ-ously served a pro-tobacco one was repeateddand dramaticallyextendeddin Australia's implementation of world-first ‘plain’packaging in December 2012. The assumption underpinning thislegislation is that unbranded cigarette packets reduce the appeal ofsmoking, increase the salience of health warnings and correctmisperceptions about the harms of tobacco use, thereby decreasingthe number of young people who start smoking and increasing thenumber of people who quit (Dennis, 2013; McKeganey and Russell,2015). However, as Chapman and Freeman (2014, p. xiii) observe,“there is nothing plain about Australia's plain packs”, which arenow dominated by hard-hitting anti-smoking appeals that take up90% of the front of the packet and 75% of the back. This featurefigured centrally in the (unsuccessful) complaint mounted by thetobacco industry in its submissions to the Australian High Courtchallenging the legality of the legislation. In the court case, thepacket was described as “occupied” and “conscripted” to serve theCommonwealth government's purposes, thereby effectively over-riding the industry's proprietary rights (Pottage, 2013, p. 521).Although the tobacco industry is pursuing various legal routes todismantle the legislation, its lack of success has spurred othercountries into considering plain packaging and the UK governmenthas since announced its intention to implement similar legislation,which is due to go into effect in May 2016.1.2. The agency of objectsEvident in both the enactment of cigarette packaging legislationand industry efforts to overturn it is the assumption that packets dothings. In the view of mainstream tobacco control, a packet freedfrom industry branding and refurbished with ‘hard-hitting’ anti-smoking messages discourages purchase. In the event that ciga-rettes are acquired, the packet reinforces the dangers of smokingfor the duration of its life, thereby presumably affecting futurepurchasing behavior. According to Fong (2001, p. 2), “An individualwho smokes one pack per day, for example, is potentially exposedto the health warning 7300 times in a single year”. This view isendorsed by the World Health Organization (2011), which notes:“prominent health warning labels… provide themost direct healthmessages to smokers and potentially reach smokers every time theypurchase or consume tobacco products” (p. 22e23, emphasisK. Bell et al. / Social Scienceadded). As this statement suggests, there is a clear recognition ofthe ways in which the traditional ‘power’ of the package to shapehow smokers interpret its contents may be disrupted and redirectedto serve the interests of tobacco control rather than the tobaccoindustry.Despite the diametrically opposed agendas of these two entities,both groups share the assumption that the branded aesthetics ofthe cigarette packet (of either danger or desire, depending on whois in charge) shape smokers' responses to its content. In both sce-narios, the packet is deemed to have a degree of agencydan agencythat is sometimes seen to subsume or override that of the smoker.Thus, if the ‘Modern Constitution’ is based on a conceptual dividebetween humans and non-humans (Latour, 1993), branding andadvertising are areas where it clearly breaks down. As Cronin(2004) observes, the imagined animation of commodities trou-bles distinctions between the categories of ‘person’ and ‘thing’. Forexample, in a 2008 commentary on plain packaging, Hastings,Gallopel-Morvan and Rey state: “It is abundantly clear that youngpeople are drawn into smoking by branding and that liveried packsplay an active role in this process” (p. 361, emphasis added). In suchframings, the industry-branded packet becomes a “silent salesman”(Chantler, 2014, p. 4; Chapman and Freeman, 2014, p. 35) that en-acts a “poisonous seduction” against “susceptible” minds (Hastingset al., 2008, p. 361), with an unbranded (or rebranded) packetlogically seen to reverse these effects.In this paper we take seriously the idea of the agency of objects,but in ways rather different from such representations of cigarettepackaging. As Latour (2005, p. 71) observes,there is hardly any doubt that kettles ‘boil’ water, knifes [sic]‘cut’ meat, baskets ‘hold’ provisions, hammers ‘hit’ nails on thehead, rails ‘keep’ kids from falling, locks ‘close’ rooms againstuninvited visitors, soap ‘takes’ the dirt away, schedules ‘list’ classsessions, price tags ‘help’ people calculating, and so on … This,of course, does not mean that baskets ‘cause’ the fetching ofprovisions or that hammers ‘impose’ the hitting of the nail.The highly politicized context of cigarette packaging legislationhas clearly been instrumental to such framings, given the need for aclear and compelling policy narrative about the effects of branding.However, there are “many metaphysical shades between full cau-sality and sheer inexistence” (Latour, 2005, p. 72). Indeed, claimsabout the efficacy of branding do not unambiguously translate intochanges in product sales (Cronin, 2004)das recent debates aboutthe impact of plain packaging in Australia attest (see McKeganeyand Russell, 2015). Following Cronin (2004, p. 63), we would sug-gest that the truth of such effects is indeterminate “and ultimatelyless significant than the discursive work to which claims aboutthose effects are put”.Inwhat follows, we take the view that cigarette packets are bothmaterial products and mobile signs, and we are interested in their“complex, protean and only half-appreciated” social lives (Cronin,2004, pp. 3e4). With this in mind, we attend closely to the expe-rienced (as opposed to assumed) relationships forged betweencigarette smokers and packets based on ethnographic interviewsconducted in Vancouver, Canada; Canberra, Australia; Liverpool,England; and San Francisco, USA. In conducting this research, ourgoal was to try to understand how people engage with cigarettepackets in the context of smoking itself in aid of producing a‘thick(er) description’ (Geertz, 1973) of this phenomenon than hasdominated studies of cigarette packaging to date.2. The study and settingBetween October 2013 and March 2015, we carried out in situedicine 142 (2015) 136e144 137interviews with people smoking in public spaces at the four& Mfieldsites: 60 in Vancouver, 70 in Canberra, 60 in Liverpool and 55 inSan Francisco. Despite our declared intention to produce a ‘thickdescription’ of smokers' engagement with cigarette packets, ourstudy does not have all the hallmarks of a typical ethnographicendeavor. We did not have particular fieldsites we wedded our-selves to and revisited time and again; nor did we develop long-term relationships with participants in the studydinterviewsinstead took the form of one-off encounters with people smoking inpublic in a variety of settings. However, the interviews we carriedout are characterized by the key ethnographic intention to get at‘thickness’ and ‘livedness’ as people engaged in the aspect of sociallife inwhich wewere interested, and how they described it to us asthey practiced it.In each city, we visited a number of sites in an attempt to reachsmokers of different classes, ages and backgrounds. These sitesvaried from city to city but included: downtown cores, businessdistricts, ethnic enclaves, neighborhoods known for their diversity,universities, colleges, hospitals, pubs, parks, and shopping centers.We did not approach everyone we saw smokingdwe used ourdiscretion, focusing on people we thought would be open to talking(e.g. people who were stationery, people who had just lit a ciga-rette, people not intensively engaged in an activity where wejudged interruptions would be viewed with annoyance). Althoughwe initially planned to talk to smokers 16 or over, this is somethingthemajority of our institutional ethics review committees balked atwithout parental consent. The youngest person interviewed was 17in Canberra, 19 in Vancouver, and 18 in Liverpool and San Francisco.The proportion of men and women we interviewed was relativelyequal across the four sites, but despite our efforts to approach adiverse array of smokers, the majority of people interviewed ateach site were white.After briefly explaining the study, we asked if people werewilling to chat and proceeded if they affirmed their interest indoing so. Although the majority of people we approached agreed tobe interviewed, their general willingness to do so varied from siteto site; for example, only 10% of those approached in Vancouverdeclined to talk, in contrast to 30% in San Francisco. We did notobtain written consent for the interviews, which would haveundermined their informal and contextual natureda fact ourrespective ethics committees recognized. Not all interviews wererecorded, although the percentage varied from site to site. Again,we used our discretion in asking permission to record interviewsbased on our sense of whether this might inhibit conversation;interviewees also regularly declined to be recorded, preferring tokeep things informal. In all such instances, jottings were fleshed outinto fieldnotes immediately following the interview.At the outset of the study, we devised an interview schedulecomprising several core questions about participants' engagementwith cigarette packets, but, as is often the case in ethnographicinterview contexts, the conversations at each site also reflected ourown individual research interests and the specificities of the localsocial and legislative contexts (see Table 1 for an overview). Par-ticipants themselves also shaped interviewsd particularly theirtemporal dimensions. Some interviews lasted for the time it tookfor the participant to smoke a single cigarette: at the point of itsextinguishment, so too was the conversation. Sometimes, aninterview lasted for the course of two cigarettes chain-smoked inrapid succession. Frequently, interviewees indicated that their timewas limited at the outset, but stayed chatting after they finishedsmoking, clearly enjoying the conversation.In many respects, our study was designed to supplementdandspeak back todthe International Tobacco Control Four CountrySurvey, a longitudinal cohort survey carried out in the four coun-tries we examine here. An underlying premise of the survey is thatK. Bell et al. / Social Science138countries with more extensive legislation in place act as a model ofwhat will occur in countries with laxer legislation; in other words,legislation is treated as the independent variable and smoking asthe dependent one (see Hammond et al., 2006). In this paper, weattenuate this view through an examination of themes that reoc-curred in interviews across all four fieldsites, despite the markeddifferences between cigarette packages in each context (see Fig. 1).With this agenda in mind, the analysis we present is based twointerrelated aspects of our interview data: 1) how participantsresponded to cigarette packets as a sign, and 2) how participantsresponded to cigarette packets as an object. We generated dataaround the first theme through questions such as, “how muchattention do you pay to the warning label?”, “Do you think thewarning label has an impact on your smoking?”, “Do you thinkwarning labels have an impact on other smokers?”. The secondtheme was investigated via questions about how smokers engagedwith their own cigarette packet and packets we showed them fromother countries (especially the Australian packet).We did not pool data emerging from these enquiries and thensubject it to analysis; such a process would have served to erasecontext, which wewere concerned to preserve. Instead, at each sitewe individually analyzed our interview data via standard ethno-graphic coding processes (see Emerson et al.,1995) and developed alist of key themes that were then jointly discussed to determinethose common to each of the fieldsites. Thus, it is important to bearin mind that the themes discussed below are not necessarily themost common at each of the four individual fieldsites, but insteadthose that consistently reoccurred across them. All names pre-sented in the findings are pseudonyms. Institutional ethicsapproval for the study was obtained from the University of BritishColumbia Behavioural Research Ethics Board, the Australian Na-tional University Human Research Ethics Committee, the Universityof Liverpool Research Ethics Committee and the Pacific Institute forResearch and Evaluation Institutional Review Board.3. Findings3.1. Not looking and looking awayAcross all four fieldsites, most interviewees told us that theypaid little attention to the warning label on their pack of cigarettes.This is perhaps to be expected in San Francisco, given the smalltextual label on the side of US packets. Indeed, intervieweesfrequently mentioned the “Surgeon General's warning” but couldonly broadly recall messages (about lung cancer, etc.). For example,Brian (“I'm about to be 33”) and Kimmy (28) were a white coupleinterviewed together in the Mission District in San Francisco asthey enjoyed a smoke outside a bar. Brian had recently returned tosmoking after a year of abstinence and according to Kimmy, whopurchased the pack they were smoking, “he hasn't, you know,officially become a smoker again”. They tended to finish eachother's thoughts throughout the interview, a phenomenon that alsooccurred when they were asked about the warning labels on cig-arettes. Kimmy noted: “I mean, the thing I noticemost is just saying‘Surgeon General's warning’ in big, bold capital print”. Brianinterjected “And the rest is blah, blah, blah”. Kimmy agreed; “Yeah,the rest is blah, blah, blah”.While wemight assume that the inconspicuous nature of the USwarning labels explained smokers' responses, this lack of recall andattention was equally evident at sites with large and confronta-tional graphic labels in place. For example, in Canberra, most in-terviewees could not say what health warning label was on theirpacket without first looking at it. Typically, smokers would retrievetheir packet from a pocket or a bag or, if it lay on the table or seatnext to them, pick it up, examine it, and then comment on it. Foredicine 142 (2015) 136e144example, Ben, a 35-year-old white office worker in Canberra,r smoutdustrs covf theadvccoaccthrOtheK. Bell et al. / Social Science & Medicine 142 (2015) 136e144 139handed Simone his packet when she asked to see it. “What are yourthoughts on this one?” she enquired of him, when he proffered thecrumpled, almost empty, packet from his pocket. “Which one have Igot there?” he enquired back. “It's this one, with the teeth on it”,Simone responded, showing him the front face of the packet (seeFig. 2). “Well, it's not too pleasant” Ben replied; “But not the worstone, either”.Likewise, in Liverpool, only four of the 60 smokers could recallthe label on the packet they were carrying with them, and mostindicated that they did not look at it. Mabel, a 64-year-old whitewoman, was typical in this respect. Mabel was approached outsidea hospital where she was currently an in-patient being treated forlung cancer. She happened to be holding her packet as she smokedTable 1Overview of the social and legislative context of smoking in the four fieldsites.Legislation Vancouver, Canada Canberra, AustraliaSmokingprevalence14% in BC 14% in the ACTSmoking bans Comprehensive indoor smoking banBan within 6 m of building entrances& exitsBan at all commercial outdoor eatingareasBan in City parks and beachesComprehensive indooBan at all commercialareasCigarettepackagingGraphic warning labels cover 75%of both sides of the packPackets are free of indgraphic warning labelof the front and 75% oPromotion &advertisingTotal ban on cigarette advertisingBan on display of tobacco products inlocations selling tobaccoTotal ban on cigaretteBan on display of tobain locations selling tobSmokingcessationsupportFree support inc. access to nicotinereplacement therapy (NRT) availablethrough BC Smoking Cessation ProgramFree support availableAlcohol, Tobacco andAssociation ACTa cigarette and when asked about the warning label on it sheresponded: “I haven't even looked at it, I don't even look at it now”.She then perused the warning label on her pack of Windsor Blues,which featured a close-up image of a man with a grotesque necktumor (the current series of European Union pictures is beingphased out, but this label is visible on the back of the UK cigarettepacket in Fig. 1). She began to read out the label before pausing toremark, “Ugh, I hate when it's got that on!”These kinds of responses were repeated almost verbatim inVancouver, where very few interviewees could recall specific de-tails about the warning label on the packet of cigarettes they werecurrently smoking. The most common responses were: “No idea”,“no, I don't look at it” or “I pay no attention”. Even in the two in-stances where smokers could correctly identify the warning labelon their packet, their comments were suggestive of an engagementmore complex than the simple act of ‘looking’. For example, Aaron,a 40-year-old white engineer originally from New Zealand, wasinterviewed at a downtown community garden where he wasenjoying a smoke on an unusually sunny day. Aaron, who migratedto Vancouver seven years previously, was currently trying to quit,although rather pessimistic about his ability to do so. When Kirstenasked if he could recall the warning label on his packet, Aaronimmediately responded: “the sick woman. Tarbox?” Once theyconfirmed the label on the packet Kirsten asked if Aaron couldrecall other warning labels and he thought about it for a few mo-ments and responded: “the limp dick, the eyeball with the needle init, the kid in the car”.Aaron's comments speak to a phenomenon witnessed at all thefieldsites: some labels are clearly far more memorable for partici-pants than others. Indeed, it is worth noting that the “tobacco usecan make you impotent” label (Fig. 3) is not actually part of thecurrent series of Canadianwarning labels; it was phased out in 2011when larger, ‘harder-hitting’ warning labels were introduced. AsAaron migrated to Canada in the mid 2000s, he would certainlyhave seen it, but a cigarette packet bearing this label would notphysically have crossed his palm for the past three years. Thus, suchostensible acts of recall may speak more to what smokers expect tosee on a packet than describing what they actually saw.To varying degrees, these views challenge the idea of warningLiverpool, England San Francisco, USA24.5% in Liverpool 12% in CAoking banoor eatingComprehensive smokingban in all enclosed andsubstantially enclosedspacesComprehensive indoor smoking banSmoking ban within 20 feet ofCity buildingsBan in City parks, outdoor streetfairs and festivalsy branding;er 90%backGraphic warning labelscover 30% of the frontand back of the packSmall text-based warning labelson the sides or front of the packertisingproductsoGeneral ban on cigaretteadvertising with theexception of point ofsale display in pubs,clubs and shops. SinceApril 2012, larger shopssuch as supermarkets arerequired to cover theirdisplays of cigarettesBan on TV advertisingBan on magazine advertising inpublications targeting childrenBan on billboards, public transitoughr DrugFree support inc. accessto NRT available throughNHS stop smoking servicesFree support available throughCalifornia Smokers' HelplineFree patches available to eligiblesmokerslabels as something that are straightforwardly ‘read’ by smokerswhen they purchase a pack. As we noted at the outset, a basicassumption underwriting the introduction of cigarette packaginglegislation is that smokers are forced to engage with them each andevery time they reach for a cigarette. Indeed, an explicit part of thelogic of plain packaging legislation is the assumption that withoutindustry branding to distract them, smokers will be forced toengage with the warning label. However, while participantsconsistently emphasized their lack of attention to the warning la-bels and this was concretely manifested in their inability to recallthem, certain labels clearly did register in some way. At the threefieldsites with graphic labels in place, participants frequentlysingled out especially abject and “gross” labels (e.g. “the eye with aneedle in it” and “rotting tongue” in Vancouver; in Canberra “thebaby one” and “the teeth one”; in Liverpool “the teeth one” and “thethroat one”). Thus, in some instances this inattention could bemoreaccurately glossed as a kind of active looking away. In Radley's(2002) words,What happenswhenwe turn away from an explicit image of thiskind? In turning away from the image the observer com-pletesdin one particular waydthe act of interpretation, inas-much as it is developed at all. When we do this we remove thedepiction from our view so that with its removal the ‘difficulty’of its appearance is suppressed, if not entirely extinguished (p. 5,emphasis added).US cK. Bell et al. / Social Science & Medicine 142 (2015) 136e1441403.2. Techniques of avoidance, refusals of engagementAs already hinted at, techniques of avoidance were commonthroughout the three fieldsites with graphic warning labels inplace, a phenomenon that has also been reported in a recentqualitative study on Australian smokers' responses to plain pack-Fig. 1. Front (top) and back (bottom) of an Australian, Canadian, UK andaging (see Hardcastle et al., 2015). In Vancouver and Canberra, aminority of participants decanted cigarettes to other containers orcertain packets were exchanged for ones with less threateningwarnings (6 of 60 in Vancouver, 9 of 70 in Canberra). However, weare interested here in the more commondand less overtdforms ofavoidance we witnessed at all three fieldsites, which did not relateFig. 2. The Australian “teeth” warning label (Health Warning Image© Professor Lau-rence J. Walsh, the University of Queensland, reproduced with permission of theCommonwealth of Australia).to changing the packet but instead the forms of visual and bodilyengagement with it.Various participants explained their efforts to avoid engagingwith the pack, outlining their specific techniques for minimizingcontact with it. Take Becky, a white 53-year-old administrator fromLiverpool interviewedwhile shewas on a break outside of her officeigarette packet (photographs by Katrina Ham; property of the authors).building. A stylish dresser who had smoked since the age of 15,Becky described taking cigarettes directly from her bag by touch ather desk, and then smoking them singly outside. “Out of sight, outof mind” she observed. She continued:I buy in a multi-pack, so I put them in the cupboard, I take apacket out, take them into work. I'm not necessarily ever reallylooking at that packet, becausewhen I come out of here, I go intomy bag, I open the cigarettes, take the cigarette out andwalk outhere, so I'm not even looking at the box, really.Becky insisted that this concealment was less about her personaldislike of the pictures and messages and more about the fear ofother people's reactions. In her words: “One thing I have noticed is Iwon't put the cigarettes out on a table now, you know, in a pub or arestaurant, and it's not because it's bothering me, the picture, but Ithink other people are going to judge”.Fig. 3. The “tobacco use can make you impotent” label (Licensed under Health Canadacopyright; reproduced with permission).While various participants described such acts of visual avoid-ance to us, in numerous instances we also witnessed them our-selves. For example, Rob, a white 45-year-old secondary schoolteacher interviewed in Canberra, was waiting for his wife to pick upa cake order for a family occasion when they chatted. It was a coolday, and when Simone asked to see his packet, Rob drew it out fromhis coat pocket and noted it was “the heart muscle photo” (Fig. 4).When she asked how he responded to the images, Rob said hefound them “disturbing; I think it's a bit off, really, for it to beallowed. They don't show diseased livers on wine casks”. As he putthe packet back into his pocket, he remarked, “this jacket is good,because I can keep the pack in there and not have to see it”. WhenSimone questioned him further, Rob explained that the pocket waslarge enough to accommodate his hand and the pack, so he did nothave to draw it out to retrieve a cigarette. The whole operationcould be done in the darkness of the pocket, entirely out of Rob'ssight. When she asked if this was something he did when hewasn'twearing this particular jacket, Rob responded, “I keep it out of mysight probablymost of the timedmy choice to look at it, same as it'smy choice to smoke”.In other cases, the hand itself served to envelop the label. Kirstenmet Vlad on Commercial Drivedone of Vancouver's most diverseK. Bell et al. / Social Science & Mneighborhoods, where hipsters and homeless people regularly rubshoulders. Fifty-eight-year-old Vlad, originally from Croatia, was ona break from his job as a painter when they chatted. He had startedsmoking at 18, and glumly noted that he knew hewas going to haveto quit smoking at some point for gooddhe was a diabetic, and hisdoctor had started giving him ultimatums. When Kirsten askedabout the labels, he responded that he did not look at them whenhe opened the packet. “I don't care about what's on the packet, justwhat's in it!” he declared. Using his pack of blackmarket cigarettes,Vlad then demonstrated his technique for opening his packet.Placing his left hand over the front of the packet, he used his rightthumb to flip it open, thus hiding it entirely from view.At first glance, informants' comments about cigarette packetsmight seem somewhat contradictorydto varying degrees all sug-gested that the images on the packet did not matter, yet all tooksteps to avoid them. However, read another way, their accountsspeak to the role of packets not justdor primarilydas a visual sign,but as a tangible object. After all, while tobacco control and thetobacco industry might be intensely preoccupied with significatoryFig. 4. The Australian “heart muscle” label (Health Warning Image© WinnipegRegional Health Authority; reproduced with permission of the Commonwealth ofAustralia).power of the packet, for smokers their primary function resides intheir ability to hold cigarettes, whilst simultaneously keeping themreadily accessible and protecting them from damage.As fieldwork progressed we came to realize that a primarymeans through which one's cigarette packet is apprehended is bytouch rather than by sight. Smokers ‘see’ cigarette packets largelythrough the operations of their handsdhands are placed in bagsand pockets as people fumble about for their smokes; they areopened with fingers that remove cellophane and foil and reach intothe packet to draw out a cigarette. Thus, wemight say that cigarettepackets exhibit the quality of ‘handiness’ in Heidegger's sense ofthe term. For Heidegger, we encounter objects not primarilythrough their appearance but through their ‘handiness’. In his now-famous example of the hammer, he explains:The less we stare at the thing called hammer, the more we takehold of it and use it, the more original our relation to it becomesand the more undisguisedly it is encountered for what it is, as auseful thing. The act of hammering itself discovers the specific‘handiness’ of the hammer. We shall call the useful thing's kindof being inwhich it reveals itself by itself handiness ([1953]2010,p. 69, emphasis in original).This contrast Heidegger draws between the ‘outward appearance’of things (or their ‘presence-at-hand’) and their ‘handiness’ (or‘readiness-to-hand’) is critical to understanding smokers' engage-ment with cigarette packets.To redeploy the hammer example, when the skilled carpenter isengaged in trouble-free hammering, she has “no conscious recog-nition of the hammer, the nails, or the work-bench, in the way thatone would if one simply stood back and thought about them”(Wheeler, 2011, emphasis in original). Clearly, for a minority ofsmokers in Vancouver and Canberra, the altered packets have hadthe effect of forcing a new aesthetic relation, one which hascompromised its ‘handiness’ to the extent that it becomes effec-tively unusable. However, for the most part, these new visual at-tributes did not undermine its usability or fundamentally transformsmokers' relation to the packet. As Biddle (1993, p. 189) notes,drawing on the insights of Merleau-Ponty, “The materiality of whatsurrounds you embodies attitude and orientation, in so far as youdevelop habits, relations of being, with these objects”. Moreover,such interactions generally occur in the context of years of habitualengagement. This is not to say that the visual aspect of such thingsis irrelevant. According to Heidegger, their use is not blind; rather,“it has its ownway of seeing which guides our operations and givesthem their specific certainty” (p. 70).3.3. Comparing packetsWith such insights in mind we can begin to make sense ofsmokers' responses to the Australian plain packet. For the mostpart, smokers we interviewed in Vancouver, Liverpool and SanFrancisco insisted that the Australian packet would have no impacton their smoking, although they varied substantially in their degreeof receptiveness to this type of packagingdwith some taking theview that “it can't hurt to try” and others condemning such legis-lation as patronizing and offensive. Regardless of the interviewee'sindividual smoking history, the almost universal refrain we heardwas “it wouldn't make a difference to me personally”. Numerousparticipants asserted that, in effect, it was too “late” forthemdbecause they already smoked and knew their brand, it didnot really matter what the packet looked like. Many also empha-sized that theywerewell aware of the risks of smoking, so efforts toreplace industry branding with warning labels would “not beedicine 142 (2015) 136e144 141telling me anything I don't already know”.& MHowever, while few of the people we interviewed suggestedthat plain packaging would affect their own smoking, this wasgenerally accompanied by the proposition that itmight impact kidsor “people who haven't yet started smoking”. For example, George,a white 31-year-old chef, was interviewed on the front steps of thedowntown San Francisco restaurant where he worked. George hadsmoked on and off since the age of 15, quitting for six-month pe-riods before being “pulled back” by his “enjoyment” of cigarettes.When asked about what he thought of warning labels, he noted:“I've seen pictures of what they do in other countries, like, they'llhave terrible graphic images of dead lungs or premature fetuses,whatever. I would probably still smoke. I don't know if it wouldmake much difference”. When pushed about what impact it mighthave if graphic labels (in all senses) were introduced in the US, hethought about it for a few moments and responded, “I think itwould help maybe a bit … like stopping kids from buying them,maybe, or keep them from smoking at a young age maybe”.This view was also frequently voiced in Australia itself, wherevarious informants similarly highlighted the potential role of plainpackets in reducing the uptake of smoking. Kaylee, a 42-year-oldstay-at-home mother, was typical in this respect. Interviewedoutside a Canberra shopping centre with her children (aged 12 and14) in tow, Kaylee commented that the warning labels would likelyhave more of an impact on kids than her generation: “That's howthey [cigarettes] are these days, a dangerous thing, and that's whatkids think they are. They don't question thatdsmoking isn't coolanymore, I'm not cool; I'm killing myself. Tomorrow's adults willnot question the health warnings, they will just accept that that iswhat cigarettes are”. However, Kaylee's comments, in tandemwiththose of many other smokers we interviewed, clearly emphasizedthe ways in which the social environment surrounding smokinghad fundamentally changed, suggesting that the ‘effects’ of pack-aging on non-smokers were disentanglable from this largercontext.Indeed, for some participants it was precisely this context thatmade cigarette packaging itself largely irrelevant. James, a white50-year-old smoker from Liverpool, was interviewed outside a pubshortly after he stepped out for a cigarette. As a smoker for over 30years, and one who was directly bearing the effects of the intro-duction of England's smoke-free legislation in 2007, James did notbelieve that the change to plain packets was enough to furthertransform the already radically altered environment of smoking.For him, thework of visibly stigmatizing smokers had already takenplace, so the appearance of the packet no longer meant what it oncehad. In his words:I mean, you're somewhat of a pariah anyway if you smoke, so theidea of taking out a packet of cigarettes which doesn't have itsown branding on, I mean, I don't think anyoned[thinks] ‘Ooh,look he's smoking such and such’, you know? That just doesn'texist anymore, sodso I think it just won't have any effect onanyone I don't think.His underlying point was that people who begin smoking now doso in an environmentmarkedly different from that inwhich he tookup the habit, so the meaning of branding had irrevocably altered.In a minority of cases, especially when comparing their owncigarette packages to ones from countries with stronger warninglabels in place, some participants did assert a correlation betweenwarning strength and quitting. Perhaps unsurprisingly, this viewwas expressed most frequently in San Francisco, where in-terviewees commonly mentioned more “graphic” and “grotesque”cigarette packets they had seen in other countries. While only aminority thought such packets would impact their smoking, theseK. Bell et al. / Social Science142departures from the normwere once again instructive in their ownright. For example, 30-year-old Jolene, who had a background inmarketing, was interviewed at a park near the Embarcadero in SanFrancisco. When asked what the warning label on her pack ofParliaments said, she responded: “I don't pay too much attention toit. It's really in light lettering; it's not something that stands outparticularly.” Jolene attributed her lack of recall to the relativelyinconspicuous nature of the US labels. In her words,I've done quite a bit of traveling. Spain was probably the mostinteresting because they would have actual pictures of decayedlungs on them. Uh, I've seen that in Canada as well, bright, bold,black lettering with white backgrounds with ‘smoking kills’… Ithink it draws it to the forefront and makes you feel really badabout it.Yet this assumption that more prominent warning labels wouldhave an effect was occasionally asserted amongst intervieweesregardless of the type of warning label on their packet. Thus, whileseveral informants from San Francisco suggested that the promi-nent graphic warning labels in Canada were likely to be moreeffective than the US labels, the vast majority of locals in Vancouverinsisted that the Canadian labels had no impact on their smoking,although fifty-seven-year-old John, originally from California,asserted that the Australian packet would probably do the trick.John had been living in Vancouver for the past seven years whenKirsten interviewed him; they met out the front of a local hospitalwhere he had been in for a checkup, having broken his back in aconstruction site accident when preparations for the 2010 Van-couver Winter Olympics were under way. John was very unhappyabout his smoking and was determined to quit at some point,although he clearly was not optimistic about his capacity, declaringthat he had smoked “since before birthdmymother was a smoker”.When they discussed the healthwarnings, Johnwas unable to recallthe specific label on his pack, responding: “I don't even notice it”.However, as they scrutinized John's cigarette packet together hespeculated that: “If it covered the whole pack, maybe then I mightpay attention to it”. When Kirsten showed him an Australian packethe immediately responded, “See that would discourage me, rightthere!”In many respects, such narratives about other ‘stronger’ packetspotentially eliciting the sort of response one's own packet failed toproduce echo the prevailing public health assumptions aboutcigarette packagingdi.e. that more prominent warning labels aremore effective. But we suggest that such responses are illustrativeof precisely the split wementioned earlier between an engagementwith packets as purely visual objects and one's own packet as auseable or ‘handy’ thing, perspectives that are distinct and largelyincommensurable.4. DiscussionDespite the legislative attention currently focused on cigarettepackets as a means of reducing tobacco consumption, for thesmokers we interviewed, regardless of the outward appearance oftheir packets, they typically came to be enfolded into a context ofexisting habitual engagement wherein the visual attributes of thepacket were markedly less relevant than its other attributes. Theserelations formed an existing context through which new pack el-ements were interpreted, encountered and dealt with. Such re-lations proved enduring and not so easily brokendclearly,otherwise many smokers would not have such difficulty in relin-quishing the habit (Dennis, 2011).Our study findings therefore problematize the assumption thathow established smokers engage with packets when asked to do soedicine 142 (2015) 136e144on a purely intellectual or aesthetic level reflects how they engage& Mwith packets as they are enfolded into their everyday lives. Thisassumption is embedded in virtually all of the research on cigarettepackaging that has been conducted to datedfrom experimentalstudies, to large-scale surveys, to qualitative research. For example,Mead et al. (2015) have recently explored theways that low-incomesmokers in Baltimore engage with graphic warning label-sdincluding many of the same labels in place at our fieldsites. Theynote that: “participants were asked about their cognitive and af-fective reactions to each label (such as what was the main messageof the label and how it made them feel) andwhich labels weremostlikely to motivate them to quit” (p. 3). Participants in the focusgroups did so readily and their responses were taken at face value,with the research team reporting: “we found that participants weremost motivated by labels portraying the negative consequences ofsmoking” (p. 8). However, examining cigarette packets as theycirculate in smoking practice produces a rather different viewof theostensible ‘power’ of the packet.Although an underlying premise of Mead et al.’s studydand ofcigarette packaging legislation more broadlydis that smokersrepeatedly engagewith thewarning label on the packet, this view isnot borne out by our research at any of the four fieldsites, regardlessof the form of cigarette packaging in place. In our view, this isexplained by the fact that smokers do not generally engage withtheir packets as objects viewed primarily through the lens of theiroutward appearance, but through their ‘handiness’. This is not tosuggest that the appearance of the packet is irrelevant; that somesmokers make conscious efforts to avoid the warning labels affirmsthis. Indeed, there are clearly instances where the rebranded packetdoes disrupt habitual engagements, fundamentally compromisingits handiness. However, this transformed relationship with thepacket does not necessarily transform smokers' relationship withthe objects it contains. Smokes can be decanted into other con-tainers; packets can be exchanged; various bodily techniques thatavoid visual engagement can emerge that become as habitual assmoking itself.At this point in the paper, readers might expect to see somecaveats presented about the generalizability of our data, and thelimitations imposed by our ethnographic approach. However, indisciplinary conversations about what constitutes evidence in an-thropology, various scholars have suggested that anthropologicalwork is generalizable, if the parameters of this concept areexpanded. For example, Fassin (2015) differentiates between‘extensive’ and ‘comprehensive’ generalization. The former is aboutextending local findings to make general statements and is char-acterized by sampling methods that aim to ensure the represen-tativeness of the datadthe International Tobacco Control FourCountry Survey is an exemplar of this type. Comprehensivegeneralization, on the other hand, is about identifying processesand mechanisms of general value, although they will not be foundeverywhere; Fassin argues that ethnography enables the latter kindof generalization. Similar arguments are found in Hastrup's (2004)distinction between ‘horizontal’ and ‘vertical’ generalization, withthe latter focused not on “wall-to-wall” generalizations, but insteadconcerned with the processes by which meanings are established,challenged and altered. In this way, wemight think of our fieldworkas akin to “dipping into a river repeatedly at different locations todetermine whether the water is of the same quality with the samekind of sediments and minerals on a consistent basis” (Csordas,2004, p. 475). Based on these dips, and the consistency of thesediments we found, it is evident that straightforward assertionsabout the impact of rebranded cigarette packets on currentsmokers need to be treated with a considerable degree of caution.Obviously, we are not attempting to speak to the way that non-smokers engage with rebranded packets, although the ‘potentialK. Bell et al. / Social Sciencesmoker’ is a keydperhaps the keydlegislative target of plainpackaging initiatives (see Chapman and Freeman, 2014). Yet, if thisis a limitation of our study, it is equally a limitation of all availableresearch into this topic, because such examinations must neces-sarily be speculative (Chantler, 2014). At present, the response ofthe ‘potential smoker’ to cigarette packaging is assessed in muchthe same way as that of the smoker herselfdnamely, throughmockups of plain packaging presented to subjects asked to ratetheir visual appeal (Chantler, 2014). Indeed, such studies are typi-cally conducted with smokers themselves, or include mixed pop-ulations of smokers and non-smokers (see Moodie et al., 2012,2013), with the assumption that the former is a proxy for thelatter or that similar responses from both speak to the universalappeal (or lack thereof) of packaging and its likely effects onsmoking ‘behavior’.Beyond our concerns about the ways such research asks par-ticipants to engage with packets on a purely aesthetic level, ourstudy results suggest the need for caution in generalizing fromcurrent smokers to potential smokers. Recall that most participantsarticulated a clear distinction between their own experiences andthat of people who have not started smoking yet. They generallyasserted that plain and graphic packs had no impact on their ownsmoking but that they might stop people from taking up the hab-itdbecause enduring relations had not yet been forged, valued, andsufficiently embodied as to form a context for encounteringpackets. Such informants also thought that it would be hard fornew smokers to establish relationships with plain and graphicpackets, as these objects would set the tone for unpleasant en-counters. We are not suggesting that these comments merely betaken at face value as evidence that cigarette packaging legislationdoes not ‘work’ for current smokers but it will ‘work’ for futureones; however, they do suggest that packaging might hold differentmeanings for these groups.While the ‘charisma’ of cigarette brands is often treated as aneffect of the “progressive development of branding semantics thatwas evolved by the tobacco industry's advertising agencies in thedecades that preceded the general proscription of tobacco adver-tising” (Pottage, 2013, p. 527), in light of these proscriptions and theothers that have accompanied them (smoking bans, etc.) can weassume that branding means the same thing now as it did 20 yearsagodor even ten? As Cochoy notes, “Far from being a space inwhich one and the same speaker can express themselves freely, apackage is a forum, a space of public expression, in which a host ofdifferent messages intersect, interconnect, and jostle one another”(in Pottage, 2013, p. 526).5. ConclusionIn this paper we have not attempted to answer the question ofwhether plain packets and/or those adorned with large andthreatening warning labels ‘work’, although we recognize that it isof intense interest in public health and tobacco control circles. Aswe stated at the outset, we feel this question cannot actually beanswered in the terms that legislators expect. While discussions ofeffects have a clear role to play in promoting or repressing politicalagendas around cigarette packaging, the effects themselves areultimately indeterminate (c.f. Cronin, 2004). To some extent, thereappears to be growing recognition of this, given the ways thatdiscourses on plain packaging changed pre- and post-implementation in Australia. As McKeganey and Russell (2015)observe, advocates who initially promoted plain packaging as theequivalent of a “vaccine that works very well against lung cancer”two years into the legislation had begun to characterize it as havinga “slow burning distal impact” (p. 566). Yet, while discourses onplain packaging may have become less linear and absolute in tone,edicine 142 (2015) 136e144 143the focus is still very much on how smokers (and non-smokers)engage with packets as a visual sign. However, if our research hasshown one thing, it is that we cannot understand smokers' in-teractions with the cigarette packets that circulate in their livespurely in such termsdand we suspect that potential smokers' en-gagements are equally complex.Simply put, we cannot treat the cigarette packet as a tabula rasaupon which the tobacco industry or the government inscribesmeaning and induces a certain kind of response. Nor are weattempting to invert this view to suggest that cigarette packets areinert and their meaning is that which smokers make of them.Instead, we suggest that if packets bear with them their encounterswith operations (with the industry and the state) that would bendCsordas, T.J., 2004. Evidence of and for what? Anthropol. Theory 4 (4), 473e490.Dennis, S., 2011. Smoking causes creative responses: on state anti-smoking policyand resilient habits. Crit. Public Health 21 (1), 25e35.Dennis, S., 2013. Golden chocolate olive tobacco packaging meets the smoker youthought you knew: the rational agent and new cigarette packaging legislationin Australia. Contemp. Drug Probl. 40 (1), 71e97.Emerson, R.M., Fretz, R.I., Shaw, L.L., 1995. Writing Ethnographic Fieldnotes. Uni-versity of Chicago Press, Chicago.Fassin, D., 2015. Postface in La force de l'ordre: Une anthropologie de al police desquartiers, second ed. Editions du Seuil, Paris.Fong, G.T., 2001. A Review of the Research on Tobacco Warning Labels, withParticular Emphasis on the New Canadian Warning Labels. Tobacco LabellingResource Centre. Available at: http://www.tobaccolabels.ca/wp/wp-content/uploads/2013/12/Canada-2002-A-Review-of-the-Research-on-Tobacco-Warn-ing-Labels-With-Particular-Emphasis-on-the-New-Canadian-Warning-Labels-Report-Fong1.doc (accessed 17.03.15.).Geertz, C., 1973. The Interpretation of Cultures. Basic Books, New York.Hammond, D., Fong, G.T., McNeill, A., Borland, R., Cummings, K.M., 2006. Effec-K. Bell et al. / Social Science & Medicine 142 (2015) 136e144144them to a certain kind of work, they equally bear the hallmarks ofother encounters and circulations. For current smokers, these en-gagements are primarily bodily, often registered specifically in andthrough the operations of touch, and speak to the ways in whichcigarette packets come to be ‘seen’ through embodied interactionsin which the visual dimensions of the packet are often markedlyless important than its handiness or usability.AcknowledgmentsThis research was funded by a Population Health InterventionResearch Grant titled “Confronting Cigarette Packaging”, jointlysponsored by the Canadian Institutes of Health Research (#GIR-127071) and the Canadian Cancer Society Research Institute(#702183). We would like to thank our colleague Dr RebeccaHaines-Saah, who provided useful feedback on this paper andconducted six of the smoker interviews in Vancouver. We wouldalso like to acknowledge the research assistants on this project fortheir support in conducting interviews: Helen Alexiou in Canberra,Anna Hopkins, Anne-Marie Martindale and Elizabeth Peatfield inLiverpool, and Lilian Wilson-Pacheco, Raul Chavez and RachelleAnnechino in San Francisco. We also gratefully acknowledge theinput of the three anonymous reviewers at Social Science andMedicine, especially ‘Reviewer 1’, whose incisive comments helpedus to sharpen and clarify our arguments. Finally, we want to thankthe many smokers who were kind enough to talk to the inquisitivestrangers who approached them on the street to quiz them abouttheir cigarette packets.ReferencesBiddle, J., 1993. The anthropologist's body or what it means to break your neck inthe field. Aust. J. Anthropol. 4 (3), 184e197.Chantler, C., 2014. Standardised Packaging of Tobacco: Report of the IndependentReview Undertaken by Sir Cyril Chantler. Department of Health, London.Available at: http://www.kcl.ac.uk/health/10035-TSO-2901853-Chantler-Re-view-ACCESSIBLE.PDF (accessed 09.07.15.).Chapman, S., Freeman, B., 2014. Removing the Emperor's Clothes: Australia andTobacco Plain Packaging. Sydney University Press, Sydney.Cronin, A.M., 2004. Advertising Myths: the Strange Half-lives of Images and Com-modities. Routledge, London.tiveness of cigarette warning labels in informing smokers about the risks ofsmoking: findings from the International Tobacco Control (ITC) Four CountrySurvey. Tob. Control 15, iii19eiii25.Hardcastle, S.J., Chan, D.C.K., Caudwell, K.M., Sultan, S., Cranwell, J.,Chatzisarantis, N.L.D., Hagger, M.S., 2015. Larger and more prominent graphichealth warnings on plain-packaged tobacco products and avoidant responses incurrent smokers: a qualitative study. Int. J. Behav. Med. http://dx.doi.org/10.1007/s12529-015-9487-x early view.Hastings, G., Gallopel-Morvan, K., Rey, J.M., 2008. The plain truth about tobaccopackaging. Tob. Control 17 (6), 361e362.Hastrup, K., 2004. Getting it right: knowledge and evidence in anthropology.Anthropol. Theory 4 (4), 455e472.Health Canada, 2000. The Tobacco Act: History of Labelling. Health Canada, Ottawa.Heidegger, M., 2010 [1953]. Being and Time (J. Stambaugh, Trans.). State Universityof New York Press, Albany.Latour, B., 1993. We Have Never Been Modern (C. Porter, Trans.). Harvard UniversityPress, Cambridge.Latour, B., 2005. Reassembling the Social: an Introduction to Actor-Network-Theory.Oxford University Press, Oxford.McKeganey, N., Russell, C., 2015. Tobacco plain packaging: evidence based policy orpublic health advocacy. Int. J. Drug Policy 26 (6), 560e568.Mead, E.L., Cohen, J.E., Kennedy, C.E., Gallo, J., Latkin, C.A., 2015. The role of theory-driven graphic warning labels in motivation to quit: a qualitative study onperceptions from low-income, urban smokers. BMC Public Health 15, 92.Moodie, C., Stead, M., Bauld, L., McNeill, A., Angus, K., Hinds, K., Kwan, I., Thomas, J.,Hasting, G., O'Mara-Eves, A., 2012. Plain tobacco Packaging: a Systematic Re-view. Centre for Tobacco Control Research, Institute for Social Marketing, Uni-versity of Stirling, Stirling, Scotland. Available at: http://phrc.lshtm.ac.uk/papers/PHRC_006_Final_Report.pdf (accessed 10.07.15.).Moodie, C., Angus, K., Stead, M., Bauld, L., 2013. Plain tobacco Packaging Research:an Update. Centre for Tobacco Control Research, Institute for Social Marketing,University of Stirling, Stirling, Scotland. Available at: http://www.stir.ac.uk/media/schools/management/documents/Plain%20Packaging%20Studies%20Update.pdf (accessed 10.07.15.).Pottage, A., 2013. No (more) logo: plain packaging and communicative agency. Univ.Calif. Davis Law Rev. 47, 101e131.Radley, A., 2002. Portrayals of suffering: on looking away, looking at, and thecomprehension of illness experience. Body Soc. 8 (3), 1e23.Reinberg, S., 2012. U.S. will push to have graphic warnings on cigarettes: pledgecomes after judge blocked FDA mandate, calling it unconstitutional. HealthDay.http://consumer.healthday.com/cancer-information-5/lung-cancer-news-100/u-s-will-push-to-have-graphic-warnings-on-cigarettes-662276.html (accessed05.11.14.).Wheeler, M., 2011. Martin Heidegger. Stanford Encyclopedia of Philosophy. Availableat: http://plato.stanford.edu/entries/heidegger/ (accessed 20.03.15.).WHO, 2011. WHO Report on the Global Tobacco Epidemic, 2011: Warning about theDangers of Tobacco. World Health Organization, Geneva.


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