In March, the government introduced plain packaging as part of a comprehensive tobacco control programme. This means tobacco companies are no longer be able to sell cigarettes in branded packaging; instead they are sold in generic olive brown packets retaining the enlarged graphic health warnings which are already prominent on the current branded packets. Justinn Cochran has spent the last four years researching the effects of tobacco packaging. We talk to her about her work, the psychological impact of tobacco imagery and how this can contribute to the country’s smokefree 2025 goal.

So what got you into this area of research?

I find addiction really interesting from a psychological perspective. The idea of being able to reduce people’s craving psychologically and help people stop smoking is exciting and such a massive area where so much more research is needed. I think that’s where it started.

On a personal level, some of my family smoke and I think ultimately that has also made me more invested in finding new ways to help people quit smoking. I’ve seen how nicotine addiction can have this unforgiving hold on a person’s life and I’ve seen how hard this addiction is to shake no matter how educated you are on the health risks. My grandmother ultimately died from smoking. Well, from COPD (chronic obstructive pulmonary disease) that was brought on by decades of smoking. My family and I watched as this horrible illness made it hard for her to catch her breath without an oxygen mask and then made her too weak to walk to the toilet. Yet some of my family still smoke. That has made it hard, even with all my psychology and addiction knowledge, to understand why some of my family continue to smoke. But again, it just speaks to what we’re up against and motivates me to help find a solution.

Can you talk about the psychological effects of nicotine?

Sure, nicotine changes your brain. It changes the nicotinic receptors in your brain and with long term use this ultimately changes the reward signals to your brain. I read recently that it takes about the same amount of time for nicotine to saturate your brain’s reward system as it does to smoke a standard cigarette down to the butt. In other words, you don’t actually get any more “reward from smoking” after that – not at least until the nicotine is metabolised - and I’d bet that’s no happy accident made by cigarette companies.

Craving occurs when the nicotine begins to be metabolised and these receptors are ready for more nicotine. After this saturation/craving process has happened over and over the brain starts to think that maybe more receptors are required to keep from going into the craving phase. So, the brain creates more nicotine receptors. Ultimately all this accomplishes is stronger cravings when the receptors lack nicotine again. These changes to your brain can take months, even years, depending on how addicted you are, to wear off completely and it can take years for the psychological effects to wear off also. I have a colleague that is a former smoker from 20-30 years ago, and he said he still has dreams about smoking, which trigger him to wake up and want to smoke. Think of what we’re working against- it’s a beast.

One issue we are working towards is creating smokefree spaces because watching others smoke can be a trigger. Can you explain this from a psychological perspective?

I have been investigating how we pay attention to tobacco imaging and what is more effective. Attention is a finite resource, and humans can’t pay attention to everything in their environment. Evolutionarily, this means humans have learned to pay attention to things that are important to survival. We found this in that most smokers direct their attention toward things related to smoking more quickly than a non-smoker would. As part of my master’s research we found that a smoker’s brain activity and cravings was greater than a non-smoker’s within half a second of looking at images of strangers smoking a cigarette. This means that a smoker trying to quit may feel less triggered to relapse if they aren’t exposed to others smoking around them.

What have you found regarding the effects of tobacco packaging?

I wanted to understand if tobacco packaging can be influential in reducing smokers’ cravings and brain activity. When we showed participants disgust-related images (e.g. tarred lungs, scabby/ pussy gums), we found this to be more influential in reducing their attention than health-related images (e.g. “Smoking causes cancer”).

Does this actually mean it can reduce their cravings?

Whether disgust related images actually leads to behaviour change like reducing smoking is less well known, but it has been shown to predict other behaviours around sexual health and colorectal cancer.

Do you have any idea on who plain packaging might benefit most- perhaps young people?

I would imagine these changes on plain packaging could have an effect on those already thinking of quitting, those on the edge of making a change.

But plain packaging might also keep more people from starting by reminding them of the negative aspects of smoking. We know that teenagers try smoking and become addicted before realising it. Another issue with this group is that long term health effects aren’t front of mind. So perhaps disgust might make more of a difference for them than health-related messages. Many kids have a bullet-proof attitude (“this won’t happen to me”, “that’s something I don’t need to think about until I’m in my twenties”). It’s that mentality of explaining away the health risks that won’t resonate with that group, so disgust could be more helpful.

There is talk out there that plain packaging is a good step for the government, although it’s not going to be the thing that saves smokers. What do you think?

I agree- it’s not going to be the real silver bullet, but it is a good step. Like I said, you’re removing another association, but people are good at adapting. So this could mean smokers eventually start to form new associations between the plain packets and smoking even if they are the puke brown colour and are covering in disgusting pictures. We should be coming out with new images regularly to have the maximum effect. This should be implemented alongside other strategies around reducing supply and decreasing access.