Room 101: are gender-specific cigarette packets the way forward?

  • Frank HoughtonEmail author
  • Lisa O’Rourke Scott
  • Sharon Houghton
  • Diane O’Doherty
  • Derek McInerney
  • Bruce Duncan
Letter to the Editor

You asked me once,’ said O’Brien, ‘what was in Room 101. I told you that you knew the answer already. Everyone knows it. The thing that is in Room 101 is the worst thing in the world...The worst thing in the world,” said O’Brien, “varies from individual to individual. It may be burial alive, or death by fire, or by drowning, or by implement, or fifty other deaths. There are cases where it is some quite trivial thing, not even fatal.”[1]

The above quotation from George Orwell’s dystopian novel 1984 offers an insight into the ways in which different people fear different perceived threats [ 1]. The threat of danger is an important element in current tobacco control policies [ 2, 3]. However, an examination of the current combined anti-smoking messages and graphics currently mandated by the European Union reveals a number of important issues [ 4]. In relation to the 42 required images, this includes both a lack of racial diversity [ 5], as well as an inequity in female representation [ 6]....


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.


  1. 1.
    Orwell G (1948) 1984. Secker & Warburg, LondonGoogle Scholar
  2. 2.
    Droulers O, Gallopel-Morvan K, Lacoste-Badie S, Lajante M (2017) The influence of threatening visual warnings on tobacco packaging: measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods. PLOS.
  3. 3.
    Moore J, Thorson E, Leshner G (2011) Terror management theory and anti-tobacco advertising: an experimental examination of influence of death explicit anti-tobacco messages on young adults. J Health Mass Commun 3(1–4):5–29Google Scholar
  4. 4.
    European Commission (2018) Health Warnings. Accessed 10.10.18
  5. 5.
    O’Doherty D, Houghton F, McInerney D, Houghton S, Duncan B (2018) Ethnic and racial blindness in EU anti-smoking campaigns, slogans and images. Ir J Med Sci.
  6. 6.
    O’Doherty D, Houghton F, McInerney D, Duncan B, Houghton S (2018) EU anti-smoking graphic warnings on cigarette packets: semiotics & the issue of gender under-representation. Ir J Med Sci.
  7. 7.
    Jacobson B (1981) The Ladykillers: why smoking is a feminist issue. Pluto Press, LondonGoogle Scholar
  8. 8.
    Holleb AI (1985) Lung cancer: a feminist issue. CA Cancer J Clin 35(2):125–126CrossRefGoogle Scholar
  9. 9.
    Gritz ER (1993) Lung cancer: now, more than ever, a feminist issue. CA Cancer J Clin 43(4):197–199CrossRefGoogle Scholar
  10. 10.
    Woll PJ (1998) Smoking and risk of myocardial infarction - smoking is a feminist issue. BMJ 317(7164):1018Google Scholar
  11. 11.
    Levis DM, Stone-Wiggins B, O’Hegarty M et al (2014) Women’s perspectives on smoking and pregnancy and graphic warning labels. Am J Health Behav 38(5):755–764CrossRefGoogle Scholar
  12. 12.
    Tan ASL, Bigman CA, Nagler RH, Minsky S, Viswanath K (2017) Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults. Cancer Causes Control 28(10):1143–1155CrossRefGoogle Scholar
  13. 13.
    Fulkerson JA, French SA (2003) Cigarette smoking for weight loss or control among adolescents: gender and racial/ ethnic differences. J Adolesc Health 32(4):306–313CrossRefGoogle Scholar
  14. 14.
    Vlassoff C, Garcia Moreno C (2002) Placing gender at the centre of health programming: challenges and limitations. Soc Sci Med 54:1713–1723CrossRefGoogle Scholar
  15. 15.
    Whitehead M (1985) The concepts and principles of equity and health. World Health Organization Regional Office for Europe, CopenhagenGoogle Scholar
  16. 16.
    Dennis S (2016) Smokefree - a social, moral and political atmosphere. Bloomsbury Academic, LondonGoogle Scholar
  17. 17.
    Drope J, Schluger N, Cahn Z, Drope J, Hamill S et al (2018) The tobacco atlas. American Cancer Society and Vital Strategies, AtlantaGoogle Scholar
  18. 18.
    GBD 2015 Tobacco Collaborators et al (2017) Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015. Lancet 389(10082):1885–1906CrossRefGoogle Scholar
  19. 19.
    Öberga M, Woodward A, Jaakkolac MS, Perugad A, Prüss-Ustüne A (2010) Global estimate of the burden of disease from second-hand smoke. World Health Organisation, GenevaGoogle Scholar
  20. 20.
    Lim SS et al (2012) A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2224–2260CrossRefGoogle Scholar
  21. 21.
    World Health Organization (2013) WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship. World Health Organisation, LuxembourgGoogle Scholar
  22. 22.
    IPSOS MRBI (2017) Healthy Ireland survey 2017- summary of findings. Government Publications Office, DublinGoogle Scholar
  23. 23.
    Chapman S, Freeman B (2011) From brand to bland--the demise of cigarette packaging. BMJ 343:d4376. CrossRefGoogle Scholar
  24. 24.
    Soldow G (2006) Homoeroticism in advertising: something for everyone with androgyny. In: Reichert T, Lambiase J (eds) Sex in consumer culture: the erotic content of media and marketing. Routledge, New York, pp 319–336Google Scholar
  25. 25.
    Paoletti J (2015) Sex and unisex: fashion, feminism, and the sexual revolution. Indiana University Press, BloomingtonGoogle Scholar
  26. 26.
    Jackson C, Warin J (2010) The importance of gender as an aspect of identity at key transition points in compulsory education. Br Educ Res J 26(3):375–391CrossRefGoogle Scholar
  27. 27.
    Hart B (1996) The construction of the gendered self. J Fam Ther 18:43–60CrossRefGoogle Scholar
  28. 28.
    Hayashi H, Tan A, Kawachi I, Minsky S, Viswanath K (2018) Does segmentation really work? Effectiveness of matched graphic health warnings on cigarette packaging by race, gender and chronic disease conditions on cognitive outcomes among vulnerable populations. J Health Commun 23(6):523–533CrossRefGoogle Scholar
  29. 29.
    European Commission (2012) Tobacco Packaging Health Warning Labels Aggregate Report. In: Eurobarometer Qualitative Study. European Commission, BrusselsGoogle Scholar
  30. 30.
    Parr V, Ell P, Gagg K (2011) Market testing of potential health warnings and information messages for tobacco product packaging: phase 2 front and back of pack graphic health warnings- qualitative formative research report. GfK Blue Moon, SydneyGoogle Scholar
  31. 31.
    Sambrook Research International (2009) A review of the science base to support the development of health warnings for tobacco packages. Sambrook Research International, Newport, Shropshire, EnglandGoogle Scholar
  32. 32.
    Ayres I, Ayres-Brown AR (2015) Unhappy meals: sex discrimination in toy choice at McDonald’s. Wm & Mary J Women & L 21(2):237–273Google Scholar
  33. 33.
    Pettigrew S, Roberts M (2006) Mothers’ attitudes towards toys as fast food premiums. Young Consum 7(4):60–67CrossRefGoogle Scholar
  34. 34.
    Gutzke DW (2016) Women drinking out in Britain since the early twentieth century. Manchester University Press, ManchesterCrossRefGoogle Scholar
  35. 35.
    Tandleman (2008) Anyone remember the “Lady’s” Glass? Tandleman’s Beer Blog. Accessed 10 Oct 2018
  36. 36.
    Taylor T (2015) A special glass for the ladies. Accessed 10 Oct 2018
  37. 37.
    Borland R, Wilson N, Fong GT, Hammond D, Cummings KM, Yong HH, Hosking W, Hastings G, Thrasher J, McNeill A (2009) Impact of graphic and text warnings on cigarette packs: findings from four countries over five years. Tob Control 18:358–364CrossRefGoogle Scholar
  38. 38.
    Hammond D (2011) Health warning messages on tobacco products: a review. Tob Control 20:327–337CrossRefGoogle Scholar
  39. 39.
    Noar SM, Hall MG, Francis DB, Ribisl KM, Pepper JK, Brewer NT (2016) Pictorial cigarette pack warnings: a meta-analysis of experimental studies. Tob Control 25(3):341–354CrossRefGoogle Scholar

Copyright information

© Royal Academy of Medicine in Ireland 2019

Authors and Affiliations

  1. 1.Department of Applied Social SciencesLimerick Institute of TechnologyLimerickIreland
  2. 2.Department of PsychologyUniversity of LimerickLimerickIreland
  3. 3.Department of Business & MarketingLimerick Institute of TechnologyLimerickIreland
  4. 4.Hauora TairawhitiGisborneNew Zealand

Personalised recommendations