Evaluating the impact of introducing standardized packaging with larger health-warning labels in England: findings from adult smokers within the EUREST-PLUS ITC Europe Surveys

Abstract

Background The European (EU) Tobacco Product Directive (TPD) was implemented in May 2016 to regulate the design and labelling of cigarettes and roll-your-own tobacco. At the same time, the UK introduced standardized packaging measures, whereas Germany, Greece, Hungary, Poland, Romania and Spain did not. This study examines the impact of introducing standardized packaging in England using a quasi-experimental design. Methods Data from adult smokers in Waves 1 (2016; N=9547) and 2 (2018; N=9724) from the International Tobacco Control Policy Evaluation surveys (England) and EUREST-PLUS surveys (Germany, Greece, Hungary, Poland, Romania and Spain) were used. Generalized estimating equations were used to estimate changes in pack/brand appeal, salience of health-warning labels (HWLs) and perceived relative harm of different brands in England (where larger HWLs and standardized packaging were implemented), vs. each EU country (where only larger HWLs were implemented). Results There was an increase in the percentage of respondents from Germany, Hungary and Poland reporting they did not like the look of the pack (4.7%, 9.6%, and 14.2%, respectively), but the largest increase was in England (41.0%). Moreover, there was a statistically significant increase in the salience of HWLs in Hungary, Poland and Romania (17.0%, 13.9%, and 15.3%, respectively), but the largest increase was in England (27.6%). Few differences were observed in cross-country comparisons of the perceived relative harm of different brands. Conclusions Findings suggest that standardized packaging reduces pack appeal and enhances the salience of HWLs over and above the effects of larger HWLs. Findings provide additional evidence and support for incorporating standardized packaging into the EU TPD.

Consumer Response to Standardized Tobacco Packaging in the United Kingdom: A Synthesis of Evidence from Two Systematic Reviews

“…Sub-group analysis, controlling for demographics and family and peer smoking, showed no association between harm ratings and smoking susceptibility. In a seven-country longitudinal survey, 22 there was no significant change between Wave 1 (transition period) to Wave 2 (post-standardized packaging) in the percentage of participants in England who reported that their own brand was no different in harmfulness compared to other brands (78.1% W1, 78.6% W2) or that their own brand was no smoother or harsher compared to other brands (30.4% W1, 32.6% W2).…”

“…Four studies, two quantitative 22 , 23 and two qualitative, 24 , 25 examined appeal. Participants were asked about different facets of appeal (eg, quality, prestige, coolness, popularity), either using no visual prompts or shown images of, or actual, standardized packs.…”

“…A longitudinal study involving seven European countries, 22 with Wave 1 data collected early in the standardized packaging transition period in the UK and Wave 2 data collected 9–14 months after the end of the transition period, reported a 41% increase in the percentage of participants from England who did “not at all” like the look of their cigarette pack (Wave 1: 13.9% vs Wave 2: 54.9%, p<0.001). There were increases in three other countries in the percentage of participants who did “not at all” like the look of their cigarette packs, but the change between waves was significantly greater in England than in each of the six countries which did not have standardized packaging at the time (p<0.05).…”

“…Five studies, comprising three quantitative studies 22 , 23 , 26 and two qualitative studies, 24 , 25 examined whether standardized packaging affected perceptions of the harm associated with smoking or cigarettes. Participants were asked about harm either using no visual prompts or shown images of, or actual, standardized packs.…”

Anticipated responses to a hypothetical minimum price for cigarettes and roll-your-own tobacco: an online cross-sectional survey with cigarette smokers and ex-smokers in the UK

“…Results for both items were summed (range 0-6) and participants coded as light (0-1), moderate (2-3) or heavy smokers (4-6). [34][35][36][37] Those not providing valid answers for time to first cigarette were coded 'Not stated' for HSI category.…”