Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019

Abstract

Background and aimIn 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive, over the course of a 1-year sell-off period ending in May 2017. These measures have been shown to have been associated with increases in tobacco prices and product diversity. We now investigate the association between implementation of the new legislation and smoking status in England.DesignSegmented regression analysis of repeated cross-sectional surveys using a generalised linear model with individual-level data to test for a change in trend and immediate step change.SettingEngland.ParticipantsParticipants in the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. The sample included 278 219 individual observations collected between November 2006 and December 2019.InterventionImplementation of standardised packaging legislation (May 2016 and May 2017).MeasurementsIndividual-level current smoking status adjusted for implementation of tobacco control policies, cigarette price, seasonality and autocorrelation.FindingsThe implementation of standardised packaging was associated with a significant step reduction in the odds of being a smoker after May 2017 (OR: 0.93; 95% CI 0.87 to 0.99). The magnitude of the association was similar when modelling the step change in May 2016 at the start of the 1-year policy implementation period (OR: 0.90; 95% CI: 0.83 to 0.97).ConclusionsThis is the first independent study demonstrating that implementation of standardised packaging was associated with a reduction in smoking in England which occurred in anticipation of, rather than after, full policy implementation. It appears that the odds of being a smoker were affected by the prospect of the move to standardised packs and accompanying legislation.

Impact of Standardised Packaging of Tobacco Products Regulations on cigarette consumption and youth smoking in England: interrupted time-series analysis

“…We used a diverging approach for this research question because we assumed that the introduction of Standardised Packaging of Tobacco Products Regulations may have been more likely to cause a step change in the decline in the rate of current smoking among 16-24-year-olds at the beginning of the introduction than a gradual change. This approach is in line with findings from Opazo Breton et al 7 who found a significant change in the level but not the slope of the odds of smoking, starting after the introduction of the policy in May 2016.…”

“…Second, we modelled the effect of the intervention as a gradual level shift from June 2016 until May 2017 (ie, a year earlier than our primary analysis; coded 0 up to May 2016, then increasing by 1/12 until May 2017 and coded 1 from then onwards) because, even though our primary hypothesis was that the policy took effect once the grace period for tobacco manufacturers had past and it was fully implemented, we additionally wanted to test a potential effect starting at the time the policy was first implemented (beginning of the grace period), as was found by research assessing the policy's impact on smoking prevalence. 7 Third, we modelled trends in mean daily cigarette consumption for those exclusively (rather than predominantly, as in our primary analysis) smoking FM and RYO cigarettes, respectively. Finally, we calculated Bayes factors (using an online calculator, 21 results presented in the online supplemental file) to test whether there was evidence for the null hypothesis of no difference or if the data were insensitive to detect an effect corresponding to an increase in mean daily cigarette consumption.…”

“…They also identified other tactics used by the tobacco companies prior to the full implementation in May 2017, such as focussing on the low-price segments, for example, by offering more roll-your-own (RYO) variants, and offering new pack sizes with 23 or 24 factory-made (FM) cigarette sticks. 6 Opazo Breton et al 7 found the start of the 1-year implementation period was associated with a significant step decrease in the odds of smoking in England. They hypothesised that the reduction in smoking prevalence was induced by the announcement of the standardised packaging rather than the actual switch.…”

European Tobacco Products Directive (TPD): current impact and future steps

“…Eight EU MS (including at that time the UK) went beyond the TPD’s minimum labelling provisions and introduced plain packaging for tobacco products,26 leading to the development of a regional evidence base in support of plain packaging. Based on evidence from EU MS, plain packaging along with pictorial warnings appear to increase awareness of tobacco-related diseases, making warnings more salient and supporting reductions in smoking 27–29. More recent evidence also indicates that about half of the EU population supports the adoption of plain packaging, however with significant cross-country differences (ranging from 72% in Ireland and the UK, 66% in Belgium to 28% in Portugal) 30…”

Associations of Prevalence of E-cigarette Use With Quit Attempts, Quit Success, Use of Smoking Cessation Medication, and the Overall Quit Rate Among Smokers in England: A Time-Series Analysis of Population Trends 2007–2022

“…In addition, we ran a sensitivity analysis varying the date of the tobacco products directive to the end date of the implementation period (May 2017). 34 …”