Abstract
BackgroundPlain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. We ran a randomised controlled trial to investigate the impact of plain packaging on smoking behaviour and attitudes.MethodsIn a parallel group randomised trial design, 128 daily smokers smoked cigarettes from their usual UK brand, or a plain Australian brand that was closely matched to their usual UK brand for 24 hours. Primary outcomes were number of cigarettes smoked and volume of smoke inhaled per cigarette. Secondary outcomes were self-reported ratings of motivation to quit, cigarette taste, experience of using the pack, experience of smoking, attributes of the pack, perceptions of the health warning, changes in smoking behaviour, and views on plain packaging.ResultsThere was no evidence that pack type had an effect on either of the primary measures (ps > 0.279). However, smokers using plain cigarette packs rated the experience of using the pack more negatively (−0.52, 95% CI −0.82 to −0.22, p = 0.001), rated the pack attributes more negatively (−1.59, 95% CI −1.80 to −1.39, p < 0.001), and rated the health warning as more impactful (+0.51, 95% CI 0.24 to 0.78, p < 0.001).ConclusionsPlain cigarette packs reduce ratings of the experience of using the cigarette pack, and ratings of the pack attributes, and increase the self-perceived impact of the health warning, but do not change smoking behaviour, at least in the short term.Trial registrationCurrent Controlled Trials ISRCTN52982308. Registered 27 June 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-1586-8) contains supplementary material, which is available to authorized users.
Highlights
Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location
Of the remaining 268 participants, 257 did not meet the inclusion criteria, 10 failed to attend their allocated testing session and one participant declined to participate after completing the initial assessment
In both cases the confidence intervals were wide and included the null, so that we cannot conclude that plain cigarette packs had any effect on smoking behaviour after first exposure
Summary
Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. Mandatory plain (“standardised”) packaging requires cigarettes and hand-rolling tobacco to be sold in packs with a standard pack shape, method of opening and colour, leaving only the brand name in a standard font and location. A cross-sectional observational study from Australia during the period of implementation of plain cigarette packaging found that smokers using plain cigarette packs perceived their cigarettes to be of lower quality and less satisfying, had thought about quitting more often, and rated quitting as a higher priority in their lives than those still using branded cigarette packs [10]. Anecdotal evidence which emerged from Australia soon after the introduction of plain cigarette packaging suggested that cigarettes from plain cigarette packs tasted worse than those from branded cigarette packs [11]. An analysis of calls to an Australian smoking cessation helpline found an increase in calls after the introduction of plain cigarette packaging [12]
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