Abstract
BackgroundVery few countries regulate maximum cigarette pack size. Larger, non‐standard sizes are increasingly being introduced by the tobacco industry. Larger portion sizes increase food consumption; larger cigarette packs may similarly increase tobacco consumption. Here we consider the evidence for legislation to cap cigarette pack size to reduce tobacco‐related harm.Aims and analysisWe first describe the regulations regarding minimum and maximum pack sizes in the 12 countries that have adopted plain packaging legislation and describe the range of sizes available. We then discuss evidence for two key assumptions that would support capping pack size. First, regarding the causal nature of the relationship between pack size and tobacco consumption, observational evidence suggests that people smoke fewer cigarettes when using smaller packs. Secondly, regarding the causal nature of the relationship between reducing consumption and successful cessation, reductions in number of cigarettes smoked per day are associated with increased cessation attempts and subsequent abstinence. However, more experimental evidence is needed to infer the causal nature of these associations among general populations of smokers.ConclusionCigarette pack size is positively associated with consumption and consumption is negatively associated with cessation. Based on limited evidence of the causal nature of these associations, we hypothesize that government regulations to cap cigarette pack sizes would positively contribute to reducing smoking prevalence.
Highlights
Many countries have tobacco control legislation that establishes a minimum number of cigarettes that can be included in a single pack
We reviewed publicly available legislation and contacted local policymakers or organizations, as well as tobacco researchers, through a targeted approach based on the countries of interest and through a general query sent to the Society for Research on Nicotine and Tobacco (SRNT) members, to identify the minimum, maximum and range of pack sizes available in different countries (Table 1)
Cigarette pack size is increasing in several markets around the world, and the current limited regulatory attention to pack size is being exploited by industry for market gain
Summary
Cigarette pack size is positively associated with consumption and consumption is negatively associated with cessation. Based on limited evidence of the causal nature of these associations, we hypothesize that government regulations to cap cigarette pack sizes would positively contribute to reducing smoking prevalence. Keywords Cigarette pack size, choice architecture, policy, portion size, public health, tobacco control
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