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BackgroundPlain packaging and minimum pack size legislation for tobacco products was introduced in the UK in May 2016, with a 1-year sell-off period until May 2017, during which both fully branded and plain packs of various sizes were legally available. This study investigates trends in prices of roll-your-own tobacco (RYO) before, during and after implementation of this legislation, and compares trends with those observed in the cigarette market.MethodsWe used Nielsen Scantrack data for the period from March 2013 to June 2018 to describe trends in UK inflation-adjusted prices and volumes of both RYO and cigarettes, and linear regression to estimate changes in prices associated with the introduction of plain packaging and the minimum pack sizes of 30 g RYO and 20 cigarettes.ResultsIn contrast to a downward trend in cigarette sales volumes, RYO volumes rose throughout the study period. By the time plain packs accounted for 75% or more of sales, the average price of products sold in equivalent pack sizes had increased, relative to average prices in the year before implementation and with adjustment for tax changes, from 34.9 to 38.8 pence per gram for RYO (mean difference 4.26, 95% CI 3.99 to 4.53 pence, 12% increase), and from 38.6 to 41.13 pence for cigarettes (mean difference 2.53, 95% CI 2.24 to 2.83 pence, 7% increase) per cigarette.ConclusionsNew legislation resulted in higher prices for RYO and manufactured cigarettes. However, sales volumes of RYO continued to increase throughout the study period, perhaps because RYO remains a less expensive means of smoking tobacco.

Background Consumption of sugar-sweetened beverages (SSBs) is associated with increased risk of obesity, diabetes, heart disease and dental caries. Our aim was to assess the effects of plain packaging, warning labels, and a 20 % tax on predicted SSB preferences, beliefs and purchase probabilities amongst young people. Methods A 2 × 3 × 2 between-group experimental study was conducted over a one-week period in August 2014. Intervention scenarios were delivered, and outcome data collected, via an anonymous online survey. Participants were 604 New Zealand young people aged 13–24 years who consumed soft drinks regularly. Participants were randomly allocated using a computer-generated algorithm to view one of 12 experimental conditions, specifically images of branded versus plain packaged SSBs, with either no warning, a text warning, or a graphic warning, and with or without a 20 % tax. Participant perceptions of the allocated SSB product and of those who might consume the product were measured using seven-point Likert scales. Purchase probabilities were measured using 11-point Juster scales. Results Six hundred and four young people completed the survey (51 % female, mean age 18 (SD 3.4) years). All three intervention scenarios had a significant negative effect on preferences for SSBs (plain packaging: F (6, 587) = 54.4, p <0.001; warning label: F (6, 588) = 19.8, p <0.001; 20 % tax: F (6, 587) = 11.3, p <0.001). Plain packaging and warning labels also had a significant negative impact on reported likelihood of purchasing SSB’s ( p  = <0.001). A 20 % tax reduced participants’ purchase probability but the difference was not statistically significant ( p  = 0.2). Conclusions Plain packaging and warning labels significantly reduce young people’s predicted preferences for, and reported probability of purchasing, SSBs.

Background Cigarette pack design plays a crucial role in attracting customers, especially when other marketing methods are limited by policy. University students who engage in casual smoking take the risk of developing an addiction. The objective of this study was to assess the effects of plain packaging (PP) and graphic health warnings (GHWs) on cigarette packages on three outcome variables (negative affect, avoidant responses, and intentions to quit) among ever-smoker university students in Ankara, Turkey, where youth smoking prevalence is high. Methods An online survey-based experiment was used to collect data. The respondents were randomly assigned to one of the five conditions that contained images of cigarette packs with specific design elements. Regression analyses ( n  = 623) were used to compare across conditions and to estimate the effects of combined warnings (versus text-only warnings), stronger GHWs (versus old GHWs), and PP (versus branded packages) on the outcome variables, accounting for potential confounders. Results Stronger GHWs generated more negative affect (0.31 points out of 5, p  = 0.010) and avoidant responses (0.42 points out of 5, p  = 0.002) than old warnings (when brand logos were visible). Plain packages generated more negative affect (0.48 points out of 5, p  < 0.001) and avoidant responses (0.46 points out of 5, p  = 0.001) than branded packages (with old warnings). Disentangling the effects of PP and new GHWs revealed that neither had individual differential effect on intentions to quit within 6 months. Conclusions Although no differential effect of PP or harsher GHWs was found on intentions to quit when respondents were exposed to images on screen, both design elements were found to be effective in generating negative affect and avoidant responses. More work is needed to design effective tobacco control measures among youth during critical years of tertiary education.

Summary The Turkish government first announced its intention to proceed with tobacco plain packaging legislation in 2011; however, it was 7 years before the legislation passed in December 2018. This study (conducted in 2018 before the legislation was passed) explored the policy context in Turkey between the first announcement that plain packaging legislation would be introduced and the passage of the legislation in 2018, and identified barriers and facilitators influencing its introduction. Publicly available documents relevant to plain packaging in Turkey were analysed. Interviews were conducted in 2018 with ten key informants including academics, bureaucrats in government ministries and leaders of non-government organizations (NGOs). Thematic analysis was undertaken, using a framework for systematically analysing how issues reach the policy agenda. The introduction of plain packaging legislation proved to be problematic, with many false starts and delays. Findings suggest these were mainly due to political barriers including changes in government, tobacco industry opposition and the national economic crisis. However, plain packaging legislation in Turkey managed to advance on the policy agenda, primarily through the collaborative advocacy efforts of NGOs, academics, and leadership from particular tobacco control advocates and politicians. Turkey’s experience provides lessons for the wider uptake of tobacco plain packaging legislation, illustrating the critical importance of building effective coalitions between a range of stakeholders and political support within government while raising public awareness. Lay summary This research provides insights into the barriers and facilitators of decision making and action that shaped the process of introducing tobacco plain packaging legislation in Turkey. Major barriers that slowed Turkey’s progress in enacting plain packaging included the financial and national economic crisis in 2018, changes in health ministers and opposition by the tobacco industry. A major facilitator of the policy process was the collaborative advocacy efforts of non-government organizations, academics, politicians and the leadership of certain tobacco control advocates. The insights from this case study may help other low- and middle-income countries to anticipate and successfully navigate the challenges involved in introducing tobacco plain packaging, an important policy measure for reducing the burden of tobacco-related disease in their populations, and its social and economic impacts. Building effective coalitions and fostering and supporting leadership are important strategies for the successful introduction of plain packaging legislation.

Background There is strong evidence that plain cigarette packaging and health warning labels (HWLs) reduce brand appeal and increase health knowledge. There is limited evidence examining this population-level public health approach for cannabis packaging. This issue is of particular importance in light of the recent legalization of recreational cannabis in Canada. The current study examined perceptions of plain packaging and HWLs for cannabis packages among young adults. Methods An online experimental study was conducted with a sample of university students in Alberta, Canada ( n  = 656). Respondents were randomly assigned to view cannabis packages in one of four conditions: Condition 1: branded pack, Condition 2: plain pack (uniform color, brand imagery removed, standardized font), Condition 3: branded pack with a HWL, and Condition 4: plain pack with a HWL. Respondents in Conditions 3 and 4 viewed five text-based HWLs, each corresponding to a health effect associated with cannabis use: (1) brain development, (2) mental health issues, (3) impaired driving, (4) nonlethal overdose, and (5) addiction. After viewing packs, respondents rated packs and health warnings on various measures. Results Branded packages without HWLs were rated as most appealing compared to all other packs ( p < 0.001 for all contrasts). No differences were found in ratings of appeal when comparing branded and plain packs with HWLs. Warning messages for cognitive development and impaired driving were rated highest on levels of perceived effectiveness, believability, and fear, whereas the addiction warning was rated among the lowest. In general, there were gaps in health knowledge related to cannabis use, however after viewing packs with warnings (compared to viewing packs without warnings) levels of health knowledge increased across all health effects ( p < 0.01 for all). Lastly, a significant majority of young adults reported they would purchase the branded pack without a HWL (39.5%), compared to all other pack types ( p < 0.05 for all contrasts). The lowest proportion of young adults reported they would purchase a plain pack with a HWL (1.1%). Conclusions Plain packaging and health warnings may reduce brand appeal and increase health knowledge among young adults.

Background Perceptions of tobacco packaging may be consequential for consumption and initiation. We explored the potential effect of standardised packaging on young adults’ ratings of the appeal of brands of snus (Swedish moist snuff) and on their perceptions of typical users of these brands. We were interested in both the effects on average levels of ratings and on the within-subject variability of the ratings. The latter was used as a measure of the extent to which individuals can differentiate between brands. Methods A sample of 625 Norwegians aged 16–30 were randomly allocated to one of three between-subject conditions: Branded Packaging, Standardised Packaging, or Standardised Packaging with Health Warnings. The participants rated 10 snus brands on measures of general appeal and on their perceptions of the typical brand user (e.g., “… is sporty and active”). Results The standardised packages (without health warnings) were not rated more negatively than the branded packages, while the standardised packages with health warnings were rated slightly more negatively than the branded packages. However, in terms of within-subject standard deviations, the variability of the brand ratings across the packages was substantially lower for standardised packaging types in comparison to branded packages. Conclusions Even in cases where standardised tobacco packaging appears to have little overall effect on the valence of the average ratings, it can have a strong effect on the variability of the ratings. This suggests that standardised packaging can reduce the potential for brand differentiation.

We assess the impact of legislation mandating the plain packaging of cigarettes in 2012 in Australia on both primary and secondary demand. We first examine the causal impact of the legislation at the cigarette category level by comparing the changes in sales before and after legislation with the corresponding changes in sales in a comparable market, New Zealand, where the plain packaging mandate (PPM) was not imposed. Our results suggest a decline in sales due to the PPM of around 67 million units (sticks) per month, representing around 7.5% of the market. Our results on the mechanism using brand-level sales data from Australia suggest reduced differentiation after the PPM, with higher price sensitivity. Premium and mainstream brands’ price sensitivities are most affected after the PPM, but we also find channel-specific differences, with grocery (convenience) channels showing an increase (a decline) in post-PPM short-term price sensitivity. Because the government has some control over price through excise taxes, understanding changes in price sensitivities provides guidance to health authorities on the relative impacts of price- and non-price-related policy on cigarettes sales. We also explore other public policy implications of our results, such as the expected reduction in sales per month we might see in New Zealand due to their instituting a PPM.

ObjectiveTo assess the long-term impact of plain packaging (PP) of cigarettes with larger graphic health warnings (HW) introduced in December 2012 on adolescents’ relevant tobacco-related perceptions.MethodsCross-sectional school-based surveys of 12 to 17 year olds in 2011 (n=4413), 2013 (n=4423), 2014 (n=4576) and 2017 (n=4266). Students rated the character of four popular cigarette brands, indicated their agreement regarding brand differences in smoking ease, quitting, addictiveness, harmfulness and pack attractiveness and positive/negative perceptions of pack image. The frequency of students reading, attending to, thinking and talking about HW was assessed. Responses of students seeing cigarette packs in the previous 6 months (2011: 63%; 2013: 67%, 2014: 56%, 2017: 56%) were examined.ResultsSmoking prevalence declined from 2011 to 2017. Among students who had recently seen packs, cigarette packs were rated less positively and more negatively in 2017 than in 2011 (p<0.001) with ratings similar between 2013 and 2017. Positive character ratings for each brand reduced between 2011 and 2013 (ps<0.05) with further reductions between 2013 and 2017 (ps<0.05). Fewer students agreed, and more were uncertain, that brands differed in their smoking ease, addictiveness, harmfulness and pack attractiveness in 2017 than 2011. The frequency of students reading, attending, talking or thinking about HW did not change between 2011 and 2017.ConclusionsPP’s initial impact in reducing adolescent’s positive perceptions of cigarette packs and brand differences continued in the following years with tobacco packaging less appealing to young people in 2017 than 2011 and students more uncertain about brand differences.

AimsTo explore the impact, if any, that using plain (non-branded) cigarette packs in real-life settings has on young adult smokers.MethodsNaturalistic-type research was employed, where smokers used brown ‘plain’ packs for 2 weeks and their regular packs for 2 weeks, in real-life settings. Participants were recruited in Glasgow, Scotland. Of the 140 smokers aged 18–35 years who participated in the naturalistic study, 48 correctly completed and returned all questionnaires. Over the 4-week study period, participants completed a questionnaire twice a week assessing pack perceptions and feelings, feelings about smoking, salience of health warnings and smoking-related behaviours. A subsample of 18 participated in a post-study interview, which employed a semistructured topic guide to assess perceptions and experiences of using plain packs.ResultsTrends in the data show that in comparison with branded packaging, plain packaging increased negative perceptions and feelings about the pack and about smoking. Plain packaging also increased avoidant behaviour (hiding the pack, covering the pack), certain smoking cessation behaviours, such as smoking less around others and forgoing cigarettes, and thinking about quitting. Almost half (n=8) of those in the post-study interview, predominantly women (n=6), reported that the use of plain packs had either increased avoidant behaviour or reduced consumption.ConclusionsThis pilot naturalistic study suggests that plain packaging could potentially help reduce tobacco consumption among some young adult smokers, and women in particular. Employing an innovative research methodology, the findings of this study are consistent with, and indeed support, past plain packaging research.

(1) Background: In December 2020, a broad majority of political parties in Denmark agreed on a new tobacco control act. In addition, price increases on tobacco in 2020 and 2022 became part of the Danish Finance Act. This study protocol describes the study “§SMOKE–A Study of Tobacco, Behavior, and Regulations” designed to monitor and evaluate the implementation and effect of the new strengthened tobacco control acts. The overall aim is to monitor tobacco use among young people before, during, and after implementation of the new tobacco control legislation, including an increased price on tobacco, a ban on point-of-sale tobacco displays, and plain packaging. Subgoals are to monitor overall use of nicotine products, attitudes, and norms. (2) Methods: This study is designed as a five-year impact evaluation with repeated cross-sectional survey data collections. The baseline survey was conducted before implementing an increased price on tobacco, the first step in the new legislation, initiated 1 April 2020. Study participants (n = 37,500) were a random sample of individuals living in Denmark aged 15 to 29 years. (3) Conclusions: This study examines the impact of the new strengthened tobacco control legislation in Denmark from 2020 to 2025. The findings of this study are relevant to other countries facing implementation of similar measures to explore intended and unintended consequences of the legislation and help to identify how the legislation could be further improved.