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
Authors: Aleyan Sarah , Driezen Pete , McNeill Ann , McDermott Máirtín , Kahnert Sarah , Kyriakos Christina N , Mons Ute , Fernández Esteve , Trofor Antigona C , Zatoński Mateusz , Demjén Tibor , Katsaounou Paraskevi A , Przewoźniak Krzysztof , Balmford James , Filippidis Filippos T , Fong Geoffrey T , Vardavas Constantine I , Hitchman Sara C ,   the EUREST-PLUS Consortium, Vardavas Constantine I , Glahn Andrea , Kyriakos Christina N , Nguyen Dominick , Nikitara Katerina , Radu-Loghin Cornel , Starchenko Polina , Tsatsakis Aristidis , Girvalaki Charis , Igoumenaki Chryssi , Papadakis Sophia , Papathanasaki Aikaterini , Tzatzarakis Manolis , Vardavas Alexander I , Bécuwe Nicolas , Deaconu Lavinia , Goudet Sophie , Hanley Christopher , Rivière Oscar , Demjén Tibor , Kiss Judit , Kovacs Anna Piroska , Fernández Esteve , Castellano Yolanda , Fu Marcela , Nogueira Sarah O , Tigova Olena , McNeill Ann , East Katherine , Hitchman Sara C , McDermott Máirtín , Aleyan Sarah , Mons Ute , Kahnert Sarah , Tountas Yannis , Behrakis Panagiotis , Filippidis Filippos T , Gratziou Christina , Katsaounou Paraskevi , Peleki Theodosia , Petroulia Ioanna , Tzavara Chara , Trofor Antigona Carmen , Eremia Marius , Lotrean Lucia , Mihaltan Florin , Rohde Gernot , Asano Tamaki , Cichon Claudia , Far Amy , Genton Céline , Jessner Melanie , Hedman Linnea , Janson Christer , Lindberg Ann , Maguire Beth , Ravara Sofia , Vaccaro Valérie , Ward Brian , Willemsen Marc , de Vries Hein , Hummel Karin , Nagelhout Gera E , Zatoński Witold A , Herbeć Aleksandra , Janik-Koncewicz Kinga , Przewoźniak Krzysztof , Zatoński Mateusz , Fong Geoffrey T , Agar Thomas K , Driezen Pete , Gravely Shannon , Quah Anne C K , Thompson Mary E 
Published: March 2020

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.