Sarah Aleyan1,2, Pete Driezen1,3, Ann McNeill2,4, Máirtín McDermott2, Sarah Kahnert5,6, Christina N Kyriakos7,8, Ute Mons5, Esteve Fernández9,10,11,12, Antigona C Trofor13,14, Mateusz Zatoński15,16,17, Tibor Demjén18, Paraskevi A Katsaounou19,20,21, Krzysztof Przewoźniak15,22,23, James Balmford24, Filippos T Filippidis20,21,25, Geoffrey T Fong1,3,26, Constantine I Vardavas7,8,21, Sara C Hitchman2. 1. School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada. 2. Department of Addictions, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. 3. Department of Psychology, University of Waterloo, Waterloo, ON, Canada. 4. SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), UK. 5. Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany. 6. Medical Faculty, University of Heidelberg, Heidelberg, Germany. 7. European Network for Smoking and Tobacco Prevention, Brussels, Belgium. 8. Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece. 9. Tobacco Control Unit, Catalan Institute of Oncology (ICO), Barcelona, Spain. 10. Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain. 11. School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain. 12. Consortium for Biomedical Research in Respiratory Diseases (CIBER en Enfermedades Respiratorias, CIBERES), Madrid, Spain. 13. University of Medicine and Pharmacy 'Grigore T. Popa', Iasi, Romania. 14. Aer Pur Romania, Bucharest, Romania. 15. Health Promotion Foundation, Warsaw, Poland. 16. Department for Health, Tobacco Control Research Group, University of Bath, Bath, UK. 17. European Observatory of Health Inequalities, President Stanislaw Wojciechowski State University of Applied Sciences, Kalisz, Poland. 18. Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary. 19. First ICU Evaggelismos Hospital Athens, National and Kapodistrian University of Athens, Athens, Greece. 20. Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 21. European Respiratory Society, Lausanne, Switzerland. 22. Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 23. Collegium Civitas, Warsaw, Poland. 24. Faculty of Medicine and Medical Center, Institute of Medical Biometry and Statistics, University of Freiburg, Freiburg im Breisgau, Germany. 25. Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK. 26. Ontario Institute for Cancer Research, Toronto, ON, Canada.
Abstract
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.
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.
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Authors: Mary E Thompson; Geoffrey T Fong; Christian Boudreau; Pete Driezen; Grace Li; Shannon Gravely; K Michael Cummings; Bryan W Heckman; Richard O'Connor; James F Thrasher; Georges Nahhas; Ron Borland; Hua-Hie Yong; Ann McNeill; Sara C Hitchman; Anne C K Quah Journal: Addiction Date: 2019-01-24 Impact factor: 6.526
Authors: Geoffrey T Fong; Mary E Thompson; Christian Boudreau; Nicolas Bécuwe; Pete Driezen; Thomas K Agar; Anne C K Quah; Witold A Zatoński; Krzysztof Przewoźniak; Ute Mons; Tibor Demjén; Yannis Tountas; Antigona C Trofor; Esteve Fernández; Ann McNeill; Marc Willemsen; Constantine I Vardavas Journal: Tob Induc Dis Date: 2018-12-12 Impact factor: 2.600
Authors: Shannon Gravely; Janet Chung-Hall; Lorraine V Craig; Geoffrey T Fong; K Michael Cummings; Ron Borland; Hua-Hie Yong; Ruth Loewen; Nadia Martin; Anne C K Quah; David Hammond; Janine Ouimet; Christian Boudreau; Mary E Thompson; Pete Driezen Journal: Tob Control Date: 2021-09-21 Impact factor: 6.953