Christina N Kyriakos1,2, Pete Driezen3,4, Charis Girvalaki1,2, Sara C Hitchman5, Filippos T Filippidis6,7, Shannon Gravely3, James Balmford8, Katerina Nikitara2, Ute Mons9, Esteve Fernández10,11,12,13, Krzysztof Przewoźniak14,15,16, Antigona C Trofor17,18, Tibor Demjén19, Witold Zatoński14,20, Yannis Tountas7, Geoffrey T Fong1,3,21, Constantine I Vardavas1,2. 1. Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece. 2. European Network for Smoking and Tobacco Prevention, Brussels, Belgium. 3. Department of Psychology, University of Waterloo, Waterloo, Canada. 4. School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada. 5. Addictions Department, King's College London, London, UK. 6. Department of Primary Care and Public Health, Imperial College London, London, UK. 7. Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece. 8. Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany. 9. Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany. 10. Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain. 11. Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain. 12. School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain. 13. Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain. 14. Health Promotion Foundation, Warsaw, Poland. 15. Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland. 16. Collegium Civitas, Warsaw, Poland. 17. University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania. 18. Aer Pur Romania, Bucharest, Romania. 19. Smoking or Health Hungarian Foundation, Budapest, Hungary. 20. European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland. 21. Ontario Institute for Cancer Research, Toronto, ON, Canada.
Abstract
BACKGROUND: The European Tobacco Products Directive (TPD), which went into effect in May 2016, regulates packaging design and labelling of cigarettes and roll-your-own (RYO) tobacco. The aim of the current study was to examine whether smokers and recent quitters in six European Union (EU) countries (Germany, Greece, Hungary, Poland, Romania and Spain) reported noticing TPD-related changes to packaging, and correlates of noticing these changes. METHODS: Cross-sectional data from the Wave 2 of the ITC 6 European Country Survey in 2018 after implementation of the TPD. Bivariate analyses included adult smokers (n = 5597) and recent quitters (n = 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n = 5597) and conducted using SAS-callable SUDAAN. RESULTS: Over half of smokers (58.2%) and 30% of quitters noticed at least one of five types of TPD-related pack changes. Over one-quarter of all respondents noticed changes to health warnings (30.0%), standardized openings (27.7%), minimum pack unit size (27.9%), and the removal of tar, nicotine and carbon monoxide information (26.7%) on packaging. Cross-country differences were observed across all measures, with noticing all pack changes markedly lower in Spain than the other countries. Correlates of noticing specific pack changes included sociodemographic characteristics, smoking behaviours and related to packaging. CONCLUSIONS: This is one of the first cross-country studies to examine the extent to which TPD changes to cigarette and RYO tobacco packaging are being noticed by smokers and recent quitters. Findings indicate that the majority of smokers noticed at least one type of pack change, but this varied across countries and sub-populations.
BACKGROUND: The European Tobacco Products Directive (TPD), which went into effect in May 2016, regulates packaging design and labelling of cigarettes and roll-your-own (RYO) tobacco. The aim of the current study was to examine whether smokers and recent quitters in six European Union (EU) countries (Germany, Greece, Hungary, Poland, Romania and Spain) reported noticing TPD-related changes to packaging, and correlates of noticing these changes. METHODS: Cross-sectional data from the Wave 2 of the ITC 6 European Country Survey in 2018 after implementation of the TPD. Bivariate analyses included adult smokers (n = 5597) and recent quitters (n = 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n = 5597) and conducted using SAS-callable SUDAAN. RESULTS: Over half of smokers (58.2%) and 30% of quitters noticed at least one of five types of TPD-related pack changes. Over one-quarter of all respondents noticed changes to health warnings (30.0%), standardized openings (27.7%), minimum pack unit size (27.9%), and the removal of tar, nicotine and carbon monoxide information (26.7%) on packaging. Cross-country differences were observed across all measures, with noticing all pack changes markedly lower in Spain than the other countries. Correlates of noticing specific pack changes included sociodemographic characteristics, smoking behaviours and related to packaging. CONCLUSIONS: This is one of the first cross-country studies to examine the extent to which TPD changes to cigarette and RYO tobacco packaging are being noticed by smokers and recent quitters. Findings indicate that the majority of smokers noticed at least one type of pack change, but this varied across countries and sub-populations.
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