Reactions to standardized cigarette packs with varying structural designs, and the association with smoking susceptibility: A postimplementation cross-sectional survey with never-smoking adolescents in Scotland

Abstract

Aim: From 20th May 2017, cigarettes in the United Kingdom must be sold in standardised (plain) packaging. We explore post-implementation reactions to standardised cigarette packaging among never-smokers in Scotland, whether reactions vary in relation to permitted variations in pack structure, and whether reactions are associated with susceptibility. Methods: A cross-sectional survey with 12-17 year-old never-smokers (n=507) in Scotland, conducted November 2017-November 2018. Participants were shown one ‘regular’ standardised cigarette pack (flip-top lid and straight-edged pack, similar to designs in Australia) and three standardised packs with varied pack structures (bevelled-edges, slim pack, and shoulder box), which are permitted post-implementation in the UK. Participants rated each pack on eight five-point reaction measures (e.g. attractiveness). Participants also indicated which pack, if any, they would choose. Smoking susceptibility was the outcome. Results: The mean reaction scores for all four packs were mostly negative, however the shoulder box was consistently rated less negatively than the regular, slim, or bevelled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than non-susceptible participants (25% vs. 7%; χ2=29.70; p=0.001). For all four packs, not finding them off-putting was associated with susceptibility (Adjusted Odds Ratio range: 2.73-3.69), albeit only a minority of adolescents did not find each pack off-putting. Conclusions: Adolescents have negative reactions to the standardised cigarette packs implemented in the United Kingdom, albeit permitted variations in structure can reduce the extent of negativity. Most reactions to standardised packaging had no association with susceptibility. Implications: We provide the first empirical evidence that adolescents find the standardized cigarette packs implemented in the United Kingdom unappealing and that most pack reactions have no association with susceptibility among never-smokers, with the exception of the minority who did not think that they would put them off smoking. This suggests that the legislation is achieving one of its primary aims, to reduce the appeal of packaging. That permitted variations in pack structure (eg, shoulder boxes) somewhat reduce negative reactions suggests that the United Kingdom, and other countries introducing similar legislation, should ensure that all aspects of pack design are fully standardized.