Impact of standardised packaging in the UK on warning salience, appeal, harm perceptions and cessation-related behaviours: a longitudinal online survey

Introduction In the UK, since 20 May 2017, tobacco companies must sell cigarettes and rolling tobacco in standardised packs. Methods Three waves of a longitudinal online survey with smokers (>= 16) before standardised packaging (wave 1 (W1): April to May 2016) and after standardised packaging (wave 2 (W2): September to November 2017; wave 3 (W3): May to July 2019). Of the 6233 smokers at W1, 4293 responded at W2 and 3175 at W3. We explored smokers' response to warning salience, appeal (appeal, quality, value, satisfaction and taste compared with a year ago), harm (harmfulness compared with a year ago, harm compared with other brands and whether some brands have more harmful substances), and quit plans, attempts and quitting. Results Compared with W1, the proportions noticing warnings first on packs, and rating cigarettes/rolling tobacco less appealing and worse value than a year ago, were higher at W2 and W3. Disagreeing that some brands contain more harmful substances was higher at W2. Interactions between social grade and survey wave for warning salience, and each appeal and harm outcome, were non-significant. Smokers switching from not noticing warnings first at W1 to noticing warnings first at W2, or who had a lower composite appeal score at W2, were more likely to plan to quit and to have made a quit attempt at W2. Smokers who switched to disagreeing that some brands contain more harmful substances at W2, after giving a different response at W1, were more likely to quit at W3. Conclusions Standardised packaging appears to be having the intended impacts.

Automated summary

The study findings suggest that standardized packaging has had the intended impacts on smokers, including increasing the noticeability of warning labels, diminishing the appeal and value of cigarettes/rolling tobacco compared to before, and strengthening disagreement on the presence of more harmful substances in certain brands. There were no significant differences in responses to standardized packaging based on social grade.