Article Text

Download PDFPDF

Has the introduction of plain packaging with larger graphic health warnings changed adolescents’ perceptions of cigarette packs and brands?
  1. Victoria White,
  2. Tahlia Williams,
  3. Melanie Wakefield
  1. Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
  1. Correspondence to Associate Professor Victoria White, Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, VIC 3004, Australia; Vicki.white{at}


Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on adolescents’ perceptions of pack image and perceived brand differences.

Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of new cigarette packaging) and in 2013 (7–12 months afterwards). Students aged 12–17 years (2011 n=6338; 2013 n=5915) indicated whether they had seen a cigarette pack in previous 6 months. Students rated the character of four popular cigarette brands, indicated level of agreement regarding differences between brands in ease of smoking, quitting, addictiveness, harmfulness and look of pack; and indicated positive and negative perceptions of pack image. Changes in responses of students seeing cigarette packs in the previous 6 months (2011: 60%; 2013: 65%) were examined.

Results Positive character ratings for each brand reduced significantly between 2011 and 2013. Changes were found for four of five statements reflecting brand differences. Significantly fewer students in 2013 than 2011 agreed that ‘some brands have better looking packs than others’ (2011: 43%; 2013: 25%, p<0.001), with larger decreases found among smokers (interaction p<0.001). Packs were rated less positively and more negatively in 2013 than in 2011 (p<0.001). The decrease in positive image ratings was greater among smokers.

Conclusions The introduction of standardised packaging has reduced the appeal of cigarette packs. Further research could determine if continued exposure to standardised packs creates more uncertainty or disagreement regarding brand differences in ease of smoking and quitting, perceived addictiveness and harms.

  • Packaging and Labelling
  • Prevention
  • Advertising and Promotion

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.