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Effects of plain package branding and graphic health warnings on adolescent smokers in the USA, Spain and France
  1. J Craig Andrews1,
  2. Richard G Netemeyer2,
  3. Scot Burton3,
  4. Jeremy Kees4
  1. 1Marquette University, Milwaukee, Wisconsin, USA
  2. 2University of Virginia, Charlottesville, Virginia, USA
  3. 3University of Arkansas, Fayetteville, Arkansas, USA
  4. 4Villanova University, Villanova, Pennsylvania, USA
  1. Correspondence to Dr J Craig Andrews, Marquette University, Milwaukee 53233, WI, USA; craig.andrews{at}


Objective The purpose of this study is to provide an experimental test of the effects of plain pack branding and graphic health warnings (GHWs) in three different countries for an important and vulnerable population, that is, adolescents who are experimenting with smoking.

Methods The effects of plain pack branding (logo present, logo absent), and graphic visual warning level (absent, low, medium, high) are studied experimentally for their impact on adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting in the USA, Spain and France. A total of 1066 adolescents who were experimenting with smoking served as participants in the study. A quota sample produced 375 respondents in the USA, 337 in Spain and 354 in France.

Results Overall findings indicate that the GHWs were effective in impacting adolescent cigarette craving, evoked fear, pack feelings and thoughts of quitting. The plain pack effects were not as strong, yet reduced craving, increased fear, and decreased pack feelings for all three samples combined, and for US adolescent smokers individually, irrespective of the GHWs. For French adolescent smokers, plain pack effects for craving were limited to low/moderate GHW levels. For Spanish adolescent smokers, plain pack feeling effects were limited to the absence of the GHWs.

Conclusions The results show that plain packs can independently strengthen the more instantaneous, direct effects (short of quitting thoughts) found with the GHWs. Yet, the plain pack results were attenuated for Spanish and French adolescent smokers, who are currently exposed to GHWs.

  • Packaging and Labelling
  • Prevention
  • Priority/special populations
  • Public policy
  • Advertising and Promotion

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  • Funding This research received no specific grant from any outside funding agency in the public, commercial or not-for-profit sectors. Internal support was received from Marquette University Miles, Kellstadt, and Way-Klingler funds.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Marquette University Institutional Review Board.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement We have access to all data reported in the manuscript and will provide this data on request to the editors or their assignees.