Article Text

Download PDFPDF

Plain tobacco packaging, increased graphic health warnings and adolescents’ perceptions and initiation of smoking: DePICT, a French nationwide study
  1. Fabienne El-Khoury Lesueur1,
  2. Camille Bolze1,
  3. Ramchandar Gomajee1,
  4. Vicki White2,
  5. Maria Melchior1
  6. the DePICT study group
    1. 1 Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris, France
    2. 2 Centrefor Behavioural Research in Cancer (CBRC), CancerCouncil Victoria, Melbourne, Australia
    1. Correspondence to Dr Fabienne El-Khoury Lesueur, Department of Social Epidemiology, INSERM, Sorbonne Université, Institut Pierre Louis d’Epidémiologie et de Santé Publique IPLESP, Paris 75012, France; fabienne.khoury{at}


    Background Plain packaging (PP) of tobacco products and increased graphic warnings may contribute to lower attractiveness of smoking, particularly among youths. In France, this policy was introduced on 1 January 2017. We examined changes in smoking-related perceptions and behaviours among a nationwide sample of French adolescents before (2016) and 1 year post (2017) implementation.

    Methods DePICT is a two-wave cross-sectional national telephone survey of adolescents aged 12–17 years per study wave (2016: n=2046 2017: n=1999). All participants reported smoking-related perceptions, as well as ever and current tobacco use. Smokers were also asked about their perceptions of tobacco brands. Data were weighted to be representative of youths in the French population: adjusted prevalence ratios (PRs, 95% CI) estimating changes between the two study waves were calculated using multivariate log-binomial regression models.

    Results In 2017, as compared with 2016, French adolescents were more likely to report fear of the consequences of smoking (PR=1.06, 95% CI 1.02 to 1.09) and that smoking is dangerous (PR=1.08, 95% CI 1.05 to 1.11). They were also less likely to report that their friends (PR=0.61, 95% CI 0.54 to 0.70) and family (PR=0.51, 95% CI 0.44 to 0.60) accept smoking. Additionally, smoking initiation significantly decreased (PR=0.96, 95% CI 0.93 to 0.98) and a non-statistically significant drop in current tobacco use was observed (PR=0.93, 95% CI 0.78 to 1.11). Smokers’ attachment to their tobacco brand also decreased (PR=0.47, 95% CI 0.30 to 0.73).

    Conclusion Our findings suggest that PP and increased graphic warnings could contribute to changes in smoking norms and rates among adolescents.

    • packaging and labelling
    • denormalization
    • public policy
    • priority/special populations

    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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

    View Full Text

    Statistics from


    • Contributors All authors have materially participated in the research and/or the manuscript preparation. MM is the PI of the DePICT study. FE-K, CB and MM were implicated in designing and implementing the study. VMW assisted in planning the analysis. FE-K analysed the data and wrote the first draft of the manuscript, and all authors contributed to and have approved the final manuscript.

    • Funding This work was supported by a grant from the French National Cancer Institute (INCA N°2016-097). The funders of the study had no role in study design, data collection, data analysis, data interpretation, writing of the report, or in the decision to submit the article for publication.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval DePICT was approved by the ethical review committee of the French National Institute of Health and Medical Research (INSERM, CEEI-IRB 00003888).

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

    • Collaborators Renaud Crespin, Karine Gallopel-Morvan, Gwenn Menvielle, Brigitte Metadieu, Viet Nguyen-Than, Patrick Peretti-Watel

    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.