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Long-term impact of plain packaging of cigarettes with larger graphic health warnings: findings from cross-sectional surveys of Australian adolescents between 2011 and 2017
  1. Victoria M White1,2,
  2. Nicola Guerin2,
  3. Tahlia Williams2,
  4. Melanie A Wakefield2
  1. 1 Psychology, Deakin University, Burwood, Victoria, Australia
  2. 2 Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
  1. Correspondence to Dr Victoria M White, Psychology, Deakin University, Burwood 3125, Victoria, Australia; vicki.white{at}


Objective To assess the long-term impact of plain packaging (PP) of cigarettes with larger graphic health warnings (HW) introduced in December 2012 on adolescents’ relevant tobacco-related perceptions.

Methods Cross-sectional school-based surveys of 12 to 17 year olds in 2011 (n=4413), 2013 (n=4423), 2014 (n=4576) and 2017 (n=4266). Students rated the character of four popular cigarette brands, indicated their agreement regarding brand differences in smoking ease, quitting, addictiveness, harmfulness and pack attractiveness and positive/negative perceptions of pack image. The frequency of students reading, attending to, thinking and talking about HW was assessed. Responses of students seeing cigarette packs in the previous 6 months (2011: 63%; 2013: 67%, 2014: 56%, 2017: 56%) were examined.

Results Smoking prevalence declined from 2011 to 2017. Among students who had recently seen packs, cigarette packs were rated less positively and more negatively in 2017 than in 2011 (p<0.001) with ratings similar between 2013 and 2017. Positive character ratings for each brand reduced between 2011 and 2013 (ps<0.05) with further reductions between 2013 and 2017 (ps<0.05). Fewer students agreed, and more were uncertain, that brands differed in their smoking ease, addictiveness, harmfulness and pack attractiveness in 2017 than 2011. The frequency of students reading, attending, talking or thinking about HW did not change between 2011 and 2017.

Conclusions PP’s initial impact in reducing adolescent’s positive perceptions of cigarette packs and brand differences continued in the following years with tobacco packaging less appealing to young people in 2017 than 2011 and students more uncertain about brand differences.

  • Smoking adolescents
  • plain packaging
  • tobacco products
  • standardised packaging
  • graphic warning labels

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  • Contributors VMW oversaw data collection for all survey years and took the lead in writing the paper and in data analyses. NG led data collection in 2017 and contributed to data analyses and study write up. TW managed data collection for 2013 and 2014 and contributed to the design of data analyses and paper writing. MAW contributed to the design of the study and contributed to paper writing. All authors reviewed the final version of the paper.

  • Funding Australian Government Department of Health, Victorian Government Department of Health and Human Services, Cancer Council Victoria.

  • Competing interests No, there are no competing interests.

  • Patient consent for publication Not required.

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

  • Data sharing statement No data are available.