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Increased support for standardised packaging in the UK: a longitudinal online survey
  1. Crawford Moodie1,
  2. Catherine Best1,
  3. Nathan Critchlow1,
  4. Martine Stead1,
  5. Sara C Hitchman2,
  6. Ann McNeill2
  1. 1 Institute for Social Marketing and Health, University of Stirling, Stirling, UK
  2. 2 UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, King’s College London, London, UK
  1. Correspondence to Dr Crawford Moodie, Department of Marketing, Institute for Social Marketing, Stirling FK9 4LA, UK; c.s.moodie{at}stir.ac.uk

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Introduction

While standardised (or plain) packaging is required in at least 14 countries, the only evidence on postimplementation support comes from Australia. Public support is important for public health policy as it can be instrumental in whether governments introduce measures, and can help justify the decision to have done so.1 2 In Australia, support for plain packaging during the transition period was higher among smokers using plain packs than smokers using fully branded packs.2 A longitudinal survey found that support among smokers increased from 28% preplain packaging to 49% 6 months postplain packaging.3 Cross-sectional surveys found that while approval among smokers and ex-smokers was unchanged from prior to the policy being implemented to 12 months postplain packaging, there was a significant decrease in disapproval (from 36.4% preimplementation to 28.2% for smokers, and from 17.2% preimplementation to 13.9% for ex-smokers).4

Since 20 May 2017, cigarettes and rolling tobacco in the UK must be sold in standardised packs. We explored whether support for standardised packaging changed following the introduction of this policy.

Methods

A longitudinal online survey (the ‘Adult Tobacco Policy Survey’) with a cohort of smokers recruited prestandardised packaging (April–May 2016) and followed up 4–6 months poststandardised packaging (September–November 2017) and 24–26 months poststandardised packaging (May–July 2019). To be eligible for inclusion at wave (W) 1, participants had to be current cigarette smokers. Of the 6233 cigarette smokers at W1, 4293 responded at W2 (3629 cigarette smokers, 607 ex-smokers, 36 who only used other forms of tobacco, 7 who reported being a smoker but had not smoked in the past 3 months, and 14 who responded ‘Don’t know’ for smoking status) and 3175 at W3 (2412 cigarette smokers, 700 ex-smokers, 44 who only used other forms of tobacco, 6 who reported being a smoker but had not smoked in the past 3 months, and 13 who responded ‘Don’t know’ for smoking status). The sample at W1 was weighted by age, gender, government office region and tobacco consumption to represent the national profile of smokers aged 16 and over in the UK and in subsequent waves weights were adjusted for sample attrition; see technical report (online supplemental file).

Participants were shown an image of standardised packs and asked ‘To what extent, if at all, do you agree or disagree that tobacco companies should be/continue to be required to continue to sell cigarettes and rolling tobacco in standardised packs—that is, in packs which all look the same except for the brand and variant name?’ with options ‘Strongly agree’, ‘Agree’, ‘Neither agree nor disagree’, ‘Disagree’, ‘Strongly disagree’ and ‘Don’t know’ collapsed into approval (Strongly agree/Agree), neutral (Neither agree nor disagree/Don’t know) and disapproval (Strongly disagree/Disagree).

Results

Approval for standardised packaging increased at each wave for cigarette smokers and ex-smokers, from 25.4% at W1 to 35.7% at W2 and 39.3% at W3, and for cigarette smokers, from 25.4% at W1 to 34.0% at W2 and 35.4% at W3 (see table 1). Among ex-smokers, approval was 44.8% at W2 and 52.0% at W3. Generalised estimating equations, adjusted for smoking status, show a statistically significant increase in the proportion of participants approving of standardised packaging across waves (W1 vs W2 OR=1.50, 95% CI 1.23 to 1.82; W1 vs W3 OR=1.71, 95% CI 1.57 to 1.86).

Table 1

Support for standardised packaging among cigarette smokers and ex-smokers across three waves

Discussion

Approval for standardised packaging in the UK increased, and disapproval decreased, post implementation, consistent with findings from Australia2–4 and other tobacco control policies such as pictorial warnings, a retail display ban, and smoke-free public places.3 The higher support found following the introduction of tobacco control policies, which may be due to increased acceptability, decreased concerns about the impacts, adaptation, realisation that it may aid cessation or other factors,1 3 helps governments defend the decision to have implemented these policies,1 may be a springboard to further policies and could encourage other governments to follow suit.

Ethics statements

Patient consent for publication

Ethics approval

Ethical approval was granted by the University of Stirling, with the first two waves approved by the Faculty of Health Sciences and Sport Ethics Committee and the third wave by the General University Ethical Panel.

Acknowledgments

The authors would like to thank YouGov for sample recruitment at each wave.

References

Supplementary materials

  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

Footnotes

  • Twitter @cathbest, @n_critchlow, @kingsNRG

  • Correction notice This paper has been updated since first published to amend funding details and details regarding the timeline of sample follow-up.

  • Contributors CM and SCH designed the study and obtained funding. CB was responsible for data management and analysis. CM drafted the manuscript, and all authors approved the final manuscript.

  • Funding The first two waves were funded by Cancer Research UK and the British Heart Foundation (Grant No: A18507). The third wave was conducted by the Public Health Policy Research Unit (PH-PRU), commissioned and funded by the National Institute for Health Research Policy Research Programme. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or its arm's length bodies, and other Government Departments.

  • Competing interests None declared.

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