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Australia's plain tobacco packs: anticipated and actual responses among adolescents and young adults 2010–2013
  1. Sally Dunlop1,2,
  2. Donna Perez1,
  3. Anita Dessaix1,
  4. David Currow1
  1. 1Cancer Institute New South Wales, Sydney, New South Wales, Australia
  2. 2Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Dr Sally Dunlop, Division of Cancer Screening and Prevention, Cancer Institute NSW, Level 9, 8 Central Ave, Australian Technology Park, Eveleigh, NSW 2015, Australia; sallydunlop{at}


Background In December 2012, Australia introduced world-first legislation mandating plain packaging for all tobacco products. To date, there is very little evidence on youth responses to the changed packs.

Aim To assess attitudes towards, and responses to, tobacco plain packs preimplementation and postimplementation.

Methods The Tobacco Promotion Impact Study (TPIS) was a yearly cross-sectional telephone survey of adolescents and young adults (12–24 years) from the states of New South Wales (NSW) and Queensland, conducted at three time points preimplementation (June 2010; June 2011; June 2012) and one time point postimplementation (June 2013; total n=8820).

Results There were significant increases in support for plain packaging from preimplementation to postimplementation for: never smokers (56% in 2012 vs 63% in 2013; OR=0.77, 95% CI 0.65 to 0.90, p=0.001), experimenters/ex-smokers (55% in 2012 vs 72% in 2013; OR=0.51, 95% CI 0.38 to 0.68, p<0.001) and current smokers (35% in 2012 vs 55% in 2013; OR=0.49, 95% CI 0.32 to 0.75, p=0.001). At postimplementation, 18% of never smokers reported that plain packaging made them less likely to try smoking and 16% of experimenters/ex-smokers reported that plain packaging made them less likely to smoke again. Youth were significantly less likely to have anticipated these responses preimplementation (never smokers: 8% in 2011; OR=0.43, 95% CI 0.28 to 0.65, p<0.00; experimenters/ex-smokers: 11%; OR=0.65, 95% CI 0.52 to 0.82, p<0.001). At postimplementation, 34% of smokers reported a quitting-related response to plain packaging (tried to quit or thought about quitting); the proportion who anticipated such a response preimplementation was significantly less (14% in 2011; OR=0.33, 95% CI 0.20 to 0.53, p<0.001). 28% of smokers reported a social denormalisation response at postimplementation (hid their pack from view, used a case to cover their pack, felt embarrassed); the proportion who anticipated such a response preimplementation was significantly less (9% in 2011; OR=0.24, 95% CI 0.14 to 0.42, p<0.001).

Conclusions The actual response of youth to plain packaging was greater than anticipated prior to their introduction, and support for plain packaging increased from preimplementation to postimplementation among all groups of youth. Jurisdictions planning to implement plain tobacco packaging should be encouraged by these findings.

  • Denormalization
  • Packaging and Labelling
  • Prevention
  • Public policy
  • Cessation

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  • Contributors SD, DP and AD conceived the study and SD analysed the data. All authors contributed to drafting the manuscript and critically revised the final manuscript.

  • Funding The TPIS was funded by the Cancer Institute NSW.

  • Competing interests None declared.

  • Ethics approval NSW Population and Health Services Research Ethics Committee.

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

  • Data sharing statement For further information on the TPIS data, please contact the authors.