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Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019
  1. Magdalena Opazo Breton1,
  2. John Britton2,
  3. Jamie Brown3,4,
  4. Emma Beard3,4,
  5. Ilze Bogdanovica2
  1. 1School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
  2. 2School of Medicine, University of Nottingham, Nottingham, UK
  3. 3Department of Clinical, Educational and Health Psychology, University College London, London, UK
  4. 4Cancer Research UK Health Behaviour Research Centre, University College London, London, UK
  1. Correspondence to Dr Ilze Bogdanovica, Division of Epidemiology and Public Health, University of Nottingham, Nottingham NG5 1PB, UK; Ilze.Bogdanovica{at}nottingham.ac.uk

Abstract

Background and aim In 2016, England initiated the implementation of standardised tobacco packaging, introduced in conjunction with minimum pack sizes and other measures included in the 2014 European Tobacco Products Directive, over the course of a 1-year sell-off period ending in May 2017. These measures have been shown to have been associated with increases in tobacco prices and product diversity. We now investigate the association between implementation of the new legislation and smoking status in England.

Design Segmented regression analysis of repeated cross-sectional surveys using a generalised linear model with individual-level data to test for a change in trend and immediate step change.

Setting England.

Participants Participants in the Smoking Toolkit Study, which involves repeated, cross‐sectional household surveys of individuals aged 16 years and older in England. The sample included 278 219 individual observations collected between November 2006 and December 2019.

Intervention Implementation of standardised packaging legislation (May 2016 and May 2017).

Measurements Individual-level current smoking status adjusted for implementation of tobacco control policies, cigarette price, seasonality and autocorrelation.

Findings The implementation of standardised packaging was associated with a significant step reduction in the odds of being a smoker after May 2017 (OR: 0.93; 95% CI 0.87 to 0.99). The magnitude of the association was similar when modelling the step change in May 2016 at the start of the 1-year policy implementation period (OR: 0.90; 95% CI: 0.83 to 0.97).

Conclusions This is the first independent study demonstrating that implementation of standardised packaging was associated with a reduction in smoking in England which occurred in anticipation of, rather than after, full policy implementation. It appears that the odds of being a smoker were affected by the prospect of the move to standardised packs and accompanying legislation.

  • public policy
  • packaging and labelling
  • advocacy

Data availability statement

Data used for this study are available upon reasonable request from the authors.

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Data availability statement

Data used for this study are available upon reasonable request from the authors.

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Footnotes

  • Contributors MOB designed the study, carried out analysis and was involved in writing up the manuscript. JBritton contributed to designing the study and was involved in writing up the manuscript. JBrown was involved in designing the study and in writing up the manuscript. EB was involved in designing the study and in writing up the manuscript. IB was involved in designing the study, contributed to analysis of the data and was involved in writing up the manuscript.

  • Funding The work was supported by Cancer Research UK grant number C45256/A20606. Cancer Research UK (C1417/A22962) supported the data collection and EB’s salary. All authors are members of SPECTRUM, a UK Prevention Research Partnership (UKPRP) Consortium (MR/S037519/1). UKPRP is an initiative funded by the UK Research and Innovation Councils, the Department of Health and Social Care (England) and the UK devolved administrations, and leading health research charities.

  • Competing interests JB and EB have received unrestricted research grants from Pfizer related to smoking cessation. JB, MOB and IB have no competing interests to declare. All authors declare no financial links with tobacco companies or e-cigarette manufacturers or their representatives.

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

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