RT Journal Article SR Electronic T1 Evaluating the impact of plain packaging among Canadian smokers: findings from the 2018 and 2020 ITC Smoking and Vaping Surveys JF Tobacco Control JO Tob Control FD BMJ Publishing Group Ltd SP tobaccocontrol-2021-056635 DO 10.1136/tobaccocontrol-2021-056635 A1 Shannon Gravely A1 Janet Chung-Hall A1 Lorraine V Craig A1 Geoffrey T Fong A1 K Michael Cummings A1 Ron Borland A1 Hua-Hie Yong A1 Ruth Loewen A1 Nadia Martin A1 Anne C K Quah A1 David Hammond A1 Janine Ouimet A1 Christian Boudreau A1 Mary E Thompson A1 Pete Driezen YR 2021 UL http://tobaccocontrol.bmj.com/content/early/2021/10/19/tobaccocontrol-2021-056635.abstract AB Background In February 2020, Canada implemented plain packaging without any changes to the size and content of health warning labels (HWLs), which were last updated in 2012 (pictorial HWLs on 75% of the pack front and back). This pre-post evaluation study assessed the impact of plain packaging in Canada on: (1) pack appeal; (2) HWL effectiveness; and (3) support for plain packaging. Additionally, a quasi–experimental design was used to assess the Canadian results relative to two comparator countries: Australia, where plain packaging (with new larger HWLs) was implemented in 2012, and the United States (USA), where plain packaging has not been implemented and the same text warnings have appeared on cigarette packs since 1985.Methods Data are from adult smokers who participated in the 2018 and/or 2020 International Tobacco Control Smoking and Vaping Surveys in Canada (n=4600), Australia (n=1834) and the USA (n=3046). Online surveys were conducted before (February to July 2018) and after (February to June 2020) the implementation of plain packaging in Canada. Adjusted regression analyses were conducted on weighted data.Results Plain packaging was associated with a significant increase in the percentage of Canadian smokers who did not like the look of their cigarette pack (2018: 28.6% vs 2020: 44.7%, p<0.001), whereas no change in pack appeal was observed among smokers in Australia and the USA over the same period. Plain packaging was not associated with changes in HWL effectiveness in Canada. Support for plain packaging increased significantly among Canadian smokers (2018: 25.6% vs 2020: 33.7%, p<0.001).Conclusions Plain packaging in Canada substantially reduced pack appeal and increased support for the policy among adult smokers; however, there was no increase in the effectiveness of Canada’s 8-year-old HWLs. The impact of plain packaging on health warning effectiveness may depend on the design of the warnings and length of time since implementation.Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. The data are jointly owned by a third party in each country that collaborates with the International Tobacco Control Policy Evaluation (ITC) Project. Data from the ITC Project are available to approved researchers 2 years after the date of issuance of cleaned data sets by the ITC Data Management Centre. Researchers interested in using ITC data are required to apply for approval by submitting an International Tobacco Control Data Repository (ITCDR) request application and subsequently to sign an ITCDR Data Usage Agreement. To avoid any real, potential or perceived conflict of interest between researchers using ITC data and tobacco-related entities, no ITCDR data will be provided directly or indirectly to any researcher, institution or consultant that is in current receipt of any grant monies or in-kind contribution from any tobacco manufacturer, distributor or other tobacco-related entity. The criteria for data usage approval and the contents of the Data Usage Agreement are described online (http://www.itcproject.org). The authors of this paper obtained the data following this procedure. This is to confirm that others would be able to access these data in the same manner as the authors. The authors did not have any special access privileges that others would not have.