1. Government mandated plain packaging of cigarettes with larger general health warnings was linked to a decrease in adolescents’ positive perception of cigarettes and cigarette packs in Australia.
Evidence Rating Level: 3 (Average)
Study Rundown: To reduce the incidence of smoking, the World Health Organization’s Framework Convention on Tobacco Control has set specific packaging requirements of signatory countries with the goal of reducing the appeal of cigarettes and the advertising strength of cigarette packs. In December 2012, Australia signed on to implement these requirements, which included implementing a standard plain, brown package with a larger general health warning on the back. This study sought to investigate the changes in perception among adolescents regarding cigarette packaging by analyzing the results of surveys administered to a cross-section of Australian 12-17 year olds in both 2011 and 2013, representing a time point before and after the change in packaging. Compared to 2011 there were decreases in the positive perceptions of cigarette packs among both non-smokers and those who had tried or were currently smoking in 2013. In conjunction, more adolescents answered “I don’t know” in the 2013 survey when it came to characterizing different brands as more harmful, easier to smoke, or more addictive, signifying decreases in positive perceptions of one brand over others.
While the decrease in positive perceptions of cigarettes is encouraging, the effect size of this difference perception was very modest. Combined with the increasing number of answers of “I don’t know” in regards to differences in brands, especially since there were decreases in both those that agreed and disagreed, it is difficult to ascertain the overall effect of this plain packaging or the increase in size of the general health warning. Methodologically, the self-reporting on the surveys may change the answers of the adolescents, as fewer may be willing to admit they smoke or think positively about smoking given increasing societal pressure. However, while these interventions into reducing the appeal of cigarette packaging show only slight changes in perceptions, the short interval between government policy and the administration of this survey may mean that increasing negative perceptions of cigarettes are starting to take hold among adolescents
Relevant Reading: WHO Framework Convention on Tobacco Control
In-Depth [cross-sectional study]: 97 (30% response rate, n=6338) Australian schools in 2011 and 82 (60% among schools sampled in 2011 and 38% among replacement schools, n=5915) in 2013 with children aged 12-17 years were surveyed about smoking demographics and perception. Various questions with answers on a five point scale (Strongly Agree to Strongly Disagree) were asked about brand character ratings, appeal of cigarette packs, and cigarette packs. A slight increase of 64% to 70% (p<0.001) of adolescents who had never smoked was identified from 2011 to 2013. With 6 being the lowest appeal and 30 being the highest, scores for four different brands of cigarettes dropped generally by 1 point or less in all smoking demographic groups (p<0.001). Adolescents more strongly agreed with negative perceptions of smoking and less strongly agreed with positive perceptions of smoking (p<0.001). An increase in the response “I don’t know” and a decrease in the responses “Agree” or “Disagree” were seen when asking adolescents about the differences between harmful effects, addictiveness, and ease of smoking of different brands (p<0.05). There was a significant decrease from 43% to 25% in the number of adolescents who thought one brand of cigarettes looked better than others (p<0.001).
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