Two recent studies have added to the growing body of evidence that suggests that plain packaging can make smoking less appealing, reduce cigarette consumption and encourage plans to quit.

In the first paper, Wakefield and colleagues set out to determine whether those smoking from plain packages, introduced by law in Australia in September 2012, had different smoking beliefs and attitudes to quitting compared with those still smoking from traditionally branded packs. The new plain packaging, consisting of dark brown packs with large health warnings, but brand names limited to a standard font and size, were introduced gradually between October and December 2012.

The authors conducted telephone interviews in November and December 2012 as part of an annual smoking and health survey in the state of Victoria. Questions relating to the impact of plain packaging were asked within the context of a broader survey. A total of 536 interviews were conducted during the study period with ‘usual brand’ smokers, of whom about three quarters (72.3%) were currently smoking from a plain pack, and one quarter (27.7%) from a regular branded pack.

The study found some baseline differences between the branded and plain pack smokers, and these were included as covariates in the multivariate statistical models used to interpret the data.

Compared with branded pack smokers, those smoking from plain packs perceived their cigarettes to be lower in quality, adjusted odds ratio (OR) 1.66, P = 0.045. They also found their cigarettes to be less satisfying than a year ago, OR 1.70, P = 0.052, were more likely to have thought about quitting in the past week, OR 1.81, P = 0.013 and rated stopping smoking as a higher priority. There was no difference in the frequency of thoughts about smoking-related harm.

Measures of the appeal of smoking were related to the extent of the roll-out of plain packages for branded pack smokers, and approached those of plain pack smokers once 80% of survey respondents were smoking from plain packs.

In the second paper, the authors explored young adult women smokers’ cognitive and emotional responses to using plain, dark brown cigarette packs with both pictorial and verbal smoking warnings, and determined whether the plain packaging was associated with any short-term change in smoking behaviour.

Between 2011 and 2012, 301 young female smokers, aged 18-35, were recruited in large towns and cities in Scotland. Participants were randomised to transfer their cigarettes to brown packages for the first week of the study, and to smoke from the original packs for the second, and vice versa. Participants completed regular questionnaires as part of the study, and received a small payment for completion of each questionnaire on top of a participation fee of £15.

Plain packaging was associated with a higher rate of negative perceptions and feelings both about the pack and about smoking in general (P < 0.001).

There were no significant overall differences in attitudes towards the health warnings between the pack types, but participants reported looking more closely at the warnings on plain packs and also thinking more about the warnings (P < 0.001).

Participants were more likely to hide or cover their plain cigarette packs in public (P < 0.001), and were more likely to forego a cigarette (P < 0.05), smoke less around others (P < 0.001) and think about quitting (P < 0.001) while using the plain packs.

There has been much publicity about a recent UK government postponement of a decision on the introduction of plain cigarette packaging. The Government has said it wants to wait until there is more evidence on the effectiveness of this strategy in reducing smoking before it considers implementation. These two papers are timely in their publication, and add significant information to the debate.

 Dr Jez Thompson