Impact of Standardized Tobacco Packaging on Smoking-related Behaviors and Perceptions in Singapore

Overview

Journal Tob Induc Dis

Date 2024 Aug 2

PMID 39091892

Authors

Lionel Ng

Chuen Seng Tan

Jeong Kyu Lee

Yvette van der Eijk

Affiliations

Soon will be listed here.

Abstract

Introduction: Singapore phased in standardized tobacco packaging on 1 July 2020 following a three-month grace period. This pre-post study evaluated its impacts on smoking-related behaviors and perceptions among adults who currently smoke.

Methods: Baseline and follow-up data were collected in a pre- and post-questionnaire from a cohort of 1873 Singaporean adults who were currently smoking at baseline. Baseline data were collected from December 2019 to May 2020, and follow-up data from July 2021 to September 2021. We used descriptive statistics and bivariate analyses to assess pre-post changes (Bhapkar's test, Wilcoxon signed rank test) and to identify characteristics of participants who had quit or cut down smoking at follow-up (Pearson's chi-squared, Fisher's exact test).

Results: At follow-up, 11.7% (n=220) had quit smoking. There was a higher proportion of those smoking non-daily (pre: 13.1%, post: 16.9%; p<0.001), and those intending to quit within the next year (pre: 14.8%, post: 17.5%; p<0.05) or six months (pre: 10.4%, post: 13.2%; p<0.01). Tobacco products were scored more negatively in relation to packaging, quality, satisfaction, value for money and overall appeal (scores pre: 15.9, post: 14.3; p<0.001), harmfulness (scores pre: 0.61, post: 0.54; p<0.05), noticing others smoking the same brand (scores pre: 1.92, post: 1.65; p<0.001), and considering quitting due to health warnings (scores pre: 0.81, post: 0.86, p<0.05). Fewer reported that some cigarette brands have higher prestige (pre: 58.0, post: 54.3%; p<0.01), and more reported using flavored cigarettes (pre: 42.2%, post: 60.1%; p<0.001) and e-cigarettes (pre: 4.2%, post: 6.1%; p<0.01).

Conclusions: In Singapore, the changes observed before and after the implementation of standardized packaging suggest that it might be associated with quit-related outcomes, reduced tobacco product appeal, and increased effectiveness of graphic health warnings.

References

Swift E, Borland R, Cummings K, Fong G, McNeill A, Hammond D . Australian smokers' support for plain or standardised packs before and after implementation: findings from the ITC Four Country Survey. Tob Control. 2014; 24(6):616-21. PMC: 4678150. DOI: 10.1136/tobaccocontrol-2014-051880. View

El-Khoury Lesueur F, Bolze C, Gomajee R, White V, Melchior M . Plain tobacco packaging, increased graphic health warnings and adolescents' perceptions and initiation of smoking: DePICT, a French nationwide study. Tob Control. 2018; 28(e1):e31-e36. PMC: 6824742. DOI: 10.1136/tobaccocontrol-2018-054573. View

Greenland S . The Australian experience following plain packaging: the impact on tobacco branding. Addiction. 2016; 111(12):2248-2258. DOI: 10.1111/add.13536. View

Kotnowski K, Hammond D . The impact of cigarette pack shape, size and opening: evidence from tobacco company documents. Addiction. 2013; 108(9):1658-68. DOI: 10.1111/add.12183. View

Yong H, Borland R, Hammond D, Thrasher J, Cummings K, Fong G . Smokers' reactions to the new larger health warning labels on plain cigarette packs in Australia: findings from the ITC Australia project. Tob Control. 2015; 25(2):181-7. PMC: 4601932. DOI: 10.1136/tobaccocontrol-2014-051979. View

Gravely S, Chung-Hall J, Craig L, Fong G, Cummings K, Borland R . Evaluating the impact of plain packaging among Canadian smokers: findings from the 2018 and 2020 ITC Smoking and Vaping Surveys. Tob Control. 2021; 32(2):153-162. PMC: 9330177. DOI: 10.1136/tobaccocontrol-2021-056635. View

Durkin S, Brennan E, Coomber K, Zacher M, Scollo M, Wakefield M . Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers. Tob Control. 2017; 24(Suppl 2):ii26-ii32. PMC: 4392190. DOI: 10.1136/tobaccocontrol-2014-052058. View

Moodie C, Angus K, Mitchell D, Critchlow N . How tobacco companies in the United Kingdom prepared for, and responded to, standardised packaging of cigarettes and rolling tobacco. Tob Control. 2018; 27(e1):e85-e92. DOI: 10.1136/tobaccocontrol-2017-054011. View

Lee C, Kahende J . Factors associated with successful smoking cessation in the United States, 2000. Am J Public Health. 2007; 97(8):1503-9. PMC: 1931453. DOI: 10.2105/AJPH.2005.083527. View

10.

Balmford J, Borland R, Yong H . Impact of the introduction of standardised packaging on smokers' brand awareness and identification in Australia. Drug Alcohol Rev. 2015; 35(1):102-109. PMC: 4792799. DOI: 10.1111/dar.12331. View

11.

Moodie C, Best C, Lund I, Scheffels J, Critchlow N, Stead M . The Response of Smokers to Health Warnings on Packs in the United Kingdom and Norway Following the Introduction of Standardized Packaging. Nicotine Tob Res. 2021; 23(9):1551-1558. PMC: 8372634. DOI: 10.1093/ntr/ntab027. View

12.

van der Eijk Y, Teo K, Tan G, Chua W . Tobacco industry strategies for flavour capsule cigarettes: analysis of patents and internal industry documents. Tob Control. 2021; 32(e1):e53-e61. DOI: 10.1136/tobaccocontrol-2021-056792. View

13.

Wakefield M, Morley C, Horan J, Cummings K . The cigarette pack as image: new evidence from tobacco industry documents. Tob Control. 2002; 11 Suppl 1:I73-80. PMC: 1766062. DOI: 10.1136/tc.11.suppl_1.i73. View

14.

White V, Guerin N, Williams T, Wakefield M . Long-term impact of plain packaging of cigarettes with larger graphic health warnings: findings from cross-sectional surveys of Australian adolescents between 2011 and 2017. Tob Control. 2019; 28(e1):e77-e84. DOI: 10.1136/tobaccocontrol-2019-054988. View

15.

Opazo Breton M, Britton J, Brown J, Beard E, Bogdanovica I . Was the implementation of standardised tobacco packaging legislation in England associated with changes in smoking prevalence? A segmented regression analysis between 2006 and 2019. Tob Control. 2021; . DOI: 10.1136/tobaccocontrol-2021-056694. View

16.

Dunlop S, Dobbins T, Young J, Perez D, Currow D . Impact of Australia's introduction of tobacco plain packs on adult smokers' pack-related perceptions and responses: results from a continuous tracking survey. BMJ Open. 2014; 4(12):e005836. PMC: 4275762. DOI: 10.1136/bmjopen-2014-005836. View

17.

Wakefield M, Coomber K, Zacher M, Durkin S, Brennan E, Scollo M . Australian adult smokers' responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey. Tob Control. 2017; 24(Suppl 2):ii17-ii25. PMC: 4401339. DOI: 10.1136/tobaccocontrol-2014-052050. View

18.

Pasquereau A, Guignard R, Andler R, Gallopel-Morvan K, Nguyen-Thanh V . Plain packaging on tobacco products in France: Effectiveness on smokers' attitudes one year after implementation. Tob Induc Dis. 2022; 20:35. PMC: 8985692. DOI: 10.18332/tid/146600. View

19.

White V, Williams T, Wakefield M . Has the introduction of plain packaging with larger graphic health warnings changed adolescents' perceptions of cigarette packs and brands?. Tob Control. 2017; 24(Suppl 2):ii42-ii49. PMC: 4401345. DOI: 10.1136/tobaccocontrol-2014-052084. View

20.

Shiffman S, Dunbar M, Scholl S, Tindle H . Smoking motives of daily and non-daily smokers: a profile analysis. Drug Alcohol Depend. 2012; 126(3):362-8. PMC: 3970262. DOI: 10.1016/j.drugalcdep.2012.05.037. View