Cigarette pack design and adolescent smoking susceptibility: a cross-sectional survey

Objectives: To compare adolescents' responses to three different styles of cigarette packaging: novelly (branded packs designed with a distinctive shape, opening style or bright colour), regular (branded pack with no special design features) and plain (brown pack with a standard shape and opening and all branding removed, aside from brand name). Design: Cross-sectional in-home survey. Setting: UK. Participants: Random location quota sample of 1025 never smokers aged 11-16 years. Main outcome measures: Susceptibility to smoking and composite measures of pack appraisal and pack receptivity derived from 11 survey items. Results: Mean responses to the three pack types were negative for all survey items. However, 'novelty' packs were rated significantly less negatively than the 'regular' pack on most items, and the novelty and regular packs were rated less negatively than the 'plain' pack. For the novelty packs, logistic regressions, controlling for factors known to influence youth smoking, showed that susceptibility was associated with positive appraisal and also receptivity. For example, those receptive to the innovative Silk Cut Superslims pack were more than four times as likely to be susceptible to smoking than those not receptive to this pack (AOR=4.42, 95% Cl 2.50 to 7.81, p<0.001). For the regular pack, an association was found between positive appraisal and susceptibility but not with receptivity and susceptibility. There was no association with pack appraisal or receptivity for the plain pack. Conclusions: Pack structure (shape and opening style) and colour are independently associated, not just with appreciation of and receptivity to the pack, but also with susceptibility to smoke. In other words, those who think most highly of novelty cigarette packaging are also the ones who indicate that they are most likely to go on to smoke. Plain packaging, in contrast, was found to directly reduce the appeal of smoking to adolescents.