The perceptions of UK youth of branded and standardized, 'plain' cigarette packaging

Background: Tobacco packaging is an important form of promotion. Standardizing cigarette packages ('plain' packaging) represents a novel tobacco control policy. This study examined perceptions of branded and standardized cigarette packages among British youth. Methods: Seven hundred twelve youth aged 11-17 completed an online survey. Participants viewed pairs of packages altered using a 3 x 2 factorial design: health warning type (40% text, 40% pictorial or 80% pictorial) x standardized pack colour (white vs. brown). A discrete-choice task was used in which participants selected packs based on attractiveness, taste, tar, health risk, impact of health warning and enticement to start smoking. Participants also compared regular Silk Cut and 'Superslims' Silk Cut packs. Participants completed a final selection task from two standardized and two branded packs. Results: Warning type was significantly associated with all six outcomes: packs with larger pictorial warnings were more likely to be perceived as less attractive, less smooth, greater health risk, higher tar delivery, more effective health warnings and less likely to encourage initiation. The same pattern was found for brown vs. white standardized packages, with the exception of attractiveness and initiation. Compared with the regular Silk Cut pack, the 'Superslims' Silk Cut pack was perceived as significantly more favourable on all six outcomes. Finally, among respondents who selected a pack in the pack selection task, 95.1% selected a branded pack vs. 4.9% who selected a standardized pack. Conclusions: Increasing the size of pictorial health warnings and standardizing the appearance and shape of packages may discourage smoking initiation among young people.