Plain packaging on cigarette packs in Canada advanced efforts for reducing smoking

Removing branding from cigarette packs in Canada significantly lowered the appeal of cigarettes, according to a new study from the International Tobacco Control (ITC) Project, at the University of Waterloo.

This policy—known as plain packaging—aims to eliminate the tobacco industry's use of attractive pack designs to make cigarettes appealing, especially to youth. Plain packaging requires all tobacco packages to have a standardized appearance, with no branding, including logos. All packages must use the same drab brown colour, with no attractive features and all text printed in a standardized font and location. Plain packaging was required on cigarettes and other tobacco products sold in Canada on February 7, 2020. Canada was the tenth country to require plain packaging since Australia in 2012. But Canada's plain packaging law was the first country to also standardize cigarettes length and width.

"Branding on cigarette packaging is known to detract smokers' attention away from health warnings by using positive and appealing imagery to compete with dramatic pictorial messages on health warnings," said Geoffrey Fong, professor of psychology at Waterloo, and Principal Investigator of the ITC Project. "Past evaluation studies of plain packaging in other countries, including those conducted by the ITC Project, found that plain packaging increased the effectiveness of new or revised health warnings."

But in Canada, plain packaging was not accompanied by new warnings. Instead, plain packaging was introduced on packages where the same warnings have been in place since 2012. Studies show that unless warnings are frequently revised and increased in size, they will become less effective over time due to wear-out: the same messages repeated won't have the same impact. The ITC evaluation study examined 4600 Canadian smokers at two points in time—in 2018 (before plain packaging) and in 2020 (after plain packaging). After plain packaging, more Canadian smokers reported that they did not like the look of their cigarette pack, increasing from 28.6 percent in 2018 to 44.7 percent in 2020. In the two control countries—Australia and the United States—which did not change their packaging regulations during that period, there was no change in smokers' reported pack appeal. Reducing appeal is an important strategy for reducing tobacco use, especially among young people, since appeal is linked to smoking initiation and progression to regular smoking among youth. The ITC evaluation study in Canada found that because plain packaging was not accompanied by new, revised warnings, plain packaging in Canada did not lead to increased warning effectiveness, in contrast to plain packaging in other ITC countries—Australia, New Zealand, and England—where it did lead to increased effectiveness of new, revised warnings. "These important findings reaffirm the importance of plain packaging to reduce the appeal of the most dangerous consumer product in the world—one that kills at least one-half of its regular users," said Fong. "Canada's plain packaging success strengthens the evidence of the power and importance of this regulation to combat smoking. At the same time, our findings point to the need for more frequent enhancement and revision of health warnings to maximize their impact."

The study, Evaluating the impact of plain packaging among Canadian smokers: Findings from the 2018 and 2020 ITC Smoking and Vaping Surveys, was released online today in the journal Tobacco Control.