Package Standardization for Smoking Prevention

Age: 18 - 65

Sex: Any

Trial Phase: Academic

Sponsor: RAND

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Approved in 7 Jurisdictions This treatment is already approved in other countries

Compensation: Varies

Number of Visits: 1

Duration: 1 day

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests how changes in the color and design of cigarette packages might affect young adults' interest in smoking. The study will compare three groups: packages with half standardized color, fully standardized packages, and regular packages with no changes. The goal is to determine if these changes can reduce smoking intentions. The trial seeks participants aged 21-34 who have smoked cigarettes in the past month. As an unphased study, it offers participants the chance to contribute to important research that could influence public health policies on smoking.

Do I have to stop taking my current medications to join the trial?

The trial information does not specify whether you need to stop taking your current medications.

What prior data suggests that package standardization is safe for smoking prevention?

Research shows that changing cigarette packages can influence perceptions of smoking. For partial changes, studies suggest that plain packaging makes smoking less appealing, especially to young people, and enhances the visibility and effectiveness of health warnings.

With full package changes, research indicates that people may smoke less. Smokers often perceive these plain packages as less safe, which might lead them to reconsider smoking. Some studies even found a small decrease in smoking among young adults with plain packaging.

Overall, both partial and full package changes have been well-received. These changes aim to alter the appearance of cigarette packages to reduce smoking. No reports indicate harmful effects from merely changing the packaging design. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the trial on package standardization for smoking prevention because it explores how changing cigarette packaging can impact smoking behavior. Unlike traditional methods that rely on warning labels or smoking cessation aids, this trial tests whether standardizing the look of cigarette packs—either partially or fully—can make smoking less appealing. By removing brand imagery and using plain colors and fonts, researchers hope to reduce the allure of smoking, especially among young people. This approach is unique because it doesn't focus on the smoker's behavior directly but rather on altering the marketing appeal of cigarettes, potentially leading to a decrease in smoking rates.

What evidence suggests that package standardization is effective for smoking prevention?

Research has shown that plain packaging of cigarettes can make them less appealing and highlight health warnings. This effect is particularly strong among young people, who may be more influenced by packaging appearance. In this trial, participants will encounter different packaging strategies: some will see cigarette packages with partial standardization, where half of the package uses a standardized color, while others will see full standardization, with packages fully standardized by color and font. Studies have found that removing flashy designs and using simple colors and fonts can discourage tobacco use. Evidence suggests that even partial standardization of packaging reduces positive views of smoking. Full standardization has increased attempts to quit smoking among adults. Overall, both strategies show promise in reducing the desire to use tobacco. ^{1 6 7 8 9}

Are You a Good Fit for This Trial?

This trial is for young adults aged between 21-29 who have smoked cigarettes in the past month. There are no specific exclusion criteria, so a wide range of smokers within this age group can participate.

Inclusion Criteria

Past month cigarette smoker

I am between 21 and 29 years old.

Exclusion Criteria

Not applicable.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants are exposed to different tobacco packaging designs to evaluate their influence on tobacco use intentions

1 day

1 visit (in-person)

Follow-up

Participants are monitored for changes in smoking motivation immediately after exposure

Immediately after shopping

What Are the Treatments Tested in This Trial?

Interventions

• Package standardization

Trial Overview The study is looking at how changing cigarette packaging to a standardized color affects the intentions of young adults to use tobacco. It's an experiment focusing on whether less appealing packaging can influence smoking habits.

How Is the Trial Designed?

Group I: Partial standardization Experimental Treatment 1 Intervention

Cigarette packages appear with half of the package using a standardized color

Group II: Full standardization Experimental Treatment 1 Intervention

Cigarette packages appear with all of the packages fully standardized (by color and font)

Group III: Status Quo Packages Active Control 1 Intervention

Cigarette packages appear as they normally do - no standardization

Who Is Running the Clinical Trial?

RAND

Lead Sponsor

Trials

145

Recruited

617,000+

Published Research Related to This Trial

Standardized plain cigarette packaging, implemented in Australia in December 2012, has been shown to reduce positive perceptions of smoking and discourage tobacco use, supporting its role in public health efforts to combat smoking-related morbidity and mortality.

Evidence from various studies indicates that plain packaging can effectively prevent youth smoking initiation and promote cessation among current smokers, providing a strong rationale for governments considering similar measures despite potential legal challenges from tobacco companies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Plain packaging of cigarettes: do we have sufficient evidence? Smith, CN., Kraemer, JD., Johnson, AC., et al.[2020]

In a randomized controlled trial with 128 daily smokers, plain packaging did not significantly change the number of cigarettes smoked or the volume of smoke inhaled, indicating no immediate effect on smoking behavior.

However, smokers reported a more negative experience with plain packs and found health warnings to be more impactful, suggesting that while plain packaging may not alter smoking habits in the short term, it could influence perceptions and attitudes towards smoking.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of first exposure to plain cigarette packaging on smoking behaviour and attitudes: a randomised controlled study. Maynard, OM., Leonards, U., Attwood, AS., et al.[2022]

Standardizing tobacco packaging to a 'plain' design significantly enhances the effectiveness of health warnings, making them more noticeable and impactful for consumers.

Plain packaging also helps to reduce misconceptions about the health risks of smoking and decreases the appeal of tobacco products, especially among younger audiences, suggesting it could be a powerful tool in tobacco control efforts.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Plain packaging" regulations for tobacco products: the impact of standardizing the color and design of cigarette packs. Hammond, D.[2023]

The New Zealand Government aimed to become a smokefree country by 2025 and planned to implement standardized tobacco packaging (SP) in 2012, but faced legal threats from tobacco companies that delayed the process.

The threat of international litigation created a 'regulatory chill,' postponing the enactment of SP legislation by three years, highlighting how legal challenges can hinder public health initiatives.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Regulatory chills: tobacco industry legal threats and the politics of tobacco standardised packaging in New Zealand. Crosbie, E., Thomson, G.[2020]

Transnational tobacco companies (TTCs) used misleading tactics to oppose standardized packaging (SP) of tobacco products, including misquoting studies and employing a 'mimicked scientific critique' that rejected valid evidence.

The analysis revealed that TTCs' claims against SP lack a solid foundation, indicating that their strategies are aimed at delaying public health measures rather than presenting genuine scientific concerns.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Representation and misrepresentation of scientific evidence in contemporary tobacco regulation: a review of tobacco industry submissions to the UK Government consultation on standardised packaging. Ulucanlar, S., Fooks, GJ., Hatchard, JL., et al.[2022]

Standardised tobacco packaging significantly reduces the appeal of cigarettes and smoking, leading to perceptions of lower quality and less desirable smoker identities, based on a systematic review of 25 quantitative studies.

The packaging design enhances the effectiveness of health warnings, making them more memorable and impactful, while also influencing consumer perceptions of product harm and strength, with darker packs seen as more harmful.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Is consumer response to plain/standardised tobacco packaging consistent with framework convention on tobacco control guidelines? A systematic review of quantitative studies. Stead, M., Moodie, C., Angus, K., et al.[2022]

In March 2017, 73.5% of adults were aware of the new standardised packaging legislation, with awareness significantly higher among smokers (83.7%) compared to never smokers (20.7%).

The legislation is likely to influence purchasing behavior, as over half of adult smokers (52.4%) were using pack sizes that would become illegal, and 31.4% reported switching to cheaper brands since the legislation began.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Awareness of Standardised Tobacco Packaging among Adults and Young People during the Final Phase of Policy Implementation in Great Britain. Bogdanovica, I., Opazo Breton, M., Langley, T., et al.[2023]

Subtle changes in cigarette packaging, such as dimensions and color saturation, significantly influenced the choices of adult smokers, indicating that packaging design can affect consumer behavior.

In a separate study, factors like design and color hue were found to be key in how smokers perceived the appeal and harmfulness of cigarette packs, suggesting that regulators should pay attention to these elements in tobacco control policies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Changes to cigarette packaging influence US consumers' choices: Results of two discrete-choice experiments to inform regulation. Lee, JGL., O'Brien, KF., Blanchflower, TM., et al.[2021]

A systematic review of 10 studies found no evidence that standardized packaging of tobacco products leads to an increase in illicit tobacco use among smokers or retailers.

Most studies indicated that smokers did not intend to purchase illicit tobacco after the introduction of standardized packaging, suggesting that this policy may not negatively impact illicit trade.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Standardized packaging and illicit tobacco use: A systematic review. Haighton, C., Taylor, C., Rutter, A.[2020]

A study involving 712 British youth aged 11-17 found that larger pictorial health warnings on cigarette packages made them appear less attractive and reduced the likelihood of encouraging smoking initiation.

Standardized packaging, particularly brown versus white, also contributed to perceptions of higher health risks and less appeal, suggesting that such policies could effectively deter young people from starting to smoke.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The perceptions of UK youth of branded and standardized, 'plain' cigarette packaging. Hammond, D., White, C., Anderson, W., et al.[2016]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC9619229/

Will plain packaging of cigarettes achieve the expected? ... Evidence indicates that plain packaging decreases the attractiveness of tobacco products and enhances the effectiveness of health warnings. This ...

2. withpower.com withpower.com/trial/phase-smoking-cigarette-4-2022-fe922

Package Standardization for Smoking Prevention Research shows that plain packaging can reduce positive perceptions of smoking and discourage tobacco use, especially among youth. It also increases the ...

3. tobaccocontrol.bmj.com tobaccocontrol.bmj.com/content/31/2/263

Plain tobacco packaging: progress, challenges, learning ... The aim of this paper is to overview progress made with respect to the adoption of plain (or standardised) packaging, key challenges faced, evaluative evidence ...

4. tobaccofreekids.org tobaccofreekids.org/plainpackaging/tools-resources/policy/research-evidence

Research Evidence A national study of adult smoker quit attempts showed an increase from 20% prior to the introduction of plain packaging, compared to 26.6% 1 year after ...

5. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC11292604/

Impact of standardized tobacco packaging on smoking ... This pre-post study evaluated its impacts on smoking-related behaviors and perceptions among adults who currently smoke.

6. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC7392163/

Standardised cigarette packaging may reduce the implied ... Smokers' ratings of the standard NAS pack on the implied safety scale (mean=4.6; SD=2.9) were 1.9 times (P <0.001) higher than smokers' ratings ...

7. tobaccocontrol.bmj.com tobaccocontrol.bmj.com/content/34/5/632

interrupted time-series analysis | Tobacco Control The unadjusted analysis suggested the implementation of standardised packaging was associated with a small (3%) decrease in smoking prevalence among 16–24-year- ...

8. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC6478110/

Tobacco packaging design for reducing tobacco use - PMC Studies of other behavioural outcomes found evidence of increased avoidance behaviours when using standardised packs, reduced demand for standardised packs and ...

9. sciencedirect.com sciencedirect.com/science/article/abs/pii/S0306460321001362

Effects of pictorial warning label message framing and ... Highlights · Gain- and loss-framed pictorial warnings reduced the appeal of cigarette packs. · Plain packaging reduced appeal with and without pictorial warnings.