The impact of new health warnings on standardized packaging on warning salience and effectiveness, and longer-term response to warnings on standardized packs: a longitudinal online survey in the United Kingdom

Abstract

Background: Evaluative research suggests that implementing standardised cigarette packaging with new larger pictorial health warnings is associated with increased warning salience and effectiveness. However, in countries with standardised packaging, little is known about how smokers respond to novel on-pack warnings. There is also limited research exploring longer-term response to warnings on standardised packs. Methods: The Adult Tobacco Policy Survey is a four-wave longitudinal online survey following a cohort of smokers aged 16 and older in the United Kingdom. Wave 1 was conducted pre-standardised packaging (2016) and waves 2 to 4 post-standardised packaging (2017, 2019 and 2022 respectively). A new set of warnings was introduced on standardised packs between waves 3 and 4. We explored the impact of these new warnings, and longer-term response to warnings on standardised packs. Results: There were no statistically significant differences on any warning measure between waves 3 and 4. However, noticing warnings on packs, reading or looking closely at them, thinking about them, thinking about the risks, most avoidant behaviours (covering warnings, putting the pack away, using a cigarette case/alternative container), and forgoing cigarettes, were significantly higher at wave 4 than at wave 1. Conclusions: The findings suggest that in markets with standardised packaging, changing the warnings, while using similar messaging and retaining the same warning size and layout, may help reduce wearout but may be insufficient to significantly increase how noticeable and effective they are. The findings provide support for the long-term benefits of simultaneously introducing standardised packaging with new, larger warnings.