@article{3104217,
    title = "Evaluating the impact of introducing standardized packaging with larger health-warning labels in England: findings from adult smokers within the EUREST-PLUS ITC Europe Surveys",
    author = "Aleyan, S. and Driezen, P. and Kyriakos, C.N. and Thompson, M.E. and Balmford, J. and Demjén, T. and Fernández, E. and Mons, U. and Tountas, Y. and Janik-Koncewicz, K. and Zatoński, W. and Trofor, A.C. and Vardavas, C.I. and Fong, G.T. and Glahn, A. and Nguyen, D. and Nikitara, K. and Radu-Loghin, C. and Starchenko, P. and Tsatsakis, A. and Girvalaki, C. and Igoumenaki, C. and Papadakis, S. and Papathanasaki, A. and Tzatzarakis, M. and Vardavas, A.I. and Bécuwe, N. and Deaconu, L. and Goudet, S. and Hanley, C. and Rivière, O. and Kiss, J. and Kovacs, A.P. and Castellano, Y. and Fu, M. and Nogueira, S.O. and Tigova, O. and McNeill, A. and East, K. and Hitchman, S.C. and Kahnert, S. and Behrakis, P. and Filippidis, F.T. and Gratziou, C. and Katsaounou, P. and Peleki, T. and Petroulia, I. and Tzavara, C. and Eremia, M. and Lotrean, L. and Mihaltan, F. and Rohde, G. and Asano, T. and Cichon, C. and Far, A. and Genton, C. and Jessner, M. and Hedman, L. and Janson, C. and Lindberg, A. and Maguire, B. and Ravara, S. and Vaccaro, V. and Ward, B. and Willemsen, M. and De Vries, H. and Hummel, K. and Nagelhout, G.E. and Herbeć, A. and Przewoźniak, K. and Zatoński, M. and Agar, T.K. and Quah, A.C.K. and EUREST-PLUS Consortium",
    journal = "Central European Journal of Public Health",
    year = "2020",
    volume = "30",
    pages = "III91-III97",
    publisher = "Oxford University Press",
    issn = "1210-7778",
    doi = "10.1093/eurpub/ckaa053",
    keywords = "adult;  England;  experimental design;  Germany;  Greece;  human;  Hungary;  Poland;  review;  Romania;  smoking;  Spain;  article;  female;  major clinical study;  male",
    abstract = "Background: The European (EU) Tobacco Product Directive (TPD) was implemented in May 2016 to regulate the design and labelling of cigarettes and roll-your-own tobacco. At the same time, the UK introduced standardized packaging measures, whereas Germany, Greece, Hungary, Poland, Romania and Spain did not. This study examines the impact of introducing standardized packaging in England using a quasi-experimental design. Methods: Data from adult smokers in Waves 1 (2016; N¼9547) and 2 (2018; N¼9724) from the International Tobacco Control Policy Evaluation surveys (England) and EUREST-PLUS surveys (Germany, Greece, Hungary, Poland, Romania and Spain) were used. Generalized estimating equations were used to estimate changes in pack/brand appeal, salience of health-warning labels (HWLs) and perceived relative harm of different brands in England (where larger HWLs and standardized packaging were implemented), vs. each EU country (where only larger HWLs were implemented). Results: There was an increase in the percentage of respondents from Germany, Hungary and Poland reporting they did not like the look of the pack (4.7%, 9.6%, and 14.2%, respectively), but the largest increase was in England (41.0%). Moreover, there was a statistically significant increase in the salience of HWLs in Hungary, Poland and Romania (17.0%, 13.9%, and 15.3%, respectively), but the largest increase was in England (27.6%). Few differences were observed in cross-country comparisons of the perceived relative harm of different brands. Conclusions: Findings suggest that standardized packaging reduces pack appeal and enhances the salience of HWLs over and above the effects of larger HWLs. Findings provide additional evidence and support for incorporating standardized packaging into the EU TPD. © The Author(s) 2020. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved."
}