BMJ Open 3:e002402 doi:10.1136/bmjopen-2012-002402
  • Smoking and tobacco
    • Research

Young adult women smokers’ response to using plain cigarette packaging: a naturalistic approach

  1. Anne Marie Mackintosh
  1. Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirling, Scotland
  1. Correspondence to Dr Crawford Moodie; c.s.moodie{at}
  • Received 25 November 2012
  • Revised 21 February 2013
  • Accepted 25 February 2013
  • Published 18 March 2013


Objectives To explore young adult women smokers’ cognitive and emotional response to using dark brown ‘plain’ cigarette packs in natural settings and whether plain packaging is associated with any short-term change in smoking behaviour.

Design A naturalistic approach. Participants used plain cigarette packs provided to them for 1 week and for 1 week their own fully branded packs, but otherwise smoked and socialised as normal. Participants completed questionnaires twice a week.

Setting The six most populated cities and towns in Scotland.

Participants 301 young women smokers were recruited, with a final sample of 187 (62.1%). To meet the inclusion criteria women had to be between the ages of 18 and 35, daily cigarette smokers and provide a breath sample to confirm smoking status.

Primary and secondary outcome measures Pack perceptions and feelings, feelings about smoking, salience and perceptions of health warnings and avoidant and cessation behaviours.

Results In comparison to fully branded packaging, plain packaging was associated with more negative perceptions and feelings about the pack and about smoking (p<0.001). No significant overall differences in salience, seriousness or believability of health warnings were found between the pack types, but participants reported looking more closely at the warnings on plain packs and also thinking more about what the warnings were telling them (p<0.001). Participants reported being more likely to engage in avoidant behaviours, such as hiding or covering the pack (p<0.001), and cessation behaviours, such as foregoing cigarettes (p<0.05), smoking less around others (p<0.001), thinking about quitting (p<0.001) and reduced consumption (p<0.05), while using the plain packs. Results did not differ by dependence level or socioeconomic status.

Conclusions No research design can capture the true impacts of plain packaging prior to its introduction, but this study suggests that plain packaging may help reduce cigarette consumption and encourage cessation in the short term.


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