PURPOSE: To examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs.
METHODS: We used a 5 (degree of plain packaging and graphic health warning)x 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings.
RESULTS: When brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers.
CONCLUSIONS: Removing as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced. [Author's abstract]