Impact of standardized tobacco packaging on smoking-related behaviors and perceptions in Singapore

• Published in: Tobacco induced diseases Vol. 22; no. August; pp. 1 - 12
• Main Authors: Ng, Lionel, Tan, Chuen Seng, Lee‡, Jeong Kyu, van der Eijk‡, Yvette
• Format: Journal Article
• Language: English
• Published: Greece European Publishing on behalf of the International Society for the Prevention of Tobacco Induced Diseases (ISPTID) 01.08.2024; European Publishing
• Subjects: adult smokers; plain packaging; Research Paper; tobacco marketing; tobacco packaging; tobacco policy; tobacco policy; plain packaging; adult smokers; tobacco marketing; tobacco packaging
• ISSN: 1617-9625; 2070-7266; 1617-9625
• DOI: 10.18332/tid/189551

Singapore phased in standardized tobacco packaging on 1 July 2020 following a three-month grace period. This pre-post study evaluated its impacts on smoking-related behaviors and perceptions among adults who currently smoke. Baseline and follow-up data were collected in a pre- and post-questionnaire from a cohort of 1873 Singaporean adults who were currently smoking at baseline. Baseline data were collected from December 2019 to May 2020, and follow-up data from July 2021 to September 2021. We used descriptive statistics and bivariate analyses to assess pre-post changes (Bhapkar's test, Wilcoxon signed rank test) and to identify characteristics of participants who had quit or cut down smoking at follow-up (Pearson's chi-squared, Fisher's exact test). At follow-up, 11.7% (n=220) had quit smoking. There was a higher proportion of those smoking non-daily (pre: 13.1%, post: 16.9%; p<0.001), and those intending to quit within the next year (pre: 14.8%, post: 17.5%; p<0.05) or six months (pre: 10.4%, post: 13.2%; p<0.01). Tobacco products were scored more negatively in relation to packaging, quality, satisfaction, value for money and overall appeal (scores pre: 15.9, post: 14.3; p<0.001), harmfulness (scores pre: 0.61, post: 0.54; p<0.05), noticing others smoking the same brand (scores pre: 1.92, post: 1.65; p<0.001), and considering quitting due to health warnings (scores pre: 0.81, post: 0.86, p<0.05). Fewer reported that some cigarette brands have higher prestige (pre: 58.0, post: 54.3%; p<0.01), and more reported using flavored cigarettes (pre: 42.2%, post: 60.1%; p<0.001) and e-cigarettes (pre: 4.2%, post: 6.1%; p<0.01). In Singapore, the changes observed before and after the implementation of standardized packaging suggest that it might be associated with quit-related outcomes, reduced tobacco product appeal, and increased effectiveness of graphic health warnings.