title: Effects of first exposure to plain cigarette packaging on smoking behaviour and attitudes: a randomised controlled study.
abstract: BACKGROUND
  Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. We ran a randomised controlled trial to investigate the impact of plain packaging on smoking behaviour and attitudes.
  
  
  METHODS
  In a parallel group randomised trial design, 128 daily smokers smoked cigarettes from their usual UK brand, or a plain Australian brand that was closely matched to their usual UK brand for 24 hours. Primary outcomes were number of cigarettes smoked and volume of smoke inhaled per cigarette. Secondary outcomes were self-reported ratings of motivation to quit, cigarette taste, experience of using the pack, experience of smoking, attributes of the pack, perceptions of the health warning, changes in smoking behaviour, and views on plain packaging.
  
  
  RESULTS
  There was no evidence that pack type had an effect on either of the primary measures (ps > 0.279). However, smokers using plain cigarette packs rated the experience of using the pack more negatively (-0.52, 95% CI -0.82 to -0.22, p = 0.001), rated the pack attributes more negatively (-1.59, 95% CI -1.80 to -1.39, p < 0.001), and rated the health warning as more impactful (+0.51, 95% CI 0.24 to 0.78, p < 0.001).
  
  
  CONCLUSIONS
  Plain cigarette packs reduce ratings of the experience of using the cigarette pack, and ratings of the pack attributes, and increase the self-perceived impact of the health warning, but do not change smoking behaviour, at least in the short term.
  
  
  BACKGROUND
  Current Controlled Trials ISRCTN52982308. Registered 27 June 2013.
authors.affiliation: MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK. olivia.maynard@bristol.ac.uk.|UK Centre for Tobacco and Alcohol Studies, Bristol, UK. olivia.maynard@bristol.ac.uk.|School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom. olivia.maynard@bristol.ac.uk.
authors.forename: Olivia M
authors.initials: OM
authors.lastname: Maynard
authors.affiliation: School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom. Ute.Leonards@bristol.ac.uk.
authors.forename: Ute
authors.initials: U
authors.lastname: Leonards
authors.affiliation: MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK. Angela.Attwood@bristol.ac.uk.|UK Centre for Tobacco and Alcohol Studies, Bristol, UK. Angela.Attwood@bristol.ac.uk.|School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom. Angela.Attwood@bristol.ac.uk.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Attwood
authors.affiliation: UK Centre for Tobacco and Alcohol Studies, Bristol, UK. Linda.Bauld@stir.ac.uk.|Institute of Social Marketing, University of Stirling, Stirling, UK. Linda.Bauld@stir.ac.uk.
authors.forename: Linda
authors.initials: L
authors.lastname: Bauld
authors.affiliation: Department of Psychology, University of Exeter, Exeter, UK. L.Hogarth@exeter.ac.uk.
authors.forename: Lee
authors.initials: L
authors.lastname: Hogarth
authors.affiliation: MRC Integrative Epidemiology Unit (IEU) at the University of Bristol, Bristol, UK. Marcus.Munafo@bristol.ac.uk.|UK Centre for Tobacco and Alcohol Studies, Bristol, UK. Marcus.Munafo@bristol.ac.uk.|School of Experimental Psychology, University of Bristol, 12a Priory Road, Bristol, BS8 1TU, United Kingdom. Marcus.Munafo@bristol.ac.uk.
authors.forename: Marcus R
authors.initials: MR
authors.lastname: Munafò
mesh_terms: D000293:Adolescent; D000328:Adult; D001315:Australia; D004349:Drug Packaging; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D009042:Motivation; D010465:Perception; D019064:Product Packaging / Q000379:methods*; D012107:Research Design; D057566:Self Report; D012907:Smoking; D062789:Tobacco Products; D014029:Tobacco Use Disorder; D055815:Young Adult