The impact of standardised tobacco packaging and warnings on relapse prevention: a longitudinal online survey in the UK.

Introduction: The aim of standardised tobacco packaging is to discourage uptake, encourage cessation, help people who previously smoked avoid relapse and reduce exposure to secondhand tobacco smoke. Despite the growing body of evaluative research on standardised packaging, no study has explored the impact, if any, on relapse. In the UK, standardised packaging was phased in between May 2016 and May 2017.

Methods: The Adult Tobacco Policy Survey is a longitudinal online survey with people who smoke and previously smoked in the UK, with one wave conducted pre-standardised packaging (2016) and three waves post-standardised packaging (2017, 2019, 2022). We explored whether the look of standardised packs, and the warnings on standardised packs, were considered to help prevent relapse.

Results: Across the three post-standardised packaging waves, around one-third (33.5%-35.9%) of people who previously smoked agreed that the look of packs helped them to stay quit at least a little ('a little' 14.8%-15.0%; 'somewhat' 9.8%-10.9%; 'a lot' 8.9%-10.0%), while almost a half (47.5%-49.3%) agreed that warning labels helped them stay quit at least a little ('a little' 17.0%-18.1%; 'somewhat' 13.1%-14.7%; 'a lot' 15.3%-17.6%). There were no significant changes across the post-standardised packaging waves. Women, participants below 40 years of age and those from non-white ethnic backgrounds were more likely to report that the packaging and the warnings helped them stay quit across the post-standardised packaging waves.

Conclusions: The findings provide support for a foundational, yet overlooked, role of standardised packaging, which is to help people who previously smoked to stay quit.