CONFERENCE PROCEEDING
Awareness of changes to tobacco product content and packaging design after implementation of the EU Tobacco Products Directive among smokers: Findings from the EUREST-PLUS ITC Europe Surveys
Christina N. Kyriakos 1, 2  
,  
Pete Driezen 3
,  
Sarah Kahnert 5
,  
Sara C. Hitchman 6, 7
,  
Esteve Fernandez 8, 9, 10
,  
Ute Mons 5
,  
Tibor Demjén 13
,  
Yannis Tountas 14
,  
Witold A. Zatoński 15, 17
,  
Geoffrey T. Fong 3, 18
,  
 
 
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1
University of Crete, Heraklion, Greece
2
European Network for Smoking and Tobacco Prevention (ENSP), Brussels, Belgium
3
Department of Psychology, University of Waterloo (UW), Waterloo, Canada
4
Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
5
Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
6
UK Centre for Tobacco and Alcohol Studies, King’s College London (KCL), London, United Kingdom
7
National Addiction Centre, King’s College London, London, United Kingdom
8
Catalan Institute of Oncology (ICO), Spain
9
Biomedical Research Institute (IDIBELL), Spain
10
Universitat de Barcelona (UB), Spain
11
University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
12
Aer Pur Romania (APR), Bucharest, Romania
13
Smoking or Health Hungarian Foundation (SHHF), Budapest, Hungary
14
National and Kapodistrian University of Athens (UoA), Athens, Greece
15
Health Promotion Foundation (HPF), Warsaw, Poland
16
Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
17
European Observatory of Health Inequalities, President Stanisław Wojciechowski State University of Applied Sciences, Kalisz, Poland
18
Ontario Institute for Cancer Research, Toronto, Canada
19
Laboratory of Toxicology, Medical School, University of Crete, Heraklion, Greece
Publish date: 2019-03-26
 
Tob. Prev. Cessation 2019;5(Supplement):A94
KEYWORDS
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ABSTRACT
Introduction:
The European Union (EU) Tobacco Product Directive (TPD), which went into effect in 2016, regulates tobacco product content and packaging design, aimed at decreasing misperceptions around reduced harmfulness and addiction potential. The aim of the current study was to examine the extent to which smokers noticed TPD-related changes to tobacco product design and correlates associated with noticing these changes.

Methods:
Data came from Wave 2 of the ITC 6 European Country Survey as part of the EUREST-PLUS project, among a nationally representative sample of adult smokers from six EU countries in 2018 (n=6037). Bivariate and logistic regression analyses of weighted data were conducted using SAS-callable SUDAAN.

Results:
56.3% of smokers noticed any TPD-related design change to cigarettes or roll-your-own tobacco. Over one-quarter of smokers noticed changes to health warnings (30.0%), standardized opening (27.7%), minimum unit size (27.9%), and the removal of tar, nicotine, and carbon monoxide (TNCO) information (26.7%) on packaging. Fewer smokers noticed packages no longer resembling food/cosmetic products (18.7%) and the removal of characterising flavours (12.8%). Noticing any change was significantly associated with older age (compared to ages 18-24), higher education, higher income, being a daily smoker, and usually smoking a menthol or other flavoured tobacco product. Awareness of changes varied significantly across countries for all measures. Compared to Spanish smokers, Greek smokers had 14.8 greater odds of noticing the removal of TNCO information (28.8% vs 4.9%, OR=14.8, p<0.001). Romanian smokers had greater odds of noticing packages no longer resembling food/cosmetic products (28.8%) as compared to respondents from Spain (4.1%, OR=10.71, p<0.001). Noticing the removal of characterising flavours was more likely among respondents from Hungary (17.2%, OR=5.25), Romania (18.1%, OR=4.66), and Poland (16.1%, OR=4.08) as compared to smokers from Spain (4.2%, p<0.001).

Conclusions:
Findings indicate that TPD regulatory changes to tobacco product content and packaging design are being noticed by over half of smokers, but this varied across countries and populations.

FUNDING
European Union’s Horizon 2020 research and innovation programme under grant agreement No 681109 (C. I. V.).
eISSN:2459-3087