HSE Tobacco Free Ireland Programme, Health Service Executive, Dublin, Ireland.
HSE Environmental Health Service, Galway, Ireland.
Eur J Public Health. 2024 Oct 1;34(5):970-978. doi: 10.1093/eurpub/ckae128.
Smoking prevalence remains high in Europe and widening socioeconomic group differences are driving health inequalities. While plain packaging policies disrupt tobacco industry tactics that sustain smoking, evidence of their equity impact is sparse. This study evaluated the implementation of plain packaging in Ireland in 2018 on consumer responses, overall and by the socioeconomic group. Consecutive nationally representative cross-sectional surveys (2018, n = 7701 and 2019, n = 7382) measured changes in 13 consumer responses among respondents who smoked across three domains: product appeal, health warnings effectiveness, and perceived harmfulness of smoking. Multiple logistic regression-derived adjusted odds ratios with 95% confidence intervals to compare responses post- versus pre-implementation adjusting for age, gender, educational level, and heaviness of smoking. A stratified analysis examined changes by socioeconomic group indexed using educational level. There were statistically significant changes in consumer responses to plain packaging policy implementation across 7/13 outcomes studied. Five changes were aligned with expected policy impacts (2/6 product appeal outcomes and 3/4 health warning effectiveness outcomes). Two responses were also observed which were not expected policy impacts (1 appeal-related and 1 perceived harm-related outcome). There was no change in five outcomes. Differences in consumer responses between educational groups were generally small, mixed in nature, and indistinguishable when interval estimates of effect were compared. Implementation of plain packaging in Ireland had intended impacts on consumer responses. Including plain packaging requirements in revising the European Union's legislative frameworks for tobacco control will help build progress towards a Tobacco-Free Europe without exacerbating smoking inequalities.
吸烟在欧洲仍然很普遍，社会经济群体差异的扩大正在导致健康不平等。虽然普通包装政策破坏了烟草行业维持吸烟的策略，但关于其公平影响的证据很少。本研究评估了 2018 年在爱尔兰实施普通包装对消费者反应的影响，总体上和按社会经济群体进行评估。连续进行的全国代表性横断面调查（2018 年，n=7701 人；2019 年，n=7382 人）在三个领域衡量了吸烟的受访者在 13 项消费者反应方面的变化：产品吸引力、健康警示效果和吸烟的危害性感知。使用多逻辑回归分析得出调整后的优势比和 95%置信区间，以比较实施前后（根据年龄、性别、教育水平和吸烟严重程度进行调整）的反应。分层分析根据使用教育水平索引的社会经济群体检查变化。在研究的 13 项结果中有 7 项发生了与普通包装政策实施相关的消费者反应变化。有 5 项变化与预期的政策影响一致（6 项产品吸引力结果中的 2 项和 4 项健康警告效果结果中的 3 项）。还观察到了 2 项不是预期政策影响的反应（1 项与吸引力相关，1 项与感知危害相关）。有 5 项结果没有变化。教育群体之间的消费者反应差异通常较小，性质混杂，当比较效果的区间估计时，差异难以区分。爱尔兰实施普通包装对消费者反应产生了预期影响。在修订欧盟烟草控制立法框架时纳入普通包装要求将有助于朝着实现没有加剧吸烟不平等的“无烟欧洲”迈进。
