The short-term impact of standardised packaging on smoking and snus use in Norway.

Abstract

INTRODUCTION\nStandardised packaging on tobacco products was required in Norway July 1, 2018. We report pre-registered analyses of the potential impact on daily smoking and on daily snus use among women and men.\n\n\nMETHODS\nInterrupted time series (segmented regression) on repeated cross-sectional surveys (2012 to 2019) from two sources: probability samples (Registry Sample, N=46,957) and market research samples (Market Research Sample, N=64,465) of Norwegian adults aged 16 to 79. Self-reported daily smoking and snus use were regressed on a step change impact variable, controlled for trend and demographics (sex, age, region, and education based on national registers in the Registry Sample, and self-reported in the Market Research Sample).\n\n\nRESULTS\nThere were tendencies of a decline in smoking (Odds Ratio [OR]=0.94; 95% confidence interval [CI]=0.87, 1.02; lower-tail p-value [Plower]=0.07), and women s snus use (OR= 0.89; CI=0.77, 1.03; Plower=0.06), but not men s snus use (OR=1.01; CI=0.92, 1.11; Plower=0.59). Analyses using only the Registry Sample did not detect declines in smoking (OR=0.99; CI=0.88, 1.11; Plower=0.43) or women s snus use (OR=0.99; CI=0.80, 1.24]; Plower=0.48), and indicated no decline in men s snus use (OR=1.18; CI=1.03, 1.35; Plower=0.99). Exploratory analyses suggested potential acceleration of the declining trend in smoking (change in trends, OR=0.97) and of the increasing trend in men s snus use (OR=1.03).\n\n\nCONCLUSIONS\nThe analyses indicate that standardised packaging in Norway did not produce a decline in men s snus use. Results are inconclusive regarding smoking and women s snus use. Exploratory analyses indicated a decrease in smoking and an increase in men s snus use.\n\n\nIMPLICATIONS\n-We could not confirm or disconfirm whether standardised packaging is an effective tobacco control measure in a Norwegian context.-According to our analyses, standardized packaging may have effects on smoking prevalence and women s snus use, but is unlikely to reduce men s snus use.-The present results may reflect higher effectiveness of standardised packaging for products with stronger health warnings.-As the results varied according to samples and outcomes, the study underlines the importance of pre-registering future analyses on this topic.-Future confirmatory research should test models of gradual impact of standardised packaging.