An adaptive design allowed the early termination of a study that would have been underpowered to detect an effect. The limitations identified in this study can inform a more efficient RCT. Given the potential impact of increasing pack sizes on tobacco consumption, and the value of a policy to cap cigarette pack sizes to contribute to reducing global smoking prevalence, further research is urgently required to address the dearth of experimental evidence in this area. In this dataset, dashes written by participants on their labels had been erroneously entered as missing data.
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Jones B, Kenward MG. Design and analysis of cross-over trials, 3rd ed: CRC Press; Download references. The authors would like to thank the staff at Roy Morgan Research Ltd. For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Ilse Lee, Mark A. Pilling, Gareth J. Anna K. You can also search for this author in PubMed Google Scholar. M and M. P contributed to the conception and design of the study protocol. B and T. M managed the day-to-day running of the study. M and K. D-L conducted data analysis and all authors helped with data interpretation. This manuscript was written by I. L and A. B with input from all co-authors. All authors read and approved the final version of the manuscript.
Correspondence to Theresa M. Written informed consent was obtained from all participants. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The pilot study had aimed to recruit up to 70 participants in order to estimate the likely standard deviation SD of the primary outcome, and the retention rate among those recruited.
Owing to a concern that the pool of potential participants within the research agencies panel for the main RCT would be diminished by this external pilot, a decision was made to terminate the pilot study after 17 participants had been randomised and full outcome data had been obtained from 14 participants.
We used these data to estimate the within-arm SD. This involves an interim stage of analysis to allow for a more accurate estimation of the SD as a basis for assessing whether the expected effect size can be feasibly demonstrated A note on protocol V3. Use a brand that is stocked in a pack size of 20 by at least one of the two major Australian supermarkets in the month before recruitment. Willing to post weekly envelopes — on four consecutive weeks - containing all empty packs of cigarettes smoked in the preceding week with completed forms.
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Reprints and Permissions. Lee, I. Cigarette pack size and consumption: an adaptive randomised controlled trial. BMC Public Health 21, Download citation. Received : 30 October Accepted : 29 June Published : 18 July Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF.
When the composition of pack size categories differed between cheap and expensive quartiles, the estimated median prices and, in turn the estimated price gaps between quartiles, differed depending on whether actual or expected prices were used. Consistent with prior research in the UK, [ 1 , 2 ] we observed that cigarette pack sizes sold in 23 EU countries varied between markets, price quartiles, and over time. Internal industry documents show that the TI understands the nuances of using different package quantities to undermine tax increases and target certain consumer groups.
Indeed, we found that packs with fewer than 20 sticks were virtually eliminated from the EU market after Our findings may therefore help to inform policies in the many countries lacking such legislation. Our research might also contribute to the understanding of the role of smaller pack sizes. Importantly, however, the impact of banning or mandating certain pack sizes remains poorly researched, and further research is needed to confirm our findings.
Differences in upfront prices between packs of expensive and cheap cigarettes are likely to be underestimated when prices are converted to expected stick pack prices or only stick products are sampled for research and monitoring purposes.
Accurate assessment is important as large price differences undermine tobacco control efforts by negatively influencing quit attempts and smoking initiation, and have been associated with poor health outcomes. While Euromonitor data is intended for commercial use, its pricing and packaging data have been increasingly used in public health research. However, we cannot be certain if samples are fully representative of national markets.
It is also beyond the scope of this study to assess the impact of pack size and affordability on consumer behaviour. The use of commercial pricing rather than sales data, meant we were unable to explore price gaps using the weighted average price a measure based on sales volume or industry-defined price segments, as in previous studies. We can therefore only make high-level conclusions about general observations seen across the EU and over time.
It is therefore imperative that the current study be viewed as providing a preliminary analysis across the EU region as a whole, exposing strategies potentially adopted by the TI in need of further investigation. Comprehensive country-specific studies using sales and price-promotions data are needed to further evaluate and understand: 1 pack size use by the TI as a pricing and targeting strategy, 2 its relation to consumer behaviour, and 3 the impact of regulating pack sizes.
This information is needed to critique information on the impact of pack sizes disseminated by TI-funded bodies such as Change Incorporated funded by Philip Morris International. In conclusion, these results show the scale and nature of varying pack sizes across the EU. Pack sizes varied differentially between cheap and expensive price quartiles and between countries and years. This study provides further impetus for a greater focus on tobacco product pack size.
Specifically, there is a need for a thorough evaluation of industry strategies, consumer responses to pack sizes, and the impact of regulating the use of small pack sizes on smoking rates and consumption both within and beyond Europe, particularly in those countries where the sale of single cigarettes and small pack sizes remains common.
Pricing data was not available for every year in all countries see methods for details. An expensive quartile of the market was not available for Denmark and Romania as four distinct price quartiles could not be calculated for these annual price distributions. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Introduction The tobacco industry TI has used small cigarette pack sizes to encourage brand-switching and consumption, and to mitigate the impacts of tobacco tax increases.
Methods We conducted a longitudinal analysis of pricing data from 23 EU countries between — Results Cigarette pack sizes changed over time, across the EU. Introduction Effective action against smoking-related disease requires a detailed understanding of strategies employed by the tobacco industry TI to sustain smoking rates, [ 1 — 3 ] including varying pack sizes, both small e.
Data and methods We purchased commercial data from Euromonitor International, a private market research company reporting annual product and country-specific information, including on tobacco products sold in EU countries.
Download: PPT. Fig 1. Pack size category as a percentage of the annual sample over time a pack size composition across all price quartiles b pack size composition of the cheap quartile c pack size composition of the expensive quartile.
Discussion and conclusions Consistent with prior research in the UK, [ 1 , 2 ] we observed that cigarette pack sizes sold in 23 EU countries varied between markets, price quartiles, and over time. Supporting information. S1 Fig. Pack size category as a percentage of cheap left-hand graphs and expensive right-hand graphs quartiles based on actual pack prices per country-year.
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