Background:
From 20 May 2017, cigarettes in the United Kingdom must be sold in standardised (plain) packaging, however, in the UK cigarette packs are permitted to have varying shapes (e.g. bevelled-edges and slim) and opening methods (e.g. shoulder box), unlike in Australia and New Zealand where packs must only have straight-edges and a flip-top lid.

Objectives:
We explore post-implementation reactions to standardised cigarette packaging among never-smokers in Scotland, whether reactions vary in relation to permitted variations in the pack structure, and whether reactions are associated with susceptibility.

Methods:
A cross-sectional survey with never-smokers aged 12–17 years (n=507) in Scotland, was conducted November 2017 to November 2018. Participants were shown one ‘regular’ standardised cigarette pack (flip-top lid and straight-edged pack, similar to the designs in Australia) and three standardised packs with varied pack structures (bevelled-edges, slim pack, and shoulder box), which are permitted post-implementation in the UK. Participants rated each pack on 8 five-point reaction measures (e.g. attractiveness). Participants also indicated which pack, if any, they would choose. Smoking susceptibility was the outcome.

Results:
The mean reaction scores for all four packs were mostly negative, however, the shoulder box was consistently rated less negatively than the regular, slim, or bevelled-edge packs. Most participants (87%) said they would not select any of the four packs, although susceptible participants were more likely to select one than non-susceptible participants (25% vs 7%; χ2=29.70; p=0.001). For all four packs, not finding them off-putting was associated with susceptibility (adjusted odds ratio range: 2.73–3.70), albeit only a minority of adolescents did not find each pack off-putting.

Conclusions:
Adolescents have negative reactions to the standardised cigarette packs implemented in the United Kingdom, albeit permitted variations in structure can reduce the extent of negativity. Most reactions to standardised packaging had no association with susceptibility.