Should cigarette pack sizes be capped?

Anna K.M. Blackwell, Ilse Lee, Michelle Scollo, Melanie Wakefield, Marcus R. Munafò, Theresa M. Marteau

Research output: Contribution to journalArticlepeer-review

13 Citations (SciVal)


Background: Very few countries regulate maximum cigarette pack size. Larger, non-standard sizes are increasingly being introduced by the tobacco industry. Larger portion sizes increase food consumption; larger cigarette packs may similarly increase tobacco consumption. Here we consider the evidence for legislation to cap cigarette pack size to reduce tobacco-related harm. Aims and analysis: We first describe the regulations regarding minimum and maximum pack sizes in the 12 countries that have adopted plain packaging legislation and describe the range of sizes available. We then discuss evidence for two key assumptions that would support capping pack size. First, regarding the causal nature of the relationship between pack size and tobacco consumption, observational evidence suggests that people smoke fewer cigarettes when using smaller packs. Secondly, regarding the causal nature of the relationship between reducing consumption and successful cessation, reductions in number of cigarettes smoked per day are associated with increased cessation attempts and subsequent abstinence. However, more experimental evidence is needed to infer the causal nature of these associations among general populations of smokers. Conclusion: Cigarette pack size is positively associated with consumption and consumption is negatively associated with cessation. Based on limited evidence of the causal nature of these associations, we hypothesize that government regulations to cap cigarette pack sizes would positively contribute to reducing smoking prevalence.

Original languageEnglish
Pages (from-to)802-809
Number of pages8
Issue number5
Publication statusPublished - 1 May 2020

Bibliographical note

Funding Information:
This paper was prepared with funding from a Collaborative Award in Science from the Wellcome Trust (Behaviour Change by Design: 206853/Z/17/Z) awarded to T.M., P.F., G.H. and M.M. The funder was not involved in the preparation of this paper. A.K.M.B and M.R.M. are members of the United Kingdom Centre for Tobacco and Alcohol Studies, a UKCRC Public Health Research: Centre of Excellence which receives funding from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration.

Publisher Copyright:
© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction


  • choice architecture
  • Cigarette pack size
  • policy
  • portion size
  • public health
  • tobacco control

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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