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

11 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


  • 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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