Strengthening tobacco control policy: using plain packaging to reduce product appeal and enhance public awareness.

Background: Tobacco use remains a leading cause of preventable morbidity and mortality worldwide. While smoking prevalence has recently declined in Hong Kong, progress has slowed. Plain packaging may reduce product appeal and enhance the impact of pictorial health warnings (PHWs), supporting reduced tobacco use. Methods: A cross-sectional study was conducted from August to November 2023 among 1,256 adult smokers in Hong Kong. Participants were recruited at outdoor public smoking hotspots and shown branded and plain cigarette packs with 85% PHWs. Perceptions of pack attractiveness, noticeability of PHWs, smoking-related harm, behavioural intentions, and support for plain packaging were assessed through structured interviews. Quantitative data were weighted by age and sex, and qualitative responses were analysed thematically. Results: Most participants perceived plain packs as less attractive (79.8%) and PHWs on plain packs were more noticeable (57.5%) than branded packs. About 45.1% perceived plain packs as disgusting, and 28.0% agreed they better conveyed severe smoking harms than branded packs. While only 17.3% reported plain packs may reduce their intention to smoke, 33.1% reported that it could deter youth from smoking. Support for plain packaging was moderate, with 35.7% in favour and 34.5% neutral. The qualitative findings reinforced these perceptions. Conclusion: Smokers perceived plain packaging as less attractive, the PHWs on it as more noticeable, and potentially useful in preventing smoking initiation in youth. These findings support the integration of plain packaging into Hong Kong's tobacco control strategy and offer valuable insights for jurisdictions considering similar legislation.