Skip to main content
PLOS One logoLink to PLOS One
. 2020 Aug 13;15(8):e0237513. doi: 10.1371/journal.pone.0237513

Size matters: An analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017

May C I van Schalkwyk 1,2,*, Martin McKee 2, Jasper V Been 3,4,5, Christopher Millett 1, Filippos T Filippidis 1
Editor: Stanton A Glantz6
PMCID: PMC7425903  PMID: 32790798

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. Since 2016, the European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes. We examined cigarette pack sizes in the EU and whether pack size composition differed between cheap and expensive price segments, as well as the impact of the revised TPD.

Methods

We conducted a longitudinal analysis of pricing data from 23 EU countries between 2006–2017. We examined pack sizes over time to assess the impact of the TPD, differences in pack size composition between cheap and expensive price segments, and compared gaps in median prices between products using actual and ‘expected’ prices (price if all packs contained 20 sticks).

Results

Cigarette pack sizes changed over time, across the EU. The distribution of pack sizes varied between price segments, with small pack sizes especially frequent in the cheap segment of the cigarette market, but this varied over time and across countries. Packs of <20 cigarettes almost disappeared from the data samples after implementation of the TPD.

Conclusion

Implementation of the TPD appears to have virtually eliminated packs with <20 cigarettes, restricting their use by the TI. Our analysis suggests pack sizes have been used differentially across the EU. Country-level analyses on the industry’s use of pack sizes, consumer responses, and evaluations of restricting certain pack sizes are needed to confirm our findings and strengthen policy.

Introduction

Effective action against smoking-related disease requires a detailed understanding of strategies employed by the tobacco industry (TI) to sustain smoking rates, [13] including varying pack sizes, both small (e.g. 10 cigarettes) and large (e.g. 35), to segment the market. [3] Thus, Marlboro 10s, an iconic but expensive brand when sold in larger packs, are perceived as “convenient, unique and affordable by young adults”. [4] Yet there is little independent research on consumer responses to pack size. [3,5]

High purchase price of a cigarette pack reduces tobacco consumption, especially among those with low disposable income, explaining why sticks are still sold individually in many low-income countries. [6] In the UK, between 2009 and 2015, the TI varied pack sizes, [1] with more cheap forms of manufactured and roll-your-own (RYO) cigarettes and introduction of smaller pack sizes (17–19 stick and 10g packs, respectively). [1] This ensured that cheap products would remain available despite considerable tax increases, [1] undermining the main objective of this highly effective tobacco control policy. [7,8]

More smokers, particularly the poorest, now consume cheaper forms of manufactured or RYO cigarettes. This complicates analyses based on standardised 20-stick pack prices, which may not reflect real-world price differentials. Conversely, for those able to afford a higher upfront cost, cartons of cigarettes enable a price-per-stick saving, again undermining the deterrent effect of price increases. [9] One Australian study concluded that “[V]ariation in pack size remains a powerful form of promotion”. [10]

The European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes, [11] having come into force on the 19th May 2014 and subsequently applicable in all EU countries since the 20th May 2016. However, other than a few studies in individual countries, [12] little is known about how pack sizes changed across the EU prior to harmonisation. This information is important, as the TI can be expected to seek other ways of circumventing TPD goals. These data can also inform evaluation of this policy change and provide a baseline for future research. Additionally, the European experience can inform policies elsewhere. We therefore describe (1) differences in pack size composition between cheap and expensive price segment across the EU and (2) compliance with minimum pack size following implementation of the TPD.

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. Analysts record details of multiple tobacco products, aiming to cover at least the 10 brands with the highest market share per country and year. The details of multiple products within a brand are recorded and provided by Euromonitor. For each product, pack size, packs per item, brand and company, and price in local currency, are recorded. The initial dataset contained 34,207 product observations from 23 EU countries spanning 2006–2017. Euromonitor does not routinely collect tobacco data from Croatia, Cyprus, Malta, and Luxembourg. Austria was not included in the analysis as data were only available from 2016 onwards. Data for 2007 from Belgium and 2006 from Slovakia were missing. Ethical approval was not required.

We conducted a two-staged analysis: a ‘pooled’ analysis using data from all countries to explore trends at the EU level across time, followed by an analysis with data separated by country and year, to explore trends at the country level. All analyses were assessed graphically.

Each product was assigned to one of three pack size categories, <20, 20 or >20 sticks, based on recorded pack size. Mean percentage of each pack size category per year was calculated, allowing each country to be weighted equally. Pack size composition as a percentage of the annual sample was then presented graphically.

The distributions of actual (real-world prices faced by the consumer) cigarette pack prices for each year were then arranged in ascending order and divided into quartiles. The products within the lowest and upper-most quartiles were designated as ‘cheap’ and ‘expensive’ products respectively. The percentage share of each price quartile, made up by each pack size category, was presented graphically. We then repeated the same analysis for each country included in the study.

Analyses were based on annually-recorded pack size and price data only. This approach allowed us to use the data available to analyse differences in pack sizes in cheap and expensive quartiles in each country over the study period.

We also explored the impact of using ‘expected’ (i.e. had all products contained 20-sticks) versus actual pack prices on the calculated difference in median price of cheap and expensive cigarettes. [1,2,13] First, we calculated the difference in median price of cheap and expensive quartiles based on the actual price described above. Then, we calculated the expected price (by dividing the actual price by the pack size and multiplying by 20 thereby standardising all prices to those that would be expected had all products contained 20 sticks). We then followed the same approach using this calculated expected price. That is, products in the lowest quartile were designated as ‘cheap’ and those in the upper most quartile as ‘expensive’ and measured the difference in median prices between these two quartiles. If the difference in median price is larger when using actual rather than expected pack prices, then comparisons based on expected 20-stick packs (a conventional method used in research analyses of tobacco taxation and prices) [13] will underestimate the size of the real-world price gap faced by consumers.

All prices were adjusted for inflation to a baseline year of 2015 and converted to Euros as described previously. [14]

Results

While 20-packs were the norm in most years (the mean percent ranged from 67% to 91% during the study period), the variety of cigarette pack sizes in annual samples changed over the study period at the EU level (Fig 1). Pack size composition in any given year differed between the cheap and expensive quartiles, with <20-packs comprising a greater percentage of the cheap quartile. The mean percentage of <20-packs peaked at 37% in 2012 within the cheap quartile but were then virtually eliminated (1%) across the EU market by 2017 and after the introduction of the TPD. Minimal changes were observed in the percentage of the annual samples composed of large pack sizes.

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.

Fig 1

The dashed reference bar indicates the year of introduction of the TPD.

Similar results were observed at the county level, with 20-packs being the norm in most years and countries. The pack size composition in annual samples changed over the study period, both within and between countries (S1 Fig). Furthermore, differences in pack size composition between price quartiles (based on actual price) were observed, which varied among years and countries. Nineteen of 23 countries had pack sizes of <20 cigarettes in the market during the study period. In 9 of them, the <20 pack size category was exclusively in the cheap segment. Conversely, pack sizes >20 were more likely to be in the expensive segment, where they made up a larger proportion of products. Under-20 pack sizes were not observed in four countries (France, Estonia, Lithuania, and Poland). 20-packs were sold in all countries and in all price segments at some point between 2006 and 2017. In some countries, for example, Germany, the Netherlands and the UK, the entire cheap segment comprised <20 pack sizes in multiple years, whereas in the Czech Republic <20 packs comprised at most 3% in the cheap segment. Differences were similarly observed for the dominance of large pack sizes within any given market and year. For example, larger pack sizes (>20) were the dominant pack-size category observed in the expensive quartile in most years in some of the countries.

By 2017 <20 packs had disappeared from all but 3 countries (Belgium, Bulgaria, Romania), although even there they comprised a small proportion.

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. That is, when the cheap quartile contains products with <20 sticks and the expensive quartile, products with >20 sticks, or vice versa (meaning the pack size composition differs between price segments in the market of analysis), the use of expected 20-stick pack prices (i.e. conversion of all product prices to a standard 20-stick pack price) alters the estimated magnitude of the price gap (data not shown).

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. While <20, 20 and >20 stick packs were observed in both the expensive and cheap quartiles, smaller pack sizes (<20 sticks) featured predominantly in the cheap quartile, likely representing TI tactics to ensure that upfront cost of packs remained affordable and potentially undermining the intended effects of tobacco tax increases. Implementation of the TPD appears to have dramatically reduced the presence of packs with <20 cigarettes across the EU market.

Internal industry documents show that the TI understands the nuances of using different package quantities to undermine tax increases and target certain consumer groups. [3] The introduction of legislation mandating minimum pack sizes, such as the EU TPD, can limit the use of such strategies, and potentially reduce consumption and initiation. Indeed, we found that packs with fewer than 20 sticks were virtually eliminated from the EU market after 2016. 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. Although small packs may help some smokers with higher intention to quit to ration consumption, [3,5] availability of ‘cheap’ products may hinder smoking cessation or encourage experimentation with tobacco among youth and less affluent individuals. 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 20-stick pack prices or only 20-stick products are sampled for research and monitoring purposes. [13,15,16] Similarly, Liber et al note that the use of expected 20-stick pack prices masked the ‘volume discount’ afforded to smokers of international versus domestic cigarettes in Southeast Asia. [17] Although the use of expected 20-stick pack prices supports comparative analyses across products and time, this should be complemented by gauging the extent to which this leads to under- or over-estimation of price differences between segments. By converting actual prices to those that would be expected if all packs contain 20 sticks, researchers are essentially ‘standardising-out’ the effect that the differences in pack size composition between price segments has on the real-world price gaps that consumers face. 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. [13] It also allows for the identification of tax shifting, including over-shifting (increasing product prices above and beyond the tax). Over-shifting can lead to increases in price gaps as well as industry profits which in turn may be seen as a threat to tobacco control efforts as such resources can serve to maintain the industry’s power to fight public health tobacco control measures. [18]

While Euromonitor data is intended for commercial use, its pricing and packaging data have been increasingly used in public health research. [13,19] Variation in sampling methods would be unlikely to fully explain such clear differences in pack sizes between segments, and our findings in the UK agree with previous analyses of that market. 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. [1] Small sample sizes and a single time point when data were collected in each year and country precluded us from drawing conclusions about individual markets and years, and from quantifying changes in pack and stick price within markets and price segments. 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). [20]

In conclusion, these results show the scale and nature of varying pack sizes across the EU. Our scoping study suggests that pack sizes of <20 appear to have been virtually eliminated from EU markets, strongly suggesting that the TPD policy was effective. 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.

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.

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 2008 Denmark and 2016 Romania as four distinct price quartiles could not be calculated for these annual price distributions.

(DOCX)

Data Availability

The data underlying the results presented in the study are commercially available from Euromonitor International https://www.portal.euromonitor.com/portal/magazine/homemain.

Funding Statement

JB is supported by personal fellowships from the Netherlands Lung Foundation and Erasmus MC. The Public Health Policy Evaluation Unit is grateful for support from the NIHR School of Public Health Research. Role of the Funder: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript, or the decision to submit the manuscript for publication.

References

  • 1.Hiscock R, Branston JR, McNeill A, Hitchman SC, Partos TR, Gilmore AB. Tobacco industry strategies undermine government tax policy: evidence from commercial data. Tob Control. 2018;27:488–497. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Gilmore AB, Tavakoly B, Taylor G, Reed H. Understanding tobacco industry pricing strategy and whether it undermines tobacco tax policy: the example of the UK cigarette market. Addiction. 2013;108(7):1317–1326. 10.1111/add.12159 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 3.Persoskie A, Donaldson EA, Ryant C. How tobacco companies have used package quantity for consumer targeting. Tob Control. 2019;28:365–373. [DOI] [PubMed] [Google Scholar]
  • 4.Kotnowski K, Hammond D. The impact of cigarette pack shape, size and opening: evidence from tobacco company documents. Addiction. 2013;108(9):1658–1668. 10.1111/add.12183 [DOI] [PubMed] [Google Scholar]
  • 5.Marti J, Sindelar J. Smaller Cigarette Pack as a Commitment to Smoke Less? Insights from Behavioral Economics. Roma PG, ed. PLoS One. 2015;10(9):e0137520 10.1371/journal.pone.0137520 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 6.Savell E, Gilmore AB, Sims M, et al. The environmental profile of a community’s health: a cross-sectional study on tobacco marketing in 16 countries. Bull World Heal Organ. 2015;93:851–861. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 7.Chaloupka FJ, Yurekli A, Fong GT. Tobacco taxes as a tobacco control strategy. Tob Control. 2012;21(2):172–180. 10.1136/tobaccocontrol-2011-050417 [DOI] [PubMed] [Google Scholar]
  • 8.Licht AS, Hyland AJ, O’Connor RJ, et al. How Do Price Minimizing Behaviors Impact Smoking Cessation? Findings from the International Tobacco Control (ITC) Four Country Survey. Int J Environ Res Public Health. 2011;8(5):1671–1691. 10.3390/ijerph8051671 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 9.Partos TR, Gilmore AB, Hitchman SC, Hiscock R, Branston JR, McNeill A. Availability and Use of Cheap Tobacco in the United Kingdom 2002–2014: Findings From the International Tobacco Control Project. Nicotine Tob Res. 2018;20(6):714–724. 10.1093/ntr/ntx108 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10.Scollo M, Zacher M, Coomber K, Bayly M, Wakefield M. Changes in use of types of tobacco products by pack sizes and price segments, prices paid and consumption following the introduction of plain packaging in Australia. Tob Control. 2015;24(Suppl 2):ii66–ii75. 10.1136/tobaccocontrol-2014-052071 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 11.Official Journal of the European Union. Directive 2014/40/EU of the European Parliament and of the Council of 3 April 2014. European Union.; 2014. https://ec.europa.eu/health/sites/health/files/tobacco/docs/dir_201440_en.pdf. Accessed October 13, 2018.
  • 12.Breton MO, Britton J, Huang Y, Bogdanovica I. Cigarette brand diversity and price changes during the implementation of plain packaging in the United Kingdom. Addiction. 2018;113(10):1883–1894. 10.1111/add.14282 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Filippidis FT, Laverty AA, Hone T, Been JV., Millett C. Association of Cigarette Price Differentials With Infant Mortality in 23 European Union Countries. JAMA Pediatr. 2017;171(11):1100–1106. 10.1001/jamapediatrics.2017.2536 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.van Schalkwyk MCI, McKee M, Been J V, Millett C, Filippidis FT. Analysis of tobacco industry pricing strategies in 23 European Union countries using commercial pricing data. Tob Control. 2019;28:e102–e109. 10.1136/tobaccocontrol-2018-054826 [DOI] [PubMed] [Google Scholar]
  • 15.Linegar DJ, van Walbeek C. The effect of excise tax increases on cigarette prices in South Africa. Tob Control. 2018;27(1):65–71. 10.1136/tobaccocontrol-2016-053340 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.López-Nicolás Á, Stoklosa M. Tax harmonisation and tobacco product prices in the European Union, 2004–2015. Tob Control. 2019;28:434–439. 10.1136/tobaccocontrol-2018-054342 [DOI] [PubMed] [Google Scholar]
  • 17.Liber AC, Ross H, Ratanachena S, Dorotheo EU, Foong K. Cigarette price level and variation in five Southeast Asian countries. Tob Control. 2015;24(e2):e137–141. 10.1136/tobaccocontrol-2013-051184 [DOI] [PubMed] [Google Scholar]
  • 18.Gilmore AB, Branston JR, Sweanor D. The case for OFSMOKE: how tobacco price regulation is needed to promote the health of markets, government revenue and the public. Tob Control. 2010;19(5):423–430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19.Mendez Lopez A, Loopstra R, McKee M, Stuckler D. Is trade liberalisation a vector for the spread of sugar-sweetened beverages? A cross-national longitudinal analysis of 44 low- and middle-income countries. Soc Sci Med. 2017;172:21–27. 10.1016/j.socscimed.2016.11.001 [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 20.Change Incorporated. No Deal Brexit Could Cause a Rise in Smoking. https://uk.changeincorporated.com/context/no-deal-brexit-could-mean-return-of-booze-cruise-cigs. Published 2019. Accessed October 6, 2019.

Decision Letter 0

Stanton A Glantz

27 Jan 2020

PONE-D-19-33505

Size matters: an analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017

PLOS ONE

Dear Dr van Schalkwyk,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

Please be sure to address Reviewer 1's concerns about the need to comply with PLOS ONE's data access policy.

We would appreciate receiving your revised manuscript by Mar 12 2020 11:59PM. When you are ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter.

To enhance the reproducibility of your results, we recommend that if applicable you deposit your laboratory protocols in protocols.io, where a protocol can be assigned its own identifier (DOI) such that it can be cited independently in the future. For instructions see: http://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols

Please include the following items when submitting your revised manuscript:

  • A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). This letter should be uploaded as separate file and labeled 'Response to Reviewers'.

  • A marked-up copy of your manuscript that highlights changes made to the original version. This file should be uploaded as separate file and labeled 'Revised Manuscript with Track Changes'.

  • An unmarked version of your revised paper without tracked changes. This file should be uploaded as separate file and labeled 'Manuscript'.

Please note while forming your response, if your article is accepted, you may have the opportunity to make the peer review history publicly available. The record will include editor decision letters (with reviews) and your responses to reviewer comments. If eligible, we will contact you to opt in or out.

We look forward to receiving your revised manuscript.

Kind regards,

Stanton A. Glantz

Academic Editor

PLOS ONE

Journal Requirements:

1. When submitting your revision, we need you to address these additional requirements.

Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at

http://www.journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and http://www.journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

**********

2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: No

Reviewer #2: Yes

**********

4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: No

**********

5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors present a concise study of cigarette pack size and pricing across EU countries using commercial market research data. Use of commercial data such as this gives valuable insights into both tobacco industry strategies, and by proxy, consumer purchasing preferences. The authors provide a balanced description of the strengths and limitations of this data, and how this research fits into the broader picture of research needed to understand tobacco product and pricing strategies. The aims of the study are important and my suggestions are designed to encourage the authors to make the findings of this rich data source more accessible and generalisable.

The authors have analysed a huge amount of data: 23 countries, 11 years per country (mostly), and at least 10 brands per years and country. Two important aims are identified: to describe “differential use of cigarette pack sizes by price segment across the EU” and “compliance with minimum pack size following implementation of the TPD”. The first aim mentions differential use of pack sizes. Use is an ambiguous term here: does it refer to a tobacco industry strategy, or consumer use – in which case, it would be important describe the market share coverage of the top 10 brands if possible. It is also unclear whether the Euromonitor data identifies the top 10 brands, then includes the details of all products within that brand (e.g. multiple variants and pack size combinations). Or is it 10 individual products (stock-keeping units) per country-year?

The current approach to presenting the results does not comprehensively address the aims of the study – clearly an artefact of the longitudinal data from many countries. The current graphs are quite cluttered and small, and the stacked histogram format makes it difficult to compare proportions across years and countries. It might not be necessary to present data for all years – perhaps every second or third year would suffice. It would also more clearly demonstrate the findings of the second aim if you were to annotate on the graph when the TPD was implemented. Including only the lower and upper quartiles of prices is also limiting. At present, the reader cannot examine the pack size composition of the whole market in any country or year – for how many years and countries were no packs of <20 observed prior to the TPD?. Alternatively, country-level data could be presented as supplementary tables and counties could be grouped into meaningful categories, perhaps by price or proportion of small packs.

The authors could consider whether it would be more informative to present the % of products that were in each pack size category, then the % of the cheapest and most expensive quartiles that were made up of packs of <20 and >20 cigarettes. This would also very clearly demonstrate the data necessary to assess the second aim of the study. It would also be useful to more clearly see whether there was a change in the proportion of large packs after the TPD. Did the TI maintain dispersion by introducing more large packs to the market when the lower-priced small packs were eliminated?

The supplementary graph is similarly difficult to review, and perhaps the figure title could be modified to guide the reader through this data. A more detailed explanation of these findings is needed in the results. Overall, the distribution of difference between the actual and expected prices looks quite similar, with a few notable exceptions. The graph does not allow for easy comparison of the magnitude of differences. It is also difficult to assess whether these large differences correspond to countries and years that had higher proportions of non-20 pack sizes from Figure 1.

Some additional points of clarification would be useful:

For a non-EU audience, please briefly describe how the pre- and post-2004 countries differ on factors that might relate to tobacco pricing.

Was the TPD pack size directive implemented on 1 January 2016, or was it phased in?

Page 9: Please elaborate how price differences act to undermine tobacco control efforts, beyond the poor health outcomes associated with tobacco use.

Reviewer #2: This paper confirms that standardizing pack sizes in the EU was an effective strategy to block promotion through smaller pack sizes. However the authors have tried to pack too much information into the accompanying graphs, making them unreadable.

The authors may wish to make them readable by reducing the amount of information displayed. It is suggested that date for just three years at the beginning middle and end of the study period be displayed. Rather than displaying data for all countries, the point could be made by showing data for one country from each sub-region

**********

6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

[NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files to be viewed.]

While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email us at figures@plos.org. Please note that Supporting Information files do not need this step.

PLoS One. 2020 Aug 13;15(8):e0237513. doi: 10.1371/journal.pone.0237513.r002

Author response to Decision Letter 0


28 Jun 2020

Reviewer #1: The authors present a concise study of cigarette pack size and pricing across EU countries using commercial market research data. Use of commercial data such as this gives valuable insights into both tobacco industry strategies, and by proxy, consumer purchasing preferences. The authors provide a balanced description of the strengths and limitations of this data, and how this research fits into the broader picture of research needed to understand tobacco product and pricing strategies. The aims of the study are important and my suggestions are designed to encourage the authors to make the findings of this rich data source more accessible and generalisable.

We would like to thank the reviewer for their thoughtful feedback and have attempted to address each of the specific points made.

The authors have analysed a huge amount of data: 23 countries, 11 years per country (mostly), and at least 10 brands per years and country. Two important aims are identified: to describe “differential use of cigarette pack sizes by price segment across the EU” and “compliance with minimum pack size following implementation of the TPD”. The first aim mentions differential use of pack sizes. Use is an ambiguous term here: does it refer to a tobacco industry strategy, or consumer use – in which case, it would be important describe the market share coverage of the top 10 brands if possible. It is also unclear whether the Euromonitor data identifies the top 10 brands, then includes the details of all products within that brand (e.g. multiple variants and pack size combinations). Or is it 10 individual products (stock-keeping units) per country-year?

We have removed the term ‘use’ and now refer to differences in pack size composition within price segments throughout the text, most notably where the term is first mentioned in the Abstract and the main text:

Abstract:

Introduction:

We examined cigarette pack sizes in the EU and whether pack size composition differed between cheap and expensive price segments, as well as the impact of the revised TPD.

(Page 2 lines 25-32)

Methods:

We conducted a longitudinal analysis of pricing data from 23 EU countries between 2006-2017. We examined pack sizes over time to assess the impact of the TPD, differences in pack size composition between cheap and expensive price segments, and compared gaps in median prices between products using actual and ‘expected’ prices (price if all packs contained 20 sticks).

(Page 2 lines 34-39)

Introduction:

We therefore describe (1) differences in pack size composition between cheap and expensive price segment across the EU and (2) compliance with minimum pack size following implementation of the TPD.

(Page 5, lines 100-103)

We have added the following sentence to the Methods section, elaborating on the product details that are recorded by Euromonitor:

The details of multiple products within a brand are recorded and provided by Euromonitor.

(Page 5, lines 109-110)

The current approach to presenting the results does not comprehensively address the aims of the study – clearly an artefact of the longitudinal data from many countries. The current graphs are quite cluttered and small, and the stacked histogram format makes it difficult to compare proportions across years and countries. It might not be necessary to present data for all years – perhaps every second or third year would suffice. It would also more clearly demonstrate the findings of the second aim if you were to annotate on the graph when the TPD was implemented. Including only the lower and upper quartiles of prices is also limiting. At present, the reader cannot examine the pack size composition of the whole market in any country or year – for how many years and countries were no packs of <20 observed prior to the TPD?. Alternatively, country-level data could be presented as supplementary tables and counties could be grouped into meaningful categories, perhaps by price or proportion of small packs.

The authors could consider whether it would be more informative to present the % of products that were in each pack size category, then the % of the cheapest and most expensive quartiles that were made up of packs of <20 and >20 cigarettes. This would also very clearly demonstrate the data necessary to assess the second aim of the study. It would also be useful to more clearly see whether there was a change in the proportion of large packs after the TPD. Did the TI maintain dispersion by introducing more large packs to the market when the lower-priced small packs were eliminated?.

We thank the reviewer for these very helpful suggestions. We considered both reviewers’ comments simultaneously when revising the analyses and figure, and how best to convey the main messages of the paper. As reviewer one discusses, to answer if <20 packs have been eliminated from the market it is important to look across all price segments. We have therefore undertaken additional grouped analyses at the EU level including (1) all price quartiles, and (2) separately for the cheap and expensive price quartiles to meet both aims of the study – to research the impacts of the TPD and explore for differential pack size composition between price segments.

Specifically, we conducted a two-staged analysis: a new grouped analysis (as suggested by the first reviewer) using data from all countries to explore trends at the EU level across time, followed by our original analysis with data separated by country and year, to explore trends at the country level. The results are presented graphically displaying the mean percentage of each pack size category in line with the first reviewers’ recommendations. We have also drawn attention to the trends in the large pack size category (>20 cigarettes) in the Results section (Page 7, lines 171-172).

The results of the EU level analysis are presented as Figure 1 (replacing the original Figure 1 of country-level analyses) and the original country-level analyses are now included as Supplementary Material. We have removed the original figures from the Supplementary Material (differences in price gaps when comparing cheap and expensive price segments). Based on the feedback from both the reviewers, we believe that the original Supplementary Material did not add to the overall messages of the paper. As advised by the first reviewer, Figure 1 has a reference bar in each of the graphs indicating the year the TPD was introduced.

We have kept both analyses, the new grouped analysis as well as the original country-level analysis, as we believe the results of both these analyses complement each other and provide a more comprehensive picture of the high-level trends for the reader. The country-level figures have been further edited (i.e. fewer year labels are included) to make the picture more interpretable by, and visually appealing to, the reader.

The text in the Methods and Results now reflects the inclusion of these additional analyses and changes to the content of Figure 1 and Supplementary Material.

The supplementary graph is similarly difficult to review, and perhaps the figure title could be modified to guide the reader through this data. A more detailed explanation of these findings is needed in the results. Overall, the distribution of difference between the actual and expected prices looks quite similar, with a few notable exceptions. The graph does not allow for easy comparison of the magnitude of differences. It is also difficult to assess whether these large differences correspond to countries and years that had higher proportions of non-20 pack sizes from Figure 1

We have removed the original content of the Supplementary Material. Based on both the reviewers’ comments, we feel that the figure does not strengthen the paper and is not useful to the reader. Our aim is to raise the point that differences in pack size composition between price segments, when present in the market, will affect the price gap between cheap and expensive products. If product prices are then converted into standard 20-stick pack prices, which is often done in the academic literature, the median price gap that is measured will be over or underestimated. This section of the results now reads (new text in bold):

That is, when the cheap quartile contains products with <20 sticks and the expensive quartile, products with >20 sticks, or vice versa (meaning the pack size composition differs between price segments in the market of analysis), the use of expected 20-stick pack prices (i.e. conversion of all product prices to a standard 20-stick pack price) alters the estimated magnitude of the price gap (data not shown).

(Page 8, lines 211-216)

The following sentence was deleted from the Methods section:

Finally, we present graphically the difference in median prices for actual and expected pack sizes.

(Page 6, Line 148)

Some additional points of clarification would be useful:

For a non-EU audience, please briefly describe how the pre- and post-2004 countries differ on factors that might relate to tobacco pricing.

We thank the reviewer for this comment. Although there are some contextual differences between pre- and post-2004 countries, we have decided that splitting EU member states in these two groups adds to the complexity of the text without offering much additional information to the reader. Thus, in an effort to simplify our text to clearly convey the main messages we have deleted the following sentence from the Data and Methods section:

We separated countries based on year of EU accession (pre- and post-2004), as in previous studies, given differences in economic development and regulatory environments.

(Page 5, lines 115)

We have also edited the Results section to delete references to pre- and post-2004 countries. The relevant text now reads:

Under-20 pack sizes were not observed in four countries (France, Estonia, Lithuania, and Poland).

(Page 7, lines 181-182)

For example, larger pack sizes (>20) were the dominant pack-size category observed in the expensive quartile in most years in some of the countries.

(Page 8, lines 198-199)

The figure containing the country-level analyses (new Supplementary Material) is no longer separated into pre and post-2004 countries.

Was the TPD pack size directive implemented on 1 January 2016, or was it phased in?

We have added the following to the Introduction (new text in bold):

The European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes, having come into force on the 19th May 2014 and subsequently applicable in all EU countries since the 20th May 2016.

(Pages 4-5, lines 91-96)

Page 9: Please elaborate how price differences act to undermine tobacco control efforts, beyond the poor health outcomes associated with tobacco use.

The sentence now reads (new text in bold):

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. It also allows for the identification of tax shifting, including over-shifting (increasing product prices above and beyond the tax). Over-shifting can lead to increases in price gaps as well as industry profits which in turn may be seen as a threat to tobacco control efforts as such resources can serve to maintain the industry’s power to fight public health tobacco control measures.

(Page 10, lines 267-273)

Reviewer #2: This paper confirms that standardizing pack sizes in the EU was an effective strategy to block promotion through smaller pack sizes. However the authors have tried to pack too much information into the accompanying graphs, making them unreadable.

The authors may wish to make them readable by reducing the amount of information displayed. It is suggested that date for just three years at the beginning middle and end of the study period be displayed. Rather than displaying data for all countries, the point could be made by showing data for one country from each sub-region

Many thanks for this helpful feedback. We believe that the second reviewer’s comments have been addressed through the changes made to the analyses, the inclusion of simplified graphs based on grouped data, and the edits made to the country-level graphs which are now included as Supplementary Material, as described in detail above in response to reviewer one’s comments about the analyses and presentation of the data.

Specifically, we have conducted additional analyses using grouped data from all countries included in the study to display the high-level trends in all price quartiles as well as the cheap and expensive quartiles. These results are presented graphically as the percentage of each pack size category per year (mean across all countries), with the aim of making the graphs more readable by reducing the amount of information displayed, as recommended by the second reviewer also.

However, instead of displaying data for only one country or sub-region, we present the grouped data of all EU countries and provide the country-level graphs in the Supplementary Material in a more interpretable form. By providing both analyses in this way we aim to give the reader a more comprehensive picture of the overall trends at both the EU and country level over the study period.

Attachment

Submitted filename: Response to Reviewers.docx

Decision Letter 1

Stanton A Glantz

29 Jul 2020

Size matters: an analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017

PONE-D-19-33505R1

Dear Dr. van Schalkwyk,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org.

If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Stanton A. Glantz

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

**********

2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

**********

3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

**********

5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

**********

6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors have vastly improved an already strong paper. The results are much easier to comprehend, the new analysis addresses the aims directly, and their edits throughout the text greatly improve the focus and clarity of their research.

Well done. This is an important study.

Reviewer #2: My main concern in the original review was readability of the graphic material. While the authors have improved readability differently than the way I suggested, the important thing is that readability issues have been satisfactorily addressed.

**********

7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Acceptance letter

Stanton A Glantz

4 Aug 2020

PONE-D-19-33505R1

Size matters: an analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017

Dear Dr. van Schalkwyk:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Professor Stanton A. Glantz

Academic Editor

PLOS ONE

Associated Data

    This section collects any data citations, data availability statements, or supplementary materials included in this article.

    Supplementary Materials

    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.

    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 2008 Denmark and 2016 Romania as four distinct price quartiles could not be calculated for these annual price distributions.

    (DOCX)

    Attachment

    Submitted filename: Response to Reviewers.docx

    Data Availability Statement

    The data underlying the results presented in the study are commercially available from Euromonitor International https://www.portal.euromonitor.com/portal/magazine/homemain.


    Articles from PLoS ONE are provided here courtesy of PLOS

    RESOURCES