Tag Archives: plain packaging

The policy termites slowly eating out the foundations of smoking

The Conversation

File 20170712 9330 1byrb4h
Like a mound of termites, tobacco control policies are eating away at smoking in ways we’re not always conscious of. from www.shutterstock.com

Simon Chapman, University of Sydney

Across 40 years of working in tobacco control, there have been countless times when I’ve been asked “so, has [insert here] policy or [insert here] campaign worked?”.

The question has its roots in clinical interventions where we see what happens when you take an analgesic for pain, get an injection before having a tooth pulled, or apply a fungicide on athlete’s foot. These things work.

So it’s natural we should ask the same about a piece of legislation or a multi-million dollar TV campaign about smoking. Do these things make a difference?

In 1993 I wrote an essay on this issue in the British Medical Journal, Unravelling gossamer with boxing gloves: problems in explaining the decline in smoking.

In the wake of Philip Morris being ordered to pay the Australian government about A$50million in legal costs over the company’s failed attempt to thwart plain packaging, I was asked the question again this week: “Has plain packaging worked?”

So here’s an update on the direct and subtly synergistic ways tobacco control has seen Australia achieve record lows in both adult and teenage smoking.

From a trickle to a deluge

Since the bad news on smoking and health began to trickle in from 1950, then deluged us, hundreds of millions of smokers have stopped smoking around the world, particularly in nations where governments have introduced population-focussed laws and regulations. These include measures like laws, taxes and mass campaigns that reach huge proportions of the population as opposed to dinky little interventions very few people ever see or are exposed to.

When a smoker decides to quit, they will have usually tried before – many with about the same conviction as attempts to exercise more or lose weight. But when they finally succeed, ex-smokers will often nominate a reason “why” they quit.

There is broad daylight between the first reason ex-smokers give about why they quit and all other reasons they nominate. Health concerns are the overwhelming reason for quitting (91.7%), followed by cost (way back at 58.7%); 90% of smokers regret they ever started.

The straw the broke the camel’s back

People also often nominate a recent “straw that broke the camel’s back” as the precipitating reason for the final decision to quit and resolve to see it through.

This can be a symptom they have experienced, an incident like the sudden death of a smoking friend, a particularly poignant campaign advertisement they can’t get out of their head (this classic has few peers), the heartfelt pleading by a child or partner, the sudden realisation very few of their colleagues or friends smoke or the price of cigarettes going through a psychological barrier, like A$40 a pack.

These triggers are known as proximal factors that stimulate quitting: factors easily identified, nominated by smokers aware of their influence, and sometimes easy to quantify with proxy measures like immediate boosts in calls to quitlines.

Background factors that eat away at smoking

But there are also vital distal or background factors that work like hidden termites in a building. These slowly and subconsciously eat away the foundations of smokers’ feelings of being invincible to disease, their apathy and act to denormalise pro-smoking environments. The effect is that smokers get fewer reminders about smoking and a growing awareness smoking is not something the great majority of people do anymore.

Examples of these distal factors are advertising bans, graphic warnings on packs, plain packaging, smoke-free public spaces and tobacco taxation.

Very few smokers tell you they quit smoking because tobacco advertising was banned. The impact of advertising bans instead works in slow-burn fashion, as it has done in Australia since 1993 when the last forms of advertising ended.

With plain packs, some smokers experienced an increased urgency to quit after exposure to the purposefully unappealing plain packs with their goullish (but deadly accurate) large graphic health warnings. But the primary goal was to have whole generations grow up never having being beguiled by the designer edginess of pack livery and noting plain packaging of tobacco products was exceptional among all other consumer goods.

Tobacco is the only product where legislation mandates plain packaging: 17 nations have either implemented, legislated it or announced they will. Tobacco is also the only product that has to be stored out of sight in retail outlets.

All these factors do not act in isolation, but like a constant and unstoppable termite colony, working in synergy to erode the appeal of smoking.

A day in the life of an ex-smoker

In my 1993 BMJ essay, I described a day in the life of a smoker who quit. The smoker woke to news on the radio of yet more bad research news about smoking; lived with disapproving family members who often urged him to quit because they had been educated about the risks; winced every time at the price he had to pay for a pack; was acutely aware of all the places he couldn’t smoke and why those laws had been introduced; was self-conscious about the stench of stale tobacco he carried about; and couldn’t shake some of the powerful anti-smoking advertising that intruded his TV viewing.

A smoker might well nominate just one of these influences when a researcher calls, but all play a part in a comprehensive approach to reducing the world’s leading cause of death, if you exclude poverty.

Humans are not like lab rats who can be artificially kept in strictly controlled environments and exposed to single or fixed combinations of policy variables while isolated from all others so researchers can measure the exact impact of any one factor.

The ConversationPeople whose questions are based on that premise need to be gently reminded of that. Male lung cancer incidence rates today were last seen in the early 1960s and women’s seem likely to never reach even half the peak seen at the height of the male epidemic. We need to stay the course and make smoking history.

Simon Chapman, Emeritus Professor in Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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It’s time to focus on an endgame for tobacco regulation

The Conversation

Kathryn Barnsley, University of Tasmania

New comprehensive research shows smoking imposes a heavy economic burden throughout the world, gobbling up almost 6% of global health spend and nearly 2% of the world’s GDP. In 2012 this amounted to US$1,436 billion (A$1,898 billion).

This is particularly evident in high income jurisdictions, like Australia, North America and Europe. Each year, smoking kills an estimated 15,000 Australians, and costs Australia A$31.5 billion in social (including health) and economic costs.

New initiatives in tobacco control are urgently needed. Plain packaging has been a success, but required steely determination by ministers to ensure continuity.

Smoking rates are declining in Australia, although the rate appears to be slowing. And there are still worryingly high rates of smoking in some populations and jurisdictions, such as the Northern Territory. In 2009 Australian researchers predicted smoking cessation rates would need to double to ensure Australian smoking prevalence dropped to the policy target of 10% by 2020.

Over a decade ago leading tobacco control expert Derek Yach, a Yale Professor and former senior World Health Organisation (WHO) executive, warned against complacency in tobacco control, and urged greater action. In 2016 Ruth Malone (former editor of the journal Tobacco Control) was still emphasising the point, highlighting current measures will not achieve an end to the tobacco pandemic. She asked,

Will caution and inertia shape another century of public health catastrophe?

Anti-science ideology

We are currently experiencing a crisis of public confidence in expertise, knowledge and evidence. The new US Vice President Mike Pence once famously wrote that “smoking doesn’t kill”.

New ways of thinking emphasise individual responsibility and de-emphasise population measures that regulate corporations. This is also having an impact on our health, and has led University of Melbourne’s Rob Moodie to call for change, saying:

The only evidence-based mechanisms that can prevent harm caused by unhealthy commodity industries are public regulation and market intervention.

Related to these global sentiments, the cigarette industry has some strategies in play. Big tobacco presents public arguments to counter reform, using terms that soften the need for regulation such as “nanny state” and “free choice”, and more recently “unintended consequences” and “sensible regulation”.

The tobacco industry is also actively evolving, for example through taking over e-cigarette production and sales.

Reform through endgame strategies and charismatic ideas

The tobacco endgame concept moves thinking away from the mere control of tobacco towards plans for ending the tobacco pandemic, and foresees a tobacco-free future. The unifying term “endgame” includes those policy approaches which orient researchers and decision-makers toward this goal.

WHO Director-General Margaret Chan championed endgame strategies in 2013 and urged a focus on precision, impeccable science, feasibility and realism.

Innovative strategies and “charismatic” ideas have also been proposed to counter an innovative tobacco industry. These ideas are canvassed below.

Reduction in retail outlets

In New Zealand, modelling undertaken at the University of Otago predicted reduction in retail outlets would modestly contribute to an endgame goal.

Others have suggested an increase in distance from home to the nearest tobacco retailer, or lowering density of outlets could assist quit rates.

Simply reducing access to cigarette retail outlets could lower smoking rates. thomashawk/flickr, CC BY-NC-SA

A tobacco-free generation

This idea was first proposed in Singapore, and followed up in Tasmania. It’s a supply-side measure that would, from January 2018, prohibit the sale of tobacco products to any person born after the year 2000.

It has drawn criticism from the tobacco industry, but has 75% community support, and even 72% among smokers.

More broadly, Australian smokers do want the government to regulate the industry more heavily, as they believe the tobacco industry is partly responsible for the predicament they find themselves in.

Regulation of markets and cigarette engineering

The regulated market model proposes the tobacco market be controlled by one agency, which tenders to manufacturers for tobacco products and then distributes to retailers. This would, in effect, make tobacco a controlled substance, like methadone.

Reducing palatability of tobacco products, and the banning of filter ventilation and other elements of cigarette engineering have been proposed in Australia for some years. The idea of reducing addictiveness by lowering nicotine content is attractive, particularly as it would assist existing as well as beginner smokers.

The federal government contracted two consultants to provide reports on cigarette palatability and engineering in 2013. Late on Friday 27 January 2017 the heavily redacted documents were released under FOI. However, it is possible to see the extent of comprehensive research that has been undertaken.

One document includes the disclaimer:

No regulatory decisions have been made by the Department of Health or the Australian Government about potential new tobacco product content regulation controls or revised disclosure requirements for tobacco products.

There is no independent regulatory oversight or quality control on the content of cigarettes themselves, and no recall provisions.

The ‘sinking lid’ – an idea from New Zealand

Another supply-side reduction proposal is to require regular reductions in the amount of cigarettes made available for sale and to increase prices. This is the “sinking lid” idea. Strong border controls and geographical isolation are prerequisites in order to reduce the potential for smuggling. Therefore island nations and states are ideal places to experiment with this proposal. Considerable support exists for this approach.

Together, these endgame proposals to lower tobacco use should be actively explored and implemented as appropriate by governments around Australia. The economic and social costs of tobacco smoking remain enormous, and it’s time to take action.

The ConversationKathryn Barnsley, Adjunct researcher, University of Tasmania

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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How the tobacco industry is gaming Australian health regulations

The Conversation

Steven Greenland, Swinburne University of Technology

Australia’s tough tobacco regulations are acting as a catalyst for the industry to develop sophisticated marketing practices. These companies are gaming the system by anticipating regulatory impact and then using unregulated marketing elements to overcome it.

Australia has been a guiding light for countries looking to improve public health through the effective regulation of tobacco, which remains the world’s biggest cause of preventable illness and death, and still kills around 15,000 Australians annually.

December 2012 saw the implementation of Australia’s innovative plain packaging legislation, this was followed by four 12.5% annual tobacco tax excise increases. As a result the number of Australian smokers has fallen to a record low.

However the tobacco industry has used several strategies, including price reduction, brand differentiation and promoting the idea of healthier cigarettes, to undermine Australia’s new regulatory environment.

Plain packaging was introduced in 2012 to much fanfare, but tobacco companies are making serious efforts to alleviate the effects of plain packaging on their bottom line.
Lukas Coch/AAP

Pricing for packets

To offset price hikes manufacturers have expanded lower priced product ranges, with new ultra low priced brands. One example of this is the British American Tobacco Australia’s (BATA) Just Smokes, which sells for around 70% of the premium brand prices. BATA has also shifted Rothmans, previously a premium brand, into the economy segment by cutting its price by more than 30%.

Another pricing initiative is twin pack promotion. Most consumers recognise that progressively larger packs offer progressively lower unit prices – a lower cost per single item or single pack.

This used to be true for tobacco, with the largest cartons (usually with 200 cigarettes) offering best value. However, since 2012 discounted twin packs represent best value.

A supermarket twin pack, per cigarette price, is up to 10% cheaper than single packs – effectively discouraging single pack purchases. Australia’s leading brand Winfield twin pack, per cigarette price, is equal to or below that of larger cartons.

Regulatory price increases are financial deterrents to smoking. The low price branding and discounting strategies in Australia are clear attempts to get around these, and reduce smokers’ financial motivation to quit or cut down.

Heavily discounted twin packs also teach smokers, through financial reward and penalty, to buy twin rather than single packs. This is of particular concern since research shows that larger purchases trigger higher consumption.

In 2014 the industry claimed tobacco consumption had actually increased after plain packaging. While this was disproved, it suggests big tobacco anticipated increased consumption as smokers switched to twin pack purchase behaviour.

New tobacco products and promotions

Plain packaging was expected to restrict tobacco brands. However, after 2012 manufacturers introduced numerous new products, and brand ranges actually expanded.

For example, Australia’s leading brand Winfield supported more than 20 brand variants in 2015-2016 compared to just 12 in 2012-2013. Brand differentiation is a proven marketing approach for generating greater sales, with each variant targeting a specific consumer market segment.

Since plain packaging was introduced, tobacco companies have varied the names of brands as well. Names have evolved to include the information previously covered by packaging, such as colour and new product features. For example, Dunhill Infinite is now Dunhill Infinite White + Taste Flow Filter.

Today around 80% of Australia’s leading brands’ variant names include a colour, compared to less than half before plain packaging. Tobacco companies are also using colours to mislead consumers that certain product ranges are “healthier” options.

A universal colour code has been promoted by the industry in which smokers interpret lighter colours (white, silver, gold, yellow and blue) as being less harmful, and darker colours (red and black) as more harmful. Before plain packaging colour hues were a pack design component, now the myth of healthier tobacco options is perpetuated by colour names. This is disturbing from a public health perspective as it represents industry efforts to lessen smokers’ health motivations for quitting.

The effects of clever marketing

Australia’s tobacco regulations have significantly reduced smoking. However, their impact would be greater without unscrupulous industry initiatives to overcome and thwart them.

Industry response to plain packaging and excise increases have not been simple marketing efforts to increase sales, but illustrate cynical attempts to reduce financial and health motivations for quitting, and to encourage smokers to smoke more. Australian regulators, and those in other countries, should therefore consider further regulation.

Research suggests that future effective controls might include:

  • Introducing a standard fixed per stick price for all cigarettes – preventing differentiation by price and cheaper brand options
  • Prohibiting price variation by pack size – preventing volume discounting or twin pack promotion that encourage smokers to make larger purchases and smoke more
  • Restricting pack size to a maximum of 10 or 20 cigarettes to limit increased consumption associated with larger pack sizes
  • Banning colour variant names – removing colour-health connotations
  • Restricting brand variant ranges, for example to one variant or representation per brand, to limit the way tobacco companies use differentiation to increase sales.

The tobacco industry is committed to gaming regulations, like plain packaging and tax excise increases, and developing approaches to undermine their impact. However, the Australian government is equally committed to reducing the national adult daily smoking rate to 10% by 2018. The additional tobacco controls outlined above should help the government achieve this.

The ConversationSteven Greenland, Associate professor, Swinburne University of Technology

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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The slow-burn, devastating impact of tobacco plain packs

The Conversation

Simon Chapman, University of Sydney

It is three years since Australia fully implemented its historic tobacco plain packaging law. From December 1, 2012, all tobacco products have been required to be sold in the mandated standardised packs, which, with their large disturbing graphic health warnings, are anything but “plain”.

Ever since, there have been frenzied efforts by the tobacco industry and its ideological baggage carriers to discredit the policy as a failure.

The obvious subtext of this effort has been to megaphone a message to other governments that they should not contemplate introducing plain packaging because it has “failed”: smoking, it is claimed, has not fallen any faster in Australia after plain packaging that it was already falling before. All that has occurred, they argue, is that illicit trade has increased.

The supreme irony here is of course that if such criticism was correct, then to paraphrase Hamlet’s mother Gertrude, “The tobacco industry doth protest too much, methinks.” Why would the industry and its astro-turfed bloggers waste so much money and effort denigrating a policy which was having little or no impact?

Why take the Australian government to the High Court (and fail six to one) to try and block the law? Why invest in supporting minnow tobacco-growing states such as the Dominican Republic, Honduras and Cuba in their efforts to have the World Trade Organization rule against plain packaging?

Why not just ignore an ineffective policy instead of making it only too obvious to all by such actions that it is in fact a grave threat to your industry?

Two key assumptions have underscored efforts to discredit the impact of plain packaging. First, critics assume the impacts of the law should have been evident immediately as it was implemented: as one colleague put it recently “within ten seconds of the law passing”.

Second, they assume (but never actually state) that the impact of plain packaging on smoking by children (the principal target) and adults was supposedly going to be greater than anything we have previously observed in the entire history of tobacco control.

In 1999, the late Tony McMichael, professor of epidemiology at the Australian National University, published a classic paper called Prisoners of the Proximate where he wrote about the need to understand the determinants of population health in terms that extend beyond proximate single risk factors and influences.

In tobacco control, both proximal (discrete, recent and quick-acting) and distal (on-going, slow-burn) effects of policies and campaigns can occur.
Price rises (and falls through discounting) can have both immediate and lasting effects, jolting smokers into sometimes unplanned quitting and also slowly percolating an unease about the costs of smoking that translate into quitting down the track.

Tobacco advertising bans are a good example of a policy that has such slow-burn effects across many years. Few if any quit smoking in direct response to tobacco advertising bans. They work instead by causing the next generations of kids to grow up in an environment devoid of massive promotional campaigns depicting smoking in positive ways.

I have often heard smokers say “plain packaging won’t make me quit smoking”. This is akin to the myopic self-awareness of those who swear “advertising (for any product) never influences me” while noting that it only influences the more impressionable.

Plain packs were unlikely to act suddenly in the way tax rises do, although the unavoidably huge graphic health warnings may well have acted like straws that broke the Camel’s back of worry about smoking. Their impact was far more likely to be of the slow-burn sort, where the constant reminder that tobacco, unique among all products, is the only consumer good treated this way by the law. It is exceptionally dangerous, with a recent estimate that two in every three long-term smokers will die from tobacco use.

In 1994 I wrote a now highly cited paper in the British Medical Journal which talked about the impossibility of “unravelling gossamer with boxing gloves” when it came to being certain about precisely why smokers quit. I took a day in the life of a smoker who quit, and pointed to the myriad of influences both distal and proximal that coalesce to finally stimulate a smoker to quit.

While a smoker might nominate a particular policy, conversation with a doctor or anti-smoking campaign as being “the reason” they quit, much of what went on before provides the broad shoulders of concern that carry the final attribution. There are synergies between all these factors and the demand to separate them all is like the demand to unscramble an omelette.

So what has happened to smoking in Australia since plain packs?

Data released this month from a national schools survey involving more than 23,000 high school children found smoking rates were the lowest ever recorded since the studies first commenced in 1984 (see graph). This momentum is starving the tobacco industry of new smokers, which is one important reason why all tobacco companies are now busily acquiring e-cigarette brands.

Proportion of 12- to 15-year-olds who smoke, 1984 to 2014

Trends in proportion of current (smoked in past seven days) and committed smokers (smoked on three or more of the past seven days) among 12 to 15-year old students, Australia, 1984-2014. National Drug Strategy report 2014.

With adults, National Accounts data just released show that for the 11 quarter-year periods since March 2013, consumption of tobacco products in aggregate fell an unprecedented 20.8%, while the previous 11 quarters it fell 15.7% and in the 11 before that, only 2.2%.

The latest available data on adult smoking prevalence we have is from 2013 and shows just 12.8% of Australians over 14 smoked on a daily basis. This is the lowest on record and again, the biggest percentage falls experienced since the surveys commenced (see graph).

Reductions in daily smoking among Australians aged over 14, 1991 to 2013

AIHW National Drug Strategy Household Survey 2013: preliminary findings. 2014 Author-sourced.

Meanwhile, the tobacco industry plods along funding heavily lambasted studies which purport to show none of this is happening.

The argument that plain packaging would cause illicit trade to boom was made with monotonous regularity by Big Tobacco between April 2010 when plain packaging was announced and its December 2012 implementation. When the industry lost its case in the High Court, the argument was quietly dropped.

Today, the industry explains illicit trade entirely by the heinous government tobacco tax rises cloaked in a sanctimonious rhetoric of speaking up for poor smokers and corporate citizen concern about tax avoidance bleeding Treasury. In all this it fails to mention that it has long used tax rises as air cover to quietly raise its own profit margins.

As I wrote recently in The Conversation:

From August 2011 to February 2013, while excise duty rose 24¢ for a pack of 25, the tobacco companies’ portion of the cigarette price (which excludes excise and GST), jumped A$1.75 to A$7.10. While excise had risen 2.8% over the period, the average net price had risen 27%. Philip Morris’ budget brand Choice 25s rose A$1.80 in this period, with only 41¢ of this being from excise and GST.

Ireland, the United Kingdom and France have already passed laws to introduce plain packs. Norway and Canada will soon, and New Zealand, Chile, Turkey, South Africa and Brazil have also made high-level noises about joining in too. The world has a lot to thank Rudd and Gillard governments (and particularly Health Minister Nicola Roxon) for taking this initiative, and the subsequent Coalition government for continuing to support it strongly as it continues to come under attack from those it has and will continue to hurt.

The ConversationSimon Chapman, Professor of Public Health, University of Sydney

This article was originally published on The Conversation. (Reblogged by permission). Read the original article.

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Cluster bomb of new research explodes tobacco industry lies about plain packs

The Conversation

Simon Chapman, University of Sydney

There is near-universal agreement that Australia’s implementation of tobacco plain packaging in December 2012 has seen the most virulent opposition ever experienced from the global tobacco industry.

While the industry bravely insisted early in its campaigning that plain packs “would not work” their legal actions, campaign expenditure, lobbying and general apoplexy rather suggests they feared it would be a devastating policy, with long term global ramifications.

Indeed, eleven other nations (Ireland, England, New Zealand, France, Norway, Finland, Chile, Brazil, India, South Africa, Turkey) have either legislated plain packaging or are now warming up to do so.

University of Sydney researcher Becky Freeman and I catalogued the full range of industry lies in our recently released (free) book Removing the Emperor’s Clothes. The Cancer Council Victoria has also published extremely detailed rebuttals to the major industry scuttlebutt.

Now today, the British Medical Journal’s specialist journal Tobacco Control has published a special collection of new research which puts further 10,000 watt arc lights on specious industry claims.

Key industry claims have included that plain packs would:

  • Drive prices down, as smokers turn away from buying expensive premium brands because they look exactly the same as cheap brands (other than brand names). More affordable cigarettes, they argued, would cause more smoking, including among children
  • Flood Australia with illegal tobacco
  • Cause smokers to stop buying cigarettes at small convenience stores
  • Prompt smokers to use special covers to conceal the large-scale graphic warnings on packs.

Price falls?

One of the new Tobacco Control papers monitors changes in recommended retail prices RRPs from one year before plain packs were introduced until one year after. Prices were adjusted to 2013 prices, and for inflation and average cigarette price stick and grams of roll-your-own tobacco.

The RRPs of tobacco products were higher in real terms one year after the legislation was implemented. Importantly, these increases exceeded increases resulting from consumer price indexation of duty and occurred across all three major manufacturers for both factory made and roll-your-own brands, all three cigarette market segments and all major pack sizes.

Tobacco prices rose most for leading and premium brands 10.0% and 10.1%, respectively) and among packs of 30s (18.3%) and 50s (12.5%). So far from seeing cigarette prices fall across the board, the industry raised prices.

Floods of illicit tobacco?

The tobacco industry’s most common claim was that plain packs would see smokers turn away from buying the purposefully confronting and unattractive plain packs and seek out illegal products not in plain packs.

Tobacco spokespeople made the outrageous claim that about one in seven of all cigarettes being smoked were such illegally obtained cigarettes. Apparently, while ordinary smokers across the country knew where to buy these easily, the full might and resources of the Australian Federal Police could not work out where these were being sold.

Tobacco companies have been proven wrong. Source: Curran Kelleher/Flickr, CC BY

Another study in the collection questioned 8,679 smokers across the country in telephone surveys conducted continuously, from six months before plain packs until 15 months afterwards.

The study found no significant increases in reported purchasing of “cheap whites” (illegally imported Asian sourced brands), of international brands selling for 20% or more less than the normal retail price, or of unbranded loose tobacco (so-called “chop chop”).

Rates of purchase of cheap whites and heavily discounted products were at around half of one per cent of smokers, nothing remotely like one in seven.

Small shops losing customers?

One of the most bizarre claims the industry made was that plain packs would see smokers deserting corner stores for larger retail outlets like supermarkets. This was an appeal designed to tap into wider public sentiment about local corner store owners being crushed under the dead weight of government regulation.

Those making the claim never explained why smokers would abandon small retailers for large ones because of plain packs when the very same packs would be sold in both. Consumer preference for larger retailers is entirely driven by price discounting, something never mentioned in the industry propaganda.

A third paper in the collection examined where smokers purchased their cigarettes. Unsurprisingly, it found no changes from prior to and after the introduction plain packs in where smokers bought their supplies.

Covering up the packs?

In the month that plain packs were introduced, a Queensland small businessman got his 15 minutes of fame from publicity about special pack covers that could block out the unforgettable graphic warnings. Like children covering their eyes from scary scenes in movies, the idea was that many smokers would rush to do the same, outsmarting the hapless bureaucrats who planned the legislation.

A fourth paper which reports on unobtrusive observations of smokers handling their packs in outdoor cafés found that prior to plain packs, just 1.2% of outdoor café smokers used pack covers. This rose to 3.5% in the early months of plain packs and then fell back to 1.9% one year later.

In any event, evidence shows that smokers who actively try to avoid exposure to pack warnings by covering them up, have higher subsequent rates of quit attempts than those who don’t.

Importantly too, these observations recorded that of all café outdoor patrons, one in 8.7 displayed a pack prior to the introduction of plain packs with this reducing to one in 10.3 afterwards. Such a fall is consistent with both a reduction in smoking prevalence and with growing self-consciousness among smokers about showing that they smoke in public.

Impact on adolescents?

There were several principal objectives of the plain packs legislation. But outstanding among these was the goal of making smoking less desirable among young people. This would continue the trend away from smoking, as each successive cohort of children chose not to take up the habit.

A fifth paper used school-based surveys prior to and after plain packs to examine students’ ratings of the “character” of four popular cigarette brands, and variables including perceived harmfulness, look of pack and positive and negative perceptions of pack image.

Positive character ratings for each brand reduced significantly between 2011 and 2013. Significantly fewer students in 2013 than 2011 agreed that “some brands have better looking packs than others” and packs were rated more negatively, with positive ratings decreasing most in smokers.

The tobacco industry and its acolytes can be expected to try to torture these reports to spin yet more denials of the impact it fears will quickly inspire even more countries to follow Australia’s lead.

Australia is fortunate in having some of the very best researchers in the world whose work has contributed to the development of plain packs and now to the evaluation of its impact.

Editor’s note: please ensure your comments are courteous and on-topic.

The ConversationThis article was originally published on The Conversation. (Reblogged by permission). Read the original article.


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