Plain Packaging Makes Cigarettes Less Sexy

Fran Lowry

March 23, 2015

Selling cigarettes in drab, plain packaging that contains dire and very graphic health warnings appears to be successful in getting people to think about quitting, according to a study published in a supplement to the April issue of Tobacco Control.

In 2012, the Australian government became the first in the world to enact legislation mandating that all tobacco products be sold in standardized packaging.

Its aim was threefold: to make cigarettes less appealing; to increase the effectiveness of health warnings; and to reduce the ability of cigarette packages to mislead the public about the true harms of smoking.

Now, it appears, these goals have been attained.

"Overall, we found that plain packaging largely achieved its three specific aims in the first year of the law's implementation," said Melanie Wakefield, MD, senior researcher at the Centre for Behavioural Research in Cancer, Cancer Council Victoria, in Melbourne, Australia.

"These kind of early outcomes are important because they predict a greater likelihood of later quitting thoughts and attempts," she told Medscape Medical News.

Aussies Have Proved That Plain Packaging Works

Plain packaging in Australia has been a "casebook example of effective tobacco control," Gerard B. Hastings, PhD, and Crawford Moodie, PhD, both from the University of Stirling in the United Kingdom, write in an accompanying essay.

Plain packaging

"Plain packaging is beginning to deliver on its promise," they write. "Australia has learned and applied this lesson well and that is why it has one of the lowest smoking prevalence rates in the world."

"Until recently the evidence base for plain packaging has, perforce, been hypothetical," the pair writes, but now the evidence from Australia "suggests that plain packaging is severely restricting the ability of the pack to communicate and create appeal with young people and adults."

In countries that fail to introduce similar legislation, cigarette packs "will continue to be used as a marketing channel and innovations will proliferate," they add.

"Whatever directions these innovations take, it is clear that the marketing power of the pack is only going to increase. So governments which do not act on plain packaging today will have a bigger problem to tackle tomorrow," Drs Hastings and Moodie explain.

Bad Things Come in Drab Packages

Dr Wakefield and her colleagues interviewed 5441 Australian cigarette smokers at three time points: before the implementation of plain packaging legislation, early in the transition to plain packaging, and during the first year of plain packaging (referred to as the late transition period).

The study population was obtained from a nationally representative sample of adults 18 to 69 years of age.

Participants were asked about how frequently they thought about quitting, whether they intended to quit, whether they concealed cigarette packs, whether they stubbed out cigarettes prematurely in response to thoughts about the harms cigarettes cause, and whether they stopped themselves from having a cigarette in spite of having an urge to smoke.

The rate of smokers stopping themselves from smoking was significantly higher in the early transition period than before the implementation of plain packaging (odds ratio [OR], 1.51; 95% confidence interval [CI], 1.08 - 2.10), as was the rate of quit attempts (OR, 1.43; 95% CI, 1.00 - 2.03).

In addition, the rate of intention to quit was higher during the late transition period than before implementation (OR, 1.42; 95% CI, 1.06 to 1.92), as was the rate of pack concealment (OR, 1.65; 95% CI, 1.01 - 2.72), premature stubbing out of cigarettes (OR, 1.55; 95% CI, 1.01 - 2.36), and quit attempts (OR, 1.52; 95% CI, 1.01 - 2.30).

"The pattern of findings suggests the new larger health warnings on the plain packs were increasing motivation to quit in adult smokers, leading to more quitting thoughts and quit attempts in adults. In adolescents, our studies showed it was the plain packaging and larger health warning combination that created a less positive brand image and made tobacco less appealing. These early outcomes are important because we know that high brand appeal increases smoking uptake in youth," Dr Wakefield said.

"We also tested the effect of plain packaging on a number of teens 13 to 17 years. In that age group, we found that the combination of plain packaging and larger health warnings created a less positive brand image and made tobacco less appealing to the youngsters," she reported.

Dr Wakefield pointed out that the study was not designed or powered to determine quitting success because it used a short follow-up time and focused on thoughts about quitting. The effect of plain packaging on actual reductions in smoking prevalence remains to be determined.

This research indicates that plain packaging will likely help reduce smoking prevalence. And plain packaging is just "one part of Australia's comprehensive tobacco control program, which also includes tobacco tax increases, mass media education campaigns, smoke-free laws and smoking cessation support," Dr Wakefield said.

Dr Wakefield, Dr Hastings, and Dr Moodie have disclosed no relevant financial relationships.

Tob Control. 2015; 24:ii1-ii2, ii26-ii32. Essay, Abstract


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