Uptake of plain packaging was associated with reduced satisfaction from smoking and increased will to quit

A packet of fags

We are constantly told by the tobacco lobby that we need more evidence for plain (i.e. unbranded) cigarette packaging as a public health measure.

This in spite of the vast sums they spend on, er, packaging, marketing, lobbying etc.  Presumably for no benefit to themselves.  This tremendous example of commercial philanthropy in support of the struggling advertising industry is truly heartwarming.

Fortunately, sensible people have an eye on what is going on.  An open-access cross-sectional survey in BMJ Open reports important data from the rollout period of plain packaging in Victoria, Australia.

Methods

Fag ends on a beachParticipants were from a regular telephone survey of the general public in Victoria, Australia.  4,004 interviews were conducted.  The interviews were carried out just after the introduction of legislation requiring plain packaging on cigarettes.

The 572 smokers in this sample were asked questions about brand appeal, quality, their perception of the harms from smoking, thoughts about quitting and thoughts about plain packaging.

Results

Some smokers had not made the switch to plain packaging at the time of the interview.

Smokers who had switched to plain packaging:

  • thought their tobacco was lower quality than a year ago and
  • were more likely to have considered or previously tried quitting smoking than those still on branded packs.

These findings are consistent with the idea that plain packaging makes smoking less attractive and is positively perceived by people who are planning to quit.

A skeleton in a suit

A tobacco industry executive makes the case against plain packaging

Comments

  • This is a substantial survey with longitudinal comparison data.  The findings are consistent with what we already know about plain packaging.
  • However, some smokers were still using branded packs;  the switch to plain packaging was still underway.  Perhaps people who are predisposed towards quitting are more likely to take up the plain packs earlier.
  • This type of study cannot tell us whether plain packaging causes people to quit smoking, prevents them from starting or reduces harm from smoking.
  • We need to see longer term data once the programme has fully rolled out, including objective outcomes around rates of quitting and cigarette consumption.
  • Response rate was 63%, suggesting possible confounding by people refusing to take part.  We might suspect that enthusiastic smokers would be less likely to respond to such a survey.
  • However, the survey sample was substantial, and balanced so as to include both rural and urban participants.

Reference

Wakefield MA, Hayes L, Durkin S et al. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ Open 2013; 3:e003175. doi:10.1136/bmjopen-2013-00317