Does plain packaging work?

The Herald reports:

The tobacco industry has ramped up efforts to persuade New Zealand against plain packaging, by circulating research claiming to show the policy has not worked in Australia.

However, tobacco control experts have dismissed the findings and say it will take years to see the effects of the policy.

Philip Morris, the manufacturer of Marlboro cigarettes, has drawn attention to “three separate data sets that demonstrate plain packaging has not reduced smoking rates in Australia”. Two are company-funded surveys of smoking prevalence, by Zurich University and by policy consultancy London Economics. The third is industry sales data, released by the company, showing a 0.3 per cent rise in the volume of tobacco delivered to retailers last year. …

Philip Morris Australia and New Zealand corporate affairs director Chris Argent said that since plain packaging took effect in Australia, “hard data shows that the measure has not reduced smoking rates and has had no impact on youth smoking prevalence”.

“The plain packaging ‘experiment’ in Australia has simply not worked.”

The two surveys tracked prevalence – one of them looking specifically at youth – before and after the introduction of plain packaging.

My view on plain packaging is that *if* plain packaging does reduce smoking rates, then I think it can be justified. However it should only be introduced if the evidence is that it does reduce smoking rates.

The Cancer Council Victoria said the Zurich authors of the youth study had committed a “breathtaking error of logic” in looking for an immediate drop in prevalence. Adolescents’ uptake of smoking was gradual, starting with the first puff, passing through experimentation to an increasing number of cigarettes smoked each day. Plain packaging would take years to affect youth prevalence “because the change needs to occur early in the period of uptake to divert adolescents from becoming regular smokers as they age into adulthood”.

Professor Janet Hoek, of Otago University, echoed these views.

She said it would have been remarkable if the interviewees, after just one year of plain packaging, had “completely forgotten associations the tobacco industry has carefully cultivated over the last decade”. Researchers had always expected plain packaging’s effects on prevalence to occur over the “medium term”, as branding links were replaced in people’s minds by adverse responses to tobacco and smoking.

The logical response to this is to not introduce plain packaging in any further jurisdictions until you do have the evidence that it reduces smoking rates.

In my experience many public health advocates are motivated more by hatred of the companies that sell the products they see as harmful (and tobacco is), rather than actually reducing the harm of the products.

In terms of waiting to see if they work in Australia, one challenge is other measures like changes in excise tax may impact smoking rates also, and we may never know what is the cause of any change.

That is why my preferred way forward is to introduce plain packaging in one region of New Zealand (a large one, maybe even the entire South Island) and then over time measure the change in smoking rates in that region to the rest of NZ. If the change is a greater decline then you have the evidence to introduce it to all of NZ. If there is no measureable impact, then it should be scrapped as ineffective.

Some will say why not do plain packaging, even if it doesn’t work, because anything that hurts tobacco companies is worth doing. Well I can sympathise with that, but I think the precedent it sets is a serious one. Inevitably you will then have certain groups then advocate plain packaging for other products they disapprove of – spirits, beer, wine, soft drinks, fast food etc.

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