Earlier this week an article announced that the UK is to bring in legislation that will force tobacco companies to sell their products in standardised plain packaging. This is similar to legislation Australia brought in last year.
Although there has been no official confirmation from the Department of Health (in fact, David Cameron stated the decision has not been made yet), the public consultation on plain packaging closed a while ago, so an official decision is likely to be reached soon.
At last glance there were more than 800 comments on the Guardian article. People are arguing strongly on both sides of the debate: is plain packaging another chip at our free will, undermining our freedom of choice, or a move to protect the most vulnerable in our society from a highly addictive, deadly habit?
Let's look at the evidence. What research has been conducted to assess whether plain packaging will make any difference to the uptake and maintenance of smoking habits, and indeed on shopkeepers who will be selling these non-branded packets?
I'll start with the money. When the potential for this legislation was announced in Australia, the Alliance of Australian Retailers employed Deloitte to investigate the impact that plain packaging would have on retailers. As declared on the resulting (non peer reviewed) report, the AAR are supported by British American Tobacco Australasia, Philip Morris and Imperial Tobacco Australia.
Deloitte consulted with retail operators, and predicted that plain packaging would increase each transaction time for purchasing cigarettes by between 15 and 45 seconds, because of the similarity of packets. They claimed that this would translate to losses of thousands of dollars annually for individual stores.
A group of public health scientists in Perth decided to test these claims, and designed an experiment whereby participants had to find certain brands in an array of plain versus branded cigarette packets. They found that, converse to the results predicted by Deloitte, their participants were quicker at locating the brand in question from the plain packet array, rather than among the branded packs. This was only initially; once participants had learned where the brands were in the array, type of packaging made no difference.
This study wasn't completely representative of real life. Firstly, none of the packets had health warnings. If plain packaging is brought in, the packets won't be "plain", they will have all branding removed. The brand and variant names will be written in a standardised font, with the majority of the pack being taken up with the health warning, which will remain in colour.
Also, the experiment wasn't conducted in a shop, with a shop assistant as the participant, it was run in a room with a couple of experimenters. But, as the authors of the study conclude, this was "a modest experiment undertaken with no budget and a group of volunteers in the space of one week", yet it suggests that one of the main arguments often presented against plain packaging is likely to be incorrect.
What about the important issue? Will plain packaging actually deter people from taking up smoking; in particular will it deter children from starting? As you might expect, there are a number of studies that have shown that progressively plainer packages are rated as less attractive, by smokers and non-smokers, and by adults and teenagers.
That's pretty obvious. Of course they're less attractive, but will that make kids less likely to start smoking? There is a study that has attempted to look at this, undertaken by some of my colleagues at University of Bristol (full disclosure, I am a member of the same research group as two of the authors of this paper).
This study used eye tracking technology to assess whether teenagers look at plain versus branded packets of cigarettes differently. Their "plain packets" were based very closely on what plain packets would look like in this country, and incorporated health warnings.
Images of the packets were shown on a computer screen, and participants had to look at the packets as they wished, but with the instruction that they would need to remember information about what they saw.
They found that teens who already smoke every day didn't show any difference in where they looked between plain and branded packs – they tended to avoid looking at the health warnings. But teens who smoke weekly or less spent more time looking at the health warnings on the plain packets compared with the branded ones. Teens who don't smoke at all spent more time looking at the health warnings regardless of packaging.
If plain packaging will lead teens who experiment with cigarettes to look at the health warnings more, it's possible that this would translate in to them being less drawn to smoking. However, this is a slight leap from these findings, as participants were not asked about their views on warnings.
Other studies have looked at this though. A group in Greece showed health warnings to almost 600 teenagers, comparing text versus graphic health warnings. Teens rated the graphic warnings as more likely to deter them from smoking, whether they were current smokers or not.
A study in Australia asked teenagers about their opinions on smoking before and after graphic health warnings were introduced. They found the warnings were noticed by most of the teens, and not only that, but they were read and understood. Teens also reported thinking more about stopping smoking if they already smoked, and feeling less likely to start if they didn't.
So although there's no evidence yet from Australia (where the legislation is now in place) to show whether plain packaging is working there, the studies that have been conducted to date certainly suggest that there might be a benefit in introducing it.
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