An overview of plain packaging research

Transcription

1 An overview of plain packaging research Dr. Crawford Moodie Centre for Tobacco Control Research University of Stirling Scotland Vers un monde sans tabac, Paris, 29 th May 2015 Plain (or standardised) packaging Plain packaging proposed in mid-1980s by a Canadian doctor to minimise the extent to which tobacco companies could make their products look attractive, and to maximise the danger 1

2 Rapid review of the plain packaging literature Plain packaging discussed as a possible policy measure in 2008 in the UK In 2009, the UK Department of Health commissioned a rapid review of plain packaging research (Moodie, Hastings & Ford, 2009) 20 studies identified - half from the 1990s and half from 2008 on All research from the 1990s was from the US, Canada, New Zealand or Australia. Many studies from the 2000s were not yet published 2011 systematic review In 2011, the UK Department of Health promised to consult on plain packaging They commissioned a systematic review of the available evidence to accompany the consultation (Moodie et al, 2012) 2

3 2011 systematic review The primary aim was to assess the impact of plain packaging on the: 1) appeal of the packaging and the product 2) perceptions of product strength and harm 3) salience and effectiveness of warnings A secondary aim was the impact of plain packaging on self-reported attitudes, intentions and behaviour 37 studies were included, 35 from US, Canada, Australia, New Zealand, France or UK Range of designs employed: Surveys, eye-tracking research, naturalistic research, focus groups and interviews Findings - Appeal 28 studies assessed appeal (attractiveness, quality, smoker identity) Plain packs consistently rated as less attractive than fully branded packs Plain packs perceived to be poorer quality (e.g. cigarettes would taste worse) Plain packs projected a less desirable smoker identity (boring, unfashionable, unpopular, etc) 3

4 Findings - Warnings 12 studies assessed warnings (salience, recall, believability and seriousness) Plain packaging generally found to increase warning salience and recall, although this was moderated by warning type (pictorial vs text) and size (large vs small) Qualitative studies found the warnings were considered more serious and believable on plain packs due to there being less clutter to distract from the warnings Findings - Harm Sixteen studies assessed harm (level of harm, tar delivery, risk to health, how dangerous the cigarettes inside) Plain packs considered more harmful than fully branded packs if a darker colour and less harmful if lighter Descriptors on otherwise identical plain packs, such as gold or smooth, were found to mislead about product harm 4

5 Findings Attitudes, intentions and behaviours Sixteen studies examined smoking-related attitudes, beliefs, intentions, self-reported behaviours, or perceived impact on smoking behaviour Plain packaging associated with more negative attitudes and beliefs Plain packaging associated, in general, with lower intentions to smoke Some evidence that plain packaging was considered likely to discourage uptake and encourage cessation-related behaviours, particularly among younger people, non-smokers and lighter smokers 2013 update of the literature In 2013, to provide an overview of new research since the systematic review, we updated the literature (Moodie, Angus, Bauld & Stead, 2013) 17 studies published between August 2011 (the cut-off date for study inclusion in the systematic review) and September 2013 Studies published in a range of respectable journals (Addiction, BMC Public Health, Tobacco Control, BMJ Open, Social Science & Medicine, Lancet) 5

6 General findings from update The update found that irrespective of design, location and sample, in comparison to fully branded packaging, plain packaging: reduced the appeal of the pack, product and smoking increased the salience of the health warnings reduced confusion about product harm as a result of pack colour and shape Plain packaging also associated with cessation-related behaviours among adult smokers, e.g. a reduction in consumption (Moodie & Mackintosh, 2013) and an increase in thinking about and prioritising quitting (Wakefield et al., 2013), and a decrease in smoking susceptibility among children (Ford et al., 2013) A report on plain packaging for the UK Government by Sir Cyril Chantler noted that the overall quality of evidence presented in the updated Stirling review was higher than in their original review (Chantler, 2014) 6

7 Further evidence Between September 2013 and February 2015 at least 20 additional studies were published Research found that the potential benefits of plain packaging appear to extend to smokeless tobacco (Adkinson et al., 2014) Research conducted in Italy (Manocci et al., 2013), India (Arora et al., 2013) and Macau (Chow et al., 2015) Studies looked, for the first time, at cravings (Brose et al., 2014) or employed a randomised control trial (Maynard et al., in press) As with the update of the literature, these studies provide further support for plain packaging What happened in Australia? 7

8 Research from Australia post-plain packaging School surveys with year olds in 2011 and 2013 found that while cognitive processing (e.g. thinking about, and talking about) of warnings did not change, there was a decrease in positive pack ratings (e.g. cool, exciting) (White, Williams & Wakefield, 2015; White et al., 2015) A mixed methods study with adult smokers found that for most cigar and cigarillo smokers their packs had lower appeal and quality than they did before plain packaging was introduced, with the warnings more salient. Non-premium cigarillo smokers also reported being more likely to conceal packs and contemplate quitting (Miller et al., 2015) Research from Australia post-plain packaging Continuous cross-sectional telephone surveys conducted with adult smokers from 2012 to It was found that post-plain packaging significantly more smokers disliked their pack and considered there cigarettes to be lower quality and less satisfying (Wakefield, Coomber et al., 2015) In addition, more smokers noticed the warnings, attributed motivation to quit to the warnings, avoided specific warnings and covered packs. There were mixed findings with respect to harm perceptions however (Wakefield, Coomber et al., 2015) Plain packaging was also associated with increased thinking about quitting and quit attempts (Durkin et al., 2015), and dislike of the pack, lower satisfaction from cigarettes and attributing motivation to quit to the warnings predicted daily thoughts of quitting (Brennan et al., 2015) 8

9 Research from Australia post-plain packaging The ITC survey, a longitudinal telephone study with adult smokers, found that from 2012 to 2013 support for plain packaging increased (28% to 49%), with more smokers supportive than opposed (49% vs 35%). Support was prospectively associated with higher levels of quitting activity (Swift et al., in press) The ITC survey also found that warnings were more salient in 2013 than in 2011, with smokers more likely to engage in avoidant behaviours and think more about the harms of smoking (Yong et al., 2015) A longitudinal online study with adult smokers between 2012 and 2013 found an increase in the proportion of smokers citing the health warnings as a source of information about the Quitline or cessation website. Citing health warnings as a source of information of the Quitline and website was associated with their use (Thrasher et al., in press) Research from Australia post-plain packaging A time-series analysis from 2011 to 2013 found a 78% increase in the number of calls to the Quitline after the introduction of plain packaging. There was a peak in calls 4 weeks post-implementation with the number of calls higher at six months post-implementation than at baseline (Young et al., 2014) The same time-series analysis found a significant increase in cognitive (encourage cessation), emotional (worrying because of the warnings) and avoidant responses to warnings on packs 2-3 months after the introduction of plain packaging. There was also an increase in negative pack perceptions (e.g. unattractive, does not say something good about me, does not match my style) (Dunlop et al., 2014) 9

10 No evidence for unintended consequences Plain packaging NOT associated with lower prices for licit tobacco or an increase in the use of illicit tobacco (Scollo et al., 2015a,b,c) A review of retail magazines shows that inflationadjusted recommended retail prices increased for cigarettes in all price segments (value, mid-priced and premium) - being highest for more expensive cigarettes - and for rolling tobacco (Scollo et al., 2015a) Continuous cross-sectional telephone surveys from 2012 to 2014 found no evidence for an increase in purchase of tobacco from overseas, online or dutyfree, and no evidence of an increase in the consumption of illicit cheap white cigarettes (Scollo et al., 2015b,c) 10