The New Zealand Government has stated its intention to follow Australia and introduce plain packaging of tobacco products, a policy that would see dissuasive imagery and colours replace the eye-catching and aspirational pack designs that currently advertise smoking to young people.1-3 Although the success of Australias policy will not be evident until medium-term trends in youth smoking initiation can be analysed, emerging evidence suggests two things. First, the tobacco industrys claims about extended transaction times are baseless4 and, second, plain packaging has so successfully de-normalised smoking that smokers believe the quality of their cigarettes has declined.5 These latter findings confirm earlier experimental studies that found smokers perceived progressively plainer packs as less attractive and thought the cigarettes these contained were of lower quality and less likely to taste satisfying.6-9 Several studies have documented adults support for plain packaging;10-12 however, we know less about how adolescents perceive this measure. As plain packagings main aim is to reduce smoking initiation and addiction among adolescents, it is timely to explore their support for this policy. To examine this question, we used data from four years of the ASH Year 10 survey (2009-2012). Conducted annually, these school-based surveys ask 14 and 15 year olds about a variety of current and proposed policy measures. Full details of the survey methodology and sample are provided in Healey et al., 2013.13 Each year, between 25,000 to 30,000 students complete the ASH survey and, from 2009 onwards, respondents indicated their agreement or disagreement with statements exploring plain packaging. In 2009, the statement tested was: Tobacco companies should not be allowed to promote cigarettes and tobacco by having different brand names and packaging and in 2010 it was Tobacco companies should not be allowed to promote cigarettes and tobacco by having different symbols, phrases, names or colours on the packaging . In 2011 and 2012, the question was Tobacco companies should not be allowed to promote cigarettes and tobacco with cool looking packs . The term plain packaging was not specifically used in the ASH surveys because it was not widely known or clearly understood when the statement was first introduced. Since then, the wording has been refined to encompass aspects of plain packaging and to reflect its purpose of recruiting new smokers (using cool looking packs). Agreement with the statements tested suggests adolescents support packaging that removes key design elements designed to promote the smoking experience; i.e., plain packaging. Figure 1 illustrates how support for plain packaging among 14 and 15 year olds has increased over time. Figure 1. Support for plain packaging among 14 and 15 year olds: 2009-2012 Note: Estimates are weighted by ethnicity, and school decile-based socioeconomic status to align with known population parameters. Weighting also standardises the age distribution to account for variations in field timing in different years. The maximum confidence interval across all of the data points presented was \u00b1 1.4%. Confidence intervals were adjusted for clustering at the school level. Figure 1 shows strong and growing support for removing appealing brand imagery from tobacco packaging. Support for plain packaging has always outweighed opposition and has grown rapidly and significantly over time, from 47% in 2009 to 64% in 2012, while opposition has declined from 21% to 14%; uncertainty has also declined (from 32% to 22%). By 2012, there was majority support for plain packaging from all demographic groups, as shown in Table 1. These results provide the first evidence of New Zealand adolescents support for plain packaging and reveal that this is very similar to that of adults, which was recently estimated at 69% [10]. Furthermore, the most recent dataset (2012) shows majority support among all demographic groups, which suggests adolescents, regardless of their age, gender, ethnicity, or socioeconomic status, recognise and endorse the concept of plain packaging. Evidence that both adults and adolescents strongly support plain packaging suggests politicians could make more rapid progress in implementing this important public health strategy. Table 1. Support for plain packaging by demographic characteristics Demographic trait 2009 Estimate (95% CI) 2010 Estimate (95% CI) 2011 Estimate (95% CI) 2012 Estimate (95% CI) Age 14 years 48.0 (46.7-49.3) 54.9 (53.6-56.2) 63.3 (62.0-64.7) 65.3 (64.1-66.6) 15 years 46.3 (44.8-47.8) 52.1 (50.7-53.5) 59.7 (57.8-61.7) 62.3 (60.5-64.0) Gender Male 49.1 (47.6-50.5) 55.1 (53.6-56.5) 60.8 (59.3-62.4) 62.1 (60.7-63.5) Female 45.9 (44.4-47.4) 52.7 (51.1-54.2) 63.3 (61.5-65.0) 66.4 (64.8-67.9) Ethnicity NZ European 52.2 (51.0-53.4) 58.8 (57.7-60.0) 68.1 (66.9-69.3) 70.9 (69.8-72.0) Maori 35.1 (33.2-37.0) 42.2 (40.6-43.8) 49.2 (47.2-51.2) 50.6 (48.8-52.4) Pacific 42.0 (39.6-44.4) 45.2 (43.0-47.4) 54.2 (51.3-57.0) 54.8 (52.2-57.3) Asian 52.6 (50.2-55.0) 59.8 (57.3-62.3) 63.7 (61.5-66.0) 67.0 (65.0-69.0) Other 47.7 (41.4-54.1) 60.0 (54.3-65.7) 68.9 (61.6-76.2) 67.2 (63.9-70.6) Socioeconomic status High 52.2 (50.6-53.8) 58.9 (57.3-60.5) 67.6 (65.7-69.5) 69.5 (68.1-70.9) Medium 47.0 (45.4-48.5) 54.1 (52.7-55.4) 61.6 (60.2-63.1) 64.3 (62.7-65.8) Low 38.3 (36.2-40.4) 43.2 (41.0-45.3) 51.3 (48.4-54.2) 52.9 (50.2-55.5) We call on the New Zealand Government to act now; there is compelling experimental, qualitative and survey evidence that plain packaging will reduce smokings appeal to young people, and widespread public support for the policy exists. Deferring the implementation of plain packaging until World Trade Organization and Bilateral Investment Treaty litigation has concluded will simply delay progress towards the 2025 goal of a smokefree New Zealand and condemn more young New Zealanders to the unnecessary suffering caused by smoking.

The New Zealand Government has stated its intention to follow Australia and introduce plain packaging of tobacco products, a policy that would see dissuasive imagery and colours replace the eye-catching and aspirational pack designs that currently advertise smoking to young people.1-3 Although the success of Australias policy will not be evident until medium-term trends in youth smoking initiation can be analysed, emerging evidence suggests two things. First, the tobacco industrys claims about extended transaction times are baseless4 and, second, plain packaging has so successfully de-normalised smoking that smokers believe the quality of their cigarettes has declined.5 These latter findings confirm earlier experimental studies that found smokers perceived progressively plainer packs as less attractive and thought the cigarettes these contained were of lower quality and less likely to taste satisfying.6-9 Several studies have documented adults support for plain packaging;10-12 however, we know less about how adolescents perceive this measure. As plain packagings main aim is to reduce smoking initiation and addiction among adolescents, it is timely to explore their support for this policy. To examine this question, we used data from four years of the ASH Year 10 survey (2009-2012). Conducted annually, these school-based surveys ask 14 and 15 year olds about a variety of current and proposed policy measures. Full details of the survey methodology and sample are provided in Healey et al., 2013.13 Each year, between 25,000 to 30,000 students complete the ASH survey and, from 2009 onwards, respondents indicated their agreement or disagreement with statements exploring plain packaging. In 2009, the statement tested was: Tobacco companies should not be allowed to promote cigarettes and tobacco by having different brand names and packaging and in 2010 it was Tobacco companies should not be allowed to promote cigarettes and tobacco by having different symbols, phrases, names or colours on the packaging . In 2011 and 2012, the question was Tobacco companies should not be allowed to promote cigarettes and tobacco with cool looking packs . The term plain packaging was not specifically used in the ASH surveys because it was not widely known or clearly understood when the statement was first introduced. Since then, the wording has been refined to encompass aspects of plain packaging and to reflect its purpose of recruiting new smokers (using cool looking packs). Agreement with the statements tested suggests adolescents support packaging that removes key design elements designed to promote the smoking experience; i.e., plain packaging. Figure 1 illustrates how support for plain packaging among 14 and 15 year olds has increased over time. Figure 1. Support for plain packaging among 14 and 15 year olds: 2009-2012 Note: Estimates are weighted by ethnicity, and school decile-based socioeconomic status to align with known population parameters. Weighting also standardises the age distribution to account for variations in field timing in different years. The maximum confidence interval across all of the data points presented was \u00b1 1.4%. Confidence intervals were adjusted for clustering at the school level. Figure 1 shows strong and growing support for removing appealing brand imagery from tobacco packaging. Support for plain packaging has always outweighed opposition and has grown rapidly and significantly over time, from 47% in 2009 to 64% in 2012, while opposition has declined from 21% to 14%; uncertainty has also declined (from 32% to 22%). By 2012, there was majority support for plain packaging from all demographic groups, as shown in Table 1. These results provide the first evidence of New Zealand adolescents support for plain packaging and reveal that this is very similar to that of adults, which was recently estimated at 69% [10]. Furthermore, the most recent dataset (2012) shows majority support among all demographic groups, which suggests adolescents, regardless of their age, gender, ethnicity, or socioeconomic status, recognise and endorse the concept of plain packaging. Evidence that both adults and adolescents strongly support plain packaging suggests politicians could make more rapid progress in implementing this important public health strategy. Table 1. Support for plain packaging by demographic characteristics Demographic trait 2009 Estimate (95% CI) 2010 Estimate (95% CI) 2011 Estimate (95% CI) 2012 Estimate (95% CI) Age 14 years 48.0 (46.7-49.3) 54.9 (53.6-56.2) 63.3 (62.0-64.7) 65.3 (64.1-66.6) 15 years 46.3 (44.8-47.8) 52.1 (50.7-53.5) 59.7 (57.8-61.7) 62.3 (60.5-64.0) Gender Male 49.1 (47.6-50.5) 55.1 (53.6-56.5) 60.8 (59.3-62.4) 62.1 (60.7-63.5) Female 45.9 (44.4-47.4) 52.7 (51.1-54.2) 63.3 (61.5-65.0) 66.4 (64.8-67.9) Ethnicity NZ European 52.2 (51.0-53.4) 58.8 (57.7-60.0) 68.1 (66.9-69.3) 70.9 (69.8-72.0) Maori 35.1 (33.2-37.0) 42.2 (40.6-43.8) 49.2 (47.2-51.2) 50.6 (48.8-52.4) Pacific 42.0 (39.6-44.4) 45.2 (43.0-47.4) 54.2 (51.3-57.0) 54.8 (52.2-57.3) Asian 52.6 (50.2-55.0) 59.8 (57.3-62.3) 63.7 (61.5-66.0) 67.0 (65.0-69.0) Other 47.7 (41.4-54.1) 60.0 (54.3-65.7) 68.9 (61.6-76.2) 67.2 (63.9-70.6) Socioeconomic status High 52.2 (50.6-53.8) 58.9 (57.3-60.5) 67.6 (65.7-69.5) 69.5 (68.1-70.9) Medium 47.0 (45.4-48.5) 54.1 (52.7-55.4) 61.6 (60.2-63.1) 64.3 (62.7-65.8) Low 38.3 (36.2-40.4) 43.2 (41.0-45.3) 51.3 (48.4-54.2) 52.9 (50.2-55.5) We call on the New Zealand Government to act now; there is compelling experimental, qualitative and survey evidence that plain packaging will reduce smokings appeal to young people, and widespread public support for the policy exists. Deferring the implementation of plain packaging until World Trade Organization and Bilateral Investment Treaty litigation has concluded will simply delay progress towards the 2025 goal of a smokefree New Zealand and condemn more young New Zealanders to the unnecessary suffering caused by smoking.