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A systematic review of international evidence suggests standardised (plain) packaging will decrease the appeal of smoking, increase the salience of on-pack warnings, and reduce misperceptions about the harms of smoking.1 Standardised packaging thus represents a vital measure governments should implement as part of a comprehensive approach, if they wish to end the smoking epidemic.The World Health Organization (WHO) has endorsed standardised packaging as a legitimate and effective tobacco control measure , which is fully in line with the spirit and intent of the outcome of the UN High-level Meeting, and \u2026 in accordance with international legal obligations under the WHO FCTC .2 The UK and Ireland have already passed legislation introducing standardised packaging,3,4 and other nations, including France and Norway, have announced plans to proceed with standardised packaging.3,5,6 Yet, despite this international momentum, and repeated statements from the previous Minister of Health that standardised packaging is inevitable ,7 progress in implementing this measure here has not kept pace with other countries.Given New Zealand was the first country to adopt a smokefree goal, it might also be expected to be at the vanguard of new tobacco control measures. However, although the Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill, which passed its first reading on 11 February 2014 (118 votes to 1), was returned from the Health Select Committee on 5 August 2014, it still has no second reading date. Instead of moving quickly to pass this evidence-based legislation, which has strong and growing public support in New Zealand,8,9 the Government has stated its intention to await outcomes from two international legal cases against the Australian government.10 Unfortunately, this position effectively enables the tobacco industry to create further delays by attenuating resolution of these disputes.While a cautious stance may initially have seemed prudent, the growing evidence base, increasing international adoption of standardised packaging and promising research findings from Australia,11-20 all suggest it is timely for the Government to revisit its initial position and accelerate the progress of this important legislation. If tobacco companies dictate the pace of New Zealands legislative agenda, we will see continuation of a marketing strategy that tempts young people into experimenting with smoking21 and sees 13 New Zealanders die every day from illnesses caused directly by smoking.22 We call on the Government to recognise the encouraging evidence from Australia and growing adoption of standardised packaging by other countries, and re-assess their stance. There are now even more reasons to pass and implement standardised packaging legislation without delay.The Australian government introduced standardised packaging primarily to protect young people from the devastating illnesses that reduce the length and quality of smokers lives. The legislation was designed to achieve this goal by reducing the attractiveness and appeal of tobacco products, increasing the salience and impact of health warnings, and reducing the ability of tobacco product packaging to mislead consumers about the harms of smoking. Then Health Minister Nicola Roxon stated, of course were targeting people who have not yet started, and thats the key to this plain packaging announcement to make sure we make it less attractive for people to experiment with tobacco in the first place .23 Data from Australia, which implemented standardised packaging from 1 December 2012, support predictions from experimental and exploratory studies and show standardised packaging is achieving the legislations objectives, consistent with researchers and public health groups expectations.1,12-16,21,24-35Evidence of detailed trends among young people will inevitably take time to emerge, but it is encouraging that the recent National Drug Strategy Household Survey (NDSHS) found, Younger people are delaying the take upof smoking and the age at which 14-24-year-olds smoked their first full cigarette increased from 15.4 in 2010 to 15.9 in 2013 .34 While age of initiation had been increasing for some time, the NDSHS evidence is consistent with predictions that standardised packaging would reduce the appeal of smoking. Studies conducted pre- and post-standardised packaging found smokers had significantly stronger cognitive, affective and aversive responses to on-pack warnings following standardised packagings implementation, while their perceptions of pack attractiveness and appeal all declined significantly.26 Their propensity to display packages in public settings, particularly those where children are present, also declined.11,16 Analyses of smokers thoughts of quitting as standardised packaging was implemented found these increased.12-15,25 Again, the mounting evidence from Australia corroborates predictions made using survey, qualitative and experimental data, and strengthens the case for urgent action to pass and implement standardised packaging legislation.It is also encouraging that adult smoking prevalence post-standardised packaging has fallen to the lowest level yet recorded. The 2013 NDSHS reported 12.8% of Australians aged 14 years and over were daily smokers, a decline of 2.3% percentage points from 2010; furthermore, smokers have reduced the average number of cigarettes they smoke per week from 111 cigarettes in 2010 to 96 in 2013.34 These figures are also consistent with researchers predictions and are further supported by other government data. For example, the Australian Bureau of Statistics showed total consumption of tobacco and cigarettes, as measured by estimated expenditure on tobacco, fell from $3.508 billion in the last quarter of 2012 to $3.405 billion in the first quarter of 2014, the lowest expenditure ever recorded.2 Commonwealth Treasury data showed similar results as tobacco clearances fell by 3.4% in 2013 relative to 2012.2The accumulating evidence contradicts dire predictions made by the tobacco industry and its allies that standardised packaging would result in adverse consequences, such as increased smuggling and illicit marketing of counterfeit cigarettes, or increased transaction times in stores.36 Industry claims have been comprehensively refuted by government agencies and peer-reviewed research.17,19,20,34,37 Ahead of the legislation, the Australian tobacco industry and its allies claimed through lobbying, media, and even advertising, that they would be entitled to billions of dollars in compensation. When this claim was tested in the High Court, the industry not only lost comprehensively, but was required to pay the governments costs. Furthermore, far from alienating smokers, support for standardised packaging among smokers almost doubled following the policys introduction.18Discrepancies between tobacco companies predictions and the actual effects we are now seeing should not be surprising, given the tobacco industrys long-standing reliance on spurious arguments and questionable practices to oppose proportionate policy measures. Robust analyses from the UK recently exposed how the tobacco industry has misrepresented standardised packaging and suggest the government should treat any evidence adduced by the industry with considerable scepticism.36,38Increasing adoption of standardised packaging by other countries4-6 suggests deferring progress on New Zealand legislation until international court cases have concluded is no longer a logical position for the government to hold. Deferring action risks leaving policy making captive to an industry that now has every incentive to delay these international legal proceedings for as long as possible.We have known for decades how the tobacco industry has used packaging to position smoking as glamorous, sophisticated and rebellious, particularly following restrictions on traditional mass media advertising.21,39,40 The industrys arguments that standardised packaging would have no effect are as hollow as its legal actions are desperate, and the time has surely come for the Government to acknowledge the strong research evidence, display the same initiative shown by some of its strongest allies, and take firm, decisive action that sees standardised packaging implemented as soon as possible.In summary, the Government has no need to fear standing alone or acting precipitously it neither is nor would be. However, it should be mindful of the risk New Zealand now faces: being left behind as other countries respond to the research evidence and show resolute leadership in the face of corporate bullies. We urge the Government to act on the real-world data that is rapidly amassing, take a principled and evidence-based stand, and pass and implement the standardised packaging legislation as quickly as possible. Doing so will reassert New Zealand as a leader in tobacco control, demonstrate a commitment to ending the smoking epidemic, and foster realisation of New Zealands world-leading goal of becoming smokefree by 2025.\r\n

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Janet Hoek, Professor of Marketing, Co-Director ASPIRE2025, University of Otago, Dunedin; Richard Edwards, Professor and HoD, Department of Public Health, Co-Director ASPIRE2025; Mike Daube AO, Professor of Health Policy, Curtin University, Western Australia, University of Otago, Wellington-

Acknowledgements

Correspondence

Janet Hoek, Professor of Marketing, Co-Director ASPIRE2025, University of Otago, Dunedin

Correspondence Email

janet.hoek@otago.ac.nz

Competing Interests

Dr. Hoek reports she has received funding for tobacco control research from the Health Research Council, Royal Society Marsden Fund, ASH NZ, NZ Ministry of Health, and the NZ Heart Foundation. Some of the studies funded examined plain packaging, but the findings reported in this viewpoint were not directly funded by any external grant. She is a member of the Australian Governments Expert Advisory group on plain packaging and have given expert advice on this topic to the NZ Ministry of Health and Health Promotion Agency. Professor Daube reports he was Deputy Chair of the Australian Governments National Preventative Health Taskforce and chaired the Tobacco Expert Committee that recommended plain packaging as part of a comprehensive approach.

'- Stead M, Moodie C, Angus K, Bauld L, McNeill A, Thomas J, et al. Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies. PloS one. 2013;8(10):e75919. World Health Organization. Statement of the World Health Organization in relation to the issue of standardized tobacco product packaging Geneva: World Health Organization; 2014 [cited 2014 17 November]. Available from: http://www.who.int/fctc/mediacentre/news/2014/WHOSTATEMENTWTOTBTNOV2014.pdf?ua=1. European Public Health Alliance. UK and Ireland pave the way for the adoption of Plain Packaging in the EU Belgium2015 [cited 2015 27 March]. Available from: http://www.epha.org/a/6313. Irish Times. Ireland leads EU on plain packaging of cigarettes: Irish Times; 2014 [cited 2014 17 November]. Available from: http://www.irishtimes.com/news/health/ireland-leads-eu-on-plain-packaging-of-cigarettes-1.1827268. BBC News. France to introduce plain cigarette packaging 2014 [cited 2014 17 November]. Available from: http://www.bbc.com/news/world-europe-29367253. Anonymous. Voil\u00e0 \u00e0 quoi ressemblera le paquet de cigarettes neutre Le Figaro. 2015 04 April 2015. Ryall T. Address to Waitemata Lecture Series Waitemata2014 [cited 2014 27 November]. Available from: http://innovation.health.nz/hon-tony-ryall-address-waitemata-lecture-series/. Hoek J, Healey B, Gendall P, R E, Jaine R. How do adolescents perceive plain packaging? New Zealand Medical Journal. 2013;126(1383). Hoek J, Gendall P, Maubach N, Edwards R. Strong public support for plain packaging of tobacco products. Australian and New Zealand Journal of Public Health. 2012;36(5):405-7. Rutherford H. Cigarette plain packaging closer DominionPost. 2014 12 February. Zacher M, Bayly M, Brennan E, Dono J, Miller C, Durkin S, et al. Personal pack display and active smoking at outdoor caf\u00e9 strips: assessing the impact of plain packaging 1\u2005year postimplementation. Tobacco Control. 2015;24(Suppl 2):ii94-ii7. White V, Williams T, Wakefield M. Has the introduction of plain packaging with larger graphic health warnings changed adolescents perceptions of cigarette packs and brands? Tobacco Control. 2015;24(Suppl 2):ii42-ii9. Wakefield M, Coomber K, Zacher M, Durkin S, Brennan E, Scollo M. Australian adult smokers responses to plain packaging with larger graphic health warnings 1\u2005year after implementation: results from a national cross-sectional tracking survey. Tobacco Control. 2015;24(Suppl 2):ii17-ii25. Durkin S, Brennan E, Coomber K, Zacher M, Scollo M, Wakefield M. Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers. Tobacco Control. 2015;24(Suppl 2):ii26-ii32. Brennan E, Durkin S, Coomber K, Zacher M, Scollo M, Wakefield M. Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers. Tobacco Control. 2015;24(Suppl 2):ii33-ii41. Zacher M, Bayly M, Brennan E, Dono J, Miller C, Durkin S, et al. Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor caf\u00e9 strips. Addiction. 2014. Wakefield M, Bayly M, Scollo M. Product retrieval time in small tobacco retail outlets before and after the Australian plain packaging policy: real-world study. Tobacco Control. 2014;23(1):70-6. Swift E, Borland R, Cummings K, Fong G, McNeill A, Hammond D, et al. Australian smokers support for plain or standardised packs before and after implementation: findings from the ITC Four Country Survey. Tobacco control. 2014:tobaccocontrol-2014-051880. Scollo M, Zacher M, Durkin S, Wakefield M. Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco. BMJ Open. 2014;4(8). Scollo M, Bayly M, Wakefield M. Availability of illicit tobacco in small retail outlets before and after the implementation of Australian plain packaging legislation. Tobacco Control. 2014. Hoek J, Gendall P, Gifford H, Pirikahu G, McCool J, Pene G, et al. Tobacco Branding, Plain Packaging, Pictorial Warnings, and Symbolic Consumption. Qualitative Health Research. 2012;22(5):630-9. Ministry of Health. Health effects of smoking Wellington: Ministry of Health; 2014 [cited 2014 17 November]. Available from: http://www.health.govt.nz/your-health/healthy-living/addictions/smoking/health-effects-smoking. Rudd K, Roxon N. Transcript of interview with prime minister and health minister Australia2011 [cited 2015 07 January]. Available from: http://pmtranscripts.dpmc.gov.au/preview.php?did=17256. British Heart Foundation. Standardised packaging of tobacco products: recent evidence from Australia and the United Kingdom. London: BHF, 2014 December 2014. Report No. Wakefield M, Hayes L, Durkin S, Borland R. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ open. 2013;3(7). Dunlop SM, Dobbins T, Young JM, Perez D, Currow DC. Impact of Australias introduction of tobacco plain packs on adult smokers pack-related perceptions and responses: results from a continuous tracking survey. BMJ open. 2014;4(12):e005836. Gendall P, Hoek J, Edwards R, McCool J. A cross-sectional analysis of how young adults perceive tobacco brands: implications for FCTC signatories. BMC public Health. 2012;12(1):796. Hoek J, Wong C, Gendall P, Louviere J, Cong K. Effects of dissuasive packaging on young adult smokers. Tobacco Control. 2011;20(3):183-8. Gendall P, Hoek J, Thomson G, Edwards R, Pene G, Gifford H, et al. Young adults interpretations of tobacco brands: implications for tobacco control. Nicotine Tob Res. 2011;13(10):911-8. Wakefield M, Germain D, Durkin S, Hammond D, Goldberg M, Borland R. Do larger pictorial health warnings diminish the need for plain packaging of cigarettes? Addiction. 2012;107(6):1159-67. Wakefield M. Welcome to cardboard country: How plain packaging could change the subjective experience of smoking. Tobacco control. 2011;20(5):321-2. Germain D, Wakefield M, Durkin S. Adolescents perceptions of cigarette brand image: does plain packaging make a difference? J Adolesc Health 2010;46:385-92. Wakefield M, Germain D, Durkin S. How does increasingly plainer cigarette packaging influence adult smokers perceptions about brand image? An experimental study. Tobacco Control. 2008;17(6):416-21. Australian Institute of Health and Welfare. Tobacco smoking (NDSHS 2013 key findings) Canberra: Australian Government; 2014 [cited 2014 30 October]. Available from: http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/tobacco/. The Department of Health. Tobacco key facts and figures 2014 [cited 2014 17 November]. Available from: http://health.gov.au/internet/main/publishing.nsf/Content/tobacco-kff. Ulucanlar S, Fooks GJ, Hatchard JL, Gilmore AB. Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardised Packaging. PLoS medicine. 2014;11(3):e1001629. Bayly M, Scollo M, Wakefield M. No lasting effects of plain packaging on cigarette pack retrieval time in small Australian retail outlets. Tobacco Control. 2014. Savell E, Gilmore AB, Fooks G. How does the tobacco industry attempt to influence marketing regulations? A systematic review. PloS one. 2014;9(2):e87389. Anderson SJ, Glantz SA, Ling PM. Emotions for sale: cigarette advertising and womens psychosocial needs. Tobacco Control. 2005;14(2):127-35. Ling PM, Glantz SA. Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence From Industry Documents. Am J Public Health. 2002;92(6):908-16.-

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A systematic review of international evidence suggests standardised (plain) packaging will decrease the appeal of smoking, increase the salience of on-pack warnings, and reduce misperceptions about the harms of smoking.1 Standardised packaging thus represents a vital measure governments should implement as part of a comprehensive approach, if they wish to end the smoking epidemic.The World Health Organization (WHO) has endorsed standardised packaging as a legitimate and effective tobacco control measure , which is fully in line with the spirit and intent of the outcome of the UN High-level Meeting, and \u2026 in accordance with international legal obligations under the WHO FCTC .2 The UK and Ireland have already passed legislation introducing standardised packaging,3,4 and other nations, including France and Norway, have announced plans to proceed with standardised packaging.3,5,6 Yet, despite this international momentum, and repeated statements from the previous Minister of Health that standardised packaging is inevitable ,7 progress in implementing this measure here has not kept pace with other countries.Given New Zealand was the first country to adopt a smokefree goal, it might also be expected to be at the vanguard of new tobacco control measures. However, although the Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill, which passed its first reading on 11 February 2014 (118 votes to 1), was returned from the Health Select Committee on 5 August 2014, it still has no second reading date. Instead of moving quickly to pass this evidence-based legislation, which has strong and growing public support in New Zealand,8,9 the Government has stated its intention to await outcomes from two international legal cases against the Australian government.10 Unfortunately, this position effectively enables the tobacco industry to create further delays by attenuating resolution of these disputes.While a cautious stance may initially have seemed prudent, the growing evidence base, increasing international adoption of standardised packaging and promising research findings from Australia,11-20 all suggest it is timely for the Government to revisit its initial position and accelerate the progress of this important legislation. If tobacco companies dictate the pace of New Zealands legislative agenda, we will see continuation of a marketing strategy that tempts young people into experimenting with smoking21 and sees 13 New Zealanders die every day from illnesses caused directly by smoking.22 We call on the Government to recognise the encouraging evidence from Australia and growing adoption of standardised packaging by other countries, and re-assess their stance. There are now even more reasons to pass and implement standardised packaging legislation without delay.The Australian government introduced standardised packaging primarily to protect young people from the devastating illnesses that reduce the length and quality of smokers lives. The legislation was designed to achieve this goal by reducing the attractiveness and appeal of tobacco products, increasing the salience and impact of health warnings, and reducing the ability of tobacco product packaging to mislead consumers about the harms of smoking. Then Health Minister Nicola Roxon stated, of course were targeting people who have not yet started, and thats the key to this plain packaging announcement to make sure we make it less attractive for people to experiment with tobacco in the first place .23 Data from Australia, which implemented standardised packaging from 1 December 2012, support predictions from experimental and exploratory studies and show standardised packaging is achieving the legislations objectives, consistent with researchers and public health groups expectations.1,12-16,21,24-35Evidence of detailed trends among young people will inevitably take time to emerge, but it is encouraging that the recent National Drug Strategy Household Survey (NDSHS) found, Younger people are delaying the take upof smoking and the age at which 14-24-year-olds smoked their first full cigarette increased from 15.4 in 2010 to 15.9 in 2013 .34 While age of initiation had been increasing for some time, the NDSHS evidence is consistent with predictions that standardised packaging would reduce the appeal of smoking. Studies conducted pre- and post-standardised packaging found smokers had significantly stronger cognitive, affective and aversive responses to on-pack warnings following standardised packagings implementation, while their perceptions of pack attractiveness and appeal all declined significantly.26 Their propensity to display packages in public settings, particularly those where children are present, also declined.11,16 Analyses of smokers thoughts of quitting as standardised packaging was implemented found these increased.12-15,25 Again, the mounting evidence from Australia corroborates predictions made using survey, qualitative and experimental data, and strengthens the case for urgent action to pass and implement standardised packaging legislation.It is also encouraging that adult smoking prevalence post-standardised packaging has fallen to the lowest level yet recorded. The 2013 NDSHS reported 12.8% of Australians aged 14 years and over were daily smokers, a decline of 2.3% percentage points from 2010; furthermore, smokers have reduced the average number of cigarettes they smoke per week from 111 cigarettes in 2010 to 96 in 2013.34 These figures are also consistent with researchers predictions and are further supported by other government data. For example, the Australian Bureau of Statistics showed total consumption of tobacco and cigarettes, as measured by estimated expenditure on tobacco, fell from $3.508 billion in the last quarter of 2012 to $3.405 billion in the first quarter of 2014, the lowest expenditure ever recorded.2 Commonwealth Treasury data showed similar results as tobacco clearances fell by 3.4% in 2013 relative to 2012.2The accumulating evidence contradicts dire predictions made by the tobacco industry and its allies that standardised packaging would result in adverse consequences, such as increased smuggling and illicit marketing of counterfeit cigarettes, or increased transaction times in stores.36 Industry claims have been comprehensively refuted by government agencies and peer-reviewed research.17,19,20,34,37 Ahead of the legislation, the Australian tobacco industry and its allies claimed through lobbying, media, and even advertising, that they would be entitled to billions of dollars in compensation. When this claim was tested in the High Court, the industry not only lost comprehensively, but was required to pay the governments costs. Furthermore, far from alienating smokers, support for standardised packaging among smokers almost doubled following the policys introduction.18Discrepancies between tobacco companies predictions and the actual effects we are now seeing should not be surprising, given the tobacco industrys long-standing reliance on spurious arguments and questionable practices to oppose proportionate policy measures. Robust analyses from the UK recently exposed how the tobacco industry has misrepresented standardised packaging and suggest the government should treat any evidence adduced by the industry with considerable scepticism.36,38Increasing adoption of standardised packaging by other countries4-6 suggests deferring progress on New Zealand legislation until international court cases have concluded is no longer a logical position for the government to hold. Deferring action risks leaving policy making captive to an industry that now has every incentive to delay these international legal proceedings for as long as possible.We have known for decades how the tobacco industry has used packaging to position smoking as glamorous, sophisticated and rebellious, particularly following restrictions on traditional mass media advertising.21,39,40 The industrys arguments that standardised packaging would have no effect are as hollow as its legal actions are desperate, and the time has surely come for the Government to acknowledge the strong research evidence, display the same initiative shown by some of its strongest allies, and take firm, decisive action that sees standardised packaging implemented as soon as possible.In summary, the Government has no need to fear standing alone or acting precipitously it neither is nor would be. However, it should be mindful of the risk New Zealand now faces: being left behind as other countries respond to the research evidence and show resolute leadership in the face of corporate bullies. We urge the Government to act on the real-world data that is rapidly amassing, take a principled and evidence-based stand, and pass and implement the standardised packaging legislation as quickly as possible. Doing so will reassert New Zealand as a leader in tobacco control, demonstrate a commitment to ending the smoking epidemic, and foster realisation of New Zealands world-leading goal of becoming smokefree by 2025.\r\n

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Janet Hoek, Professor of Marketing, Co-Director ASPIRE2025, University of Otago, Dunedin; Richard Edwards, Professor and HoD, Department of Public Health, Co-Director ASPIRE2025; Mike Daube AO, Professor of Health Policy, Curtin University, Western Australia, University of Otago, Wellington-

Acknowledgements

Correspondence

Janet Hoek, Professor of Marketing, Co-Director ASPIRE2025, University of Otago, Dunedin

Correspondence Email

janet.hoek@otago.ac.nz

Competing Interests

Dr. Hoek reports she has received funding for tobacco control research from the Health Research Council, Royal Society Marsden Fund, ASH NZ, NZ Ministry of Health, and the NZ Heart Foundation. Some of the studies funded examined plain packaging, but the findings reported in this viewpoint were not directly funded by any external grant. She is a member of the Australian Governments Expert Advisory group on plain packaging and have given expert advice on this topic to the NZ Ministry of Health and Health Promotion Agency. Professor Daube reports he was Deputy Chair of the Australian Governments National Preventative Health Taskforce and chaired the Tobacco Expert Committee that recommended plain packaging as part of a comprehensive approach.

'- Stead M, Moodie C, Angus K, Bauld L, McNeill A, Thomas J, et al. Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies. PloS one. 2013;8(10):e75919. World Health Organization. Statement of the World Health Organization in relation to the issue of standardized tobacco product packaging Geneva: World Health Organization; 2014 [cited 2014 17 November]. Available from: http://www.who.int/fctc/mediacentre/news/2014/WHOSTATEMENTWTOTBTNOV2014.pdf?ua=1. European Public Health Alliance. UK and Ireland pave the way for the adoption of Plain Packaging in the EU Belgium2015 [cited 2015 27 March]. Available from: http://www.epha.org/a/6313. Irish Times. Ireland leads EU on plain packaging of cigarettes: Irish Times; 2014 [cited 2014 17 November]. Available from: http://www.irishtimes.com/news/health/ireland-leads-eu-on-plain-packaging-of-cigarettes-1.1827268. BBC News. France to introduce plain cigarette packaging 2014 [cited 2014 17 November]. Available from: http://www.bbc.com/news/world-europe-29367253. Anonymous. Voil\u00e0 \u00e0 quoi ressemblera le paquet de cigarettes neutre Le Figaro. 2015 04 April 2015. Ryall T. Address to Waitemata Lecture Series Waitemata2014 [cited 2014 27 November]. Available from: http://innovation.health.nz/hon-tony-ryall-address-waitemata-lecture-series/. Hoek J, Healey B, Gendall P, R E, Jaine R. How do adolescents perceive plain packaging? New Zealand Medical Journal. 2013;126(1383). Hoek J, Gendall P, Maubach N, Edwards R. Strong public support for plain packaging of tobacco products. Australian and New Zealand Journal of Public Health. 2012;36(5):405-7. Rutherford H. Cigarette plain packaging closer DominionPost. 2014 12 February. Zacher M, Bayly M, Brennan E, Dono J, Miller C, Durkin S, et al. Personal pack display and active smoking at outdoor caf\u00e9 strips: assessing the impact of plain packaging 1\u2005year postimplementation. Tobacco Control. 2015;24(Suppl 2):ii94-ii7. White V, Williams T, Wakefield M. Has the introduction of plain packaging with larger graphic health warnings changed adolescents perceptions of cigarette packs and brands? Tobacco Control. 2015;24(Suppl 2):ii42-ii9. Wakefield M, Coomber K, Zacher M, Durkin S, Brennan E, Scollo M. Australian adult smokers responses to plain packaging with larger graphic health warnings 1\u2005year after implementation: results from a national cross-sectional tracking survey. Tobacco Control. 2015;24(Suppl 2):ii17-ii25. Durkin S, Brennan E, Coomber K, Zacher M, Scollo M, Wakefield M. Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers. Tobacco Control. 2015;24(Suppl 2):ii26-ii32. Brennan E, Durkin S, Coomber K, Zacher M, Scollo M, Wakefield M. Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers. Tobacco Control. 2015;24(Suppl 2):ii33-ii41. Zacher M, Bayly M, Brennan E, Dono J, Miller C, Durkin S, et al. Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor caf\u00e9 strips. Addiction. 2014. Wakefield M, Bayly M, Scollo M. Product retrieval time in small tobacco retail outlets before and after the Australian plain packaging policy: real-world study. Tobacco Control. 2014;23(1):70-6. Swift E, Borland R, Cummings K, Fong G, McNeill A, Hammond D, et al. Australian smokers support for plain or standardised packs before and after implementation: findings from the ITC Four Country Survey. Tobacco control. 2014:tobaccocontrol-2014-051880. Scollo M, Zacher M, Durkin S, Wakefield M. Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco. BMJ Open. 2014;4(8). Scollo M, Bayly M, Wakefield M. Availability of illicit tobacco in small retail outlets before and after the implementation of Australian plain packaging legislation. Tobacco Control. 2014. Hoek J, Gendall P, Gifford H, Pirikahu G, McCool J, Pene G, et al. Tobacco Branding, Plain Packaging, Pictorial Warnings, and Symbolic Consumption. Qualitative Health Research. 2012;22(5):630-9. Ministry of Health. Health effects of smoking Wellington: Ministry of Health; 2014 [cited 2014 17 November]. Available from: http://www.health.govt.nz/your-health/healthy-living/addictions/smoking/health-effects-smoking. Rudd K, Roxon N. Transcript of interview with prime minister and health minister Australia2011 [cited 2015 07 January]. Available from: http://pmtranscripts.dpmc.gov.au/preview.php?did=17256. British Heart Foundation. Standardised packaging of tobacco products: recent evidence from Australia and the United Kingdom. London: BHF, 2014 December 2014. Report No. Wakefield M, Hayes L, Durkin S, Borland R. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ open. 2013;3(7). Dunlop SM, Dobbins T, Young JM, Perez D, Currow DC. Impact of Australias introduction of tobacco plain packs on adult smokers pack-related perceptions and responses: results from a continuous tracking survey. BMJ open. 2014;4(12):e005836. Gendall P, Hoek J, Edwards R, McCool J. A cross-sectional analysis of how young adults perceive tobacco brands: implications for FCTC signatories. BMC public Health. 2012;12(1):796. Hoek J, Wong C, Gendall P, Louviere J, Cong K. Effects of dissuasive packaging on young adult smokers. Tobacco Control. 2011;20(3):183-8. Gendall P, Hoek J, Thomson G, Edwards R, Pene G, Gifford H, et al. Young adults interpretations of tobacco brands: implications for tobacco control. Nicotine Tob Res. 2011;13(10):911-8. Wakefield M, Germain D, Durkin S, Hammond D, Goldberg M, Borland R. Do larger pictorial health warnings diminish the need for plain packaging of cigarettes? Addiction. 2012;107(6):1159-67. Wakefield M. Welcome to cardboard country: How plain packaging could change the subjective experience of smoking. Tobacco control. 2011;20(5):321-2. Germain D, Wakefield M, Durkin S. Adolescents perceptions of cigarette brand image: does plain packaging make a difference? J Adolesc Health 2010;46:385-92. Wakefield M, Germain D, Durkin S. How does increasingly plainer cigarette packaging influence adult smokers perceptions about brand image? An experimental study. Tobacco Control. 2008;17(6):416-21. Australian Institute of Health and Welfare. Tobacco smoking (NDSHS 2013 key findings) Canberra: Australian Government; 2014 [cited 2014 30 October]. Available from: http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/tobacco/. The Department of Health. Tobacco key facts and figures 2014 [cited 2014 17 November]. Available from: http://health.gov.au/internet/main/publishing.nsf/Content/tobacco-kff. Ulucanlar S, Fooks GJ, Hatchard JL, Gilmore AB. Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardised Packaging. PLoS medicine. 2014;11(3):e1001629. Bayly M, Scollo M, Wakefield M. No lasting effects of plain packaging on cigarette pack retrieval time in small Australian retail outlets. Tobacco Control. 2014. Savell E, Gilmore AB, Fooks G. How does the tobacco industry attempt to influence marketing regulations? A systematic review. PloS one. 2014;9(2):e87389. Anderson SJ, Glantz SA, Ling PM. Emotions for sale: cigarette advertising and womens psychosocial needs. Tobacco Control. 2005;14(2):127-35. Ling PM, Glantz SA. Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence From Industry Documents. Am J Public Health. 2002;92(6):908-16.-

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A systematic review of international evidence suggests standardised (plain) packaging will decrease the appeal of smoking, increase the salience of on-pack warnings, and reduce misperceptions about the harms of smoking.1 Standardised packaging thus represents a vital measure governments should implement as part of a comprehensive approach, if they wish to end the smoking epidemic.The World Health Organization (WHO) has endorsed standardised packaging as a legitimate and effective tobacco control measure , which is fully in line with the spirit and intent of the outcome of the UN High-level Meeting, and \u2026 in accordance with international legal obligations under the WHO FCTC .2 The UK and Ireland have already passed legislation introducing standardised packaging,3,4 and other nations, including France and Norway, have announced plans to proceed with standardised packaging.3,5,6 Yet, despite this international momentum, and repeated statements from the previous Minister of Health that standardised packaging is inevitable ,7 progress in implementing this measure here has not kept pace with other countries.Given New Zealand was the first country to adopt a smokefree goal, it might also be expected to be at the vanguard of new tobacco control measures. However, although the Smoke-free Environments (Tobacco Plain Packaging) Amendment Bill, which passed its first reading on 11 February 2014 (118 votes to 1), was returned from the Health Select Committee on 5 August 2014, it still has no second reading date. Instead of moving quickly to pass this evidence-based legislation, which has strong and growing public support in New Zealand,8,9 the Government has stated its intention to await outcomes from two international legal cases against the Australian government.10 Unfortunately, this position effectively enables the tobacco industry to create further delays by attenuating resolution of these disputes.While a cautious stance may initially have seemed prudent, the growing evidence base, increasing international adoption of standardised packaging and promising research findings from Australia,11-20 all suggest it is timely for the Government to revisit its initial position and accelerate the progress of this important legislation. If tobacco companies dictate the pace of New Zealands legislative agenda, we will see continuation of a marketing strategy that tempts young people into experimenting with smoking21 and sees 13 New Zealanders die every day from illnesses caused directly by smoking.22 We call on the Government to recognise the encouraging evidence from Australia and growing adoption of standardised packaging by other countries, and re-assess their stance. There are now even more reasons to pass and implement standardised packaging legislation without delay.The Australian government introduced standardised packaging primarily to protect young people from the devastating illnesses that reduce the length and quality of smokers lives. The legislation was designed to achieve this goal by reducing the attractiveness and appeal of tobacco products, increasing the salience and impact of health warnings, and reducing the ability of tobacco product packaging to mislead consumers about the harms of smoking. Then Health Minister Nicola Roxon stated, of course were targeting people who have not yet started, and thats the key to this plain packaging announcement to make sure we make it less attractive for people to experiment with tobacco in the first place .23 Data from Australia, which implemented standardised packaging from 1 December 2012, support predictions from experimental and exploratory studies and show standardised packaging is achieving the legislations objectives, consistent with researchers and public health groups expectations.1,12-16,21,24-35Evidence of detailed trends among young people will inevitably take time to emerge, but it is encouraging that the recent National Drug Strategy Household Survey (NDSHS) found, Younger people are delaying the take upof smoking and the age at which 14-24-year-olds smoked their first full cigarette increased from 15.4 in 2010 to 15.9 in 2013 .34 While age of initiation had been increasing for some time, the NDSHS evidence is consistent with predictions that standardised packaging would reduce the appeal of smoking. Studies conducted pre- and post-standardised packaging found smokers had significantly stronger cognitive, affective and aversive responses to on-pack warnings following standardised packagings implementation, while their perceptions of pack attractiveness and appeal all declined significantly.26 Their propensity to display packages in public settings, particularly those where children are present, also declined.11,16 Analyses of smokers thoughts of quitting as standardised packaging was implemented found these increased.12-15,25 Again, the mounting evidence from Australia corroborates predictions made using survey, qualitative and experimental data, and strengthens the case for urgent action to pass and implement standardised packaging legislation.It is also encouraging that adult smoking prevalence post-standardised packaging has fallen to the lowest level yet recorded. The 2013 NDSHS reported 12.8% of Australians aged 14 years and over were daily smokers, a decline of 2.3% percentage points from 2010; furthermore, smokers have reduced the average number of cigarettes they smoke per week from 111 cigarettes in 2010 to 96 in 2013.34 These figures are also consistent with researchers predictions and are further supported by other government data. For example, the Australian Bureau of Statistics showed total consumption of tobacco and cigarettes, as measured by estimated expenditure on tobacco, fell from $3.508 billion in the last quarter of 2012 to $3.405 billion in the first quarter of 2014, the lowest expenditure ever recorded.2 Commonwealth Treasury data showed similar results as tobacco clearances fell by 3.4% in 2013 relative to 2012.2The accumulating evidence contradicts dire predictions made by the tobacco industry and its allies that standardised packaging would result in adverse consequences, such as increased smuggling and illicit marketing of counterfeit cigarettes, or increased transaction times in stores.36 Industry claims have been comprehensively refuted by government agencies and peer-reviewed research.17,19,20,34,37 Ahead of the legislation, the Australian tobacco industry and its allies claimed through lobbying, media, and even advertising, that they would be entitled to billions of dollars in compensation. When this claim was tested in the High Court, the industry not only lost comprehensively, but was required to pay the governments costs. Furthermore, far from alienating smokers, support for standardised packaging among smokers almost doubled following the policys introduction.18Discrepancies between tobacco companies predictions and the actual effects we are now seeing should not be surprising, given the tobacco industrys long-standing reliance on spurious arguments and questionable practices to oppose proportionate policy measures. Robust analyses from the UK recently exposed how the tobacco industry has misrepresented standardised packaging and suggest the government should treat any evidence adduced by the industry with considerable scepticism.36,38Increasing adoption of standardised packaging by other countries4-6 suggests deferring progress on New Zealand legislation until international court cases have concluded is no longer a logical position for the government to hold. Deferring action risks leaving policy making captive to an industry that now has every incentive to delay these international legal proceedings for as long as possible.We have known for decades how the tobacco industry has used packaging to position smoking as glamorous, sophisticated and rebellious, particularly following restrictions on traditional mass media advertising.21,39,40 The industrys arguments that standardised packaging would have no effect are as hollow as its legal actions are desperate, and the time has surely come for the Government to acknowledge the strong research evidence, display the same initiative shown by some of its strongest allies, and take firm, decisive action that sees standardised packaging implemented as soon as possible.In summary, the Government has no need to fear standing alone or acting precipitously it neither is nor would be. However, it should be mindful of the risk New Zealand now faces: being left behind as other countries respond to the research evidence and show resolute leadership in the face of corporate bullies. We urge the Government to act on the real-world data that is rapidly amassing, take a principled and evidence-based stand, and pass and implement the standardised packaging legislation as quickly as possible. Doing so will reassert New Zealand as a leader in tobacco control, demonstrate a commitment to ending the smoking epidemic, and foster realisation of New Zealands world-leading goal of becoming smokefree by 2025.\r\n

Summary

Abstract

Aim

Method

Results

Conclusion

Author Information

- Janet Hoek, Professor of Marketing, Co-Director ASPIRE2025, University of Otago, Dunedin; Richard Edwards, Professor and HoD, Department of Public Health, Co-Director ASPIRE2025; Mike Daube AO, Professor of Health Policy, Curtin University, Western Australia, University of Otago, Wellington-

Acknowledgements

Correspondence

Janet Hoek, Professor of Marketing, Co-Director ASPIRE2025, University of Otago, Dunedin

Correspondence Email

janet.hoek@otago.ac.nz

Competing Interests

Dr. Hoek reports she has received funding for tobacco control research from the Health Research Council, Royal Society Marsden Fund, ASH NZ, NZ Ministry of Health, and the NZ Heart Foundation. Some of the studies funded examined plain packaging, but the findings reported in this viewpoint were not directly funded by any external grant. She is a member of the Australian Governments Expert Advisory group on plain packaging and have given expert advice on this topic to the NZ Ministry of Health and Health Promotion Agency. Professor Daube reports he was Deputy Chair of the Australian Governments National Preventative Health Taskforce and chaired the Tobacco Expert Committee that recommended plain packaging as part of a comprehensive approach.

'- Stead M, Moodie C, Angus K, Bauld L, McNeill A, Thomas J, et al. Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies. PloS one. 2013;8(10):e75919. World Health Organization. Statement of the World Health Organization in relation to the issue of standardized tobacco product packaging Geneva: World Health Organization; 2014 [cited 2014 17 November]. Available from: http://www.who.int/fctc/mediacentre/news/2014/WHOSTATEMENTWTOTBTNOV2014.pdf?ua=1. European Public Health Alliance. UK and Ireland pave the way for the adoption of Plain Packaging in the EU Belgium2015 [cited 2015 27 March]. Available from: http://www.epha.org/a/6313. Irish Times. Ireland leads EU on plain packaging of cigarettes: Irish Times; 2014 [cited 2014 17 November]. Available from: http://www.irishtimes.com/news/health/ireland-leads-eu-on-plain-packaging-of-cigarettes-1.1827268. BBC News. France to introduce plain cigarette packaging 2014 [cited 2014 17 November]. Available from: http://www.bbc.com/news/world-europe-29367253. Anonymous. Voil\u00e0 \u00e0 quoi ressemblera le paquet de cigarettes neutre Le Figaro. 2015 04 April 2015. Ryall T. Address to Waitemata Lecture Series Waitemata2014 [cited 2014 27 November]. Available from: http://innovation.health.nz/hon-tony-ryall-address-waitemata-lecture-series/. Hoek J, Healey B, Gendall P, R E, Jaine R. How do adolescents perceive plain packaging? New Zealand Medical Journal. 2013;126(1383). Hoek J, Gendall P, Maubach N, Edwards R. Strong public support for plain packaging of tobacco products. Australian and New Zealand Journal of Public Health. 2012;36(5):405-7. Rutherford H. Cigarette plain packaging closer DominionPost. 2014 12 February. Zacher M, Bayly M, Brennan E, Dono J, Miller C, Durkin S, et al. Personal pack display and active smoking at outdoor caf\u00e9 strips: assessing the impact of plain packaging 1\u2005year postimplementation. Tobacco Control. 2015;24(Suppl 2):ii94-ii7. White V, Williams T, Wakefield M. Has the introduction of plain packaging with larger graphic health warnings changed adolescents perceptions of cigarette packs and brands? Tobacco Control. 2015;24(Suppl 2):ii42-ii9. Wakefield M, Coomber K, Zacher M, Durkin S, Brennan E, Scollo M. Australian adult smokers responses to plain packaging with larger graphic health warnings 1\u2005year after implementation: results from a national cross-sectional tracking survey. Tobacco Control. 2015;24(Suppl 2):ii17-ii25. Durkin S, Brennan E, Coomber K, Zacher M, Scollo M, Wakefield M. Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers. Tobacco Control. 2015;24(Suppl 2):ii26-ii32. Brennan E, Durkin S, Coomber K, Zacher M, Scollo M, Wakefield M. Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers. Tobacco Control. 2015;24(Suppl 2):ii33-ii41. Zacher M, Bayly M, Brennan E, Dono J, Miller C, Durkin S, et al. Personal tobacco pack display before and after the introduction of plain packaging with larger pictorial health warnings in Australia: an observational study of outdoor caf\u00e9 strips. Addiction. 2014. Wakefield M, Bayly M, Scollo M. Product retrieval time in small tobacco retail outlets before and after the Australian plain packaging policy: real-world study. Tobacco Control. 2014;23(1):70-6. Swift E, Borland R, Cummings K, Fong G, McNeill A, Hammond D, et al. Australian smokers support for plain or standardised packs before and after implementation: findings from the ITC Four Country Survey. Tobacco control. 2014:tobaccocontrol-2014-051880. Scollo M, Zacher M, Durkin S, Wakefield M. Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco. BMJ Open. 2014;4(8). Scollo M, Bayly M, Wakefield M. Availability of illicit tobacco in small retail outlets before and after the implementation of Australian plain packaging legislation. Tobacco Control. 2014. Hoek J, Gendall P, Gifford H, Pirikahu G, McCool J, Pene G, et al. Tobacco Branding, Plain Packaging, Pictorial Warnings, and Symbolic Consumption. Qualitative Health Research. 2012;22(5):630-9. Ministry of Health. Health effects of smoking Wellington: Ministry of Health; 2014 [cited 2014 17 November]. Available from: http://www.health.govt.nz/your-health/healthy-living/addictions/smoking/health-effects-smoking. Rudd K, Roxon N. Transcript of interview with prime minister and health minister Australia2011 [cited 2015 07 January]. Available from: http://pmtranscripts.dpmc.gov.au/preview.php?did=17256. British Heart Foundation. Standardised packaging of tobacco products: recent evidence from Australia and the United Kingdom. London: BHF, 2014 December 2014. Report No. Wakefield M, Hayes L, Durkin S, Borland R. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ open. 2013;3(7). Dunlop SM, Dobbins T, Young JM, Perez D, Currow DC. Impact of Australias introduction of tobacco plain packs on adult smokers pack-related perceptions and responses: results from a continuous tracking survey. BMJ open. 2014;4(12):e005836. Gendall P, Hoek J, Edwards R, McCool J. A cross-sectional analysis of how young adults perceive tobacco brands: implications for FCTC signatories. BMC public Health. 2012;12(1):796. Hoek J, Wong C, Gendall P, Louviere J, Cong K. Effects of dissuasive packaging on young adult smokers. Tobacco Control. 2011;20(3):183-8. Gendall P, Hoek J, Thomson G, Edwards R, Pene G, Gifford H, et al. Young adults interpretations of tobacco brands: implications for tobacco control. Nicotine Tob Res. 2011;13(10):911-8. Wakefield M, Germain D, Durkin S, Hammond D, Goldberg M, Borland R. Do larger pictorial health warnings diminish the need for plain packaging of cigarettes? Addiction. 2012;107(6):1159-67. Wakefield M. Welcome to cardboard country: How plain packaging could change the subjective experience of smoking. Tobacco control. 2011;20(5):321-2. Germain D, Wakefield M, Durkin S. Adolescents perceptions of cigarette brand image: does plain packaging make a difference? J Adolesc Health 2010;46:385-92. Wakefield M, Germain D, Durkin S. How does increasingly plainer cigarette packaging influence adult smokers perceptions about brand image? An experimental study. Tobacco Control. 2008;17(6):416-21. Australian Institute of Health and Welfare. Tobacco smoking (NDSHS 2013 key findings) Canberra: Australian Government; 2014 [cited 2014 30 October]. Available from: http://www.aihw.gov.au/alcohol-and-other-drugs/ndshs/2013/tobacco/. The Department of Health. Tobacco key facts and figures 2014 [cited 2014 17 November]. Available from: http://health.gov.au/internet/main/publishing.nsf/Content/tobacco-kff. Ulucanlar S, Fooks GJ, Hatchard JL, Gilmore AB. Representation and Misrepresentation of Scientific Evidence in Contemporary Tobacco Regulation: A Review of Tobacco Industry Submissions to the UK Government Consultation on Standardised Packaging. PLoS medicine. 2014;11(3):e1001629. Bayly M, Scollo M, Wakefield M. No lasting effects of plain packaging on cigarette pack retrieval time in small Australian retail outlets. Tobacco Control. 2014. Savell E, Gilmore AB, Fooks G. How does the tobacco industry attempt to influence marketing regulations? A systematic review. PloS one. 2014;9(2):e87389. Anderson SJ, Glantz SA, Ling PM. Emotions for sale: cigarette advertising and womens psychosocial needs. Tobacco Control. 2005;14(2):127-35. Ling PM, Glantz SA. Why and How the Tobacco Industry Sells Cigarettes to Young Adults: Evidence From Industry Documents. Am J Public Health. 2002;92(6):908-16.-

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