1. The proportion of smokers who supported plain packaging increased significantly after implementation of a law requiring standardized plain packaging.
2. Support for a plain packaging law was associated with a belief in the harmful health effects of smoking, a stronger desire to quit, and lower nicotine dependence.
Evidence Rating Level: 2 (Good)
Study Rundown: In 2012, Australia became the first country to pass legislation requiring plain packaging of tobacco products. Specifically, the law requires tobacco products to have plain packaging with no branding (e.g. name in a standardized font) and to be covered in large graphic warning labels (e.g. picture of smoker dying from cancer). The researchers aimed to study how smokers’ attitudes towards this law changed from before to after implementation, and whether their support was associated with quitting activity. Although initially many smokers opposed the legislation, after implementation more smokers supported the law than were opposed to it. Furthermore, smokers’ who supported the law either before or after implementation were more likely to agree with harmful health effects of smoking, express a stronger desire to quit or have tried recently quitting, and have lower nicotine dependence.
This study benefits from using a validated nationally representative cohort of smokers in Australia. However, like any prospective study, a limitation is that the association found between support for legislation and desire to quit cannot be conclusively defined as causal (i.e. those who are willing to quit are more likely to support the law). Hence, it is unknown whether the implementation of the law actually led to increased quitting behavior. Overall, the study contributes to the literature by finding that a plain packaging law, although initially unpopular, gathered more support among smokers after implementation, and may serve as an effective public health intervention to reduce smoking.
Relevant Reading: Strong public support for plain packaging of tobacco products
In-Depth [ prospective cohort]: The study analyzed Australian-specific data from a longitudinal multinational study with a nationally representative cohort of current smokers recruited through random digit dialing. Between 2007-2013, the survey assessed attitudes and behaviors of approximately 1,000 smokers, specifically at four different time points prior to implementation and once after implementation. There was a significant change in the proportion of smokers who supported the legislation (28% before versus 49% after). A multivariate analysis showed that several variables were associated with support for plain packaging, including a stronger belief in the risk of a future smoking-related harm, greater desire to quit, and lower nicotine dependence. A history of smoking-related harm and overall health status were not associated with support for plain packaging. Smokers’ who reported they were supportive of plain packaging were more likely to have plans to quit (OR 1.78, CI95% 1.28-2.20) or have tried quitting in the past 6 months (OR 1.51, CI95% 1.01-2.11).
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