-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
1/37
Plainpackagingoftobaccoproducts:areviewoftheevidence
Proposed design of plain cigarette packaging.
Source: Commonwealth of Australia (2010). Public consultation on plain packaging of tobacco products.
PreparedbyQuitVictoria,CancerCouncilVictoria,May2011
1
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
2/37
TableofContents1. .........................................................................................................................3Executivesummary
2. ....................................................................................................................................5Introduction
3. ......................................................................................................6Packaginginthemarketingmix
4. ..............................................................................................8Recenttrendsincigarettepackaging
5. ................................................................11Resultsofresearchintotheeffectsofplainpackaging
5.1Historyofinternationalresearchonplainpackaging.................................................................11
5.2Summaryofresultsofresearchbytheme..................................................................................13
5.2.1Effectsofplainpackagingoneffectivenessofhealthwarnings ..........................................13
5.2.2Effectsofplainpackagingonperceptionsofharmfulness .................................................. 13
5.2.3Effectsofplainpackagingonappealofproduct..................................................................13
5.2.4Combinedeffectofplainpackagingandhealthwarnings...................................................15
6. ..................................................................16Expertresponsestotheproposalforplainpackaging
6.1Healthsectorresponsetoproposedlegislation .........................................................................16
6.2Financialmarketresponse .......................................................................................................... 16
6.3Tobaccoindustryresponse ......................................................................................................... 17
7. ....................................19Researchrelevanttomajorindustryargumentsagainstplainpackaging
7.1Wontwork .................................................................................................................................19
7.2Willbedifficultforretailers ........................................................................................................21
7.3Representsanacquisitionofintellectualproperty.....................................................................21
7.4Hasbeenconsideredandtheideaabandonedinothercountries.............................................22
7.5Willreducepriceandcompetitioninthetobaccomarket.........................................................23
7.6Willfacilitateillicittrade .............................................................................................................24
References ............................................................................................................................................28
2
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
3/37
1. Executive summary
Thispaperpresentsthefindingsofresearchovertwodecadesandacrossfivecountriesonthetopic
ofplainpackaging.Itincludestheresultsof24publishedexperimentalstudieswhichhaveexamined
thelikelyimpactofplainpackagingonyoungpeopleandcurrentsmokers(Section5)i.Italso
summarisestheresultsofresearchpapersthatanalyseindustryargumentsaboutbarriersto
legislationresultingfrominternationallawandtradeagreements(Section7).
Themainfindingsfromthiscompilationofliteratureareasfollows:
Inaworldwideenvironmentofincreasingprohibitionoftobaccoadvertisingandsponsorship,
thecigarettepackhasbecomethekeymarketingtoolemployedbythetobaccoindustryto
attractandretaincustomers.(Section3)
Thetobaccoindustryusescigarettepacktechnologiesandinnovationsindesigntocommunicate
particularattributesabouteachbrandandbyextensionthepersonalityandsocialstatusofits
users.(Section4)
Currentpackcoloursandimagerycandilutetheimpactofgraphichealthwarnings.(Section
5.2.1)
Unregulatedpackagecolouringandimagerycontributetoconsumersmisperceptionsthat
certainbrandsaresaferthanothers.Removingcoloursfromcigarettepacksandmisleading
termssuchassmooth,goldandsilverwouldreducefalsebeliefsabouttheharmfulnessof
cigarettes.(Section5.2.2)
Adultsandadolescentsperceivecigarettesinplainpackstobelessappealing,lesspalatable,less
satisfyingandoflowerqualitycomparedtocigarettesincurrentpackaging.Plainpackaging
wouldalsoaffectyoungpeoplesperceptionsaboutthecharacteristicsandstatusofthepeople
whosmokeparticularbrands.(Section5.2.3)
Plainpackagingfeaturinglargergraphichealthwarnings(75%frontofpack)willbothreducethe
appealofthepackandstrengthentheimpactofthewarnings.(Section5.2.4)
BritishAmericanTobaccohasclaimedthatthelegislationwillnotbeeffective,pointingtothe
resultsofaninternationalanalysisithascommissioned(andprovideddatafor)ontheimpactof
healthwarningsonsales.Healthwarningshaveadifferentobjectivetoplainpackagingand
monthlyvariationsinsalesdataarenotanappropriateindicatorofeffectiveness.Inanycasethe
dataonwhichthisanalysisisbasedishighlyselectiveandthespecificationsofthemodelling
incorrectinatleastoneimportantrespect.(Section7.1).
TheAllianceofAustralianRetailersallegesthatplainpackagingwoulddamageretailerbusiness,
increasingtransactiontimeatthecounterduetodifficultiesindifferentiatingbetweenbrands.
TheAARsuggeststhatasaresult,customerswouldswitchtodiscountoutlets.However,anyloss
ofconvenienceatretailoutletswillapplyequallytodiscountandconvenienceoutlets.Measures
includinglabellingofthecontainerswherepacksarestoredandbrandnamesprintedonpacks
inaclearfontstyleandsizewouldassistretailerstoquicklyindentifyandretrieveparticular
brands.(Section6.3and7.2)
Thetobaccoindustryclaimsplainpackagingrepresentsanacquisitionofintellectualproperty
andassuchisprohibitedunderthetermsofvariousinternationaltradeagreements.The
industryhassuggestedtheAustralianGovernmentwouldbeforcedtocompensatetheindustry
iV319.05.11.Weintendtoaddtothisreviewresultsofseveralmorestudiesthatweareinformedarecloseto
publication.
3
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
4/37
inbillionsofdollars.Papersbyexpertsinconstitutionalandtrademarklawontheotherhand
suggestthatinternationalagreementspermitgovernmentstorestrictuseoftrademarksto
protectpublichealth.Theyadvisethatplainpackagingwillnotbeanacquisitionofintellectual
property,astheGovernmentdoesnotintendtousethelogosorbrandimagery;itwillsimplybe
restrictingtheuseofthesemarketingtoolsoncigarettepackages.IfCourtsweretorulethat
restrictionofuseoftrademarkswasanacquisitionofproperty,thenthelegislationhasbeendraftedtoallowtheuseoftrademarkswithlimitations.(Section7.3)
PlainpackaginghasbeencarefullyconsideredandresearchedinAustraliaandoverseasforsome
20years,butcontrarytoclaimsbytobaccocompaniesithasnotbeenabandonedasapolicy
option.ThepaperprovideslinkstostatementsbyparliamentariansinNewZealand,France,the
UnitedKingdomandtheEuropeanUnion,whicharealleitherundertakingpublicconsultationon
plainpackagingorhavenamedplainpackagingamongproposalsforfuturetobaccocontrol
strategies.(Section7.4)
Companieshaveclaimedthatthelegislationwillreducepriceandcompetitioninthemarket.
Opinionsofindustryanalystsaboutthelikelyeffectsoncompetitionaremixed.Aspointedout
by
Deloitte
MCS,
future
governments
have
open
to
them
the
option
of
further
increasing
excise
andcustomsdutyontobaccoproductsshouldaveragepricesoftobaccoproductsfall.(Section
7.5)
Tobaccoindustryclaimsthatplainpackagingwillincreaseillicittradeareexaggeratedand
misleading.TheindustrysestimationofthecurrentsizeoftheillicitmarketinAustralia(15.9%)
isbasedononeverysmallsurvey(949people)withaverylowresponserate.TheGovernments
NationalDrugStrategyHouseholdSurveyofmorethan23,000peoplesuggeststhatonlyabout
0.2%ofAustralians(1.2%ofsmokers)useunbrandedtobaccoproductshalfthetimeormore.
TheAustralianGovernmentsdraftplainpackaginglegislationspecifiesthatanticounterfeiting
markingswillbepermittedonplainpackaging,andtheAustralianTaxationOfficeandthe
AustralianCustomsandBorderProtectionServiceshouldandnodoubtwillcontinueto
vigorouslypursuetechnologiesandothersurveillanceandenforcementstrategiestopreventtheevasionofexciseandcustomsdutyinthiscountry.(Section7.6)
Insummarytherearestronggroundsforbelievingthatcurrentpackagingglamourisessmokingand
thattobaccoproductspackagedinastandardisedcolour,typefaceandformwould:
improvetheeffectivenessofhealthwarnings
reducemisconceptionsaboutrelativeharmfulnessofvariousbrandsand
reducetheoverallappealofsmoking
Theintensityofoppositiontoplainpackaginglegislationbytobaccocompaniessuggeststhat
tobaccoindustryexecutivesbelievethatsuchmeasureswillreducesalesandcompanyprofits.
4
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
5/37
2. Introduction
Tobaccoproductsareuniqueamongconsumeritemsinthattheycausetheprematuredeathof
everysecondlongtermuser.Whileitisimpracticaltobanthepurchaseofaproductthatsomany
peoplefindsodifficulttoquit,governmentstheworldoverhaveacceptedthatitisunethicalto
encourageuseoftobaccoandappropriatetolegislatetopreventallformsofitspromotion.Despite
theeffortsofgovernmentstocomprehensivelydiscouragesmoking,innovationinpackaginghas
resultedincontinuingpromotionoftobaccoproducts.
Onthe29thApril2010theAustralianGovernmentannounced[1]twoofitsmajorresponsestothe
recommendations[2]ofitsPreventativeHealthTaskforce[3]whichhadsetoutacomprehensive
packageofmeasurestomakeAustraliathehealthiestcountrybytheyear2020.Aproposalto
mandateplainpackagingforalltobaccoproductssoldinAustraliawasthecentrepieceofthe
Governmentsresponse.PlainpackagingrecognisesAustraliascommitmentasasignatorytothe
WorldHealthOrganizationFrameworkConventiononTobaccoControl[4]andhasbeenwidely
applaudedbyhealthagenciesbothinAustraliaandinternationally.Ithasalsobeenvigorously
opposedbythetobaccoindustrywhichhascommissionedanumberofreportsthatsetoutitsobjectionstotheproposal.
Thispapercompilesandwhereverpossibleprovideselectroniclinkstomorethan130publications
relevanttothetopicofplainpackaging.Itbrieflysummarisesdiscussionofpackaginginthe
marketingliterature(Section3)anddocumentsnumerousexamplesofincreasingreliancebythe
tobaccoindustryonpackagingasamarketingtool(Section4).Thesearedrawnbothfromtrade
pressandfrominternalcompanydocumentsreleasedaspartofsettlementoflegalactionbetween
tobaccocompaniesandattorneysgeneralintheUnitedStatesunderthetermsofwhichallcompany
documentsbothhistoricalandcontemporary,bothintheUSandinoverseassubsidiariesare
releasedonacontinuingbasis.iiItsummarisesthefindingsof24publishedstudiesconductedto
carefullyandsystematicallytestandquantifythelikelyimpactofplainpackaging(Section5).It
recordsthereactionsofvariousexpertgroupstotheAustralianGovernmentsannouncementabout
plainpackaging(Section6).Finallyitdescribesresearchrelevanttosomeofthemajorarguments
againstplainpackaging,providinglinkstosubmissionsbytobaccocompaniesandothersopposing
suchlegislationaswellasresearchpapersthatanalyseindustryargumentsaboutvarious
unintendedconsequencesitenvisagesforretailersandgovernment(Section7).
ii Thesehavebeencomprehensively cataloguedbyseveralUSuniversitiesandareeasilysearchableonline.See
Hhttp://legacy.library.ucsf.edu/H
5
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
6/37
3. Packaging in the marketing mix
Packagingact(s)asapromotionaltoolinitsownright.
PalmerA.Theproduct.InPalmer,AJ,eds,In:Principlesofmarketing.2000
(p215).[5]Theproductpackageisthecommunicationlifebloodofthefirmorthesilentsalesman
thatreachesouttocustomers.
UnderwoodandOzanne(p208).[6]
ifyousmoke,acigarettepackisoneofthefewthingsyouuseregularlythatmakesa
statementaboutyou.Acigarettepackistheonlythingyoutakeoutofyourpocket20times
adayandlayoutforeveryonetosee.Thatsalotdifferentthanbuyingyoursoappowderin
genericpackaging.
BrownandWilliamsonemployee(p5).[7]
TheconceptofamixofmarketingfunctionswasconceivedbyProfessorNeilBordenoftheHarvard
BusinessSchool.PerhapsthebestknowndefinitionofthismixisthatproposedbyMcCarthywho
talkedofthefourPsofmarketing.[8]Packagingdifferentiatesbrands,beingparticularlyimportantin
homogenousconsumerproductssuchascigarettes.[9]iiiColoursandtypefacehavelongbeenknown
toelicitparticularresponsesinconsumers,oftenshapedbystrongsocialandculturalforces.
Imageryandsymbolsalsoexertpowerfuleffects,linkingdesirableattributeswithparticularbrands.
Theworldsmostpopularcigarettebrand,Marlboro,[10]canreadilybeidentifiedthroughitsiconic
redchevron.Sociologically,asymbolactsasastimuluselicitingaparticularresponsebasedon
peoplesunderstandingofmeaning.TheheraldiccoatsofarmsonBensonandHedgespacksfor
instanceisanabstractwordlesssymbolthatimpartsnotionsofstatusandattestedquality.[11]
Withtheincreasingprevalenceoftobaccoadvertisingandsponsorshipbansthroughouttheworld,
thepackhasfastbecomethemostimportantpromotionalvehicleforreachingpotentialandcurrentsmokers.[12][13][14][15][16][17][18]
TheGovernmentofNorwayintroducedwhatwastheworldsmostcomprehensivebanon
advertisingin1975,andyetaqualitativestudyconductedin2003ofyoungadultNorwegian
smokersaged1823(bornfivetotenyearsafterthebancameintoplace)highlightshowthe
tobaccoindustrycontinuestomarkettothisdemographicthroughpersuasivecigarettepackdesign.
Thestudyshowedhowcigarettebrandsandcigarettepackagedesignsgavemeaningtopersonal
characteristics,tosocialidentityandtopositionsinhierarchiesofstatus.Intheyoungsmokers
accounts,brandsappearedtoaddanextradimensiontothesocialmeaningofsmokingintheirdaily
life.[19]
Morerecently
several
nations
have
banned
the
open
display
of
tobacco
products
in
retail
locations.
Thesejurisdictionshavereasoned:
Powerwallsandcountertopdisplaysarehighlyvisibleandeyecatching.Theypresentan
unavoidableandunfortunatespillofpromotionalimageryandproductremindersto
vulnerableconsumersincludingyoungpeople,formersmokersandsmokersofallages
whoaretryingtoquit(p8).[20]
iiiPortionsofthismaterialaredrawnfrom:FreemanB,ChapmanSandRimmerM.Review:thecaseforthe
plainpackagingoftobaccoproducts.Addiction2008;103:58090. Availablefrom
Hhttp://tobacco.health.usyd.edu.au/assets/pdfs/tobaccorelatedpapers/Addiction_generic.pdfH
6
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
7/37
Withremovalofpointofsaleasanopportunityforpromotion,BritishAmericanTobaccoandPhilip
Morris[21]havepredictedthat,inthefuture,packdesignalonewilldrivebrandimagery.[22] Unless
governmentsimposefurtherrestrictionsonpackaging,bansontheretaildisplayoftobaccowill
encourageafurthershiftinindustryinvestmenttowardsinnovativepackdesign,withthepack
functioningastheonlyremainingvehicleforproductpromotion.
Uniqueamongindustries,thetobaccoindustryhaslongclaimedthatithasnointerestinattracting
newcustomers(i.e.nonsmokers)butisinterestedonlyinstimulatingbrandswitchingandin
maintainingbrandloyaltyincurrentcustomers.[23]Howeverinternalindustrydocumentscandidly
acknowledgethevitalimportanceofattractingnew(predominantlyyoung)smokers.[22][24][25]
[26][27][28]Thesedocumentsconfirmthatcompanieshaveinvestedheavilyinpackdesigninorder
tocommunicatespecificmessagestospecificdemographicgroupsincludingyoungpeople.[18][22]
Intheearly1990sapresenteraddressingmarketingstaffatPhilipMorrisremarkedthatsmokers:
arereadyforchangeandonceexposedtoinnovative{packaging}especiallyyoungadults
seetheircurrentpackagingasdatedandboring(p2).[29]
Thepresenterwentontoencourage
Packsaimedatyoungerwomenshouldbeslick,sleek,flashy,glittery,shiny,silky,
bold(p9).[29]
Packdesigndoesntjustcommunicatethepersonalityofacigarettebrandtothesmoker...italso
allowssmokerstoprojectthesecharacteristicstootherswhentheyhandleanddisplaythepackage
throughouttheirdailyroutines.[18]Justasdesignerclothing,accessoriesandcarsserveassocialcues
tostyle,status,valuesandcharacter,sotoocancigarettepackssignifyarangeofattributesabout
users.Asbadgeproducts,cigarettescanreinforcethecharacteristicsconjuredbybrandimage.[18]
[7][30][31][32][33] Thisbehaviournotonlyaffectsthesingleconsumerbutalsoexertsapowerful
effectontheirfriends,associatesandevencasualcontacts.Consumertheoryandresearchhas
demonstratedthatincidentalbrandencounters(ICBEs)powerfullyaffectbuyingpatternsinwaysin
whichtheconsumerisnotfullyaware.AseriesoffourstudiesbyFerraro,BettmandandChartrandpublishedintheJournalforConsumerResearchin2008forinstancefoundthatrepeatedexposureto
simulatedICBEs:
increaseschoiceofthefocalbrandamongpeoplenotawareofthebrandexposure,that
perceptualfluencyunderliestheseeffectsandtheseeffectsaremoderatedbyperceivers
automaticresponsestothetypeofuserobservedwiththebrand.(p729).[34]
7
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
8/37
4. Recent trends in cigarette packaging
Intheearly1900sbeforetheadventoftelevisionandradio,collectablecigarettecardswereamajor
formofinpackpromotion.[35] Restrictionsonadvertisingoftobaccothroughthemassmediahave
promptedmanufacturerstoacontemporaryreturntothepackageastheprimarysourceof
promotion.
Ifyourbrandcannolongershoutfrombillboards,letalonefromthecinemascreenorthe
pagesofaglossymagazineitcanatleastcourtsmokersfromtheretailersshelf,orfrom
whereveritisplacedbythosealreadywedtoit.(p17)[13]
Manyarticlesinthetobaccoindustrytrademagazine,WorldTobacco, inrecenttimeshaveurged
manufacturerstousepackagingasanadvertisingtool[36][37][38][14][15][16][17] andadvances
inprintingtechnologyhaveenabledmanufacturerstotakepromotionthroughpackagingtoawhole
newlevel.Recentdevelopmentsincludeprintingofonpackimageryontheinnerframecard,[39]
outerfilmandteartape,[14]andtheincorporationofholograms,collectableart,metallic
finishes,[40]multifoldstickers,[16]photographs,andretroimagesinpackdesign.[41][42][43]
Withtheuptakeofprintedinnerframecardswhatwewillincreasinglyseeisthepackbeing
viewedasatotalopportunityforcommunicationsfromprintedouterfilmandteartape
throughtotheinnerframeandinnerbundle.Eachpackcomponentwillprovidean
integratedfunctionaspartofacarefullyplannedbrandorinformationcommunications
campaign(p37).[39]
Innovationsincigarettepackagingincludenotjustembellishmentstothepack,butalsothe
incorporationofdesignfeaturesoncigarettesthemselves.
Figure 1 A cigarette printed with the colours of the Dutch soccer team
Source: Raf de Ryck (private collection)
ExamplesofinnovationinpackaginginAustraliaincludethefollowing:
During200002aseriesofsubtlechangestocigarettepacksandtrademarkswere
observedonbothBenson&HedgesandWinfieldcigarettepacks.[44] Whenresearchers
calledthecompanytoenquireaboutthechanges,anemployeesaidtheywereplaying
withthelogobecausewecantdoanyadvertisinganymore(p154).[44]
InFebruary2006,onemonthpriortotheadoptionofpicturebasedwarningson
tobaccopackages,PeterStuyvesantcigaretteswerebeingsoldintrendyretrostyletins
which,unlikesoftpacketsofcigaretteswithonpackprintedwarnings,hadhealth
warningstickersthatwereeasilypeeledoff(p151)[45](Figures2and3).Retailers
reportedthatthetinswereverypopularwithyoungersmokers.
8
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
9/37
Figure 2 Peter Stuyvesantcigarettes packed in a tin container with a removable warningSource: Quit Victoria
Figure 3 Another Peter Stuyvesant tin
Source: Quit Victoria
BritishAmericanTobaccoAustralia(BATA)introducedsplitDunhillpacksinOctober
2006.[46]Thepackcouldbesplitalongaperforatedlinetocreatetwominipacks,
easilysharedbetweentwosmokersperhapsunabletoaffordafullpack(Figure4).
Oncesplit,oneofthetwopacksdidnotbearthemandatorygraphichealth
warning.[47]iv
ivBATAremovedthepacketsfromthemarketwhenitwasfoundtobeinbreachoftobaccoproductlabelling
laws.
9
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
10/37
Figure 4 Split package of Dunhill cigarettes
Source: Quit Victoria
Whenthedescriptivetermslightandmildwereprohibited,andcigarettetar
yieldswerescheduledtobereplacedwithqualitativeinformationaboutharmful
constituents,theindustryrespondedbydevelopingcolourcodedpackageswith
newterms:NowyourHorizoncustomerscangettheirfavouritebrandinanexciting
newlookpack.Withnewdescriptorsandclearernumbersallourpacksaremuch
easiertoidentify.Researchprovesthatyourcustomerswillfindthenewpackmore
appealingandaloteasiertorecognize(p214).[48]
Legislationmandatingplainpackagingthatcoveredallaspectsofthedesignofsticksandeverypart
ofthepack(includinginserts,cardboardandcellophanewrap)wouldeffectivelystandardisethe
appearanceofallbrandsoftobaccoproducts,greatlyreducingthestatussignallingroleandappeal
ofcigarettes.[49]
Figure 5 An example of cigarettes in proposed plain packaging as proposed by health groups in 2010
Source: VicHealth Centre for Tobacco Control
10
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
11/37
5. Results of research into the effects of plain packaging
Asplainpackshaveneverbeenlegislated,evidenceabouttheirpossibleimpactnecessarilyderives
fromexperimentalstudieswheresubjectshavetypicallybeenpresentedwithbothbrandedand
mockedupplainpacksandaskedaboutassociationsandpreferences.
5.1 History of international research on plain packaging
In1995anexpertpanelprovidedtotheCanadianDepartmentofHealthacomprehensivereviewof
thelikelyeffectsofplainpackagingentitledWhenPackagesCantSpeak:PossibleImpactsofPlain
andGenericPackagingofTobaccoProducts.[50]
Tothattime,foursetsofstudieshadbeenconductedonplainpackagingofcigarettes:
thesocalledMarlborostudy(Trachtenberg,1987)[51]
theNewZealandstudyset(BeedeandLawson,1992[52,53];Beedeet.al.,1991[54])
theAustralianstudy(CentreforBehaviouralResearchinCancer,1992)[55]and
theUniversityofTorontostudy(CentreforHealthPromotion,1993)[56].
Theexpertpanelfoundthatallfourstudiesproducedsomeevidencetosupportthehypothesisthat
plainandgenericpackagingmadecigaretteslessattractiveandappealing.Nocomparablestudy
providingcontraryevidencewasknowntoexist.[50]
TheresearchobjectivesoftheCanadianexpertpanelwere:
toassessthepotentialimpactofplainandgenericpackagingofcigarettesonthelikelihoodof
smokinguptake;
toassessthepotentialimpactofplainandgenericpackagingofcigarettesontherecognition
andrecallofhealthwarningmessagesoncigarettepackages;
toassessthepotentialimpactofplainandgenericpackagingofcigarettesonthelikelihoodof
cessationofsmoking;
toevaluatealternativedesignsforplainandgenericpackagingofcigarettesintermsoftheir
potentialimpactontheuptakeorcessationofsmoking;and
toprojectpossibleindustryresponsestoplainandgenericpackagingbyexamininghistorical
evidenceandtheoryofcompetitionregardingtheactionsofcompaniesinindustries
characterizedbyincreasingcommoditization.
Totacklethesefiveoverallobjectives,theExpertPanelconceived,conductedandanalysedfindings
ofabatteryofsixdifferentstudiesemployingfivemethodologicalapproaches.[50]
Study Method
1)NationalSurveyofadolescents Survey directquestioning/withinsubjectdesign
2)WordImageSurvey Survey directquestioning/withinsubjectdesign
3)VisualImageExperiment Experiment directquestioning/withinandbetweensubjectdesign
4)RecallandRecognitionExperiment Experiment directquestioning/betweensubjectdesign
5)ConjointExperiment Experiment indirectquestioning/withinsubjectdesign
6)AnalysisofIndustryEffects Analysisofprecedentsofindustrycompetitive&strategyactivitiesincommodity
industries
Thenationalsurveyofadolescentsshowedthatteenagerswerehighlyawareofcigarettebrands.Around90%wereabletorecognizethetwomajorCanadianbrandsevenwhenbrandnameswere
11
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
12/37
removedfrompackaging,withteenagerswhowereexperimentingwithsmokingonaverageableto
recognise2.9brandsandregular/frequentteenagesmokers5.9.Forallbrands,package
approacheswerethefirstthingmentionedbythemajorityofrespondentswhocorrectlyidentified
thebrandasmethodsbywhichcompaniespromotedawarenessofbrands. Whileteenagersrarely
admittothelikelihoodofpromotionalstrategiesaffectingthem,asurprisinglylargeproportion
reportedthathavingcigarettesavailableonlyinplainpackagingwouldbotherthemalot(23.8%).Manyrespondentsbelievedthathavingcigarettesavailableonlyinplainandgenericpackageswould
haveaneffectonthenumberofteenagerswhowouldstartsmoking.Morethanonethird(35.8%)
believedthatafewlesswouldstartsmokingand13.5%believedthatalotfewerwouldstart
smoking.Almostfortypercent(38.2%)believedthatplainpackagingwouldpromptmoreteenagers
tostopsmoking.
Thewordimagesurveyaimedtoassesstheassociationsteenagersmadeaboutproductsandabout
smokersthroughcomparingthepackagingofapopularandlesswellknownbrandtoplain
packaging.Thecurrent,brandedpackagingwasassociatedwithamorepositiveimagethantheplain
whitepackaging.Theresearchersconcludedthatwhileplainpackagingwouldnotpreventcigarettes
frombeingusedtoconveyanimageofbeingateensmoker,packagingcigarettesinplainand
genericpackageswouldreducetheabilitiesofbrandstodifferentiatethemselvesfromeachotherandthereforetheabilitytolinkpersonalimagewiththebrand.Totheextentthatteensattemptto
useaparticularcigarettebrandasabadgeoftheirownselfimage,aparticularbrandwouldbecome
alessusefulinstrument.[50][57]
Thevisualimageexperimentshowedthatteensaremuchlesslikelytoassociatespecificbrandswith
specifictypesofpeoplewhenpacksareplain,andevenlesssowhenplainpacksalsofeatureda
photoofalung.[50] Theresearchersconcludethat
Denudingcigarettepackagesofmajorelementsoftheirbrandmarkings(otherthantheirname)
appearstolimitteenagers'capacitytoassociatespecificimageswithspecificbrands.Underthese
circumstances,thesebrandslosetheirbadgevalueandselfdefiningcharacteristics.Whenthese
characteristicsrepresentkeymotivatorsinteenagers'decisionstosmoke,thenitseemsreasonableto
concludethatplainandgenericpackagingcanbeausefulstrategyinattemptingtodemarketcigarettes
toteenagersbecauseitwouldmakeitmoredifficulttobuildormaintainbrandequity.(Section6.3.4,p
101)
Therecallandrecognitionexperimentfoundthatatleastonewarning,Smokingcankillyou,was
betterrecalledwhenitwasontheplainpackagewheretherestofthepackagehadfewer
competingmessages.Theteensfavouritebrand,duMaurier,wasrecalledlesswhenitwasina
plainpackageasopposedtothefamiliarredpackage.
Conjointanalysisisamultivariatetechniqueusedspecificallytounderstandhowconsumersdevelop
preferencesforproductsandservicesbasedonthesimplepremisethatconsumersevaluatethe
utilityofaproductorserviceidea(realorhypothetical)bycombiningtheseparateamountsofutility
providedbyeachattribute.Whilepricewasfoundtobethemostimportantcontributortodecisions
aboutsmoking,researchersconcludedthatplainpackagingwouldalsoinfluencedecisionsabout
uptakeofsmokingandquitting.
Onthebasisofadetailedanalysisofthefindingsofallfiveofthesestudiesseechart1,pages152
155,theexpertpanelconcluded:
Virtuallyallthefindingsofthesefivestudiesconvergeonthefollowingconclusions.Plainandgenericpackaging
oftobaccoproducts(allotherthingsbeingequal),throughitsimpactonimageformationandretention,recall
andrecognition,knowledge,andconsumerattitudesandperceivedutilities,wouldlikelydepresstheincidenceof
smokinguptakebynonsmokingteens,andincreasetheincidenceofsmokingcessationbyteenandadult
smokers.Thisimpactwouldvaryacrossthepopulation.Theextentofchangeinincidenceisimpossibletoassess
exceptthroughfieldexperimentsconductedovertime.[50]p158
SincetheCanadianexpertreview,furtherresearchhasbeenconductedinCanada,[58][59][60][61][62][63]theUnitedStates,[64]Australia,[65][66][67][68]theUnitedKingdom[69]New
12
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
13/37
Zealand[70]andacrosscountries.[71]Thisresearchhasfocussedontheeffectsofplainpackagingon
awareness,recallandimpactofhealthwarnings,[53][55][61]onperceptionsofriskinessoftobacco
products,[62][69][71] andontheappealofbrandsandproducts.[52][54][58][65][66][67][70]
[68][63][64][68]
5.2 Summary of results of research by themeInareviewofevidenceontheeffectsofplainpackagingconductedupto2009Hammond
concludes:[72]
Theevidenceindicatesthreeprimarybenefitsofplainpackaging:increasingthe
effectivenessofhealthwarnings,reducingfalsehealthbeliefsaboutcigarettes,andreducing
brandappealespeciallyamongyouthandyoungadults.Overall,theresearchtodate
suggeststhatplainpackagingregulationswouldbeaneffectivetobaccocontrolmeasure,
particularlyinjurisdictionswithcomprehensiverestrictionsonotherformsofmarketing.
The following four sections summarise the findings of studies to dateboth before and since
Hammondsreviewthathaveexaminedthesemajorpotentialbenefitsofplainpackaging.
5.2.1 Effects of plain packaging on effectiveness of health warnings
Plainpackresearchshowsconsistentlythatpackbrandimagerydistractsfromandthereforereduces
theimpactofhealthwarnings.Studentshaveanenhancedabilitytorecallhealthwarningsonplain
packs.[53][61]Healthwarningsonplainpacksareseenasbeingmoreseriousthanthesame
warningsonbrandedpacks,suggestingthatbrandimagerydiffusestheoverallimpactofhealth
warnings.[60]Amulticountrytobaccosurveyexaminingtheeffectivenessofwarningsshowedthat
smokersinCanada,whowereatthetimeofthestudyexposedtolarge,picturebasedwarnings,
weresignificantlymorelikelytoreportthinkingaboutthehealthrisksofsmoking,tostopfrom
havingacigarette,andtothinkaboutquittingbecauseofthehealthwarnings.[73]Thesamestudy
alsoshowedthatthelargerandmoreprominentahealthwarning,themorelikelyitwastobe
recalled.Plainpackagingwouldenablethewarningsizetobefurtherincreasedandallowfor
additionalinformationelaboratingonwarningsandaboutsmokingcessationtobeprintedonpacks.
5.2.2 Effects of plain packaging on perceptions of harmfulness
Unregulatedpackagecolouringandimagerycontributestoconsumermisperceptionsthatcertain
brandsaresaferthanothers.[18][21][62][74] Thecolourofpacksisalsoassociatedwith
perceptionsofriskandbrandappeal:comparedwithMarlboropackswitharedlogo,Marlboro
packswithagoldlogowereratedaslowerhealthriskby53%andeasiertoquitby31%ofadult
smokersinaUKstudy.[69]Astudyof8243smokersfromtheUS,theUK,CanadaandAustraliain
2006similarlyfoundthatsmokersofgold,silver,blueorpurplebrandsweremorelikelytobelieve
thattheirownbrandmightbealittlelessharmfulcomparedtosmokersofredorblackbrands.[71]Researchersinbothstudiesconcludedthatremovingcoloursfrompacks(plainpackaging),aswellas
termssuchas'smooth''gold'and'silver'wouldsignificantlyreducefalsebeliefs.
5.2.3 Effects of plain packaging on appeal of product
Theappealoftobaccoproductscanbeunderstoodintermsoftheappealofthepackormore
broadlyasperceptionsaboutthesensoryappealoftheproduct(intermsoftaste,smoothnessetc)
ormorebroadlystillintermsofthetypesorcharacteristicsofpeoplelikelytouseparticularbrands.
AnAustralianstudypublishedin2008involvingmorethan800adultsmokersexaminedtheeffects
oftheappealoftobaccoproductsofprogressivelyreducingtheamountofpackbrandingdesign
information.AsillustratedinFigure6below,theplainestpackswereseenaslessattractive(brand/packcharacteristic),smokersofthepackswereseenassignificantlylessstylishandsociable
13
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
14/37
(smokercharacteristic)andthecigarettesinthepackswerethoughttobelesssatisfyingandof
lowerquality(sensoryperception).[66]
40
45
50
55
60
65
Positive pack
attributes
Positive smoker
attributes
Positive sensory
features
Figure 6 Level of attractiveness of increasingly plainer tobacco packaging
Source: Wakefield MA, Germain D and Durkin SJ. How does increasingly plainer cigarette packaging influenceadult smokers perceptions about brand image? An experimental study. Tobacco Control 2008;17:41621.[66]
Asimilarlydesignedstudyinvolvingadolescentspublishedin2009foundthatprogressively
removingbrandelementssuchascolour,brandedfontsandimageryfromcigarettepacks,resulted
inadolescentsmokersseeingpacksaslessappealing,havingmorenegativeexpectationsofcigarette
tasteandratingattributesofatypicalsmokerofthepacklesspositively.[67]
ACanadianstudy(resultsofwhichwerepublishedinpapersonlineinMarch2011[63]andaUS
studypublishedinApril2011[64])examinedtheeffectsofremovalofbrandimageryonyoung
femalesmokersaged18to25years.Participantswereaskedtoviewimagesoffemaleoriented
brands
ascurrentlypackaged
inthesamepackswithbrandnamesbutwithoutdescriptorsand
inplainwhitepacksonceagainwithbrandnamesbutwithoutdescriptors.
Theywerethenaskedtorateeachpackforappeal,taste,healthrisksandtarlevels.IntheCanadian
study,thehighestratedfemalepack,CapriCherry,wasratedmoreappealingthanotherbrandsby
almost67%ofparticipants.Theresearchersfoundthatremovingdescriptorsandcoloursfrompacks
substantiallyreducedtheappealoffemaleorientedbrandsforfemalesmokers:forexample,the
appealofCapriCherryfellfrom67%to17%amongwomenwhoviewedplainpackswithoutthe
wordCherry.
Plain
packs
were
also
associated
with
significantly
fewer
positive
characteristics
than
fullybrandedpacks,includingglamour,beingslim,popular,attractiveandsophisticated.Of
14
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
15/37
particularnote,youngwomenintheplainpackconditionweresignificantlylesslikelytobelievethat
smokinghelpspeoplestayslimcomparedtoparticipantsinthenodescriptorscondition.[63]
FindingsweresimilarintheUSstudy.Amongsmokerswhorequestedapackattheendofthestudy,
femalebrandedpackswerethreetimesmorelikelytobeselectedthanplainpacks.Researchers
concluded:
Plainpackagingandremovingdescriptorssuchasslimsfromcigarettepacksmayreduce
smokingsusceptibilityamongyoungwomen.[64]
5.2.4 Combined effect of plain packaging and health warnings
Isitpossiblethattheappealoftobaccoproductscouldbereducedsimplybyincreasingthesizeof
healthwarningsratherthanbyremovingbrandingelementsthroughplainpackaging?
Asoutlinedabove,plainpackagingunderminesthepositiveimageofbrands,increasesthenegative
aspectsofbrandimageandreducespositivetasteexpectations. Andashasbeenfoundinextensive
researchontheeffectofhealthwarnings,largerhealthwarningsaremorenoticeable,memorable
andthereforemorelikelytoelicitcessationrelatedattitudesandbehavioursv.AnAustralianstudy
fundedbytheNationalHealthandMedicalResearchCouncil,resultsofwhichwerepresentedatthe2011meetingoftheSocietyforResearchinTobaccoandNicotinespecificallyexploredthequestion
ofwhetherremovingthecolouranddesignfeaturesofpackagingwasmoreeffectivethanincreasing
thesizeofhealthwarningsinreducingtheappealofbrands.[68] Thestudyfoundthatoncepacks
wereplain,increasingthesizeofthefrontofpackhealthwarningsfrom30%to70%ormoredidnot
furtherreducebrandappeal.Whileotherresearchindicatesthatlargerhealthwarningsarelikelyto
bemorenoticeableandmemorabletoconsumers,inthisstudyplainpackagingwasmuchmore
effectivethanincreasingthesizeofhealthwarningsinreducingtheappealofthebrand.
Giventhedualobjectiveof
a. preventingcompaniesfrompackagingtobaccoproductsinawaythatincreasestheirappeal
particularlytoyoungpeopleand
b. informingconsumersaseffectivelyaspossibleaboutthehealthrisksofsmoking,
whatthenistheoptimalsizeofhealthwarningsoncigarettesinplainpackaging?
ANewZealandstudypublishedinTobaccoControlin2010providessomeguidancehere.[70]The
studyexaminedthecombinedeffectsofhealthwarningsandplainpackagingonthelikelihoodof
youngadults18to30yearsengaginginbehavioursknowntobelinkedtocessation.Smokersinthis
studywereaskedwhichpacktheywouldbemostandleastlikelytochooseeachtimetheywere
repeatedlypresentedwithfourcigarettepacketsfeaturingdifferentbrandingandwarningsize
combinations.Packswiththegreatestnumberofbrandingelementswerestillpreferredevenwhen
thewarningswereincreasedfrom30to50%.Howevertheywerelesslikelytobechosenwitha75%
warning.Plainpacketswith75%healthwarningsweresignificantlymorelikelytoelicitstrongercessationlinkedintentions(toreducetheamountsmoked;increasequitattempts;increasehelp
seekingtoquit)thanwerebrandedpackswitha30%frontofpackwarnings.
vSeeHhttp://www.smokefree.ca/warnings/Research.htmHforadetailedcompilationofevidence.
15
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
16/37
6. Expert responses to the proposal for plain packaging
Onthe7thApril2011theAustralianGovernmentreleasedaconsultationpaper[75]anddraft
exposurelegislationfortheTobaccoPlainPackagingBill2011[76]priortoscheduledconsideration
ofthebillinthewintersessionoftheAustralianParliament.[77]
6.1 Health sector response to proposed legislation
TheGovernmentsannouncementaboutitsintentiontointroduceplainpackagingreceived
overwhelmingsupportfromthehealthsector,withspokespeopledescribingtheannouncementas
themostimportantnationaldevelopmentintobaccocontrolsincetobaccoadvertisingwasbanned
inthe90s[78]andcommentingthatitwasdifficulttoexaggeratetheimportanceofsuch
reforms.[79][80]
Onreleaseoftheexposurebill,ProfessorMikeDaube,PresidentofthePublicHealthAssociationof
Australiaremarked:
Thetobaccoindustryhasrespondedtothismovemoreferociouslytoanythingintobaccocontrolin20yearsandIthinkthatsendsoutasignal,ifthetobaccoindustryissoworriedaboutit,thenwe've
gottobeontherighttrack.[81]
ProfessorofpublichealthandformereditoroftheBritishMedicalJournalsTobaccoControlSimon
Chapmancommented:
Ithinkit'simpossibletounderestimate theglobalimportanceofthisannouncement.Ican'tthinkof
anyotherconsumergoodanywhereintheworldwheregovernmentshavesaidthisisentirelyhow
youmustpackagethisproductforconsumers,andIthinkthat'sreallyappropriatebecausethe
numberofpeoplewhoarekilledbytobaccoeveryyeargloballyandinAustraliaisastronomical.[82]
OutgoingdirectoroftheCancerCouncilVictoriaandPresidentoftheInternationalUnionAgainst
CancerProfessorDavidHillstated:
Thereisnogreaterbarometertothelikelysuccessofaproposedtobaccocontrolinitiativethanthe
responseofthetobaccoindustry...IcommendtheAustraliangovernmentforitscourageintackling
thisvitalpublichealthissueandIurgeallmembersofParliamenttotakethisopportunitytosavethe
livesofthousandsofyoungAustraliansbypassingthislegislation.Itistimetosayenough.[83]
NewZealandAssociateHealthMinisterTarianaTuriarespondedtotheAustralianreleaseofdraft
legislationon7April2011stating:
Weareverysupportiveoftoday'sannouncementbyAustralianhealthministerNicolaRoxonanditis
myexpectationthatNewZealandwillinevitablyfollowtheirleadandlooktointroducetheplain
packagingoftobaccoproducts.[84]
Cynthia
Callard,
Executive
Director
of
Physicians
for
a
Smoke
Free
Canada
remarked:
Thebenefitsofplainandstandardizedpackagingfortobaccoproductsarewellestablished.Thisisa
healthmeasuresupportedattheinternationallevelbytheWorldHealthOrganization's globalpublic
healthtreaty,theFrameworkConventiononTobaccoControl.[85]
6.2 Financial market response
Whilehealthgroupsandexpertspraisedthemove,financialmarketsappearedtoviewthe
legislationasabigriskforindustryprofitability.Investmentbank,Citigroup,immediatelyissueda
statementexpressingtheviewthatplainpackagingwasthebiggestregulatorythreattothe
industry,aspackagingisthemostimportantwaytobaccocompanieshavetocommunicatewiththe
consumeranddifferentiatetheirproducts.[86]InJanuaryandMarch2011itcontinuedtowarn
investorsaboutthethreatposedbypackagingreforms.[87,88]
16
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
17/37
6.3 Tobacco industry response
ImperialTobaccostatedatthetimeoftheGovernmentsannouncementthatitwouldmakeevery
efforttoprotectitsbrandsandassociatedintellectualpropertyandincluding,ifnecessary,takelegal
action.[89],andrepeatedthispositiononthereleaseofthedraftlegislation.
Plainpackaginghasnotbeenintroducedinanycountryintheworldandthereisnoevidencetosupportthegovernment'sclaimthatthiswillreducesmoking,thecompanysaidinastatement.[90]
Presumablyinanticipationofthelegislation,PhilipMorrisInternationallaunchedanentirewebsitevi
dedicatedtoplainpackagingmonthspriortotheannouncement.Thewebsitefeaturesvideo
interviewswithretailersfromAustraliaandtheUK,ananimatedcliponwhyplainpackagingwillfail,
andpagespromotingtheviewsthatplainpackagingwontwork,violatestrademarkrightsandwill
increaseillicittrade.Inresponsetothereleaseofdraftlegislation,aspokesmanforPhilipMorris
toldAAPthatplainpackagingwould:
fueltheillicittradeintobaccoproducts.We'llcontinuetoopposeplainpackagingineveryway
possiblebecauseofthoseseriousissuesthatthegovernmenthasn'ttakenintoaccountwhen
pursuingthispolicy.[90]
BritishAmericanTobaccoswebsitealsoincludesapositionstatementonplainpackaging.[91]In
additiontoarguingthatsuchlegislationwouldnotbeeffective,BATclaims:
Genericpackagingwouldmakeithardertopreventsmuggledandcounterfeitproductsenteringa
market,erodinggovernmenttaxrevenueanddisruptingeffortstotackletheillegaltradeintobacco
productsthatplaysasignificantroleinfundinginternationalcrimeandterrorism.
InresponsetotheGovernmentsreleaseoftheexposurebill,aBATAustralasiaspokespersonstated
thatsuchlegislationwillresultinclaimsforcompensationthatwouldbebornebytaxpayers.[92]
Extensive requests under Freedom of Information legislation
InOctober2010theAustralianSenateEstimatesCommitteewasinformedthatanunnamedtobacco
companyhadmadeatleast19requeststhroughFreedomofInformationprovisionsforinformation
aboutGovernmentdeliberationsonplainpackaginggoingbackto1992.[93]
Alliance of Australian Retailers
Inadditiontotheirdirectrepresentationsabouttheproposedlegislation,BritishAmericanTobacco
Australia,PhilipMorrisandImperialTobaccoAustraliaalsocollaboratedtofundamassmedia
countercampaignbytheAllianceofAustralianRetailers,anorganisationestablishedshortlybefore
thecommencementofthe2010electioncampaign.Theaimofthecampaignwastostopthe
introductionofplainpackaging.[94]Advertisementsfeaturingportrayalsofconcernedretailerssayingthatplainpackagingwouldntworkandwoulddamagetheirbusinessappearedin
newspapers,ontelevisionandradio.viiDaysafterthelaunchofthecampaign,severalmajorretailers
withdrewtheirsupportfortheAlliance.RetailerWoolworthsrevokeditsmembershipofthe
AustralasianAssociationofConvenienceStores(AACS)overthecampaignanddemandedthatits
$15,000inannualfeesbereturned.[95]TheAACSwhichincludescompaniesCaltex,Shell,BPand
ColeswithdrewitssupportafterColes(whichchairstheboardoftheAACS)objectedtohavingbeen
misleadaboutthenatureofthecampaign.[95]
viHhttp://www.plainpackaging.com
viiTheadscanbeviewedhere:Hhttp://australianretailers.com.au/latestnews.html
17
http://www.plain-packaging.com/http://www.plain-packaging.com/ -
8/4/2019 Plain packaging of tobacco products: a review of the evidence
18/37
On10September2010,ABCtelevisionprogramLatelinerevealedthecontentsofleakedinternal
documents,emailsandcontractswhichshowedthefullextentoftobaccoindustryinfluenceonthe
AllianceofAustralianRetailerscampaign.[96]OnthedaytheAlliancewasformeditreceivedfunds
fromImperialTobaccoAustralia($1million),BritishAmericanTobaccoAustralia($2.2million)and
PhilipMorris($2.1million).DocumentsalsoshowedthatPhilipMorrisAustraliasoughtfromthe
lobbyingandpublicrelationsfirm,theCivicGroup,adviceandassistanceforacampaigntostopplainpackaginglawsduringthefederalelection.TheVictorianHealthPromotionFoundation
(VicHealth)andthePublicHealthAssociationofAustraliarespondedbycallingontheAustralian
Governmenttolegislateforcompletebansonalltobaccoindustryadvertisingandtoforcetobacco
companiestoreleasefulldetailsoflobbying,politicaldonationsandmarketingplansand
budgets.[97]
18
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
19/37
7. Research relevant to major industry arguments againstplain packaging
Healthgroupsarguethattheharmfulnessandaddictivenessoftobaccoproductsissufficientto
warrantrestrictionofallformsofpromotion.Packagingisclearlyaformofpromotionandthereforeshouldnotbeallowed.However,plainpackaginghasbeenvigorouslyopposedbytobacco
companiesoneachoccasionthattheideahasbeenproposed.viii
Industryargumentsagainstplainpackaginghaveincludedfirstlythatthereisalackofevidencethat
itwouldresultinreducedsmoking;secondlythatitwouldbedifficultforretailersresultinginlossof
salestodiscountoutlets;thirdlythatsuchlegislationwouldbreachinternationalagreements
concerningintellectualpropertyandthatforthisreasontheideahasbeenabandonedbyallthe
countriesthathavepreviouslyconsideredit;thatitandfinallythatitwouldfacilitateillicittrade.
Researchrelevanttoeachoftheindustrysmajorclaimsaboutunintendedconsequencesis
describedbelow.
7.1 Wont work
AsindicatedinSection4above,plainpackaginghasnotyetbeenintroducedanywhereintheworld,
soconclusionsaboutitslikelyeffectivenesshavetobebasedonknowledgeabouttheeffectsof
packagingingeneral,andstudiestestingthereactionsofrespondentsexposedtodifferent
packagingoptionsunderexperimentalconditions.
Onthe4thMay2011,BritishAmericanTobaccoreleasedareport[98]preparedforitbyconsulting
firmDeloittedescribedasanindependentassessmentoftheeffectsofregulationofpackagingon
tobaccoconsumption.Thisdetailed98pagereport[99]purportstoassessthedirectimpactofwhat
wastermedpackspaceappropriationonconsumptionoftobaccoproducts,andalsotodescribea
number
of
unintended
consequences
of
such
legislation.
TheDeloittereportarguesthatlegislationmandatinghealthwarningshasnotbeeneffective
becauseithasfailedtoreducetheconsumptionoftobaccoproductsinAustraliaandthereforethat
plainpackaginglegislationisalsounlikelytobeeffective.Itbasesthisassessmentontheresultsof
twoanalyses:
i. aneconometricanalysisofconsumptionpatternsinanumberofcountriesthathave
introducedhealthwarningsand
ii. aneventstudylookingatmonthlylevelconsumptiondatafollowingintroductionof
improvedwarningsinAustralia.
Consumptionisnotanappropriateindicatoroftheeffectivenessofhealthwarningswhichshould
onlybeconceivedasonenecessarybutnotasufficientcontributortowhatpromptsindividualsto
takeuporstopsmoking.Inanycase,amajorerrorintheassumedtimingofintroductionofthe
AustralianwarningsunderminesconfidenceinthevalidityofconclusionsdrawnfromtheDeloitte
modellingrotatinghealthwarningswerefirstintroducedinAustraliain1987not1990.
TuckedawayinSection2.2.1ofAppendixBisadisclosurethatindicatesjusthowselectivethedata
isthatBAThasprovidedDeloitteforitsanalysis:
MonthlybrandlevelconsumptiondataforAustraliahas(sic)beenprovidedby
Neilsen.Sinceactualconsumptionvolumesarenotavailable,actualdutypaid
viiiForacompilationofresponsesbytobaccocompaniestoeachofthevariousgovernmentinquiriessee
Hhttp://www.smokefree.ca/plainpackaging/industryresponse.htm
19
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
20/37
shipmentvolumeshavebeenusedforanalysis.Duetodatalimitations,notable
brandswiththemostconsistentdatahavebeenselected.Monthlyvolumeshavebeenconvertedtoaquarterlyseriesforstructuralanalysis.Deloitte.2011,[99]
page71
DeloittesfindingthatsalesofaselectionofBATproducts(theonlyproductsincludedinthe
analysis)didnotdeclinemoresteeplythanusualoverparticularperiodsdoesnotprovethatthe
marketasawholedidnotdeclineoverthosesameperiods.Interestingly,governmentdataonall
dutiedtobaccoproductsdoinfacttellasomewhatdifferentstory,withtotalpercapitaweightof
tobaccoproductssubjecttoexciseandcustomsdutydecliningmorethanwhatwouldbepredicted
bythetrendlinefollowingtheintroductionofthefirstthreesetsofwarningsoncigarettepackaging
inAustraliareferFigure7.
Figure7 Excise and customs duty receipts Australia 1970 to 2005*grams per person aged 16+yrs
Sources:OverseasTrade,ABSCatalogueno7885355,195859to196263,Table33p793196364to19678,Table35,p
1050,196869to19723,Table32p632; 197273to197677,Table22p112.
ExcisedataforAustralianTobaccoProducts,suppliedbyJohnBroweleit,ABSDec1994,andZigmontMackinois,
June
96
and
Sept
96
ExcisedataforAustraliantobaccoproducts,suppliedbyInternationalTradeSection,AustralianBureauof
Statistics,MarchandSep1998.
ImportclearancedataforAustralianTobaccoProducts,1981/2to1993/4,suppliedbyJohnBroweleit,
InternationalTrade,ABSFeb1995,andMichaelAshly,Sept1996
CustomsdataforAustraliantobaccoproducts,suppliedbyInternationalTradeSection,AustralianBureauof
Statistics,SeptemberandSeptember,1998
PopulationdatafromABSAustralianDemographicStatisticsfromCatalogue3101.0
*LastyearforwhichexcisedatahasbeenpublishedseeAIHW2007[100]
Alargebodyofresearchhasdemonstratedthatenhancedconsumerinformationontobacco
packetshavemadewarningsmorenoticeableandhaveincreasedawarenessofthehealthrisksof
20
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
21/37
smokinginAustralia[101][102][103][104][105][106][107109] [110]Canada,[111,112]andthe
UK.[113]ix
AsoutlinedinSection5above,therearestronggroundsforbelievingthatcurrentpackaging
glamourisessmokingandthatplainpackagingwouldimprovetheeffectivenessofhealthwarnings,
reducemisconceptionsaboutrelativeharmfulnessofvariousbrandsandreducetheoverallappeal
oftobaccoproductsintermsofperceivedattractivenessofthepack,expectationsaboutand
experienceoftasteandperceptionsaboutthekindsofpeoplebelievedtobelikelytouseparticular
brands.Theeffectscouldbeexpectedtobeparticularlystrongamongyoungpeopleestablishing
theiridentityandimageamongtheirpeers.
Seniorstaffoftobaccocompaniesarenotrequiredtobeexpertinorspendtimeontheanalysisof
publicpolicyoutofacademicinterest.Theydohoweverhaveafiduciarydutytocompany
shareholders.Anyonepaidonthebasisofsalesorinpartwithshareparcelswouldhaveapersonal
financialinterestincompanysalesandprofitability.Theintensityofoppositiontoplainpackaging
andimprovedhealthwarningsbytobaccocompaniesandthetimeandmoneycompanieshave
investedineffortstodelaytheirintroduction[115]suggestthattobaccoindustryexecutivesdo
believe
that
such
measures
will
accelerate
reductions
in
sales
and
company
profits.
7.2 Will be difficult for retailers
TheAllianceofAustralianRetailershasstatedthatplainpackagingwouldmakeitmoretime
consumingforretailerstofindcigarettepacketswhencustomerscomeintomakeaquickpurchase.
Withanerosionofconveniencetothepurchaser,theAlliancefearsthatmorecustomerswouldturn
tocheaperdiscountoutlets.
Deloitteacknowledgesthatsmalltomediumretailersbelievethatplainpackagingwillresultina
shiftinbusinesstolargeroutlets.Thisargumentignoresthefactthatsmallretailerswillstillbe
locatedmoreconvenientlytosmokersthanwilllargeretailers.Italsoignoresthefactthatstaffin
supermarketsandtobacconistswillfaceexactlythesamechallengesinidentifyingandselecting
stock.AsDeloittepointsoutinitsreviewofresearchonpossibleunintendedconsequencesofplain
packaginglegislation,commentatorssuchastheUKDepartmentofHealthhavepointedoutthat
stockmanagementcouldbeassistedandtransactiontimesminimisedthroughuseofbrandedbulk
containersandalphabeticalordering.
ThedraftlegislationreleasedbytheGovernment[75]proposedthatthebrandnamebelarge
enoughtobeseenbyretailers.
7.3 Represents an acquisition of intellectual property
Themajorobjectiontoplainpackagingbytobaccocompaniesinternationallyistheideathatit
representsanacquisitionofintellectualpropertyandassuchwouldbeprohibitedundertheterms
ofvariousinternationaltradeagreements,athemecoveredinallthesubmissionsbycompaniesto
governmentinquiries.[116]
OneofthemostvocalopponentsoftheproposedlegislationinAustraliahasbeentheInstituteof
PublicAffairs.TheInstitutehasreceivedwidespreadmediacoverageforitsviewsthatplain
ixInMay2009theInternationalTobaccoControlPolicyEvaluationProjectreleasedacomprehensive
assessmentoftheimpactofhealthwarningsinternationally. TheITCProjectisanongoinginternational study
thatnowcovers19countriesaroundtheworld.
114. FongGT,CummingsKM,BorlandR,HastingsG,HylandA,GiovinoGA,etal.Theconceptual
frameworkoftheInternationalTobaccoControl(ITC)PolicyEvaluationProject.TobaccoControl
2006;15(suppl.3):iii3iii11.Availablefrom:
http://tc.bmjjournals.com/cgi/content/abstract/15/suppl_3/iii3
21
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
22/37
packaginglegislationisequivalenttoacquiringtheintellectualpropertyoftobaccocompaniesand
thattheGovernmentwouldbeforcedtocompensatetobaccocompaniestothetuneof$3billion
dollarsannually.[117]
The$3bmentionedintheInstitutesreportappearstobeveryroughlycalculatedbasedonthe
amountoftotalturnoverofsalesoftobaccoproductsinAustralialessGovernmenttaxrevenue.It
assumesthattheGovernmentwouldhavetocompensatenotjustforprofitsforgonebutforthe
totalvalueofsales.Itmakesnoattempttonetoffthecostsofproductionanddistributionwhich
wouldofcoursenolongerbeincurredifproductswerenolongersold.Inanycase,theInstitutes
viewsaboutgovernmentliabilitywerequicklydismissed,withoneseniorlawexpertfromMonash
Universitycommentingthatthislineofargumentwas:
soweak,itsnonexistent.ThereisnorighttouseatrademarkgivenbytheWorldTrade
Organizationagreement.Thereisarighttopreventothersusingyourtrademarkbutthat
doesnottranslateintoarighttouseyourowntrademark.[118]
TheInstitutesargumentswerealsocomprehensivelyrebuttedinaseminarorganisedbythe
IntellectualPropertyResearchInstituteofAustralia.[119]Asexplainedattheseminarandexpanded
oninanarticleintheAustralianIntellectualPropertyLawBulletin,governmentsarepermittedtoamendtheirintellectualpropertylawstoprotectpublichealth.Plainpackagingdoesnotequateto
acquiringtheintellectualpropertyoftobaccocompanies.Governmentsdonotintendtousethe
logosandtobaccocompanieswillstillmaintainfullrightstotheirlogosandbrandimagery;theywill
simplynolongerbeabletousethesemarketingtoolsoncigarettepackages.[120]
Inanarticlebyaninvestigativejournalistin2003[121]aspokespersonfortheInstituteofPublic
AffairswasreportedasconfirmingthattheInstitutereceivedfundingfromBritishAmericanTobacco
andPhilipMorris.[122]
Thedraftlegislationproposesthatintheevent(whichtheGovernmentconsidersunlikely)that
preventingtheuseoftrademarksisfoundtobecontrarytoSection51(xxxi)oftheConstitution,
thentrademarks
would
be
allowed
but
would
have
to
conform
to
restrictions
(for
instance
on
size
andplacement)thatwouldbespecifiedinregulations.
7.4 Has been considered and the idea abandoned in other countries
TheideaofplainpackagingwasfirstconceivedinCanadainthelate1980saftertobaccocontrol
groupsconsideredtestimonyinalegalchallengetoCanadianlegislationbanningtobaccoadvertising
duringwhichanImperialTobaccoexecutiveagreedthatsmokersweregenerallyunableto
discriminatebetweenbrandswhenblindtestedandthatpackagingwasvital.[123]
Itsverydifficultforpeopletodiscriminateblindtested.Putitinapackageandputaname
onit,thenithasalotofproductcharacteristics(p1).[123]
ThiscorroboratedanearliercommentmadebyaBritishAmericanTobaccoofficialthatoneofeverytwosmokersisnotabletodistinguishinblind(masked)testsbetweensimilarcigarettesformost
smokersandthedecisivegroupofnew,youngersmokers,theconsumerschoiceisdictatedmoreby
psychological,imagefactorsthanbyrelativelyminordifferencesinsmokingcharacteristics
(p5).[124]
Proposalsforplainpackagingwereputtoandconsideredbygovernmentsonseveraloccasionsover
thefollowingtwodecadesx.Oneachoccasiontheproposalshavebeenvigorouslyopposedwithdire
warningsaboutlegalaction.AmajorreportbyCanadiangroupPhysiciansforaSmokefreeCanada
hasdocumentedextensiveinformationabouteffortsbythetobaccoindustrytopursuethe
xSeeTimelinebyPhysiciansforaSmokefreeCanada,Hhttp://www.smokefree.ca/plain
packaging/history.htmH
22
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
23/37
trademarkissueasakeyplankofaglobalstrategytoopposeplainpackaging.[125]Whilethis
strategywassuccessfulinforestallinglegislationinNewZealandin1993andCanadaandAustraliain
1995,th
d
onthattheirmonthsearlier.(p23)[125]
ereportnotes...
WhatthecompaniesdidnottelltheAustralianSenatewasthat2yearspreviouslytheyha
soughtandreceivedadvicethattheyhadnobasisforanylegalchallengeandthatthe
Britishgovernmenthadtoldthemtheydidnothaveacase.NordidtheymentiargumentshadbeensoundlyrefutedbyWIPOonly
Forthefullanalysis,seehttp://www.smokefree.ca/plain
packaging/documents/2009/packagingphoneyipclaimsjune2009a4.pdf
Inthewakeofincreasedscrutinyoftheselegalarguments[125]andfollowingtheAustralian
Governmentsannouncements,severalcountriesarereexaminingproposalsforplainpackaging.
InNovember2011theUKHealthSecretaryAndrewLansleyissuedapolicydocumentsuggesting
thatthegovernmentwilllookatwhethertheplainpackagingoftobaccoproductscouldbean
effectivewaytoreducethenumberofyoungpeopletakingupsmokingandtohelpthosewhoare
tryingtoquitsmoking.[126]On9March2011,theUKgovernmentreleasedatobaccocontrolplan
whichrepeateditsstatementofintentiontoconsiderplainpackaging.HealthyLives,HealthyPeople:
ATobaccoControlPlanforEngland[127]
Wewillconsultonoptionstoreducethepromotionalimpactoftobaccopackaging,
recomm 11:
swith
ssiblealignment.Aninitialreportbackto
recentlyexpressedsupportforplainpackaging.Inresponsetoa
questio
easures,includingattheEuropeanlevel.(unofficialtranslation)Transcript
includingplainpackaging,beforetheendof2011.[127]p22
InitsresponsetothereportoftheMaoriAffairsCommitteewhichsomemonthspreviouslyhad
endedplainpackaging,[128] theNewZealandGovernmentstatedonthe14thMarch20
TheGovernmentismonitoringAustraliasprogressonitsproposaltolegislateforplain
packagingoftobaccoproductsin2012,andwillconsiderthepossibilityofNewZealand
aligningwithAustralia.NewZealandGovernmentofficialshavecommenceddiscussion
respectiveAustraliancounterpartsonthepo
Cabinetisdueby30June2011.[129]p.78
Belgium'sHealthMinisterhasalso
ninparliamenthestated:
Withplainpackaging,onlythebrandnameisdisplayedinastandardformat.Theimpactof
suchlabellingtoreducetheattractiveness[130]andincreasetheimpactofhealthwarning
messages,especiallyforyoungnewsmokers,hasbeenshowninseveralstudies....Icontinue
tosupportsuchm
ofremarks[131]
AndinDecember2010Frenchparliamentarian,YvesBur,introducedabilltoimplementplain
packaging.[132]
es
uld
tobe
7.5 Will reduce price and competition in the tobacco market
TheDeloitteinternationalreport[99]providesausefulreviewofthereportscommissionedonthis
topicbyPhilipMorrisandJapanTobaccoInternational.ThePhilipMorrissponsoredstudybyLECG
consultingconcludedthatplainpackagingwillleadtopricecompetitionandasaresultlowerpric
acrossthewholemarket.[133]Thiswouldoccurduetoreducedproductdifferentiationandthe
entryofunbrandedproducts.TheEuropeEconomicsstudybycontrastpredictedthatpriceswo
fallonlyforpremiumbrands,withgrowingandnichebrandslikelytobehitthehardest.Little
informationisavailableinternationallyaboutwhathappenstoconsumptionoftobaccoproducts
whenpricesfall.Thishasbeenarareoccurrenceoverthepastfourdecades.LECGsestimateofan
increaseofbetween2.6%and16.6%insales(assuminga4.8%to19.2%fallinprices)appearsassumingpricesensitivityofbetween+0.54and+0.86%.Thisissubstantiallyhigherthanthe
23
http://www.smoke-free.ca/plain-packaging/documents/2009/packagingphoneyipclaims-june2009-a4.pdfhttp://www.smoke-free.ca/plain-packaging/documents/2009/packagingphoneyipclaims-june2009-a4.pdfhttp://www.smoke-free.ca/plain-packaging/documents/2009/packagingphoneyipclaims-june2009-a4.pdfhttp://www.smoke-free.ca/plain-packaging/documents/2009/packagingphoneyipclaims-june2009-a4.pdfhttp://www.smoke-free.ca/plain-packaging/documents/2009/packagingphoneyipclaims-june2009-a4.pdf -
8/4/2019 Plain packaging of tobacco products: a review of the evidence
24/37
acceptedestimatesofpricessensitivityintheeventofpriceincreaseswhichrangebetweenabout
0.3and0.5%[134]andwouldappeartobeanestimatebasedonbrandshiftingratherthanthe
likelyeffectsacrossawholemarket.Thatis,whileitisplausiblethatsalesofaparticularbrandmight
increaseby3%ifitbecomes5%cheaperandifitscompetitorsremainatthesameprice,itdoesnot
followthatsalesofallproductswouldincreaseby5%ifallproductsbecame3%cheaper.Thisis
particularlysoinanenvironmentwhichincreasinglylimitsopportunitiesforsmoking.Reductionspricesarelikelytobemostsevereinpremiumbrandswhicharecommonlysmokedbylessprice
sensitivesmokers.TheEuropeEconomicsstudy[135]concludedthatwhiletheshorttermimpact
waslikelytobelowerprices,inthelongertermpricescou
in
ldincreaseasmarketpowerandlossof
fsetbythe
Governmentfurtherincreasingexciseandcustomsdutiesontobaccoproducts.
tplainpackagingwouldfacilitateillicittradeandincreaseuseof
e
paid);andthatrevenue
at file reveals that no
innovationeffectsbegantodominateDeloitte[99] p42.
Whateverhappens,asDeloitteacknowledges,pricereductionscouldeasilybeof
7.6 Will facilitate illicit trade
Severalcompanieshavearguedtha
illicitproductsamongminors.[91]Betweenthe20thandearlyMay2011theAllianceofAustralianRetailers(AAR)ranA4sized
advertisementsinseveralAustraliannewspaperswarningthatillicittobaccoproductswerebeing
smokedbychildrenasyoungas14yearsold;that15.9%oftobaccoproductsusedinAustraliaar
illicit(thatisproductsonwhichneitherexciseorcustomsdutyhasbeen
forgoneontheseproductswouldamounttoover$1.1bseeFigure8.
Theclaimsabout teenagesmokingarebasedondata from theNationalDrugStrategyHousehold
Survey[136]whichfound in2007that4.5%ofteenagersaged14to19yearsreportedhavingever
triedillicittobaccoproducts.Itshouldbenotedhoweverthatfewerthan1%(+/ 50%)indicatedthat
theyusedithalfthetimeormore.Thefiguresquotedinthereportrelateto1419yearoldsasa
group.Prevalenceofuse for teenagersofeachage (14,15,16and soon)cannotbedetermined
fromexaminationofthereport.Detailedexaminationofthedatafileonwhichthereportwasbased
howevershowsthatonly1.2%of14yearoldsreportedeverhavingtriedunbrandedloosetobacco.
Most importantly, examination of th 14yearolds at all reported currently
ars,
reportedthatitwouldbeeasyorveryeasy
e
lic
smokingunbrandedloosetobacco.
NotonlyistheclaiminthefirstoftheadvertisementsdepictedinFigure8outrightlyfalse,itisalso
disingenuous.Salesofcigarettestoschoolchildrenhavecertainlydeclinedoverthelast20ye
howeveritisnotablethatin2008almost12%ofstudentsaged12to15yearswhoregularly
smoked,reportedthattheyacquiredtheirlastpacketofcigarettesbypurchasingitfromaretailer
suchasasupermarket,milkbar,petrolstationorconveniencestorei.e.oneofthesortsofstores
thattheAARrepresents!Almost15%of14yearolds
forthemtobuycigarettesfromsuchretailers.[137]
TheestimateoftheproportionoftobaccoproductsusedinAustraliathatareillegal(usedinth
secondadvertisementdepictedinFigure8)isbasedonareportpreparedforthethreemajor
tobaccocompaniesbyDeloitte,[138] areportwhichhasbeenheavilycriticisedbyseveralpub
healthspecialistswhoarguethatitissimplynotcrediblethatoneineverysevencigarettesin
Australiacomesoutofanunmarkedplasticbag.Theresponseratesforthesurveyonwhichthe
reportisbasedappearstobeonlyaround25%,substantiallylowerthantheveryhighpercentagesof
peoplewhotypicallyagreetotakepartinsurveyssponsoredbygovernmentorcharitableagencies.
Thetotalestimatedamountoftobaccosmokedappearstobecalculatedbylookingattheamount
purchasedbythosewhoexclusivelysmokeillicittobaccoandapplyingthisfiguretoallusers.And
yetresultsoftheNationalDrugStrategyHouseholdSurveyindicatethatmostpeoplewhohaveever
usedillicittobaccoproductsnolongerusethem,andmanythatdostillusethemonlyusethem
occasionally.WhiletheDeloitteestimatesoftheaveragequantityofillicittobaccousedaresuch
24
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
25/37
thatall(100%)ofthe15.7%ofsmokerswhopurchasedillicittobaccointhelastyearwereusing
average25illicitcigaretteseachdayfor365daysoftheyear,theGovernmentsNationalDrug
StrategyHouseholdSurveyin2007[136]foundthatonly0.2%ofAustralians
on
ubstantiallylowerthanthe15.9%beingtoutedbyBATandtheAllianceofAustralianRetailers.
xithatequatesto1.2%
ofcurrentsmokersusedillicittobaccoproductshalfthetimeormore.Evenallowingforillicitusers
smokingsomewhatmorethanaverage,thiswouldmakeillicittobaccoabout23%ofthetotal
markets
xiRefertoTable4.2onpage26ofthereportatHhttp://www.aihw.gov.au/publications/index.cfm/title/10674H
25
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
26/37
Figure 8 Advertisements placed in Melbourne Ageand other Australian newspapers, 20th
April toearly May 2011
26
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
27/37
ThethirdAARadvertisementshowninFigure8statesthat$1.12boffederaltobaccoexcisetax
revenuewaslostbecauseorganisedcriminalnetworkssmuggledandsoldillegaltobaccoincluding
counterfeitcigarettes.BasedondatafromtheNationalDrugStrategyHouseholdSurveyaboutthe
frequencyofuseamongthosewhostilluseunbrandedtobaccoproducts,therevenueforgone
wouldbemorelike$100m.TheDeloittereportfromwhichthisestimateisdrawnindicatedthat
peoplesmokingchopchopandotherunbrandedtobaccoproductswerenolongerbuyingitfrom
localmarketsashadbeenthecasesomeyearsago,butwerenowpredominantlybuyingitfrom
ordinarytobaccoretailers.Norespondentstothesurveyreportedpurchasingproductfrominformal
dealers;70%ofrespondentsreportedthattheypurchasedillicittobaccoordinaryretailersincluding
thosetheAARrepresentsand,mostfrequently,specialisttobacconists(50%)seeFigure9. Ifuseof
illicittobaccoisaswidespreadasthetobaccoindustryclaims,thenAustralianretailersincluding
thoserepresentedbytheAARmustbepurchasingatleast12%oftheproductstheysellfrom
criminalgangs.
Source: report by Deloitte. commissioned by BATA Ltd, Philip Morris Ltd and ImperialTobacco Australia Ltd, Supply of Illicit Tobacco, 2011, p22
DraftlegislationreleasedbytheAustralianGovernment[75]specifiesthatanticounterfeiting
measureswouldbeallowedonpacksincludingalphanumericcodes,covertmarkingsandforensic
leveldifferentiationofthecontentofthecardboardandothermaterial.
27
-
8/4/2019 Plain packaging of tobacco products: a review of the evidence
28/37
References
1. RuddK,SwanWandRoxonN.PrimeMinister,Treasurer,MinisterforHealth.AntiSmoking
Action.[Mediarelease].Canberra:OfficeofthePrimeMinister,29April2010[viewed3September2010].Availablefrom:http://www.alp.org.au/federalgovernment/news/anti
smokingaction/
2. AustralianGovernment.Takingpreventativeaction:Government'sresponsetoAustralia:the
healthiestcountryby2020.Canberra:DepartmentofHealthandAgeing,2010.Available
from:http://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report
preventativehealthcare
3. PreventativeHealthTaskforce.Australia:thehealthiestcountryby2020.National
PreventativeHealthStrategy.Canberra:CommonwealthofAustralia,2009.Availablefrom:
http://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/
nationalpreventativehealthstrategy1lp
4. WHOFrameworkConventiononTobaccoControl.NewYork:UnitedNations,2003.2302
Availablefrom:http://www.who.int/tobacco/framework/WHO_FCTC_english.pdf
5. PalmerA.Theproduct.InPalmer,AJ,eds,In:Principlesofmarketing.London:Oxford
UniversityPress/Books,2000.21538.Availablefrom:
http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=7500349&site=ehostlive
6. UnderwoodRandOzanneJ.Isyourpackageaneffectivecommunicator?Anormative
frameworkforincreasingthecommunicativecompetenceofpackaging.Journalof
MarketingCommunication1998;4(4):20720.Availablefrom:
http://www.ingentaconnect.com/content/routledg/rjmc/1998/00000004/00000004/art000
02?token=0042161894d0d27e41225f406a5e2c6b465d487667627b49576b64276a79595d88
7. BrownandWilliamsonTobaccoCorporation.Untitled(SpeechnotesofaBrownand
Williamsonemployee.) Mediarelease.NoDate.LegacyTobaccoDocumentsLibrary
UniversityofCalifornia,SanFrancisco1985,[viewedSeptember2010].Availablefrom:
http://legacy.library.ucsf.edu/tid/knn70f00
8. BakerM.MacmillanDictionaryofMarketingandAdvertising:Macmillan,1985.
9. UnderwoodR.Thecommunicativepowerofproductpackaging:creatingbrandidentityvia
livedandmediatedexperience.JournalofMarketingTheoryandPractice2003;11(1):62.
10. LambatI.Topdogs.Whatittakestoenterintotheleagueofglobalbestsellersandhowto
remainthereTobaccoReporter2007;February:404.
11. JenkinsF.DictionaryofMarketingandCommunication:Blackie,1987.
12. WeeksC.Tobaccomarketersgetmorecreativeasrestrictionsgrow.OttawaCitizen,2006:13
Nov.
13. EindhovenG.Elegantpackspromoteimage,defendpropertyrights.WorldTobacco
1999(170):1618.
14. Anon.Conjuringpackappeal.WorldTobacco2004;200:3540.
15. CorkA.Amatterofimage.WorldTobacco2004(203):2.
16.
Anon.
Accu
pac
provides
extra
pack.
World
Tobacco
2005(208):55
5.
17. RommelC.Thefinalwarnings.WorldTobacco2006(203):2.
28
http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/http://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcarehttp://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcarehttp://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcarehttp://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcarehttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.who.int/tobacco/framework/WHO_FCTC_english.pdfhttp://www.who.int/tobacco/framework/WHO_FCTC_english.pdfhttp://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=7500349&site=ehost-livehttp://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=7500349&site=ehost-livehttp://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=7500349&site=ehost-livehttp://www.ingentaconnect.com/content/routledg/rjmc/1998/00000004/00000004/art00002?token=0042161894d0d27e41225f406a5e2c6b465d487667627b49576b64276a79595d88http://www.ingentaconnect.com/content/routledg/rjmc/1998/00000004/00000004/art00002?token=0042161894d0d27e41225f406a5e2c6b465d487667627b49576b64276a79595d88http://www.ingentaconnect.com/content/routledg/rjmc/1998/00000004/00000004/art00002?token=0042161894d0d27e41225f406a5e2c6b465d487667627b49576b64276a79595d88http://legacy.library.ucsf.edu/tid/knn70f00http://legacy.library.ucsf.edu/tid/knn70f00http://www.ingentaconnect.com/content/routledg/rjmc/1998/00000004/00000004/art00002?token=0042161894d0d27e41225f406a5e2c6b465d487667627b49576b64276a79595d88http://www.ingentaconnect.com/content/routledg/rjmc/1998/00000004/00000004/art00002?token=0042161894d0d27e41225f406a5e2c6b465d487667627b49576b64276a79595d88http://search.ebscohost.com/login.aspx?direct=true&db=buh&AN=7500349&site=ehost-livehttp://www.who.int/tobacco/framework/WHO_FCTC_english.pdfhttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://www.preventativehealth.org.au/internet/preventativehealth/publishing.nsf/Content/national-preventative-health-strategy-1lphttp://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcarehttp://yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/report-preventativehealthcarehttp://www.alp.org.au/federal-government/news/anti-smoking-action/http://www.alp.org.au/federal-government/news/anti-smoking-action/ -
8/4/2019 Plain packaging of tobacco products: a review of the evidence
29/37
18. WakefieldM,MorleyC,HoranJKandCummingsKM.Thecigarettepackasimage:new
evidencefromtobaccoindustrydocuments.TobaccoControl2002;11(suppl.1):i73i80.
Availablefrom:http://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i73
19. ScheffelsJ.Adifferencethatmakesadifference:youngadultsmokers'accountsofcigarette
brandsandpackagedesign.TobaccoControl2008;17(2):11822.Availablefrom:
http://tobaccocontrol.bmj.com/cgi/content/abstract/17/2/118
20. HealthCanadaTobaccoControlProgramme.Aproposaltoregulatethedisplayand
promotionoftobaccoandtobaccorelatedproductsatretail.Ottawa:HealthCanada2006,
[viewedSeptember2006].Availablefrom:http://hcsc.gc.ca/hlvs/tobac
tabac/commun/consultation/currentactuelle/tobret/tab_e.html
21. PhilipMorrisLimited.Marketingnewproductsinarestrictiveenvironment.PhilipMorris
internationalmeeting,Naples,Florida,June1990.BatesNo:20447621732364. Philip
MorrisLtd,,1990.Availablefrom:http://legacy.library.ucsf.edu/tid/yhs55e00/pdf
22. CummingsKM,MorleyCP,HoranJK,StegerCandLeavellNR.MarketingtoAmerica'syouth:
evidence
from
corporate
documents.
Tobacco
Control
2002;11(suppl.1):i5
i17.
Available
from:http://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i5
23. HammondRandRowellA.Trustus:we'rethetobaccoindustry.London:ASH(UK)2001,Last
modifiedMay2001[viewed2May2007].Availablefrom:
http://www.ash.org.uk/files/documents/ASH_135.pdf
24. ChaloupkaFJ,CummingsKM,MorleyCPandHoranJK.Tax,priceandcigarettesmoking:
evidencefromthetobaccodocumentsandimplicationsfortobaccocompanymarketing
strategies.TobaccoControl2002;11(suppl.1):i62i72.Availablefrom:
http://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i62
25. CarterSM.Fromlegitimateconsumerstopublicrelationspawns:thetobaccoindustryand
youngAustralians.TobaccoControl2003;12(suppl.3):iii71iii78.Availablefrom:http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii71
26. KrugmanD,QuinnW,SungYandMorrisonM.Understandingtheroleofcigarette
promotionandyouthsmokinginachangingmarketingenvironment.JournalofHealth
Communication2005;10(3):26178.Availablefrom:
http://www.informaworld.com/smpp/ftinterface~content=a714034939~fulltext=713240928
27. PerryCL.Thetobaccoindustryandunderageyouthsmoking:tobaccoindustrydocuments
fromtheMinnesotalitigation.ArchivesofPediatrics&AdolescentMedicine
1999;153(9):93541.Availablefrom:http://archpedi.ama
assn.org/cgi/content/full/153/9/935
28. PollayRW.Targetingyouthandconcernedsmokers:evidencefromCanadiantobacco
industrydocuments.TobaccoControl2000;9(2):13647.Availablefrom:
http://tobaccocontrol.bmj.com/cgi/content/abstract/9/2/136
29. Anon.Opportunitiesinpackaginginnovation.PhilipMorris1992,[viewed29March2007].
Availablefrom:http://legacy.library.ucsf.edu/tid/hwe36e00
30. HenningfieldJE,BenowitzNL,SladeJ,HoustonTP,DavisRM,DeitchmanSD,etal.Reducing
theaddictivenessofcigarettes.TobaccoControl1998;7(3):28193.Availablefrom:
http://tobaccocontrol.bmj.com/cgi/content/abstract/7/3/281
31. BarbeauEM,LeavySperounisAandBalbachED.Smoking,socialclass,andgender:whatcan
publichealth
learn
from
the
tobacco
industry
about
disparities
in
smoking?
Tobacco
Control
29
http://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i73http://tobaccocontrol.bmj.com/cgi/content/abstract/17/2/118http://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://legacy.library.ucsf.edu/tid/yhs55e00/pdfhttp://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i5http://www.ash.org.uk/files/documents/ASH_135.pdfhttp://www.ash.org.uk/files/documents/ASH_135.pdfhttp://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i62http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii71http://www.informaworld.com/smpp/ftinterface~content=a714034939~fulltext=713240928http://www.informaworld.com/smpp/ftinterface~content=a714034939~fulltext=713240928http://archpedi.ama-assn.org/cgi/content/full/153/9/935http://archpedi.ama-assn.org/cgi/content/full/153/9/935http://archpedi.ama-assn.org/cgi/content/full/153/9/935http://archpedi.ama-assn.org/cgi/content/full/153/9/935http://tobaccocontrol.bmj.com/cgi/content/abstract/9/2/136http://legacy.library.ucsf.edu/tid/hwe36e00http://legacy.library.ucsf.edu/tid/hwe36e00http://tobaccocontrol.bmj.com/cgi/content/abstract/7/3/281http://tobaccocontrol.bmj.com/cgi/content/abstract/7/3/281http://tobaccocontrol.bmj.com/cgi/content/abstract/7/3/281http://legacy.library.ucsf.edu/tid/hwe36e00http://tobaccocontrol.bmj.com/cgi/content/abstract/9/2/136http://archpedi.ama-assn.org/cgi/content/full/153/9/935http://archpedi.ama-assn.org/cgi/content/full/153/9/935http://www.informaworld.com/smpp/ftinterface~content=a714034939~fulltext=713240928http://tobaccocontrol.bmj.com/cgi/content/abstract/12/suppl_3/iii71http://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i62http://www.ash.org.uk/files/documents/ASH_135.pdfhttp://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i5http://legacy.library.ucsf.edu/tid/yhs55e00/pdfhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://hc-sc.gc.ca/hl-vs/tobac-tabac/commun/consultation/current-actuelle/tob-ret/tab_e.htmlhttp://tobaccocontrol.bmj.com/cgi/content/abstract/17/2/118http://tobaccocontrol.bmj.com/cgi/content/abstract/11/suppl_1/i73 -
8/4/2019 Plain packaging of tobacco products: a review of the evidence
30/37
2004;13(2):11520.Availablefrom:
http://tc.bmjjournals.com/cgi/content/abstract/13/2/115
32. PolandBD,CohenJE,AshleyMJ,AdlafE,FerrenceR,PedersonLL,etal.Heterogeneity
amongsmokersandnonsmokersinattitudesandbehaviourregardingsmokingand
smokingrestrictions.TobaccoControl2000;9(4):36471.Availablefrom:
http://tobaccocontrol.bmj.com/cgi/content/abstract/9/4/364
33. PollayR.Export"A"adsareextremelyexpert,eh?TobaccoControl2001;10(1):714.
Availablefrom:http://tobaccocontrol.bmj.com/cgi/content/full/10/1/71
34. FerraroR,BettmanJandChartrandTL.Thepowerofstrangers:Theeffectofincidental
consumerbrandencountersonbrandchoice.JournalofConsumerResearch2009;35:729
41.
35. BlumA.Cigarettecardsironyinpropaganda.TobaccoControl1995;1995(2):11718.
Availablefrom:http://tobaccocontrol.bmj.com/cgi/reprint/4/2/117
36. Anon.KOOLnewlook.WorldTobacco2002(188):6.
37. JoyR.Brandidentitybecomesbrandexperience.WorldTobacco2001(184):10.
38. JoyR.Packswillcarrythemessage.WorldTobacco2003(197):612.
39. MawdittN.Puttingpackopportunitiesbackintotheframe.WorldTobacco2006(212):367.
40. Anon.Anewlevelinfoil.WorldTobacco2006(215):82.
41. SimpsonD.HongKong:Marlborotriesiton(thepack).TobaccoControl2002;11(3):171.
Availablefrom:http://tobaccocontrol.bmj.com/cgi/content/full/11/3/171
42. SladeJ.Thepackasadvertisement.TobaccoControl1997;6:16970.
43. ZimmelS.Graphicexpansionofpackprinting.WorldTobacco2003;194:39.
44. WakefieldMandLetcherT.Mypackiscuterthanyourpack.TobaccoControl2002;11:154
6.Availablefrom:http://tobaccocontrol.bmj.com/cgi/content/abstract/11/2/154
45. SwansonMG.Australia:healthwarningscanned.TobaccoControl2006;15(3):151.Available
from:http://tobaccocontrol.bmj.com/cgi/content/extract/15/3/151?rss=1
46. ChapmanS.Australia:BritishAmericanTobacco'addresses'youthsmoking.TobaccoControl
2007;16(1):23.
47. Anon.Cigarettesplitpackdefeated.TheDailyTelegraph,Sydney2006:18Nov. Available
from:http://global.factiva.com.ezproxy.library.usyd.edu.au/ha/default.aspx
48. KingBandBorlandR.Whatwas'light'and'mild'isnow'smooth'and'fine':newlabellingof
Australiancigarettes.TobaccoControl2005;14(3):2145.Availablefrom:
http://tobaccocontrol.bmj.com/cgi/content/full/14/3/214
49. FreemanB,ChapmanSandRimmerM.Thecasefortheplainpackagingoftobacco
products.Addiction2008;103:58090.Availablefrom:
http://www.ncbi.nlm.nih.gov/pubmed/18339104
50. GoldbergM,KindraG,LefebvreJ,TribuL,LiefeldJandMadillmarshallJ.Whenpackages
can'tspeak:possibleimpactsofplainandgenericpackagingoftobaccoproducts.Legacy
TobaccoDocuments,UniversityofCalifornia,SanFrancisco1995,[viewedSeptember2010].
Availablefrom:http://legacy.library.ucsf.edu/tid/rce50d00
51. TrachtenbergJA.Here'sonetoughcowboy.Forbes1987;February9:10810.
30
http://tc.bmjjournals.com/cgi/content/abstract/13/2/115http://tc.bmjjournals.com/cgi/content/abstract/13/2/115http://tobaccocontrol.bmj.com/cgi/content/abstract/9/4/364http://tobaccocontrol.bmj.com/cgi/content/abstract/9/4/364http://tobaccocontrol.bmj.com/cgi/content/full/10/1/71http://tobaccocontrol.bmj.com/cgi/content/full/10/1/71http://tobaccocontrol.bmj.com/cgi/reprint/4/2/117http://tobaccocontrol.bmj.com/cgi/reprint/4/2/117http://tobaccocontrol.bmj.com/cgi/content/full/11/3/171http://tobaccocontrol.bmj.com/cgi/content/full/11/3/171http://tobaccocontrol.bmj.com/cgi/content/abstract/11/2/154http://tobaccocontrol.bmj.com/cgi/content/abstract/11/2/154http://tobaccocontrol.bmj.com/cgi/content/extract/15/3/151?rss=1http://tobaccocontrol.bmj.com/cgi/content/extract/15/3/151?rss=1http://global.factiva.com.ezproxy.library.usyd.edu.au/ha/default.aspxhttp://global.factiva.com.ezproxy.library.usyd.edu.au/ha/default.aspxhttp://tobaccocontrol.bmj.com/cgi/content/full/14/3/214http://tobaccocontrol.bmj.com/cgi/content/full/14/3/214http://www.ncbi.nlm.nih.gov/pubmed/18339104http://www.ncbi.nlm.nih.gov/pubmed/18339104http://legacy.library.ucsf.edu/tid/rce50d00http://legacy.library.ucsf.edu/tid/rce50d00http://legacy.library.ucsf.edu/tid/rce50d00http://www.ncbi.nlm.nih.gov/pubmed/18339104http://tobaccocontrol.bmj.com/cgi/content/full/14/3/214http://global.factiva.com.ezproxy.library.usyd.edu.au/ha/default.aspxhttp://tobaccocontrol.bmj.com/cgi/content/extract/15/3/151?rss=1http://tobaccocontrol.bmj.com/cgi/content/abstract/11/2/154http://tobaccocontrol.bmj.com/cgi/content/full/11/3/171http://tobaccocontrol.bmj.com/cgi/reprint/4/2/117http://tobaccocontrol.bmj.com/cgi/content/full/10/1/71http://tobaccocontrol.bmj.com/cgi/content/abstract/9/4/364http://tc.bmjjournals.com/cgi/content/abstract/13/2/115 -
8/4/2019 Plain packaging of tobacco products: a review of the evidence
31/37
52. BeedePandLawsonR.Brandimageattraction:thepromotionalimpactofcigarette
packaging.TheNewZealandFamilyPhysician1991;18:1757.Availablefrom:
http://legacy.library.ucsf.edu/tid/sbf82f00/pdf;jsessionid=91CC73BD30F1A094EE18521634D
49295
53. BeedePandLawsonR.Theeffectofplainpackagesontheperceptionofcigarettehealth
warni