Australia sees large fall in smoking after introduction of standardised packs
BMJ 2014; 349 doi: https://doi.org/10.1136/bmj.g4689 (Published 17 July 2014) Cite this as: BMJ 2014;349:g4689
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This is a revised version of my previous reponse dated 26th July. Unfortunately, I stupidly misread some of the figures in the National Drugs Strategy Household Survey 2013, which lead me to conclude that the falls in smoking prevalence between 2010 and 2013 was the same as that in 2007 to 2010 - in fact it was higher than in the previous three years, but the gist of my rapid response is unchanged. I have amended the first paragraph, and the amended version follows:
While I strongly favour the introduction of standardised packaging and any other measures designed to make smoking less attractive, I am uncomfortable with the suggestion that there has been a “massive decline” in smoking prevalence. [1]. The absolute fall in prevalence of current smokers (2.3%) shown in the Australian Institute of Health and Welfare’s National Drugs Strategy Household Survey 2013 (NDSHS) [3], is encouraging as a headline figure, and the rate of 12.8% in adults (over the age of 12 years) is now one of the lowest in developed countries. The fall in smoking prevalence between 2010 and 2013 (from 15.1% to 12.8%) may be higher than that in the preceding three years (1.5% drop between 2007 to 2010) but this is just the continuation of a trend that began 20 years ago and is unlikely to demonstrate an effect of standardised packaging. The percentage of never smokers has been increasing by around 0.8% per year since 2001 with very little change in the proportion of ex-smokers.
What the figures from NDSHS do demonstrate is that the biggest drop in proportion of current smokers is in the 30-39 years old age group. This suggests that the headline change is, at least in part, due to a combination of two secular trends – firstly, the passage of a large and continuing cohort of people who resisted previous trends to become regular smokers 20 years ago, and secondly (more chillingly) the early deaths of those who continued smoking into their sixties and later.
The significant 4.7% rise in the proportion of never-smokers in the 18-24 years old group is encouraging. However, the small proportion of 12-17 year olds taking up daily smoking did not change and it may be that strategies other than plain packaging are needed in this age group.
There certainly isn’t any robust evidence that standardised packaging in Australia isn’t working. These downward trends are encouraging and should encourage the UK government to digest the results of its own consultation (due to close on August 7th) and move forward as quickly as possible. There are also important lessons to be learnt from the Australian real-life experiment in ensuring that standardised packaging extends to the numbers of cigarettes in each packet and their length and appearance to ensure that false perceptions of brand quality and health risks are removed as far as possible [4].
[1] Kmietowicz Z. Australia sees large fall in smoking after introduction
of standardised packs BMJ 2014;349:g4689
[2] Roca G. Australia sees large fall in smoking after introduction of standardised packs (Rapid response) BMJ 2014;349:g4689/rr/761276
[3] National Drug Strategy Household Survey 2013 Australian Institute of Health and Welfare
[4] International Association for the Study of Lung Cancer: Submission to Sir Cyril Chantler’s review of Standardised Packaging of Tobacco. December 2013
Competing interests: No competing interests
While I strongly favour the introduction of standardised packaging and any other measures designed to make smoking less attractive, I don’t support the misuse and misreporting of data to this end [1]. This simply concedes scientific “high ground” to the industry, which has been quick to respond [2]. The absolute fall in smoking prevalence (2.3%) shown in the Australian Institute of Health and Welfare’s National Drugs Strategy Household Survey 2013 (NDSHS) [3], is encouraging as a headline figure, and the rate of 12.8% in adults (over the age of 12 years) is now one of the lowest in developed countries. However, this is just the continuation of a trend that began 20 years ago. The fall in smoking prevalence (from 15.1% to 12.8%) between 2010 and 2013 is exactly the same as in the preceding three years (from 2007 to 2010).
What the figures from NDSHS do demonstrate is that the biggest drop in proportion of current smokers is in the 30-39 years old age group. This suggests that the headline change is, at least in part, due to a combination of two secular trends – firstly, the passage of a large and continuing cohort of people who resisted previous trends to become regular smokers 20 years ago, and secondly (more chillingly) the early deaths of those who continued smoking into their sixties and later.
The significant 4.7% rise in the proportion of never-smokers in the 18-24 years old group is encouraging. However, the small proportion of 12-17 year olds taking up daily smoking did not change and it may be that strategies other than plain packaging may be needed in this age group.
There certainly isn’t any robust evidence that standardised packaging in Australia isn’t working. These downward trends are encouraging and should encourage the UK government to digest the results of its own consultation (due to close on August 7th) and move forward as quickly as possible. There are also important lessons to be learnt from the Australian real-life experiment however in ensuring that standardised packaging legislation extends to the numbers of cigarettes in each packet and their length and appearance to ensure that false perceptions of brand quality and health risks are removed as far as possible [4].
[1] Kmietowicz Z. Australia sees large fall in smoking after introduction of standardised packs BMJ 2014;349:g4689
[2] Roca G. Australia sees large fall in smoking after introduction of standardised packs (Rapid response) BMJ 2014;349:g4689/rr/761276
[3] National Drug Strategy Household Survey 2013 Australian Institute of Health and Welfare
[4] International Association for the Study of Lung Cancer: Submission to Sir Cyril Chantler’s review of Standardised Packaging of Tobacco. December 2013
Competing interests: No competing interests
I am writing regarding your interpretation and use of figures by the Australian Institute of Health and Welfare into the number of daily smokers in Australia in your recent post.
This survey shows a 2.3 percentage point drop in smoking incidence between 2010 and 2013 in Australia. However, your post attributed, spuriously, this drop to the introduction of standardised or plain packaging of tobacco products in Australia.
Standardised packing of tobacco products was introduced in Australia in December 2012, yet this survey covers the period from 2010. Therefore, it is entirely incorrect to suggest that standardised packaging has been the reason for this drop. What’s more there is no increase in the rate of decline in 2013 and therefore no effect from plain packaging.
The data shows that the smoking rate has been falling by 0.4-0.9 percentage points every year for twenty years and has continued to do so since plain packaging came in. The same survey shows an identical drop (2.3 percentage point drop) between 1998 and 2001 (with a further 2.1 percentage point drop between 2001 and 2004. There has not been a huge or significant drop in smoking rates since the plain packaging policy was enacted in Australia.
Competing interests: I represent the UK tobacco industry.
This report of a measurable reduction in smoking prevalence in Australia after that country introduced standardised tobacco packaging for cigarettes is welcome news and highly encouraging[1].
It is also unsurprising. The vehemence of the opposition from the tobacco industry to this measure speaks volumes.
The cautious approach taken by the British Government to date understandable in the absence of evidence of efficacy.
However, in light of this new Australian evidence and in line with the independent review chaired by Sir Cyril Chantler report on this subject[2], I urge the Government to bring in standardised tobacco packaging as soon as possible.
In my personal opinion, every reasonable measure capable of reducing the prevalence of smoking and therefore the morbidity and mortality associated with that addiction should be deployed.
If the howls of protest from the tobacco industry grow louder and more shrill, the Government will know it is on the right track.
References:
[1] Australia sees large fall in smoking after introduction of standardised packaging. BMJ 2014;349:g4689
[2] Standardised packaging of tobacco. Report of the independent review undertaken by Sir Cyril Chantler. April 2014
http://www.kcl.ac.uk/health/10035-TSO-2901853-Chantler-Review-ACCESSIBLE...
Competing interests: I am a supporter of Action on Smoking of Health (ASH), an anti-tobacco smoking charity. I work for Public Health England but am writing in a personal capacity. The views expressed are my own and not those of my employer.
Stating relative reduction of 15% in smoking is disingenuous. Absolute reduction is 2.3%. Still worthwhile. In my opinion, BMJ editors should ensure that absolute and relative are always apparent.
Yours faithfully,
Manas Sikdar
Competing interests: No competing interests
Re: Australia sees large fall in smoking after introduction of standardised packs
Your tobacco industry correspondent G Roca is either poorly informed or engaging in the sort of misleading spin the world has witnessed from that industry for over 50 years. The fall recorded in smoking prevalence between the Australian Institute of Health and Welfare’s 2010 and 2013 national surveys was the biggest percentage fall (15.5%) ever recorded since the surveys commenced in 1991 (see Figure). In the period between the two surveys, the introduction of plain packaging (Dec 2012) was the only standout variable beyond the normal automatic Consumer Price Index adjustments to tobacco tax and the raft of other tobacco control measures (campaigns, smoke free policies etc) that have been in place for many years.
There had been an extraordinary 25% tobacco tax increase in early May 2010, but the first 5 months impact of that rise coincided with the data collection period (April 29- September 14 2010) for the previous AIHW survey, published in 2011, and so would have influenced that earlier figure.
There was a further extra tobacco 12.5% tax increase in December 2013. But data collection for the 2011-2013 AIHW report occurred between July 31 and December 1, 2013 the day an extra 12.5% tobacco tax was introduced. It could therefore have not influenced the 2013 data, showing the fall.
Moreover, the Australian Treasury has reported that customs and excise receipts for 2013 (post plain packs) were 3.4% below those for 2012 (pre plain packs). (1)
Citi, the global market investment advisors, were in no doubt about the meaning of the data, saying it provided “the best data” to support the British government’s imminent decision to legislate plain packs and that the data would “substantially undermine” the tobacco industry’s argument that there was no good evidence that plain packaging would achieve its stated aims. (2)
References
1. Australian Government. Department of Health. Tobacco Key facts and figures July 17 2014. http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-kff
2. Citi Research Equities. Tobacco - Australia data provides ammunition for plain packaging elsewhere. 2014 Jul 17.
Competing interests: No competing interests