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
Rapid Response:
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