Policy options for extending standardized tobacco packaging

Smoking is a public health problem that will cause 1 billion deaths in the 21st century, if current smoking patterns persist. (1) Tobacco companies' aggressive marketing has fostered tobacco use by creating brands and linking these to attributes and identities that users and susceptible non-users value. Although many countries now restrict traditional marketing media, tobacco companies have developed increasingly creative strategies to encourage experimentation with tobacco among non-users and deter quitting among users. Packaging has provided an important and until recently, largely unregulated, conduit for these marketing messages and has communicated appealing imagery to young people while using known and familiar brand symbols to reassure existing tobacco users. The World Health Organization's Framework Convention on Tobacco Control (FCTC) (2) obliges Parties to address tobacco packaging. Implementation guidelines for Articles II (3) and 13 (4) include consideration of plain packaging and recognize the myriad ways in which tobacco companies have used packaging to promote tobacco use. In response, Australia, France, Georgia, Ireland, New Zealand, Norway and the United Kingdom of Great Britain and Northern Ireland have either introduced or will soon be introducing standardized or plain packaging. Hungary, Romania, Slovenia and Thailand have already passed legislation to introduce plain packaging, and several other countries (including Belgium, Canada, Chile, Singapore and Sri Lanka, among others) are formally considering this policy. Plain packaging replaces the attractive brand livery displayed on tobacco packs with an aversive colour and standardized text, and is typically combined with larger pictorial warning labels, if these are not already in place. The policy recognizes that on-pack brand imagery has positioned tobacco use as an aspirational behaviour and fostered uptake among young people, (5) transforming tobacco packages from attractive display items to highly unappealing articles. Evidence from Australia shows standardized packaging and larger pictorial warning labels have reduced smokings appeal among young people, (6) increased demand for cessation support and decreased smoking prevalence. (8) Evaluations confirm predictions from experimental and other studies used to support the introduction of this policy. (8) Despite the intuitive logic of using packaging to deter rather than facilitate experimentation with tobacco products, other countries have been cautious in following Australia's approach. The time taken for plain packaging to be more widely adopted and implemented in other countries has caused some frustration among public health researchers and advocates. Nevertheless, this time lag has also provided an opportunity to examine how tobacco companies have reacted to Australia's new policy environment, and to consider whether and where Australian legislation could be extended. We suggest that countries planning to introduce standardized packaging have an opportunity to innovate in at least four ways: (i) restricting or banning brand variant names; (ii) developing larger and more salient onpack warnings; (iii) requiring tobacco products themselves to use dissuasive colours; and (iv) using packaging to create cessation portals that direct tobacco users to quit support. First, the introduction of standardized packaging in Australia saw a rapid increase in brand variant names (or descriptors) such as Marlboro Silver Fine Scent, Winfield Optimum Crush Sky and Peter Stuyvesant New York Blend. (9) These variant names attempt to recreate connotations formerly aroused by visual brand imagery and aim to reassure smokers, deter quitting and potentially attract new users. Recent work suggests the more descriptors used, the more attractive a pack appears. (10) Variants potentially mislead users by linking tobacco to appealing attributes or by minimizing the harm caused by tobacco use and serve no purpose other than to create marketing appeals. …

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