Plain cigarette packaging a hit with anti-smoking advocates, but debate about whether it works continues

Anti-smoking advocates who support the Liberal government's proposal to require plain packaging on tobacco products argue that Australia's implementation of similar regulations has had a significant effect on smoking rates in that country.

"Australia has seen the biggest decline in smoking prevalence that they've ever recorded after plain packing [was introduced]," said David Hammond, an associate professor of public health and health systems at the University of Waterloo. "All the data we have suggest that plain packing has reduced smoking in Australia."

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Rob Cunningham, senior policy analyst for the Canadian Cancer Society, agrees and says research supports the effectiveness of plain packaging.

If it wasn't effective, the tobacco companies wouldn't be so strongly opposed.- Rob Cunningham, Canadian Cancer Society

"If it wasn't effective, the tobacco companies wouldn't be so strongly opposed," he said. "And it's precisely because it's going to have an effect on sales that they are going to lobby hard against it, threaten legal cases."

But not everyone believes that Australia's policy of imposing bland tobacco branding has done much to deter smoking, which has been steadily declining for decades, according to Julian Morris, vice-president of research at the libertarian think tank the Reason Foundation.

"The decline in smoking seems to have been continuous and not dramatically effected, one way or the other, by the introduction of plain packaging," he said.

Three-month consultations

On Tuesday, the Canadian government announced it would hold three months of public consultations on the proposed plain-packaging requirements, which would regulate size and shape and require a uniform colour and font. The idea is that the removal of logos, colours and images from packaging makes tobacco products less appealing, in particular, to youth.

It's a move that's being hailed by Canadian health groups like the Heart and Stroke Foundation and the Canadian Cancer Society, as well as by the World Health Organization. 

Although other countries like the United Kingdom and France have begun the process of bringing in plain packaging rules, so far, only Australia has fully implemented them.

The country introduced the regulations in December 2012, and according to Australian health officials, they're working.

"[The] tobacco plain packaging measure is having an impact by reducing the appeal of tobacco products, increasing the effectiveness of health warnings and reducing the ability of the pack to mislead," the Australian health department claims on its website. 

"The studies also provide early evidence of positive changes to actual smoking and quitting behaviours."

The website cites Tasneem Chipty, an econometric analyst who examined data from a series of surveys. Chipty found that the packaging changes accounted for a decline in smoking prevalence of 0.55 percentage points by September 2015 and 108,228 fewer smokers.

Tobacco company rejects analysis

But Eric Gagnon, a spokesman for Imperial Tobacco Canada, rejected that analysis, arguing that the rate of decline hasn't accelerated since the introduction of plain packaging.

There's no evidence that people start or stop smoking because of the packaging they see on a carton of cigarettes, but there is evidence that kids start smoking mostly because of peer pressure, he said.

Meanwhile, Morris pointed to reviews conducted by economic professors Sinclair Davidson and Ashton de Silva from RMIT University in Melbourne who said there was no evidence to support the notion that the plain packaging policy has resulted in lower household expenditure on tobacco.

Davidson and de Silva also claimed that the analysis conducted by the Australian government of the effectiveness of plain packaging "fails on a number of criteria, including independence, transparency, replication and rigour."

Morris said other factors could account for the decrease in Australian smoking rates, including the rise in the price of cigarettes, which were hit with a tax around the same time plain packaging was introduced.

"We do know that, historically, public information about the harms of smoking on health as well as significant increases in the price of cigarettes do reduce consumption," he said.

He said it's difficult to untangle the effects of historic restrictions on advertising, public information campaigns, cigarette taxes and graphic warning labels.

"That's not to say [packaging] had no effect on cigarette consumption. It's just that it's difficult to discern," Morris said.

There's also been an increase in the number of illegal cigarettes consumed in Australia, he said.

However, Chipty took many of those variables into consideration when analyzing the data.

It's difficult to say how much the decrease in smoking rates in Australia can be attributed to plain packaging, but Cunningham said that after the new rules came into force, calls to quit-smoking help lines increased, and surveys showed smokers were more likely to want to quit and try to quit and were less likely to buy cigarettes because of the packaging.

"It was certainly one of the main factors in those historic declines," he said.