the cancer council victoria plain packaging: what it might do, and how we plan to find out what it...

The Cancer Council Victoria

Plain packaging: What it might do, and how we plan

to find out what it does.

Ron Borland PhDThe Cancer Council Victoria

[email protected]


Disclosure

• I am a member of the Technical Advisory group set up to provide expert input to the Commonwealth Government on the Plain Packaging legislation.

• This presentation is completely independent of that role.


Australian standardised packaging• Strong larger warnings (75% 0f front)• Rest in common dark olive-brown colour• Fixed pack sizes and shape• Only Brand and variant names, and number of cigarettes allowed on front


Steps in evaluation

• Contextualising policy within a broader framework

• Identifying justifications for policy

• Theorising possible effects– Intended– Unintended positive– Unintended negative

• Studies to measure theorised effects


Justifications for removing pack designs

• Form of promotion– Thus should be eliminated

• Distracts from warnings

• Encourages youth smoking

• Kylie’s paper details this fully


Good evaluation

• Multiple baselines, where possible• Multiple post-policy observations

– Obviously takes time• Controls

– Either no policy– Different policy– Different timing of policy– Some combination of above

• Mediational model– Measures mechanisms of effect, not just

important outcomes


Studies plannedStudies planned• ITC study

– Some measures tracked for several years– Others introduced in 2011– Two waves of follow-up funded

• National monthly survey (smokers and recent quitters)– 1 month follow-up for quit outcomes

• Monitoring of price and presence of PP

– Observational study over period of implementation and shortly after

• Youth survey: ASSAD– 3 yearly survey, some baseline measures collected in 2011, next survey due 2014

• Other national data collections– Excise collections

– National prevalence surveys

• Scream test

– Already demonstrated that the tobacco industry think it will have marked effects


Possible effects

• Immediate effects– Fairly certain and summarised in

previous presentation

• Longer-term effects– Some may be predictable from

immediate effects– Some likely to differ

• Can come to value what you didn’t like

– These are what really matter


Determinants of smoking

• Balance between experienced value of smoking and costs of doing so

• If use, act to maximise value of smoking for them


PersonPerson

Product promotion & packaging

Tobacco

use

Product design

Tobacco marketing: ways it affects tobacco use

Places where sold

Price

Habits

Expectations & beliefs

MarketingMarketing

Values & norms

Experiences

ProductProduct

Intrinsic features

Cues to useCues to use

Acquired features

Culture of useCulture of use

AvailabilityAvailability

PricePrice


What does branding do?

• Basis of building identity of brand and means of adding incidental value

• Allows for creation of different imagery for subsets of tobacco users– Curiously this can also be done within

a brand


How do smokers respond to branding?

• Affects their liking of the pack

• Their capacity to add user-value

• These evolve over time– Immediate preferences do not

necessarily determine longer-term preferences


Determinants of value

Value =

Intrinsic + Industry-added + User-added + Interactions

Intrinsic = Value that comes directly from use of the product

Industry-added = Value that is added by a company to make its brands more attractive to users

User-added = Beliefs and activities that smokers engage in to get more value from smoking

Interactions = Value from combinations of the above


How plain packaging might reduce value?

• Reduced value of smoking overall– Packs seen as less attractive– Packs increase focus on harms

– More focus on health warnings» Reduce reassurance from contrasting pack designs

– Resulting in:• Increase product denormalisation• Less positive experiences of use• More negative experiences of use

• Reduced brand-specific differentiation– Greater effects on premium brands??

• More industry-added value to start with– Reduced differentiation of smoker sub-groups

• Reduced variant differentiation– Less cues to taste differentiation


Possible Effects

• Reduced value ═ Reduced preparedness to pay═ Less consumption═ More quitting

BUT• Industry may compensate by dropping

prices• Will reduce above effects, but unlikely to

eliminate them– Reasons for not smoking will not decline


Outcomes to measure

Smoker-related• Quit attempts• Sustained quitting and relapse• Quit-related thoughts• Brand shifting• Price paid• Consumption• Attitudes to smoking• Reactions to health communications• Perceptions about quality


Possible effects on youth

• More negative image of smoking– smoking more difficult / tastes worse– smoking less socially desirable

• Less brand-driven use– Reduced brand-specific imagery

• Less identification with in-group brands

• Reduced experimentation

• Reduced long-term uptake


Tobacco industry arguments

• That the plain packaging law will not work• That it will cost them billions

– The more it works, the bigger the harm to them, but– The bigger the effect, the more justification for the law– They are caught on the horns of a dilemma

• That it will lead to illicit trade– Hard to measure– Rationalisation for any drop in legal sales

• The industry lose, the community gets nothing– Need to be able to counter this

• They also fear it will squeeze profit per pack sold, by reducing their capacity to charge extra for premium brands


Illicit trade

Industry claims likely effects

• Easier to counterfeit

• Incentives for smuggling branded packaging

• Makes chop-chop more attractive

• These effects are unlikely to have any significant effect on the market


Possible outcomes

Industry-related• Illicit trade• Price discounting• Removal of some Brands/Variants from the

market• Use of number of cigs per pack as a marketing

device• Use of filters as a marketing device• Use of cigarette size (length, diameter) and shape

(oval vs round) as marketing tools• Use of dark olive brown in lifestyle marketing for

other products


Justifying smoking• Most people have a need to justify their smoking,

if only to themselves– this creates challenges for the smoker

• Some possible strategies to deal with this– Quit– Using justifications:

• Addicted• It helps me; eg deal with stress• Risks exaggerated*• Part of who I am*

– Reducing cues to think about the harms• Hide the packs*• Using cigarette cases*• More smoking in private*

– Strengthening on “smoker identity”• Persecuted minority*

* likely affected by plain packaging


Could there be negative effects?

• Not likelyTheoretical possibilities:• Defensive dissonance reduction

– Increase in beliefs about the personal value of smoking

– Reinforce common identity of smokers• Persecuted minority

– Increased beliefs in being addicted• Thus less able to quit


Studies plannedStudies planned• ITC study

– Some measures tracked for several years– Others introduced in 2011– Follow-up in 2012, around implementation; and in– 2013 about 1 year after full implementation

• National monthly survey (smokers and recent quitters)– 1 month follow-up for quit outcomes

• Monitoring of price and presence of PP

– Observational study over period of implementation and shortly after

• Youth survey: ASSAD– 3 yearly survey, some baseline measures collected in 2011, next survey due 2014

• Official data collections– Excise collections

– National prevalence surveys

• Scream test


SummarySummaryDirect effects of Plain packaging on smoking prevalence will be very difficult

to identify, unless they are huge.

However, demonstrating mediated effects is likely:

• They may strengthen reactions to health warnings and thus lead to more quitting

– Difficult to evaluate given concurrent introduction of bigger health warnings

• The may further denormalise smoking and both increase quitting and reduce uptake

– But already highly denormalised

• They may led to reduced pleasure of smoking and through this lead to more quitting

• May have greater impact on those previously smoking premium brands

– But may be reduced if prices for these drop relative to other brands

• Tobacco may have more of a common identity

We need to assess all this and more

• The studies are largely in place

• We just have to wait


Core support provided by the U.S. National Cancer Institute

(P01 CA138389)

Core support provided by the Canadian Institutes of Health

Research (MOP-115016)

Australian arm mainly supported by NHMRC


Constrain tobacco

marketing

Tobacco use

Regulate tobacco products

Elements of tobacco control

Consequences of use

Smoke-free rules

Programs to prevent

uptake

Cessation programs and aids

Information:• Mandated• Campaigns

Norms for use

Tobacco use controlTobacco industry

Biology

Tax

the cancer council victoria plain packaging: what it might do, and how we plan to find out what it...

Documents

cancer council victoria

brand slide

theorised effects slide

marked effects slide

tobacco use places

tobacco industry

youth survey

experienced value of