January 15, 2014

Fancy packaging of plain packaging impact

The Sydney Morning Herald has a story on the impact of plain packaging for cigarettes in Australia.  Cancer researchers in Sydney found a big spike in calls to Quitline after the packaging change, and interpreted this as evidence it was working

The researchers said although the volume of calls to Quitline was an ”indirect” measure of people’s quitting intentions and behaviour, it was more objective than community surveys where people can answer questions in a socially desirable and biased way.

On the other side, tobacco companies say there hasn’t been any actual fall in smoking.

”In November 2013, a study by London Economics found that since the introduction of plain packaging in Australia there has been no change in smoking prevalence … What matters is whether fewer people are smoking as a result of these policies – and the data is clear that overall tobacco consumption and smoking prevalence has not gone down,” he said.

In this setting you might reasonably be concerned that either side is putting their results in fancy packaging. So what should you believe?

In fact, the claims are consistent with each other and don’t say much either way about the success of the program.  If you look at the research paper, they found an increase peaking at about 300 calls per week and then falling off by about 14% per week. That works out to be a total of roughly 2000 extra calls attributed to the packaging change, ie, just over half a percent of all smokers in Australia, or perhaps a 10% increase in the annual Quitline volume. If the number of people actively trying to quit by methods other than Quitline also goes up by 10%, you still wouldn’t expect to see much impact on total tobacco sales after one year.

The main selling point for the plain packaging (eg) was that it would prevent young people from starting to smoke. That’s what really needs to be evaluated, and it’s probably too early to tell.

 

[Update: Of course, other countries that were independently considering changing their policies shouldn't wait for years just because Australia started first. That would be silly.]

[Update: the Quitline data are just for NSW; so perhaps 1.5% of smokers]

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Thomas Lumley (@tslumley) is Professor of Biostatistics at the University of Auckland. His research interests include semiparametric models, survey sampling, statistical computing, foundations of statistics, and whatever methodological problems his medical collaborators come up with. He also blogs at Biased and Inefficient See all posts by Thomas Lumley »

Comments

  • avatar

    Agree. I wish they’d rolled it out as an RCT though – simultaneous tax hikes and other anti-smoking initiatives make it hard to disentangle packaging from other effects. It’ll also start getting interesting to compare excise returns with self-reported smoking rates in the surveys – if the smuggling claims are right, we should see a bigger consumption decline as measured in the excise figures than what we get in the survey measures.

    6 months ago Reply

    • avatar
      Thomas Lumley

      It’s possible that under-reporting will increase in the surveys, which would have roughly the same apparent impact as smuggling.

      6 months ago Reply

      • avatar

        Really?

        In a world without smuggling, I’d expect total consumption measured by survey to be below total consumption as measured by excise returns – people might be reluctant to reveal that they smoke.

        Suppose we observe a decrease in the gap between excise return measures of aggregate consumption and survey measures of aggregate consumption. That could either be due to smuggling displacing excise tobacco, or a decrease in under-reporting in surveys.

        But if we have an increase in under-reporting, that should look like a reduction in smuggling, no?

        6 months ago Reply

        • avatar
          Thomas Lumley

          um, yes. It would mask an increase in smuggling, not look like an increase in smuggling.

          Still a problem, though.

          6 months ago

  • avatar
    Rodney Rowe

    Hi Thomas,

    Interesting post.

    One question, though. The study was only looking at one region in Australia (New South Wales and the Australian Capital Territory) – does that mean you can’t really use your half a percent of all smokers stat?

    Presuming a similar effect is observed in other regional quitlines, it would be considerably higher proportion of the national total overall?

    Thanks.

    6 months ago Reply

  • avatar
    ian lowe

    It’s difficult to know which stats to believe Smokers are now starting to put their cigarette packs in cases like those you can get at http://www.smoke-screenz.com. If the government are serious about stopping people starting to smoke, double the prices.

    6 months ago Reply

    • avatar
      Thomas Lumley

      NZ and Australia are using price increases, of course. The problems with really steep price increases are the economic impact on low-income smokers who don’t quit — it’s a strongly regressive tax — and the potential for big increases in smuggling. So there are tradeoffs.

      The advantage of plain packaging is that it has the potential to reduce uptake of smoking by young people without causing significant collateral harm to anyone except tobacco companies. That’s why it would be good to know if it actually works.

      6 months ago Reply

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