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Member States Albania EVIDENCE Andorra Armenia Austria Azerbaijan Belarus BRIEF Belgium Bosnia and Herzegovina Bulgaria Plain packaging of tobacco products: Croatia Cyprus Czech Republic measures to decrease smoking initiation Denmark Estonia Finland France and increase cessation Georgia Germany Greece Hungary Iceland Ireland Israel Italy Kazakhstan Kyrgyzstan Latvia Lithuania Luxembourg Malta Monaco Montenegro Netherlands Norway Poland Portugal Republic of Moldova Romania Russian Federation San Marino Serbia Slovakia Slovenia Spain Sweden Switzerland Tajikistan The former Yugoslav Republic of Macedonia Turkey Turkmenistan Ukraine United Kingdom World Health Organization Uzbekistan Regional Office for Europe UN City, Marmorvej 51, DK-2100 Copenhagen Ø, Denmark Tel.: +45 45 33 70 00. Fax: +45 45 33 70 01. Original: English E-mail: [email protected]. Web site: www.euro.who.int 20 i EVIDENCE BRIEF Plain packaging of tobacco products: measures to decrease smoking initiation and increase cessation Abstract Evidence shows that the packaging of tobacco products is designed for badge products targetting specific groups, particularly women and young people, and that attractive packaging tends to weaken warnings about the harmful health effects of the products. To preserve the effectiveness of the health warnings – a requirement under Articles 11 and 13 of the WHO Framework Convention on Tobacco - the guidelines on the implementation of these articles recommend the adoption of plain-packaging measures. Studies have revealed that plain packaging reduces the attractiveness of the product, particularly to women and young people. They also show that, when combined with large pictorial health warnings, plain-packaging measures increase awareness about the risks related to tobacco consumption, encouraging more people to quit and fewer to start. In that these measures merely regulate the use of logos or colours for public health purposes, they are in compliance with international trade and intellectual property law. Keywords Health policy Packaging Product labeling Smoking Tobacco use cessation Address requests about publications of the WHO Regional Office for Europe to: Publications WHO Regional Office for Europe UN City, Marmorvej 51 DK-2100 Copenhagen Ø, Denmark Alternatively, complete an online request form for documentation, health information, or for permission to quote or translate, on the Regional Office web site (http://www.euro.who.int/pubrequest). © World Health Organization 2014 All rights reserved. The Regional Office for Europe of the World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. 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Layout: Lars Møller. iv Contents Acknowledgements vi Background 1 Objective 1 Evidence 1 Plain packaging reduces the attractiveness of the product, particularly to young people and women 2 Plain packaging combined with large pictorial health warnings increases awareness of the risks related to tobacco consumption 3 Plain-packaging measures encourage more people to quit and fewer to start 4 Legality of plain-packaging measures 4 Arguments of the tobacco industry in relation to plain-packaging measures 5 References 7 v Acknowledgements This document was written by Céline Brassart Olsen, Consultant, WHO Regional Of- fice for Europe, with contributions from the following staff of the Regional Office: Rula Cavaco Dias, Regional Surveillance Officer, Yulia Kadirova, Programme Assistant, and Kristina Mauer-Stender, Programme Manager, Tobacco Control Programme; and Gauden Galea, Director, Division of Noncommunicable Diseases and Life-course. vi by regulating the material used and the Background shape and size of the packages. Packaging is designed as a badge product targeted at specific groups, Article 5 of Directive 2001/37/EC of the particularly women and young people European Parliament and of the Council (1,2). The tobacco industry has always of 5 June 2001 on the approximation of used the packaging of tobacco prod- the laws, regulations and administrative ucts as a powerful advertising tool. In provisions of the Member States con- addition, it has become the best way of cerning the manufacture, presentation circumventing bans on the advertising, and sale of tobacco products regulates promotion and sponsoring of tobacco the labelling of packages with regard to products implemented by some gov- the warnings and information about the ernments in accordance with article 13 dangers to health of tar, nicotine and of the WHO Framework Convention carbon monoxide levels in cigarettes on Tobacco Control (FCTC) (3). As a (13). However, apart from the labelling result, in some countries, the packaging requirements, the Directive (13) does not of tobacco products has become “the regulate factors relating to the shape and most important promotional vehicle for appearance of the packaging itself. reaching potential and current smokers” (2,4). The design of a tobacco pack can A new tobacco-products Directive was make its contents appear safe to use, adopted in March 2014 and will enter undermining the credibility and effective- into force in 2016 in the European Union ness of health warnings. Psychology and (14). According to the new Directive, it marketing studies show that the colour will be possible for Member States to (5,6,7), shape (5,8,9) and size (5,10,11) adopt plain-packaging measures at the of a package have implications for con- national level if they wish to do so (14). sumer behaviour and the perception of product attributes. Objective In order to preserve the effectiveness of This paper seeks to provide evidence the health warnings under WHO FCTC of the effectiveness of plain-packaging article 11 (3) and of the advertising measures in smoking prevention and ban under WHO FCTC article 13 (3), cessation. the guidelines for the implementation of these articles (12) recommend the adoption of plain-packaging measures to Evidence decrease smoking initiation and increase A review of the scientific literature and smoking cessation. These consist of survey results on the effectiveness of diminishing the overall attractiveness of plain-packaging measures in decreas- the packages by replacing logos with ing smoking initiation and increasing brand names in a prescribed font, and smoking cessation revealed that, to date, Australia, is the only country to 1 have adopted these measures (in 2014). were also consulted for the purposes of Despite the short time span that has this brief. elapsed, there is evidence showing a sustained 78% increase in calls on the The following information is based on the quitline after the introduction of plain- above evidence. packaging measures, which is not attrib- utable to antitobacco advertising activity, increases in cigarette prices or other Plain packaging identifiable causes (15). A recent study published in the British Medical Journal reduces the at- found that plain packaging reduced the tractiveness of the appeal of smoking and encouraged smokers to consider quitting (16). product, particu- In addition, in the 1990s, several to- larly to young peo- bacco manufacturers were obliged to disclose company documents in the ple and women. context of a lawsuit in the United States Studies have revealed that plain packag- of America (17). During the course of the ing is found to be dull and to increase lawsuit, they acknowledged the crucial negative feelings about smoking. They role played by packaging in tobacco ini- consistently show that plain packaging tiation and consumption, thus recogniz- decreases the attractiveness of both ing the effectiveness of plain-packaging tobacco products and smoking, particu- measures in rendering tobacco packs larly to women and adolescents (Boxes less attractive.