Open Access Research Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco Michelle Scollo, Meghan Zacher, Sarah Durkin, Melanie Wakefield To cite: Scollo M, Zacher M, ABSTRACT Strengths and limitations of this study Durkin S, et al. Early Objectives: To test for early evidence whether, following evidence about the predicted the standardisation of tobacco packaging, smokers in ▪ unintended consequences of The dual-frame (landline and mobile phone) Australia were—as predicted by the tobacco industry— standardised packaging of sample design used in this study obtains more rep- tobacco products in Australia: less likely to purchase from small mixed business resentative samples than online or landline-only a cross-sectional study of the retailers, more likely to purchase cheap brands imported phone surveys. place of purchase, regular from Asia and more likely to use illicit tobacco. ▪ A limitation is that recent purchase of potentially brands and use of illicit Design: Serial cross-sectional population telephone illicit branded (contraband) tobacco was only tobacco. BMJ Open 2014;4: surveys in November 2011 (a year prior to assessed in one survey year (2013), and there- e005873. doi:10.1136/ implementation), 2012 (during roll-out) and 2013 (a year fore we could not determine whether it had bmjopen-2014-005873 after implementation). increased between 2011 and 2013. Setting/participants: Smokers aged 18 years and over ▪ As with other surveys, respondent error and mis- ▸ Prepublication history for identified in an annual population survey in the Australian reporting may have affected prevalence estimates this paper is available online. state of Victoria (2011: n=754; 2012: n=590; 2013: for illicit unbranded tobacco, considering its To view these files please n=601). illegal status. However, the extent of this misre- visit the journal online Main outcome measures: Changes between 2011 and porting should not have changed over time. (http://dx.doi.org/10.1136/ ▪ bmjopen-2014-005873). 2013 in: proportions of current smokers who purchased The survey was only conducted in Victoria and their last cigarette from discount outlets such as only among English-speaking residents; a larger Received 6 June 2014 supermarkets compared with small mixed business retail national sample would be desirable to provide a Accepted 20 June 2014 outlets; prevalence of regular use of low-cost brands more robust test of claims. imported from Asia and use of unbranded tobacco. Results: Theproportionofsmokerspurchasingfrom supermarkets did not increase between 2011 (65.4%) INTRODUCTION and 2013 (65.7%; p=0.98), and the percentage purchasing from small mixed business outlets did not Legislation mandating standardised pack- decline (2011: 9.2%; 2012: 11.2%; p=0.32). The aging of tobacco products came into force in 1 prevalence of low-cost Asian brands was low and did not Australia at the end of 2012. All Australian increase between 2011 (1.1%) and 2013 (0.9%; p=0.98). tobacco products are required to be pack- The proportion reporting current use of unbranded illicit aged in a uniform drab dark brown with stan- tobacco was 2.3% in 2011 and 1.9% in 2013 (p=0.46). dardised lettering and position of brand and In 2013, 2.6% of cigarette smokers reported having variant names2 and prominent text and purchased one or more packets of cigarettes in non- photographic health warnings comprising compliant packaging in the past 3 months; 1.7% had 75% of the front and 90% of the back of purchased one or more packets from an informal seller in each pack.3 So far, Australia is the only the past year. Cancer Council Victoria, country to have introduced such a policy, Conclusions: One year after implementation, this study 4 Centre for Behavioural although legislatures in New Zealand and found no evidence of the major unintended consequences Research in Cancer, the Republic of Ireland5 are in the process Melbourne, Victoria, Australia concerning loss of smoker patrons from small retail outlets, flooding of the market by cheap Asian brands and of considering draft legislation. While the Correspondence to use of illicit tobacco predicted by opponents of plain UK Government backed away from such a 6 Dr Michelle Scollo; packaging in Australia. measure in mid-2013, it later commissioned [email protected] a review of the evidence, published in April Scollo M, et al. BMJ Open 2014;4:e005873. doi:10.1136/bmjopen-2014-005873 1 Open Access 2014,7 headed by eminent paediatrician Sir Cyril Government has not regarded illicit tobacco as a major Chantler, which included consideration of the early problem to date.27 The majority of seizures of smuggled experience from Australia. tobacco at ports over the past 10 years have been for raw Opponents of the legislation in Australia claimed that unbranded loose tobacco known locally as chop-chop.28 standardised packaging would have three major unin- The most recent government-funded survey found that – tended consequences.8 12 First, it was argued that it 1.4% of smokers in 2010 used unbranded tobacco ‘half would create confusion for retailers faced with packs of the time or more’.29 Illicit branded cigarettes (counterfeit uniform appearance. This, it was argued, would result in and other contraband cigarettes smuggled into the increases in pack retrieval and overall serving times,13 country without payment of customs duty) have also been impatience with queuing among customers, and a conse- noted in Customs seizures since 2001, but in much quent shift in patronage, sales and profits from small smaller quantities than unbranded loose tobacco. mixed businesses (often locally owned) to large discount Quantities of such cigarettes seized have been increasing outlets such as supermarkets (generally run by large cor- since 2008–2009 but there have been corresponding falls porations).14 Second, opponents argued that it would in quantities of unbranded tobacco.28 result in a general devaluing of brands—the so-called A tobacco company-funded report by the high-profile ‘commoditisation’ of tobacco products12—leading London-based international accounting and consultancy among other things to the increased use of cheap brands firm KPMG LLP, published late in 2013,30 estimated that sourced from Asia15 16 and increased use of illicit more than one in six smokers (17.5%) used unbranded tobacco. Third, it was argued that the standardised illicit tobacco in 2013, compared with 14.2% in 2012 appearance of the packs would make them easier to (no CIs or tests of significance reported). This estimate counterfeit16 and that this—combined with the reduced was criticised for being biased as the sample was a self- valuing of brands—would lead to an increase in the use selected group of internet users.31 Accordingly, a third of contraband cigarettes, once again disadvantaging retai- objective of this study was to compare the prevalence of lers and advantaging ‘criminal gangs’ purported to be use of unbranded illicit tobacco before and after imple- widely involved in its distribution.17 Many of the same mentation of standardised packaging legislation using arguments have been proffered by those opposed to the the annual telephone population survey of Victorians – introduction of standardised packaging in the UK.18 21 that employed a random digit dial (RDD) sampling Surveys conducted for Philip Morris Limited immedi- method to achieve a representative sample. ately after and 9 months after the implementation of the The KPMG LLP report on illicit tobacco in Australia Australian plain packaging legislation reported that high also stated that 9.8% of cigarettes analysed in a dis- percentages of retailers believed that serving times had carded pack study conducted by company MS increased.22 However, studies objectively timing pack Intelligence were from non-domestic packs, almost all of retrieval among a random sample of stores before, which (9.7% of all cigarettes analysed) were presumed during and after the introduction of the legislation did to be contraband cigarettes. This represented an not corroborate these perceptions,23 24 detecting only a increase of more than 150% in the prevalence of such slight and extremely short-lived increase in serving time cigarettes since 2012.30 Empty Pack Studies are problem- immediately following implementation.24 25 The first atic in that they tend to over-represent the cigarette objective of the current study was to assess any change packs that end up in litter in public places compared in the usual place of purchase of tobacco products with those disposed of in domestic and work-based – among smokers at a time long enough after implemen- rubbish disposal systems.32 34 Such studies also cannot tation to allow retailers an opportunity to adapt to the distinguish between foreign packs that are illegally changed packaging. In particular, this study assessed smuggled into Australia and those brought in by resi- whether there had been a shift among consumers dents and visitors who have purchased them overseas between 2011 and 2013 from use of small mixed busi- and brought them in either under personal import nesses to discount outlets such as supermarkets. limits or with the required duty having been paid.33 The During the course of the campaign against standar- assumptions used by KPMG LLP to estimate the non- dised packaging of tobacco products, British American legitimate compared with the legitimate imports have Tobacco Australia warned that if the legislation went been heavily criticised.32 33 Consumers do not necessar- ahead, then cheap tobacco from overseas, in particular ily know whether the cigarettes they purchased in from Asia, would ‘flood the market’.26 A second object- Australia are contraband; however, two important indica- ive of this study was to assess whether the prevalence of tors of likely illicit status on which consumers can report use of cheap brands produced by manufacturers located are whether packs purchased bear the required in Asia increased among smokers between 2011 and Australian health warnings, and whether they have been 2013.