Why cigarette packs matter

March 12th, 2011 by Ben Goldacre in bad science | 66 Comments »

Ben Goldacre, The Guardian, Saturday 12 March 2011

This week our government committed itself to the removal, albeit slowly, of cigarette displays in shops. But plain packaging on cigarettes has been delayed for further consultation.

The Unite union is unimpressed. They represent 6,000 people in tobacco production and distribution, and put out a statement: “Switching to plain packaging will make it easier to sell their illicit and unregulated products, especially to young people”. This “may increase long-term health problems”. Tory MP Philip Davies says: “plain packaging for cigarettes would be gesture politics… it would have no basis in evidence.”

Everyone is entitled to their own opinions, but not, sadly, their own facts. Cigarette packaging has been used for brand building and sales expansion, and that is bad enough: but it has also been used for many decades to sell the crucial lie that cigarettes which are “light”, “mild”, “silver”, and the rest, are somehow “safer”.

This is one of the most important con tricks of all time: because people base real world decisions on it, even though low tar cigarettes are just as bad for you as normal cigarettes, as we have known for decades now. Manufacturers’ gimmicks, like the holes on the filter by your fingers, confuse laboratory smoking machines, but not people. Smokers who switch to lower tar brands compensate with larger, faster, deeper inhalations, and by smoking more cigarettes. The collected data from a million people shows that those who smoke low tar and “ultra-light” cigarettes get lung cancer at the same rate as people who smoke “normal” cigarettes. They are also, paradoxically, less likely to give up smoking.

So the “light” “pale” and “mild” packaging sells a lie. But do people know this? In data from two population-based surveys, a third of smokers believed incorrectly that “light” cigarettes reduce health risks, and were less addictive (it’s 71% in China).  A random telephone digit survey of 2,120 smokers found they believed on average that “ultra lights” convey a 33% reduction in risk. A postal survey of 500 smokers found a quarter believed “light” cigarettes are safer. A school-based questionnaire of 267 adolescents found once again, as you’d expect, that they incorrectly believed “light” cigarettes to be healthier and less addictive.

Where do all these incorrect beliefs come from? Careful manipulation by the tobacco industry, as you can see for yourself, in their internal documents available for free online. They aimed to deter quitters, and “mild” products, which were made to seem safer and less addictive, were the perfect vehicle.

But over 50 countries, including the UK, have now banned a few magic words like “light” and “mild”. So is that enough? No. A survey of 15,000 people in 4 countries found that after the UK ban, there was a brief dip in false beliefs, but by 2005 we bounced back to having the same false beliefs about “safer looking” brands as the US.

This is because brand packaging continues to peddle these lies. A street-interception survey from 2009 of 300 smokers and 300 non-smokers found that people think packages with “smooth” and “silver” in the names are safer, and that cigarettes in packaging with lighter colour, and a picture of a filter, were also safer.

Of course tobacco companies know this. As Philip Morris said in their internal document “Marketing New Products in a Restrictive Environment”: “Lower delivery products tend to be featured in blue packs. Indeed, as one moves down the delivery sector, then the closer to white a pack tends to become. This is because white is generally held to convey a clean healthy association.”

If you’re in doubt of the impact this branding can have, ”brand imagery” studies show that when participants smoke the exact same cigarettes presented in lighter coloured packs, or in packs with “mild” in the name, they rate the smoke as lighter and less harsh, simply through the power of suggestion. These illusory perceptions of mildness, of course, further reinforce the false belief that the cigarettes are healthier.

But these aren’t the only reasons why banning a few words from packaging isn’t enough. A study on 600 adolescents, for example, found that plain packages increase the noticability, recall, and credibility of warning labels.

There’s no real doubt that the extended, complex, interlocking branding and packaging machinations of cigarette companies play a major role in misleading smokers about the risks, by downplaying them, and sadly nothing from Unite – for shame – or some tory MP will change that.

If you don’t care about this evidence, or you think jobs are more important than people killed by cigarettes, or you think libertarian principles are more important than both, then that’s a different matter. But if you say the evidence doesn’t show evidence of harm from branded packaging, you are simply wrong.

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66 Responses

  1. paddyfool said,

    March 16, 2011 at 8:00 pm

    To further push back the public health consequences of tobacco, we’ll want to do four things: decrease the rate of acquisition (the number of people starting smoking); increase the rate of people quitting; decrease the relapse rate; and ameliorate the consequences of smoking for smokers and non-smokers alike.

    Blocking the public display of tobacco products (and thus the advertisement of their sale) would seem to be aimed at preventing people from being influenced by said advertisement into trying tobacco or going back to the fags after having quit, as does the use of unbranded packaging. How much actual benefit these would have we have no evidence basis to say; the main UK advertising ban in 2003 was followed by a reduction in smoking rates, but even if we risk the post hoc ergo propter hoc assumption, we don’t actually know what influence the public display of tobacco in shops has as opposed to the other modes of advertising that have already been banned. The obvious costs, meanwhile, would come in the nuisance value such a measure would pose to retailers and smokers who might wish to buy from them. Less obviously, each option might possibly lead to a rise in the illegitimate trade of tobacco, for reasons already discussed.

    On balance, given the anticipated public benefits and costs, I think a ban on public display might at least be worth a try; with hundreds of thousands of people in the UK still picking up the habit each year, dissuading even a small share of young people from starting might be worth something. We’ll then be able to glean some idea of whether it works by whether we see a fall in youth smoking rates over the next few years (a fair proxy for incidence); the evidence from Iceland, who’ve had a ban since 2001, is that their ban was followed by a drop in youth smoking (the share of 16 year olds who’d smoked a cigarette in the past 30 days fell from 28% in 1999 to 16% in 2007 according to ESPAD). I can see, however, why current smokers who don’t wish to quit might be upset in having to bear the nuisance value of yet more legislation that doesn’t actually benefit them, and why retailers would be even more upset, since on top of the nuisance, if it works this would cost them cigarette sales.

  2. Diawl Bach said,

    March 17, 2011 at 12:13 pm

    The unfortunate fact is that some of the evidence for the harms of passive smoking in the general population is not the most robust. Nevertheless there are some groups in society for whom the harms are well documented, especially children and the unborn child. Smoking whilst pregnant, or whilst caring for children has well documented long term harms to the child. this is the activity of an adult knowingly causing harm to a child. I cannot see the difference between this and child abuse in any other form. Any measures to decrease the ease with which any individual can choose to smoke surely will ultimately have an effect on those who are doing harm to others.

  3. jhaaglund said,

    March 17, 2011 at 1:56 pm

    I’m not sure I completely buy the idea that getting rid of cigarette displays would decrease the number of people *starting* smoking. Is there any actual evidence (say from countries that have already introduced such measures) that it leads to less people taking up smoking? Or even more people quitting who already smoke?

    @thegingerscouser, if you want to come across as reasonable, it might be an idea to stop calling people sociopaths for disagreeing with you. Like it or not, a sizeable proportion of the population does think that adults have the right to make unwise choices about their own health. If that many of people are sociopaths, we have bigger problems than fag packets to be worrying about.

    In fact, the idea that people have the right to make unwise choices is a principle of the Mental Capacity act, a key piece of legislation that has major implications for how we look at dealing with people who may or may not be able to make informed decisions. It’s hardly a mark of a sociopathic disregard for human life, empathy means, fundamentally, acknowledging and respecting other people’s feelings, it’s hard to reconcile that with completely taking decisions about a person’s own body out of their hands.

  4. jhaaglund said,

    March 17, 2011 at 2:00 pm

    Ah, just saw paddyfool’s post above, if there’s evidence that banning public displays could lead to a reduction in kids starting smoking, I’m all for it.

  5. Diawl Bach said,

    March 17, 2011 at 2:24 pm

    As jhaaglund says the mental capacity act is important legislation surrounding peoples right to make choices. I hope you understand that I am only being deliberately provocative when I say that those suffering from an addictive illness cannot be deemed to have capacity to make decisions about their addiction, and therefore shouldn’t be able to buy fags under this legislation.

  6. johnnye87 said,

    March 17, 2011 at 4:22 pm

    So the closer to white the packaging is, the safer people think the contents are?

    Am I missing something, or is that a pretty strong argument against changing the packaging to plain white?

  7. Midori said,

    March 17, 2011 at 5:32 pm

    just started reading here – it is obvious that cigarettes will never be banned – but all our respective governments could make purchasing cigarettes as awkward as possible – here some ideas:

    – only sell in huge quantities (100 +) – this would make it more difficult for kids to purchase, as more money would be required upfront, and temptation might be less
    – ban small boxes, only sell cigarettes in boxes that are really awkward to carry around/hide, etc. – that should deter a good few people
    – ban the boxes altogether, just sell in loose quantities over 100 (may not be feasible, but again would make things really awkward)
    – restrict the hours during which you can buy cigarettes (they do that here in Ireland with alcohol, why not with cigarettes? For example, you could only buy them between 9 pm and midnight, and never on Sundays or something)

    Just putting it out there…

  8. paddyfool said,

    March 17, 2011 at 5:57 pm

    Just realised I flatly contradicted myself between paragraphs in post #50 (I did a little research double-check on the opinion given in the second paragraph that there was no evidence for removing displays, found that there was some sort of evidence, and daftly stuck a description of it in the third paragraph rather than correcting the second).

  9. dslick said,

    March 22, 2011 at 6:59 am

    I get that packaging influences which brand of cigarettes a person buys, but I don’t see how that relates in any causal way to whether they smoke or not, or how much they smoke. I imagine that serious nicotine addicts would continue to buy cigarettes even if you packaged them in feces. I suppose it could be possible that some people may assume that they can smoke more “light” cigarettes than regular ones and so it may have some small effect on how many cigarettes some people smoke, but I seriously doubt it. If we want to do something useful with standardizing packaging, how about using colors, patterns and symbols that are associated with danger (e.g., similar to common warning/danger signs), or just make the warning label cover the entire package except for the brand name.

  10. Robert Carnegie said,

    March 23, 2011 at 12:27 am

    Basically, if children can’t see cigarettes in the shop then they won’t think of asking for them. Although helpfully, shops that sell tobacco currently have a big sign saying that children aren’t allowed. I wonder if that’ll go.

    Pack size isn’t relevant there, when children buy cigarettes from shops it’s one or two at a time for their pocket money – I believe I’ve seen it done in front of me, although it didn’t occur to me at first that that was what was going on.

  11. Jon d said,

    March 26, 2011 at 1:59 am

    You’ve completely skipped over the reason the light/mild brands were brought to market. as you might have said yourself at one time – it’s a bit more complicated than that.

    Seems to me you’ve gone off on one without eliminating an obvious hypothesis – that the tobacco companies created low tar brands in response to government regulation and consumer advice, which in the 70’s and 80’s was to mark cig packets into high/medium/low tar categories (based on the results from those smoking machine trials we now know to be flawed) and print a government health warning panel advising people to switch to a lower tar brand.

    I suspect there’s actually been a fascinating interaction between consumer, government and tobacco manufacturer over the past 40 or so years.

    TBH the blank packaging initiatives seem to be mostly based on politicians whims rather than evidence – the sort of thing I’d normally expect you to be railing against.

  12. artguy said,

    March 30, 2011 at 11:14 am

    Back when I was a smoker (over 7 years ago) and I ran out of cigarettes, I would smoke whatever cigarettes I could lay my hands on, regardless of what was on the packet.
    I don’t think removing displays or plain packaging is a solution to the smoking problem.
    Smoking is drug addiction and the solution to the problem is not more drugs. For some really bad science look no further than the clinical trials that demonstrate efficacy for NRT. John Polito does an excellent job of exposing this sham on his hugely popular website WhyQuit.org
    What is a real shame is how the medical profession has been duped into pushing this nonsense for big pharma.
    The solution to the smoking problem is education, and I am not talking about the health facts about smoking, every smoker knows it is bad for them and that wont stop them. The information they need to understand is why they do smoke, not why they shouldn’t. Allen Carr provides that information in a way smokers will relate to. He removes the perception in the smokers mind that there are any genuine benefits to “give up.” His last book “Scandal” is a must read easywayseminars.co.nz/images/stories/SCANDAL_by_Allen_Carr.pdf

  13. UselessFactoidCollector said,

    April 7, 2011 at 2:01 pm

    Check out the Wikipedia entry for Plain Cigarette Packaging
    from Australia …
    en.wikipedia.org/wiki/Plain_cigarette_packaging It includes
    sources such as BMJ aricle and The Case for Plain Packaging of
    Tobacco Products, Freeman et al. Instead of minimalist trendy
    packaging Australia has gone for minimalist branding (i.e. just
    brand name and variant name with no logos) and the rest of the
    package taken up by large gruesome photos of blind eyeballs,
    gangrenous feet etc. It is likely to be effective from 1 Jan 2012.
    I think quite a lot of the focus on plain or gruesome packaging is
    to reduce initial take up as opposed to making existing users give
    up. As another poster said, it can’t hurt.

  14. hatter said,

    April 13, 2011 at 10:22 am

    I’m expecting the packaging changes to fail as has everything else done so far.

    @thatgingerscouser by your logic we should ban a lot of things, perhaps everything. We wouldn’t want anyone doing anything that potentially kill them, thus hurting the people that love them.

  15. Jeffuk said,

    April 14, 2011 at 4:10 pm

    At the end of the day, there is one clear sign that this WILL reduce the number of people buying tobacco products, as such I’m in favour of it.

    If it wasn’t going to reduce their sales, the shopkeepers and tobacco industry wouldn’t be complaining; they know their market better than any external analyst.

  16. jenw83 said,

    June 1, 2011 at 4:46 pm

    There is a recent study out of England that tracts kids attitude towards smoking and their association with ads at the point of sale campaign. www.dailyrx.com/news-article/hiding-danger-kids-are-safer-10680.html