Design of plain packaged cigarette packs with updated and expanded graphic health warnings

Example of plain packaged cigarette packs with updated and expanded graphic health warnings

Front of pack: Back of pack:

Front of pack: Back of pack:

Example of plain packaged cigarette packs with updated and expanded graphic health warnings

Front of pack: Back of pack:

Example of plain packaged cigarette packs with updated and expanded graphic health warnings

Research to determine the

look of Australian plain

packs

Melanie Wakefield PhD, Cancer Council Victoria, Australia

Research approach

Department of Health & Ageing: Simon Cotterell, Kylie

Lindorff and other key staff

Expert Advisory Group

GFK Blue Moon (fieldwork agency contracted by DoHA)

Prof Ron Borland Mr Jonathan Liberman

Prof Mike Daube Dr Caroline Miller

Prof Mark Davidson Prof Andrew Mitchell

A/Prof David Hammond Prof Melanie Wakefield

Prof Janet Hoek

Overview of studies

A series of iterative studies were conducted to determine:

• Optimal colour for plain packaging;

• Optimal font and font size for brand name;

• Graphic health warning (GHW) size and layout

Identify one plain packaging design (colour, font) that

would minimise appeal and attractiveness, while

maximising perceived harm and noticeability of health

warnings

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/mr-plainpack

Selection of new health warnings subject to their own

testing process

Study 2: pack colour shortlist

Study Objectives Methodology Timing

Study 2 To identify a shortlist of potential plain packaging colours

• Online study among (n=409) at least weekly smokers, aged 18-65 years

• Rating task used Best-Worst methodology with 8 pack colours

• Smokers shown 4 pack images at a time, select best and worst on each dimension, then repeat with different subset until all packs rated

13 - 23 Dec 2010

Study 2

Shortlist of potential plain package colours

• 8 colours tested

• Darker colours perceived to be more harmful and more

difficult to quit

• Dark brown colour: perceived to be least appealing; the

lowest quality cigarette; most harmful to health; hardest

to quit

Study 3: readability test

Study Objectives Methodology Timing

Study 3 To identify the optimal combination of design elements (font size, font colour) for legibility and ease of identification amongst potential retailers

• Face-to-face interviews of 10 respondents aged ≥40 years

• The test used ‘eyeboards’ - boards with brand names in decreasing font size

• Also used mock up packs with brand names in different font sizes

17-21 Dec

2010

Study 3

Readability of fonts for potential retailers

• Test used Dark Brown and Mustard colours from Study 2

• Tested smallest font able to be read at 1 metre distance

• Size 14 Arial or Lucida Sans font style

• BUT some favourable comments about Dark Brown colour

(“chocolate”) and unfavourable about Mustard (“sickly”) when

viewed in the flesh

Study 4: online “Face-off”

Study Objectives Methodology Timing

Study 4 To shortlist plain packaging colours that minimise brand impact

• ‘Face-off’ between Dark Brown and Mustard

• Online survey among 455 at least weekly smokers aged 18-64 years

• Best-Worst methodology, with 5 common Australian brand names covering the three main market segments

• Used two existing health warnings

19 Dec 2010 –26 Jan 2011

Study 4

Consumer perceptions of Dark Brown vs Mustard

• Dark Brown - most reported seeing “Dark Olive” colour on screen

• Mustard - half reported seeing „gold‟…viewed as „striking‟, „prestigious‟, similar to premium brands B&H, Dunhill

• Dark Brown colour - rated as less appealing, most harm, lower quality, want to smoke them less, with similar results across all 5 brands tested

• Noticeability of GHWs: darker colour did not detract from noticeability of GHW

Study 5a: face-to-face, new HW size

Study Objectives Methodology Timing

Study 5 (face-

to-face)

To identify the optimal plain packaging designs in combination with the new front of pack graphic health warnings: Identify exact shade of plain pack colour Identify optimal new GHW size

• 20 face-to-face group clinics involving a self-completion questionnaire and short group discussion among 193 at least weekly smokers aged 16-64 years

• Tested 3 different shades of brown-olive background colour and 3 different HW sizes

• Used mocked-up pack protoypes

• Best-Worst comparisons, pack ratings and qualitative comments

14 – 22 Feb 2011

Study 5a: Face-to-Face, new HW size

Mocked up versions of Dark Brown, Dark Olive (matching

online perception), and Medium Olive with 30%, 60% or

75% GHW

• All three colours perceived as unappealing; Dark Olive more so

• Dark Olive had no positive associations: “death”, “dirty”, “tar”

• Dark Brown some positive associations: “classy”, “rich”,

“chocolate”, “upmarket”

• 75% GHW had significantly stronger impact than 30%

Study 5b: online, new HWs placement

Study Objectives Methodology Timing

Study 5 (online)

To identify the optimal plain packaging designs in combination with the new front of pack GHWs Identify GHW size and placement to maximise noticeability and impact

• Online survey among 409 at least weekly smokers aged 18-64

• Used pack images in Dark Olive colour for each of 2 HWs – ‘lung cancer‘ and ‘smoking harms unborn babies’

• Individual pack ratings and Best-Worst ratings

18 – 23 Feb 2011

Study 5b: Online

Identify GHW size and layout to maximise noticeability and impact

• 4 packs using the Dark Olive colour for 2 HWs

• 30%, 60%, 75% and split 60%

• 75% had highest noticeability and strongest “stop and think” impact

• Split 60% warning no better than 30%

Study 6

Study Objectives Methodology Timing

Study 6 (online)

To identify the optimal plain packaging designs in combination with the new front of pack GHWs: Rate the 75% split design against other options

Online survey among (n=205) at least weekly smokers aged 18-64 years As for Study 5 online

18 – 23 March 2011

Study 6: Online

Compare 75% to split 75% GHW

• Non-split 75% GHW was more noticeable and had highest impact

Australian plain packs

• Dark Olive colour

• Brand name 14 point Lucida Sans font

• 75% non-split GHW

Full report (and report on testing of other tobacco products) at:

http://www.yourhealth.gov.au/internet/yourhealth/publishing.nsf/Content/

mr-plainpack

PLAIN PACKAGING IN AUSTRALIA –

KEY FACTORS

Slide acknowledgements: R. Moodie, S. Chapman, M. Scollo, B. Freeman,

M. Swanson, D. Sullivan, F. Sharkie, O. Freedman, L. Sylvan and the people who

make slides for Todd Harper.

• Historical context

• National Preventative Health Taskforce

• The political context

• Two episodes

• What made the difference

OVERNIGHT SUCCESS COMES SLOWLY

EVIDENCE

1950 - Doll and Hill (BMJ), Wynder and Graham

(JAMA)

1962 – Royal College of Physicians

1964 – US Surgeon General

ACTION RECOMMENDATIONS

1976 – UICC – Guidelines for Smoking Control

1977 – RCP – 3rd report

1979 – WHO – Controlling the Smoking Epidemic

TOBACCO CONTROL AUSTRALIA in 2008 – Over-

simplified summary (Note - mix of Federal and State

activity)

Tobacco advertising bans since late 80s/early 90s

Health warnings since 1973, increasing strength every decade – 1973,

1987, 1995, 2006

Continuing State legislation/action (leapfrog effect)

Bans on point-of-sale promotion

Strong measures to protect non-smokers – cars around kids, bars and

restaurants, other public places (including some beaches)

National and State media campaigns

Strong, cohesive advocacy organisations, individuals, coalitions –

Cancer, Heart, AMA, AMA, ASH, ACOSH, PHAA – and many others

Continuing new approaches to media and media coverage

Cessation support – NRT, Quitlines, etc

(Industry last 10 – 15 years – much lobbying and working through

others but staying below parapet )

WHERE NEXT?

New Government 2008 –

policies on prevention

“(The Government)….. “will treat preventative health care as a first order economic challenge because failure to do so results in a long term negative impact on workforce participation, productivity growth and the impact on the overall health budget”.

Prime Minister Kevin Rudd, June 2008

Appointed Health Minister – Hon Nicola Roxon MP

New Government 2008

• Commitment to Prevention

• Three major health reviews: Healthy

system and hospitals; Primary Care;

National Preventative Health Taskforce

Chair:

Professor Rob Moodie

Deputy Chair:

Professor Mike Daube

Members:

Professor Paul Zimmet

Professor Leonie Segal

Dr Lyn Roberts

Mr Shaun Larkin

Ms Kate Carnell

Dr Christine Connors

Dr Linda Selvey

Task: Develop the National Preventative Health Strategy by June 2009.

Focus on obesity, tobacco and excessive consumption of alcohol

To support the development of the Strategy, the Taskforce

established working groups for each of:

• obesity (Chair – Dr. Lyn Roberts)

• tobacco (Chair – Professor Mike Daube)

• alcohol (Chair – Professor Rob Moodie)

Tobacco Committee: V. Briggs, S. Chapman, M. Daube, S.

Larkin, K. Purcell, L. Roberts, M. Scollo (writer), D. Sullivan,

M. Wakefield.

Overwhelming support from health groups

and community

PASSING THE SCREAM TEST

* BATA submission to Taskforce

“BAT believes there is already a significant amount of regulation on tobacco

products and there may now be a risk of too much, with unintended

consequences of progressing further.”

* Plain packaging/pack display – part of multi-focused Discussion

Paper

* Industry responses (BAT, Imperial, Philip Morris) – 43 out of 142

pages

Report presented to Minister 30

June 2009

15

• 2020 Targets Halt and reverse rise in overweight and obesity

Reduce daily smoking from 16.6%

to 10.0% or less

Reduce the proportion who drink at short term harm from

20% to 14% and the proportion drinking at longer term

harm from 10% to 7%

Contribute to the ‘Close the Gap’ target for Indigenous

people

Tobacco – Comprehensive approach

11 components

PACKAGING

ACTION PROPOSED

REQUIRE ALL TOBACCO PRODUCTS

TO BE SOLD IN PLAIN PACKAGING, THE

EXACT APPEARANCE OF WHICH

(PRECISE COLOUR, PAPER FINISH,

SHAPE OF PACK ETC) COULD BE

PRESCRIBED IN REGULATIONS UNDER

THE TRADE PRACTICES ACT 1974.

COMMISSION RESEARCH TO

DETERMINE EXACTLY HOW PACKS

SHOULD BE DESIGNED TO MINIMISE

APPEAL TO YOUNG PEOPLE

Continuing research

• Australia (Wakefield et al)

• Canada (Hammond et al)

• New Zealand (Hoek et al)

• US (FDA et al)

• UK (Various….)

Review in Addiction, 2008

21

22

WHO Framework Convention

on Tobacco Control

Why Plain Packaging?

• Not a magic bullet

• Not in isolation – part of comprehensive

approach

• Supports rest of program

• Research evidence

• Industry documents evidence

• Campaign, response and coverage

• Industry opposition – passes the Scream Test

• International implications

GOVERNMENT

• Release September 1st 2009

• Minister Roxon – “We are killing people by

not acting”

Action On Tobacco After Report

Current/further developing national and state programs – dealing with

• loopholes in ad ban legislation;

• bans on any display at point of sale;

• further protection for non-smokers;

• media campaigns;

• specific education and support for disadvantaged groups; etc.

Action After Report on Tobacco - 2

Federal Government

Progressive Implementation of Taskforce

recommendations – includes:

• 25% increase tobacco excise duty

• Established Australian National Preventive Health

Agency

• Major, continuing funding for tobacco media

• Tackling Indigenous Smoking Initiative (over $100m over

four years)

• Cessation supports – NRT, Quitlines, etc.

• Ban internet advertising

APRIL 29, 2010

THE POLITICS

• Minority Government – needed support of 2 of 3 Independents in

Lower House

• Majority in Senate, with strong support from Greens

• Opposition oppositional….Opposing everything

• Opposition Federally still taking tobacco donations (not Government

or Greens)

• Industry lobbying heavily

• Tortuous Parliamentary processes

• Major, coordinated health lobbying campaign

• Aims – maintain support; secure and maintain independents’

support; seek at least some Opposition members’ support; ideal all-

party support.

The Political Scene

Countering the industry lobby – Simon

Chapman paper

73.8

73.2

70.3

70.3

70.2

69.9

69.4

68.0

67.9

65.9

65.8

65.0

64.4

64.1

63.7

63.7

62.6

62.6

61.9

61.6

60.8

60.5

59.8

59.0

50.1

Consumer Products

Electrical & Electronics

Computer

Retail - General

Industrial Products

Retail - Food

Food - Manufacturing

Beverage

Automotive

Pharmaceuticals

Airlines & Aerospace

Services

Information & Media

Conglomerate

Chemicals

Raw Materials

Construction & …

Transport & Logistics

Financial - Diversified

Financial - Insurance

Energy

Financial - Bank

Telecommunications

Utilities

Tobacco

REPUTATION INSTITUTE - Global Industry Results

Excellent/Top Tier above 80

Strong/Robust 70-79

Average/Moderate 60-69

Weak/Vulnerable 40-59

Poor/Lowest Tier below 40

Public support very high

• April 2011: A survey of 4,500 Victorians

showed very strong support.

• 72% of all people approve of the policy - and

57% of smokers.

32

Health Coalition

• Government strong and active

• Minister leading from front

• Health Department strong backing

• Major health groups and experts working nationally as cohesive

coalition

• Cancer Councils, Heart Foundation, Australian Medical Association,

QUIT campaigns, ASH, ACOSH, Public Health Association, and

other health organisations

• Prominent experts (Simon who?), health/medical leaders

• Media, media, media - Proactive, reactive

• Responding to industry campaigns, exposing industry tactics,

research, reports, surveys, advertisements…

• Active support from politicians of all parties

• Lobbying, lobbying, lobbying – all parties, all members

Two Episodes

Midnight Emails

Opposition Leader Tony Abbott has said he would support any move to curb smoking

rates, but he has refused to back the government's proposal. ''My anxiety with this

[plain packaging proposal] is that it may end up being counterproductive in practice,''

he said.

But Liberal MP Mal Washer broke ranks with his leader when contacted by The

Sunday Age last week. Dr Washer, who spent 26 years as a medical practitioner

before moving into federal politics, gave a blunt assessment of the tobacco industry's

strategy.

''All this talk of chop chop and crime gangs sounds like bullshit to me. The tobacco

industry is jumping up and down because they're worried about their businesses. I

support these reforms unequivocally and whatever my party decides to do, I don't give

a shit,'' Dr Washer said.

He said smoking killed about 19,000 Australians each year, and governments had a

moral responsibility to implement any measure that could stop young people from

taking up the habit

The Age, May 22, 2011

WHAT MADE THE

DIFFERENCE? - 1

• Government that understood prevention

• Recognition of population approach

• Superb Minister – willing to take on industry

• Department with strong support: can-do public servants

• Context – history; comprehensive approach; PP as next

stage

WHAT MADE THE

DIFFERENCE? - 2

• Good process

• Coalition – key health organisations and individuals -

experienced, collegial, creative, planned, opportunistic

• Sound science and scientists

• Strong bureaucratic backing

WHAT MADE THE

DIFFERENCE? - 3

• Media

• Public opinion

• International support

• Principled politicians

WHAT MADE THE

DIFFERENCE? - 4 • Industry

– credibility already gone

- desperation evident (heads above parapet;

dishonest tactics)

- feeble/contradictory arguments

- internationally controlled

- evidently worried by global implications

- weak in media

- bullying governments

- the louder they shout…..

Tobacco industry reaction to plain packaging 2010-2011, Australia

School of Public Health University of Sydney

Twitter: simonchapman6

Prof Simon Chapman

What other nations can expect

Highly recommended

2

Main arguments (1) general

never been done before … so don’t do it!

“no evidence” it will work

makes packs easier to counterfeit …

illicit trade already massive: will get worse

will force fierce price competition, lowering prices … more smokers, especially youth

will confuse customers, staff, increase serving times

“nanny state” running amok

slippery slope: other products next?

we can’t possibly comply in time: delay needed

Main arguments (2) legal

Violates Australian constitution + WTO’s TRIPS (trade-related aspects of intellectual property rights) agreement

Trade mark, intellectual property confiscation

therefore large damages will be due

4

Should we never do anything for the first time?

5

Argument 1: Never been done before .. therefore “no evidence”

Other firsts in public health

Seat belts

RBT

Advertising bans

Vaccination

Lead free petrol

Parachutes! (never any RCTs!)

...100s more examples

Other firsts

• “Great argument: it's never been done before, therefore you shouldn't do it. This is the poor little stupid Australia argument. We should always merely follow the lead of other countries because we're not smart enough to dream up anything good ourselves.. But if the idea's so unlikely to. . work, why are the global giants fighting so hard to stop it? “ – journalist Ross Gittins

The Principle of the Dangerous Precedent

“Every public action which is

not customary either is

wrong, or if it is right it is a

dangerous precedent. It

follows that nothing should

ever be done for the first

time.”

Microcosmographia Academica

(1908)

Our 3 most powerful arguments

1. Packaging = centrepiece of promotions: we are finishing the job of banning all advertising

2. It will have its greatest impact with the next generation by reducing uptake, not current smokers

3. If it “won’t work”, then why is the global tobacco industry having weapons’ grade apoplexy?

8

BAT advertisement 31 page dossier

9

Argument 2: ““no evidence” (of any sort) that it will work

10

Best evidence found in industry sources

Current packs are VERY easy to copy

already!

11

Argument 3: it will make packs easier to counterfeit …

12

16% (>1 in 6) of all tobacco consumed = illicit.

13

Argt 4: Illicit trade will boom

Argument 4: Illicit trade will boom, prices will fall, more kids will

smoke

14

If prices fall, government can put up tax within 24hrs

http://www.plain-packaging.com

15

Argument 5: All packs “look the same” Shopkeeper & customer confusion

16

…but it may well decrease transaction times

17

Argument 6: Nanny state

Argument 7: Slippery slope … what’s next?

Advertising bans began in 1976 – 36 years ago!

The slope is not very slippery

No other product remotely kills half its users

19

Argument 8: We need 17 months AFTER legislation to comply

Legal arguments: does it violate the Australian constitution?

TRIPS/World Trade Organisation The right given to a trademark owner under TRIPS is

to prevent other people from using that trade mark.

The plain packaging legislation does not permit other people to use the trade marks of the tobacco industry, so it does not contravene that right.

TRIPS/World Trade Organisation • Article 20 provides that “the use of a trade mark in the

course of trade shall not be unjustifiably encumbered by special requirements”.

• So is their use is “unjustifiably encumbered”?

• Article 8 TRIPS provides that countries may take measures “necessary for public health” provided they are consistent with the rest of the agreement.

Why does not…

the liquor industry sue Islamic nations for prohibition?

the asbestos industry sue governments for banning its use?

Firearms manufacturers sue governments for gun control laws?

the pharmaceutical industry sue governments for the gross restrictions on sale & advertising of prescribed pharmaceuticals?

Exotic animals industry sue governments for quarantine laws?

Timeline: Philip Morris Hong Kong-Australian bilateral treaty

Date Event

29 April 2010 • Australian Government announces its decision to implement plain packaging.

remainder of 2010 and early 2011

• Objections and complaints made by Philip Morris entities to the effect that plain packaging would breach Australia’s international trade and treaty obligations.

23 February 2011 • PMA purchases Philip Morris Australia.

27 June 2011 • PMA services Notice of Claim to the Australian Government.

21 November 2011 • Tobacco Plain Packaging Bill 2011 (Cth) passes Australian Parliament.

• PMA submits Notice of Arbitration to the Australian Government.

1 December 2011 • Legislation receives Royal Assent: Tobacco Plain Packaging Act 2011 (Cth)

21 December 2011 • Australian Government submits its response to the Notice of Arbitration.

The hunt for the $3billion/year factoid

British American Tobacco

25

Between 1999 and 2003 the average annual fall in total dutied cigarettes was just 2.6%. The most sales have ever fallen in one year was just shy of 10% in 1999

Other industry tactics

Established 3rd Party “independent” spokesgroups

Right-wing shock-jocks enlisted

Freedom of Information used for “fishing trips”

BAT used Twitter & held a rare press conference

27

28

Comparison with packaging of prescribed pharmaceuticals

29

(then) Health Minister , Nicola Roxon, at UN Summit on NCDs, 2011