Are Canadian Smokers Ready for Plain Packaging? Findings from the ITC Four Country Survey,

Transcription

1 Are Canadian Smokers Ready for? Findings from the ITC Four Country Survey, Pete Driezen 1, David Hammond 1, Geoffrey T. Fong 1,2, Hua-Hie Yong 3, Jessica L. Reid 1 1 University of Waterloo 2 Ontario Institute for Cancer Research 3 Cancer Council Victoria, Australia 8 th National Conference on Tobacco or Health, Ottawa, Ontario November 26, 2013

2 The Tobacco Industry and Cigarette Packaging Pack Design The tobacco industry uses cigarette packaging to market cigarettes Industry documents reveal that: 1. Package design is a central strategy in the promotion of tobacco products 2. Through pack design (both graphic and structure), the industry communicates specific attributes of a brand (e.g., certain colours mislead consumers to believe that a brand is less harmful) 3. The importance of the pack has increased as restrictions on advertising and promotion have increased. 2 / 21

3 Pack Design: du Maurier Canada 2012 Pack Design Colours 3 / 21

4 Pack Design: du Maurier Canada 2012 Pack Design Brand Logos 3 / 21

5 Pack Design: du Maurier Canada 2012 Pack Design Fonts 3 / 21

6 Pack Design: du Maurier Canada 2012 Pack Design Brand Descriptors 3 / 21

7 The Importance of Importance What is it? Does it Work? Plain packaging is a distinctly Canadian idea, with many benefits: Eliminates packaging as a form of advertising & promotion Denormalizes tobacco use Alters consumer perceptions of tobacco (Wakefield et al, 2002, Hammond et al, 2009) Directs smokers attention to health warnings (Munafò et al 2011, Hammond 2011) Potential to reduce consumption (Moodie et al 2012) 4 / 21

8 What is Importance What is it? Does it Work? Also known as standardized packaging or generic packaging Removes alluring and promotional imagery, brand logos and colours from all tobacco packages Base colour of all cigarette packs would be the same: dull and unappealing The structure of the pack is standardized (e.g., slim packs would be prohibited) Brand family and variety identified using a standardized font, font size and location on the pack However, pictorial health warnings will remain on plain packs 5 / 21

9 Australia 2012 Importance What is it? Does it Work? 6 / 21

10 : Does it Work? Preliminary Evidence from Australia Importance What is it? Does it Work? In a population survey of Australian smokers, Wakefield et al (2013) found that prior to the December 1 st implementation deadline about half of Australian smokers approved of the legislation support varied by whether smokers were currently smoking from a plain pack (52%) or a branded pack (42%) Smokers perceptions of their cigarettes also differed by pack type. Plain pack smokers had significantly higher odds of believing their cigarettes were of lower quality (OR = 1.66) believing their cigarettes were less satisfying than one year ago (OR = 1.70) Plain pack smokers rated quitting as a higher priority than branded pack smokers 7 / 21

11 Research Objectives 1. To estimate recent levels of support for plain packaging among Canadian smokers 2. To examine whether support varies (a) internationally between Canada, the United States, the United Kingdom and Australia and (b) regionally within Canada 3. To examine the predictors of support for plain packaging 8 / 21

12 The International Tobacco Control Four Country Survey The ITC Survey Sample Measures Other Measures Statistical Methods This study uses data from Wave 8 ( ) of the ITC Four Country Survey. ITC is a longitudinal cohort survey that began in 2002 nationally representative samples of adult smokers from Canada, the US, the UK and Australia smokers lost to attrition are replenished in subsequent waves smokers who quit are retained in the cohort The ITC Survey uses standardized measures in all countries. Facilitates: international comparisons temporal comparisons natural experiments 9 / 21

13 ITC Four Country Survey: Wave 8 Sample The ITC Survey Sample Measures Other Measures Statistical Methods CA US UK AU Sample size (n) Time-in-sample (months) Mean Median % Recruited in Wave % Female Age (mean) % Ethnic minority % Daily smokers % Former smokers No replenishment in Wave 8 in the UK. Elapsed time since recruitment for respondents not lost to attrition. Age at recruitment. Quit for any length of time (< 1 month to > 1 year) 10 / 21

14 Primary Outcome Measure The ITC Survey Sample Measures Other Measures Statistical Methods Support for plain packaging, measured as agreement with Tobacco companies should be required to sell cigarettes in plain packages, that is, in packs without the usual brand colours and symbols, but keeping the warning labels. Agreement measured using a 5 point Likert scale 1 = strongly agree 2 = agree 3 = neither agree nor disagree 4 = disagree 5 = strongly disagree and converted to a binary indicator of support (agree/strongly agree vs. otherwise) 11 / 21

15 Other Measures The ITC Survey Sample Measures Other Measures Statistical Methods Socio-demographic Sex Age (18 24, 25 39, 40 54, 55+) Ethnicity (majority vs. minority group) Income (low, moderate, high, not stated) Education (low, moderate, high) Behavioural Smoking status (daily, non-daily and quitters) Cigarettes smoked per day (quitters assigned a value of zero) Denormalization Composite scales of social and industry denormalization (higher scores indicated greater denormalization) 12 / 21

16 Statistical Methods The ITC Survey Sample Measures Other Measures Statistical Methods Analysis conducted using current and former smokers Statistical methods for the analysis of complex survey data were employed were weighted and representative of adult smokers within each country Logistic regression to estimate to estimate the prevalence of support for plain packaging to examine predictors of support for plain packaging Differences were tested between countries between regions within Canada 13 / 21

17 Support for in Canada 41.3 Support by Country Predictors of Support Regional Differences United States United Kingdom Australia % Agree/Strongly Agree Support for plain packaging differed by country (p < 0.01) Support among Canadian smokers significantly higher than among smokers from the other countries (all p < 0.02) 14 / 21

18 Predictors of Support for Support by Country Predictors of Support Regional Differences Age: Older smokers were more likely to support plain packaging Ethnicity: Minority smokers more likely to support plain packaging Education: Low education smokers were more likely to support plain packaging than moderate education smokers Industry denormalization: Those who believed that tobacco products should be more tightly regulated and/or that the government should do more to tackle the harm done by smoking were more likely to support plain packaging 15 / 21

19 Regional Differences in Support for Across Canada, Atlantic Quebec Support by Country Predictors of Support Ontario Prairie Regional Differences Alberta 35.0 British Columbia % Agree/Strongly Agree Support for plain packaging varied among current and former smokers across Canada (p < 0.01) Highest in Quebec Lowest in Ontario, Alberta and BC 16 / 21

20 Data come from a longitudinal cohort of smokers Differential attrition across countries might limit the comparability of estimated levels of support (e.g., heavier smokers more likely to be lost) However, the ITC sample is replenished in each wave Estimates of support are adjusted for age, sex, smoking status and duration of participation Overall level of support for plain packaging might be over-estimated Estimates based on current and former smokers Former smokers tend to be more supportive of plain packaging However, estimates are adjusted for smoking status 17 / 21

21 Summary Summary Implications Plain packaging legislation eliminates the cigarette pack as a source of brand promotion Australia was the first country in the world to introduce and enforce plain packaging legislation This study demonstrates that in , 41% of Canadian smokers (current & former) agreed that cigarettes should be sold in plain packages This level of support was significantly higher than it was among comparable cohorts of American, British and Australian smokers Support for plain packaging differed across Canada, from 53% in Quebec to 30% in British Columbia 18 / 21

22 Implications Summary Implications Given: 1. That support for plain packaging was higher among Canadian smokers than among Australian smokers in (prior to the implementation of the Australian legislation) and 2. That Australia has successfully implemented plain packaging legislation It is time to reconsider plain packaging legislation in Canada, learning from and building upon the Australian experience 19 / 21

23 1. Hammond D, Dockrell M, Arnott D, Lee A, McNeill A. (2009). Cigarette pack design and perceptions of risk among UK adults and youth. European Journal of Public Health, 19: doi: /eurpub/ckp Hammond D. (2011). Plain packaging regulations for tobacco products: the impact of standardizing the color and design of cigarette packs. Salud Pública de México, 52(2):S226 S232. Available: 3. Moodie C, Stead M, Bauld L, McNeill A, Angus K, Hinds K, Kwan I, Thomas J, Hastings G, O Mara-Eves A. Plain Tobacco Packaging: A Systematic Review. Available: 4. Munafò M, Roberts N, Bauld, L, Leonards U. (2011). Plain packaging increases visual attention to health warnings on cigarette packs in non-smokers and weekly smokers but not daily smokers. Addiction, 106: doi: /j x. 5. Wakefield MA, Germain D, Durkin SJ. (2002). How does increasingly plainer cigarette packaging influence adult smokers perceptions about brand image? An experimental study. Tobacco Control, 17: doi: /tc Wakefield MA, Hayes L, Durkin S, Borland R. (2013). Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study, BMJ Open, 3:e doi: /bmjopen / 21

24 Core support provided by the U.S. National Cancer Institute (P01 CA138389). Additional major funding provided by the Canadian Institutes for Health Research.