Strengthening tobacco policy: The case for best practice packaging and regulation

Despite the lack of evidence to justify repealing the Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act 2023 (SERPA), the Government has nonetheless stated it intends to follow an evidence-based approach to decision making. Many have felt troubled by the inconsistency between the Government’s statements and its actions. The absence of a clear plan to achieve the Smokefree 2025 goal has created deep disquiet. The Government urgently needs to demonstrate how it will realise the goal set by a previous National Government, and ensure that their actions not only achieve the goal but benefit all peoples living in Aotearoa New Zealand (NZ) equitably.

Our recent work, published in Nicotine & Tobacco Research, builds on international evidence that could enhance existing policies, such as plain (or standardised) packaging. First introduced by Australia in 2012, plain packaging transformed tobacco packages from marketing media to health promoting platforms and greatly reduced the appeal of smoking among young people^{1, 2}. Tobacco industry opposition successfully delayed the introduction of this measure in NZ,³ but in 2018, large warnings and dissuasive green colouring finally replaced vivid on-pack branding. 

However, although plain packaging reduced smoking prevalence,^{4, 5} the impact of large pictorial warning labels (PWLs) may wear out over time, leading to diminishing effectiveness.⁶ Furthermore, if people who smoke see only fear-arousing images, they may avoid, discount or derogate on-pack warnings.^{7, 8} Our recent work offers new insights into how this problem could be addressed and suggests PWLs should be refreshed urgently and accompanied by positive cessation advice.⁹ We outline below recommendations based on our findings and recent international research that could help fill the policy vacuum created by the SERPA repeal.

Refresh and diversify existing on-pack warnings

We undertook our study five years after plain packaging was introduced, to provide a robust test of PWLs’ ongoing effectiveness. While we found some participants continued to find PWLs believable and effective, others felt PWLs had lost salience and no longer had the same impact.⁹  These findings suggest PWLs require refreshing and indicate that they should draw on more diverse themes. For example, participants suggested PWLs featuring whole people would be more effective than those featuring dismembered (and sometimes unrecognisable) body parts; they also suggested new themes, including harms to future generations and the financial impact of smoking.⁹ We recommend the Government introduce new and more varied PWLs to ensure these communicate more effectively with people who smoke.

Introduce health promoting inserts

Participants found on-pack warnings didactic and negative, and called for more positive messages that offered advice on quitting and helped them feel more confident they could succeed in becoming smokefree.⁹ Canada has used health promoting inserts for many years, Australia is introducing this measure and the UK has undertaken consultation on health promotion inserts. Studies show these measures enhance confidence in quitting and support people by offering helpful cessation advice.¹⁰ We recommend that the Government introduce health promotion inserts that support people who smoke to make quit attempts.

Introduce dissuasive cigarette sticks

Other countries are also introducing measures to change cigarette sticks’ design by requiring them to feature warnings. Canada is currently introducing this measure and Australia’s legislation allows for future on-stick warnings. Research from NZ found changing the stick design could greatly reduce the appeal of smoking to young people and, importantly, among older people who smoke,^{11, 12} a population group where declines in smoking prevalence have occurred more slowly than among other age groups. The Government should follow international best practice and move swiftly to introduce dissuasive cigarette sticks.

Remove cigarette filters

Many people who smoke mistakenly believe that cigarette filters remove toxins from the smoke they inhale and thus reduce the risks smoking poses to them.¹³ In fact, filters may lead people to inhale smoke more deeply, thus increasing the risk they face from small cell lung cancers¹⁴ Furthermore, tobacco companies have used filters to introduce new product attributes, such as capsule cigarettes, which appeal to young people and may foster smoking experimentation.¹⁵ Filters also cause considerable environmental harm,¹³ and impose large clean-up costs. Given filters offer no harm reduction benefits and pose serious environmental risks, we recommend the Government disallow this product feature.

We have outlined four well-supported measures that could enhance tobacco packaging and the design of cigarette sticks to ensure these stimulate and support quitting. Evidence that on-pack warnings are losing salience and impact should inform a wider assessment of how tobacco packaging can support the Smokefree 2025 goal. The measures presented are not a substitute for the world-leading SERPA legislation, which would have seen smoking prevalence fall rapidly and equitably. Nonetheless, they would fill the existing policy void and enable the Government to demonstrate its commitment to introducing evidence-based measures that support the Smokefree 2025 goal.

Author details

Prof Janet Hoek, Co-Director of ASPIRE Aotearoa Research Centre, and Department of Public Health, University of Otago Wellington

Lani Teddy, ASPIRE Aotearoa Research Centre, and Department of Public Health, University of Otago Wellington