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Summary

Although tobacco companies strongly opposed the introduction of plain (or standardised) packaging, this measure increased the rate at which smoking prevalence declined. Strengthening policies regulating tobacco packaging and product design could further reduce smoking uptake while stimulating and supporting cessation. In this Briefing, we outline four evidence-based measures the Government should implement rapidly, to reflect its commitment to achieving the Smokefree 2025 goal for all peoples.

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 people1, 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.

What this Briefing adds

  • The Government has committed to achieving the Smokefree 2025 goal for all population groups but has not replaced the world-leading measures it repealed with alternative actions.
  • Countries at the vanguard of tobacco control policy are refreshing on-pack warnings, introducing efficacy measures, and changing the design of cigarette sticks.
  • Studies from NZ provide a clear and robust evidence base that supports the adopting similar measures.

Implications for policy and practice

  • The Government should fill the policy void created when it repealed the SERPA measures by adopting new international best practice measures, including new PWLs, health promotion inserts, on-stick messaging, and disallowing filters.

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

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Public Health Expert Briefing (ISSN 2816-1203)

References

  1. Hoek, J., Wong, C., Gendall, P., Louviere, J., & Cong, K. (2011). Effects of dissuasive packaging on young adult smokers. Tobacco Control, 20(3), 183-188. https://doi.org/10.1136/tc.2010.037861 
  2. White, V., Williams, T., Faulkner, A., & Wakefield, M. (2015). Do larger graphic health warnings on standardised cigarette packs increase adolescents’ cognitive processing of consumer health information and beliefs about smoking-related harms? Tobacco Control, 24(Suppl 2), ii50-ii57. https://doi.org/10.1136/tobaccocontrol-2014-052085 
  3. Waa, A. M., Hoek, J., Edwards, R., & Maclaurin, J. (2017). Analysis of the logic and framing of a tobacco industry campaign opposing standardised packaging legislation in New Zealand. Tobacco Control, 26(6), 629-633. https://doi.org/10.1136/tobaccocontrol-2016-053146 
  4. Chipty, T. (2016). Study of the Impact of the Tobacco Plain Packaging Measure on Smoking Prevalence in Australia. https://www.health.gov.au/sites/default/files/study-of-the-impact-of-the-tobacco-plain-packaging-measure-on-smoking-prevalence-in-australia.pdf
  5. Bonfrer, A., Chintagunta, P. K., Roberts, J. H., & Corkindale, D. (2020). Assessing the sales impact of plain packaging regulation for cigarettes: Evidence from Australia. Marketing Science, 39(1), 234-252. 
  6. Parada Jr, H., Hall, M. G., Boynton, M. H., & Brewer, N. T. (2018). Trajectories of responses to pictorial cigarette pack warnings. Nicotine and Tobacco Research, 20(7), 876-881. 
  7. Hardcastle, S. J., Chan, D. C. K., Caudwell, K. M., Sultan, S., Cranwell, J., Chatzisarantis, N. L. D., & Hagger, M. S. (2016). Larger and more prominent graphic health warnings on plain-packaged tobacco products and avoidant responses in current smokers: A qualitative study [journal article]. International Journal of Behavioral Medicine, 23(1), 94-101. https://doi.org/10.1007/s12529-015-9487-x 
  8. Erceg‐Hurn, D. M., & Steed, L. G. (2011). Does exposure to cigarette health warnings elicit psychological reactance in smokers? Journal of Applied Social Psychology, 41(1), 219-237. 
  9. Ozarka, E., Teddy, L., Blank, M., Waa, A., & Hoek, J. (2024). Managing fear responses: A qualitative analysis of pictorial warning labels five years post-plain packaging. Nicotine & Tobacco Research. https://doi.org/DOI 10.1093/ntr/ntae112 
  10. Thrasher, J. F., Swayampakala, K., Cummings, K. M., Hammond, D., Anshari, D., Krugman, D. M., & Hardin, J. W. (2016). Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A Longitudinal assessment of an innovative policy in Canada. Preventive Medicine, 88, 59-65. 
  11. Hoek, J., & Robertson, C. (2015). How do young adult female smokers interpret dissuasive cigarette sticks? A qualitative analysis. Journal of Social Marketing, 5(1), 21-39. 
  12. Hoek, J., Gendall, P., Eckert, C., & Louviere, J. (2015). Dissuasive cigarette sticks: the next step in standardised ('plain') packaging? Tobacco Control, 25(6), 699-705. https://doi.org/10.1136/tobaccocontrol-2015-052533 
  13. Evans-Reeves, K., Lauber, K., & Hiscock, R. (2022). The ‘filter fraud’ persists: the tobacco industry is still using filters to suggest lower health risks while destroying the environment. Tobacco Control, 31(e1), e80-e82. https://doi.org/10.1136/tobaccocontrol-2020-056245 
  14. Song, M.-A., Benowitz, N. L., Berman, M., Brasky, T. M., Cummings, K. M., Hatsukami, D. K., Marian, C., O’Connor, R., Rees, V. W., Woroszylo, C., & Shields, P. G. (2017). Cigarette Filter Ventilation and its Relationship to Increasing Rates of Lung Adenocarcinoma. JNCI: Journal of the National Cancer Institute, 109(12). https://doi.org/10.1093/jnci/djx075 
  15. Hoek, J., Gendall, P., Eckert, C., Louviere, J., Blank, M.-L., & Thrasher, J. F. (2019). Young adult susceptible non-smokers’ and smokers’ responses to capsule cigarettes. Tobacco Control, 28(5), 498-505. 

About the Briefing

Public health expert commentary and analysis on the challenges facing Aotearoa New Zealand and evidence-based solutions.

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