Plain packaging? That's just for starters

Further to yesterday's post about 'talking' cigarette packs, an interesting document has come to our attention.

Entitled 'Tobacco Packaging Innovation', it's credited to Dr Richard Purves, Marisa de Andrade, Crawford Moodie and Jennifer McKell of the Institute for Social Marketing, University of Stirling.

It was posted online on June 20, 2013, which makes the following statement quite interesting:

Plain packaging was introduced in Australia in December 2012. The New Zealand Government announced plans to introduce plain packaging in February 2013, although no timeline has yet been set for doing so. Uptake of plain packaging outside of Australasia may be be more protracted.

A systematic review conducted to inform the UK consultation on plain packaging had 37 included studies, which collectively suggested that plain packaging may help; 1) reduce appeal of the pack, product and user [my emphasis]; 2) reduce consumer confusion about product harm as a consequence of pack colour and shape; 3) increase the salience of health warnings (Moodie et al, 2012a).

Note too the use of the words "may help".

In other words, seven months after the introduction of plain packaging in Australia, and a year after a "systematic review" of the evidence that included 37 hand-picked studies, the tobacco control industry can still offer nothing more than the vague hope that plain packaging "may help" reduce the appeal of cigarette packs or what they laughingly call "consumer confusion about product harm".

No wonder the Department of Health is dragging its heels over the publication of its report on the public consultation on standardised packaging which closed almost eleven months ago!

Undeterred by this calamitous failure of evidence, Purves et al ask, "So how else can the pack be used to communicate harm to smokers?":

Focus group research with young women smokers aged 16-24 years [were] recruited from Greater Glasgow to explore their response to four innovative measures to communicate health risk/cessation messages via the packaging.

The four "innovative measures" involved pack inserts, quick response (QR) barcodes, the cigarette itself, and audition ('talking') packaging.

Here's how they might be used:

Pack inserts could feature a cessation message (‘Quitting will improve your health’) or a health risk message (‘Smoking damages your lungs’).

QR barcodes could direct the user to either a national smoking helpline or the NHS choices website on the benefits of quitting.

Cigarettes could have the words ‘Smoking Kills’ printed vertically on both sides of the cigarette paper.

Audition packs would play a short pre-recorded short message:

To test the effect of the latter two audition packs were created. The first message was “Get help to quit, call 0800 0224 332 for more information on the options available”.

The second was “Smoking reduces fertility. If you are planning to have a child now or in the future smoking can reduce your chance of conception by up to 70 per cent”.

Purves et al report that the focus groups had "mixed feelings" about the possible impact of audition packs:

Some felt they would become accustomed to hearing it.

"I think you would probably get used to it but, because like you know, once you start smoking you just ignore it" (Group 4, 16-17, C2DE)

Others thought the messages may make them think about stopping or reducing consumption.

"I think that would maybe make you think twice about giving up" (Group 2, 18-24, C2DE)

"I’d maybe smoke less" (Group 7, 16-17, ABC1)

For some this appeared due to the annoyance of repeatedly hearing such messages, for others the message itself would be reinforced

Some people would maybe say "I need to pack that in because they packets are doing my nut in" (Group 1, 18-24, C2DE)

"It’s just hearing it every time you are opening it ... it would maybe start sinking in" (Group 7, 16-17, ABC1)

Those that thought audition packs had some impact, perceived the two messages differently

The message on fertility was perceived as ‘hard-hitting’, ‘effective’ and ‘off-putting’, particularly among 16-17 year olds, who said it may make them think about quitting.

"I would stop" (Group 6, 16-17, ABC1)

"I didn’t know it would reduce fertility and stuff so, I don’t know, I think you just wouldn’t bother doing it (Group 3, 16-17, ABC1)

Eventually the authors conclude that:

Article 2.1 of the WHO Framework Convention on Tobacco Control encourages member Parties to implement measures beyond the Guidelines in order to protect public health.

With some creative thinking packaging can be manipulated, not to create or enhance appeal, but to communicate risk and cessation messages.

In general, even though quitting was a low priority for young women, all four measures were perceived to have potential value in communicating the health risks of smoking and cessation messages.

The pack inserts were considered helpful in terms of communicating additional information about health risks and the benefits of quitting, particularly if double sided inserts were used with an image on one side and more detailed information on the other.

There were mixed perceptions about ‘Smoking Kills’ on the cigarette itself. Most thought it would have little impact but some suggested that it would make them think about stopping, largely due to it being perceived as embarrassing.

There was general support for the inclusion of on-pack QR barcodes directing the user to available help. Most thought this would be helpful, at least if they or others were thinking about quitting, but could be easily avoided otherwise.

Finally, the ‘talking’ packs were perceived as off-putting, particularly the message about smoking lowering the chance of conception.

So, plain packaging may be tobacco control's current 'Holy Grail' but it's only a stepping stone to further invasive policies, the most notable of which is 'talking' cigarette packs that nag you to consider the health risks of smoking every time you open the pack.

You couldn't make it up.

Update: Yesterday's Scotland on Sunday report (Talking cigarette packs to encourage quitters) has been picked up by the Daily Record (Talking cigarette packets set to warn smokers of the health risks), the Scottish Sun ('Packet in' say talking ciggies) and other Scottish newspapers.

Open letter to Andrew McNair

Dear Andrew,

Thank you for your recent comments on this blog.

You seem to fall into the 'quit or die' camp which makes you just as extreme and "dimwitted" (to use your terminology) as those who deny there are any health risks associated with smoking.

What some people question is the degree of risk associated with smoking, and that's a perfectly legitimate query given the number of smokers who live to a ripe old age without any apparent health problems.

The founder of Forest, Sir Christopher Foxley-Norris, a lifelong pipe smoker, lived until he was 92. Our chairman for 20 years, Lord Harris of High Cross, another pipe smoker, died when he was well into his eighties. He was physically and mentally active to the very end.

Nor are they isolated examples. There are millions of smokers, including cigarette smokers, who have lived just as long.

There must be factors other than luck at work and many of us would like to know what they are rather than be told "Quit – or don't start – smoking unless you want to die ten years prematurely of a horrible illness".

While there may not be any obvious physical benefits from smoking, a lot of smokers swear they benefit in other ways. For some people smoking is a pleasure as well as a habit and who are you to deny someone pleasure if it doesn't harm anyone else?

David Hockney, a good friend of Forest, has spoken about his peers in New York giving up smoking and ending up on Prozac, and he has questioned which is better. Ultimately it's up to the individual – not you, me or the state.

Hockney continues to smoke because he believes it is better for his mental health than a prescription drug. That's his choice. Is he a "dimwit" too?

Re smoking during pregnancy, I think it's sensible to err on the side of caution and not smoke whilst pregnant, but I don't think it's my job - or anyone else's - to lecture someone on the subject.

Curiously the baby boom generation, many of whom were born to mothers who smoked, is living longer than at any period in history. How has that happened?

I'm not for one moment suggesting there's a correlation between the two but if we believe the scaremongers it's hard to understand how a generation of children, millions of whom were exposed every day to tobacco smoke at home or in the car, have lived as long as they have. If you could explain that I'd be very grateful.

Mothers-to-be are almost certainly exposed to all manner of chemicals and carcinogens during pregnancy, including carbon monoxide from road traffic. The dose is the poison, so your firefighter analogy is pretty lame.

Finally, I don't think many people reading this blog object to reasonable regulations or restrictions concerning the manufacture, purchase and consumption of tobacco.

What is "vile" is the extent of those regulations – some of which have nothing to do with health – and the systematic "denormalisation" of a product whose consumers pay an exorbitant amount of tax to purchase legally.

I'm happy you're happy you gave up smoking. Why can't you leave it at that? Why visit a blog like this merely to hector and admonish people who have chosen to live their lives differently to you?

To me that's a form of bullying. There must be more productive things you can do, like minding your own business.

I don't like to say it, Andrew, but, please, get a life and leave others to live theirs.

Kind regards,

Simon

Forest
Sheraton House
Castle Park
Cambridge CB3 0AX

Talking cigarette packs? Po-faced puritans are deadly serious

Scotland on Sunday has an interesting little story:

Talking cigarette packs to encourage quitters

I've known about it for a few days because the paper rang Forest on Thursday for a quote for what was described as "a bit of a funny story".

I decided to play along and responded as follows:

"I can't imagine anything more attractive to a child than a pre-recorded message. It's like a talking birthday card.

"The more gruesome the message the more enticing it will be. That's why horror films are popular with teenagers.

"The voice will be crucial. Consumers may want a choice of gender, or regional accent, like you get on a sat nav system.

"If the idea takes off I look forward to similar warnings when you open a bottle of beer or unwrap a bar of chocolate."

I did contemplate going further with Forest's response but a little voice (no pun intended) told me not to get carried away.

For example, in the back of my mind I was thinking, "Imagine if the pack opened to the sound of a creaking door followed by the voice of Christopher Lee ... or Freddy Krueger."

Far more bad taste jokes entered my head but (thankfully) stayed there. I'm itching to say what they were!

Look North: should the smoking ban be amended?

Last night's Look North on BBC1.

The report about the smoking ban starts after ten minutes. (Only available to view for a few more hours.)

Smoking rooms: tweet @peter_levy now!

It's the sixth anniversary of the smoking ban in England on Monday.

Working men's clubs in West Yorkshire are calling for the ban to be amended to allow separate well-ventilated smoking rooms.

Who could object to that?

Well, the guy I have just been interviewed with on BBC's Look North (Yorkshire and Lincolnshire), to be broadcast at 6.30pm. He was a doctor, I think, because he kept banging on about the health benefits of the ban.

He talked about a reduction in hospital admissions, fewer instances of asthma - all bollocks, of course, but difficult to refute in the short time available.

I couldn't see him because he was in the Look North studio with presenter Peter Levy and I was in a tiny remotely operated studio in Cambridge staring into a camera while listening via an ear-piece.

Unusually for an interview recorded 'as live', we did two takes. Needless to say I was happier with the first take but they wanted to do it again because they said my answer to the first question was "too long".

Anyway, Peter Levy has invited people to tweet him in response to the question 'Should pubs and working men's clubs have a smoking room again? Or should ban continue?'

Tweet @peter_levy now.

Update: Just seen the programme. My opponent wasn't a doctor, he was public health official Dr Tim Allison of NHS East Riding of Yorkshire.

"Neither the state nor the anti-smoker industry owns our children"

Further to my previous post, Pat Nurse has written an article on the subject of smoking and pregnancy for The Free Society.

Pat writes:

The media needs to get a grip and realise that a parent’s worth doesn’t start and end with whether they enjoy one legal product over another – a product, incidentally, enjoyed by many generations before them who had healthy happy babies ...

Anti-smokers would do well to stick to the core message that smoking CAN be harmful to unborn babies because that is a message that resonates. Going off the scale into fantasy phobia land makes ideological health campaigners look like laughing stocks that no one heeds ...

The bottom line is women own their own bodies. Neither the state nor the anti-smoker industry owns our children and this judgemental and negative approach to force them to quit a legal product will only result in the alienation of those women who need healthcare, compassion and support the most.

See: Alienating and criminalising pregnant women (The Free Society)

H/T Chas for posting a link to Pat's appearance on Five Live Breakfast this morning. Click here and go to 1.24.00.

Linda Bauld: “Smoking in the UK kills one baby every day"

You may have heard Pat Nurse on Five Live Breakfast this morning.

As a smoker who puffed her way through four (?) pregnancies, Pat was invited to discuss a new report, published today by the Smoking in Pregnancy Challenge Group which is led by The Lullaby Trust and the UK Centre for Tobacco Control Studies (UKCTCS) and supported by ASH.

It might be easier, and quicker, to reproduce parts of the press release we received yesterday. (It was embargoed until midnight.)

A coalition of baby charities, campaigners, leading academics and health experts is calling for a national Carbon Monoxide (CO) screening programme for mums-to-be to help save more babies’ lives ...

Smoking is the main cause of high levels of CO in pregnant women, but a raised CO reading can also be due to breathing in second-hand smoke, the inhalation of fumes from faulty exhausts, or poorly ventilated cooking or heating appliances.

Members of the Challenge Group, which also includes the Royal College of Midwives, Tommy’s and the Royal College of Nursing, have come together for the first time to recommend urgent action to help pregnant women identify whether they have high CO levels that may be damaging to the health of their baby.

Offering every pregnant woman in the country a simple breath test to identify her level of exposure to CO, will allow smokers to consider quitting, and non-smokers to identify whether they have had any involuntary exposure from other sources such as faulty appliances ...

The Lullaby Trust’s Chief Executive Francine Bates, said: “We know that smoking in pregnancy is a significant risk factor for Sudden Infant Death Syndrome (SIDS). It’s been estimated that over 100 SIDS deaths could be prevented every year if no pregnant woman smoked.

“Mothers under 20 are five times more likely to suffer the tragedy of SIDS than those over 30. They are also more likely to smoke and find it difficult to understand why smoking has such a devastating impact on their baby’s health. Immediate results from a quick and simple test, together with the support from their midwife could persuade many young women to kick their habit”

Professor Linda Bauld, from the University of Stirling and the UKCTCS, said: “Smoking in the UK kills one baby every day. That’s why this Government’s ambition is so important.

“Unfortunately, unless we take urgent additional action this target will not be met. This report is a call to action to the government, health professionals, baby charities and researchers, but most of all it’s a call to action to mothers: understand the harm, protect your baby.”

The quote that stands out is the extraordinary claim by our old friend Professor Bauld that “Smoking in the UK kills one baby every day."

For an academic, Prof Bauld certainly has a way with soundbites.

I'm less impressed by her casual attitude to detail. Note how she says, "Smoking in the UK kills one baby every day", not "Smoking during pregnancy kills one baby every day".

If the latter was true (which I don't believe it is) that would be a pretty arresting statement. Instead, like all tobacco control campaigners, Bauld wants to implicate all smokers.

The aim, conscious or otherwise, is to make all smokers feel guilty.

To download the Smoking in Pregnancy Challenge Group report click here – Smoking Cessation in Pregnancy: a call to action.

Here's Forest's response to the press release (not the report, which we hadn't read at that point):

Simon Clark, director of the smokers' lobby group Forest, said: "We support initiatives that educate and inform women about the risks of smoking during pregnancy, but this has the potential to be quite invasive.

"If a screening programme is voluntary there's no problem. No-one however should be forced to take a carbon monoxide test or made to feel like a leper if they decline. It's their choice and their decision must be respected."

He added: "We don't condone smoking during pregnancy and we would always advise pregnant women to listen to their GP or midwife.

"Nevertheless the suggestion that smoking during pregnancy costs one baby's life every day sounds like a headline grabbing estimate rather than an undisputed fact based on scientific evidence.

"Pregnancy is a stressful time for many women. Alarming them with emotive soundbites is not going to help."

Interestingly, and despite the gold dust nature of Linda Bauld's incendiary comment, the media has reacted rather coolly to her claim that “Smoking in the UK kills one baby every day".

Apart from Five Live, and a cursory report in the Daily Mirror, I'm struggling to find any coverage of the report in print or online.

PS. Pat has emailed to say she is also doing BBC Three Counties radio. If there is any further coverage today I'll update this post.

H/T Dick Puddlecote – The report is the subject of the Five Live phone-in.

Smoke On The Water [video]

June 18, 2013.

See also: Full house, diverse crowd, and a guest taken to hospital

Update: Forest sets the summer alight (The Commentator)