Intended for healthcare professionals


Plain tobacco packaging in Australia increases calls to Quitline

BMJ 2014; 348 doi: (Published 18 February 2014) Cite this as: BMJ 2014;348:g1646
  1. Zosia Kmietowicz, BMJ

The introduction of plain tobacco packaging in Australia led to a near doubling of calls to the national “stop smoking” helpline, a study has found—bolstering the evidence that packaging can significantly affect smokers’ behaviour.1

Australia was the first country to mandate plain packaging for all tobacco products, after it passed legislation in 2011. From 1 October 2012 all manufacturers had to produce plain green packaging for their products, which were devoid of any branding and had to display the number of the Quitline telephone service.

Researchers from the University of Sydney conducted an interrupted time series analysis in New South Wales and the Australian Capital Territory from October 2012 to April 2013, and they compared this with the earlier effects of the introduction of graphic health warnings, from March 2005 to October 2006.

The study, reported in the Medical Journal of Australia, found a 78% increase in calls to Quitline after plain packaging was introduced, from 363 calls a week to 651 (95% confidence interval, 523 to 780/week; P<0.001). The peak occurred four weeks after the initial appearance of plain packaging and has so far lasted for 43 weeks. The results were adjusted for other possible influences on quitting smoking, such as anti-tobacco advertising and cigarette price increases.

The 2006 introduction of graphic health warnings had a similar effect on calls, with an 84% increase from 910 calls a week to a peak of 1673 calls a week (1383 to 1963/week; P<0.001)—although this diminished more quickly, lasting just 20 weeks.

The researchers said that this evidence of an immediate impact of plain packaging legislation “should encourage other countries that are preparing similar legislation.” They added that future studies should look at the effect of the legislation on smoking rates.

Last July England’s Department of Health was widely criticised after it announced that it wanted to wait for more evidence on the effects of plain packaging before deciding whether to adopt it.2 In November it commissioned an independent review of standardised packaging, which is expected to report in the spring.3


Cite this as: BMJ 2014;348:g1646


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