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The effect of pack warning labels on quitting

The effect of pack warning labels on quitting and related thoughts and behaviours in a national cohort of Aboriginal and Torres Strait Islander smokers

Anna Nicholson, GDipPH, BPhty(Hons) PhD Ron Borland, PhD Pele Bennet, BHSc Maureen Davey, MB BS FAFPHM Jasmine Sarin, BHSci(Indig Hlth) Anke Van der Sterren, MPH MA BA Matthew Stevens, PhD David Thomas, MB BS PhD FAFPHM



The high prevalence of smoking among Aboriginal and Torres Strait Islander people in Australia (39%) contributes substantially to health inequalities. This study assesses the impact of warning labels on quitting and related thoughts and behaviours for Aboriginal and Torres Strait Islander smokers.


Participants were recruited from communities served by 34 Aboriginal Community Controlled Health Services and communities in the Torres Strait, Australia, using quota sampling. A cohort of 642 daily/weekly smokers completed relevant questions at baseline (April 2012-October 2013) and follow up (August 2013-August 2014).


We considered three baseline predictor variables: noticing warning labels, forgoing cigarettes due to warning labels (‘forgoing’) and perceiving labels to be effective.

Forgoing increased significantly between surveys only for those first surveyed prior to the introduction of plain packs (19% vs. 34%), however there were no significant interactions between forgoing cigarettes and the introduction of new and enlarged graphic warning labels on plain packaging in any model. Forgoing cigarettes predicted attempting to quit (AOR: 1.45, 95% CI: 1.02-2.06) and, among those who did not want to quit at baseline, wanting to quit at follow-up (AOR: 3.19, 95% CI: 1.06-9.63).

Among those less worried about future health effects, all three variables predicted being very worried at follow-up. Often noticing warning labels predicted correct responses to questions about health effects that had featured on warning labels (AOR: 1.84, 95% CI: 1.20-2.82) but not for those not featured.


Graphic warning labels appear to have a positive impact on the understanding, concerns and motivations of Aboriginal and Torres Strait Islander smokers and, through these, their quit attempts.


Graphic warning labels are likely to be effective for Aboriginal and Torres Strait Islander smokers as they are for the broader Australian population.

ACCC proposes to deny authorisation for tobacco companies

The Australian Competition and Consumer Commission has issued a draft determination proposing to deny authorisation to British American Tobacco, Imperial Tobacco, and Philip Morris (the tobacco companies) to jointly stop supply to retailers or wholesalers they believe are supplying illicit tobacco.

The ACCC considers that having the three dominant tobacco companies working together, sharing information, and making decisions about whether or not to supply particular retailers raises competition concerns.

“The ACCC is concerned about the potential for the sharing of information broadly, and that, for example, the proposed arrangements could be used to selectively target retailers that stock competing brands. This could result in detriment to businesses that may be wrongly or mistakenly subject to a joint decision of the applicants to cease supply, without any opportunity for independent review of that decision,” ACCC Chairman Rod Sims said.

These three tobacco companies are the major suppliers of legal tobacco products in Australia. They have proposed the arrangements to reduce the supply of illicit tobacco in Australia.

“While we agree that reducing illicit tobacco sales is in the public interest, we are not satisfied these proposed arrangements would reduce trade in illicit tobacco sufficiently to offset the likely detriments,” Mr Sims said.

The ACCC expects to release its final decision in February 2017.

Further information about the application for authorisation is available on the ACCC Authorisations Register.

Sneaky tobacco companies use mystery shoppers to exploit ciggie loophole

TOBACCO companies are offering gift cards, flights and hotel stays to retailers to try and encourage them to push their brand onto customers.

TOBACCO companies are offering gift cards, flights and hotel stays to retailers to try and encourage them to push their brand onto customers.

With the battle for Australia’s $2.6 billion tobacco industry fiercer than ever, manufacturers are fighting to lure the nation’s dwindling number of smokers.

And while advertising bans and plain packaging laws have hit their profits, tobacco companies have found a sneaky legal loophole around them.

Marketing reps are sent to hotels, supermarkets, petrol stations, tobacconists and newsagents to train sales assistants in how to promote their brands to customers.

If they do as they are instructed, staff can win points and prizes such as gift cards, flights, hotel stays and vouchers for spa and beauty packages.

That’s where mystery shoppers come in: they keep tabs on staff, awarding points to those who recommend one cigarette brand over another.

It’s called “trade marketing”, and is one of the only legal ways cigarette makers can promote their wares under the highly restrictive regime that governs the sale and use of tobacco.

Health advocates say the scheme threatens to undermine the government’s plan to slash the rate of smoking to 10 per cent of the population by 2018.

But the loophole may soon be closed, with NSW Health Minister Jillian Skinner vowing to clamp down on the practice after being contacted by


Mystery shoppers hired by Imperial Tobacco are sent to retailers with a very specific script.

“I normally smoke Winfield 30s but I am looking for an alternative, what would you recommend instead of Winfield 30s?” the shoppers are instructed to ask, in a job summary seen by

When asked how much they want to spend, the mystery shopper says “maybe something a little cheaper”.

If asked about their preferred cigarette’s strength, the shopper replies: “I usually smoke the blue ones.”

Then it’s over to the staff member who says the magic words and steers the “customer” towards John Player Special, a brand imported by Imperial. If the staff member does not mention any other brand, they score points towards the company’s incentive program.

At this point, the mystery shopper identifies him or herself and informs the staff member that the results will be tallied at head office and prizes awarded to those with the top scores.


The script given to mystery shoppers.


Scott Walsberger, the head of tobacco control and prevention at Cancer Council NSW, said mystery shopping was central to tobacco companies’ marketing strategies.

“Trade marketing as they call it is a significant part of their work,” Mr Walsberger said, adding that building relationships with retailers was one of the only legal methods to promote cigarettes after successive law reforms.

He said tobacco companies were desperate to make their products attractive to consumers after being banned from advertising in print and on television, and having the distinctive imagery and colour in their packaging replaced with drab, dark brown.

“Every time we’ve brought in legislation, you see the tobacco industry push the envelope, continually trying to make their product attractive and market them as much as possible,” he said.

“They’re always focused on selling more cigarettes, more people getting addicted and they go to all lengths to do that — so it’s not surprising that, as we tighten up regulations of how they market their products in some ways, that they’ve sought out the channels where they’re not regulated and exploit them to continue to promote their product.”

He called for new laws to better regulate how tobacco products are sold and marketed and made available through retail outlets, and rejected the argument that trade marketing only targeted customers who were already smokers.

“They say they’re not marketing to new customers, just getting people to switch brands or building brand loyalty; we know that’s not true,” Mr Walsberger said.

“Two out of every three smokers will die from their smoking habit. If that’s your consumer base, your target audience and you’re losing two out of every three of those, you need to be recruiting new smokers. So that has to be a key part of their marketing strategy.”


Health Minister Jillian Skinner vowed to crack down on the mystery shopping scheme after being contacted by

“The NSW Government will seek to amend the Public Health (Tobacco) Act 2008 with the intention of tightening the law to prohibit this practice,” Ms Skinner said. “I am proud of this government’s record in reducing smoking in this state.”

A spokesman for Imperial Tobacco Australia said the company sold a legal product and defended its trade marketing practices.

“We work with a range of retail partners to have adult consumers of tobacco products choose our brands — including Peter Stuyvesant and JPS — over those of our competitors,” the spokesman said.

“The program in question sees shoppers specifically identifying themselves as adult consumers of tobacco products who are seeking a brand recommendation from a retailer.

“This clearly neither ‘circumvents legislation’ nor has any bearing on the choice of an adult to consume tobacco. It simply addresses which brand that adult consumer might choose.”

He said “anti-tobacco zealots” should look at the billion-dollar illicit tobacco trade and “focus their attention on serious problems rather than attempting to undermine legitimate and legal competition for no apparent purpose”.

WTO Delays Ruling In High-Stakes Tobacco Packaging Battle

The World Trade Organization will not issue a ruling on whether Australia’s “plain packaging” tobacco law usurps foreign companies’ intellectual property rights until May, according to WTO documents circulated Tuesday, delaying a decision that was slated to arrive by the end of 2016.

A single WTO panel is weighing cases launched by the governments of Indonesia, Cuba, the Dominican Republic and Honduras asserting that Australian laws that ban all distinct branding from cigarette packages in favor of graphic warnings about the danger of the products. The case has teed up a high-stakes fight over the intersection of intellectual property rights and public health safeguards.

There is no precedent for such a law being challenged in Geneva, and the panel apparently needs more time to parse through the various legal issues at play.

“The panel wishes to advise that it now expects to issue its final report to the parties not before May 2017, in light of the complexity of the legal and factual issues that arise in this dispute,” the panel said in a statement circulated to the WTO.

Australia passed its packaging law in 2011 despite the protestations of numerous multinational corporations who viewed the measure as a direct threat to their use of trademarks and other branding mechanisms to promote their business. The four countries have said the law violates the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights, or TRIPS, as well as the Agreement on Technical Barriers to Trade and the General Agreement on Tariffs and Trade.

At every step of the way, Australia has claimed that it has the right to curtail businesses’ trademarks in the name of public health. For the first time in the WTO’s history, the panel will have to grapple with how the TRIPS Agreement comports with a country’s right to pursue policy objectives that it deems necessary to safeguard the public’s welfare.

The legal battles over the plain packaging law began almost as soon as it went into effect, beginning with a case filed by Philip Morris Asia Ltd. under the Hong Kong-Australia bilateral investment treaty.

In that case, the panel handed a win to Australia, albeit on jurisdictional grounds, meaning that the WTO’s decision will likely be the first ruling to address the issue on the merits. Even when the decision does come down, the case will be far from settled as all parties will be entitled to a round of appeals.

Nevertheless, the case will continue to be closely watched not only by the litigants and others in the tobacco industry, but also by those companies selling products that could e subject to similar public health rules, such as alcoholic beverages or fatty and sugary foods.

–Editing by Katherine Rautenberg.

Facebook could help lower Indigenous smoking rates, Northern Territory health researchers say

Indigenous people have the highest rates of smoking in the country, but researchers in the Top End believe Facebook could be the most effective way of helping them quit.

Aboriginal people living in remote communities smoke at three times the rate of other Australians, according to research fellow Marita Hefler from the Menzies School of Health Research in Darwin.

Preliminary research into the role of Facebook in helping smokers to quit has found that although the living situations of Indigenous Australians differs widely across the Northern Territory, even those who lack food or clothing may still own a smartphone.

“We know that Aboriginal people use social media at very high rates; it’s been taken up even in remote communities, particularly where people have limited communication through other means,” Ms Hefler said.

Researchers believe Indigenous people use Facebook at higher rates than the overall population, making it one of the most effective ways to reach out.

“Facebook is a more effective way of reaching Indigenous Australians than traditional forms of communication; what we need to figure out is how to harness that message,” Ms Hefler said.

Early findings show that when friends and family talk about quitting smoking on social media, it has a greater effect than traditional hardline anti-smoking ads.

“The people in your Facebook networks influence you the most,” Ms Hefler said.

“In the past, anti-smoking advertising has relied heavily on having a captive audience; we know that smokers don’t like the content they are seeing, but they can’t get away. Now with the advent of Facebook, all you have to do is swipe and the message is gone.”

Cigarettes more popular than fruit in outback stores

Customers in remote Australia spent roughly four and a half times more on cigarettes than fruit and vegetables in 2015-16, said Stephen Bradley, chairman of Outback Stores, a government-owned company which manages 37 businesses in some of the remotest parts of the country.

An incentive program run by Outback Stores to improve community health has resulted in a 0.5 per cent drop in soft drink sales and a five per cent increase in fruit and vegetable sales, but Mr. Bradley admits more needs to be done.

“We remain convinced that a significant dietary change will take many years and our support programs need to operate for the longer term to be effective,” he said.

The Federal Government is aiming to close the gap between Indigenous and non-Indigenous life expectancy within a generation.

Indigenous deaths caused by heart disease and strokes have been dropping but on average Indigenous people are still dying 10 years younger than non-Indigenous Australians.

“Smoking in Aboriginal communities looks quite different to what it does in the rest of Australia,” Ms Hefler said.

“There’s historical reasons why the smoking rate is higher: it’s tied up in inter-generational trauma, and we also know the stolen generations are more likely to smoke.”

Using Facebook to quit

After suffering a heart attack on her 50th birthday, Chuna Lowah is trying to quit smoking, and is hopeful Facebook can help.

Ms Lowah has been a smoker for more than half her life and agrees the tough traditional anti-smoking ads are too easy to ignore.

“On Facebook I have seen some of my friends quitting smoking, using Facebook as a diary, and they’ve been very successful. I’m hoping that sharing my experiences will also help me quit,” she said.

The preliminary research findings from Menzies have been welcomed by NT Territory Labor MP Chansey Paech, whose central Australian electorate of Namatjira has a high Indigenous population.

“Both the Territory and Federal Governments have made significant contributions over the last several years to reduce the rates of smoking, so I’m looking forward to reading the report and seeing what the recommendations are, and hopefully reducing the smoking rate in the Northern Territory, which we know is too high,” he said.

South Australia looks to restrict e-cigarettes

Electronic cigarettes will be subject to the same restrictions as tobacco products under new laws proposed by the South Australian government.

Under current laws the devices can legally be sold to children and used in places where ordinary cigarettes cannot.

But Substance Abuse Minister Leesa Vlahos says the changes will bring them into line with conventional cigarettes, banning the sale to children, their use in enclosed public spaces and preventing any advertising or promotion.

Flavoured cigarettes to be banned under tightened WA tobacco laws

WA tobacco laws are about to become even stricter with a proposed ban on flavoured cigarettes, split-packs, and minors selling tobacco products.

In an attempt by the government to tighten restrictions on the sale of tobacco, the proposed amendment bill would stop the sale of cigarettes with added fruit and confectionary flavour, split packs, and tobacco products at public events like music festivals.

It would also make WA the first Australian state to ban minors from selling cigarettes.

Xander Sardo-Infirri, a smoker in Perth, said he doubted the efficiency of the proposed laws.

“I’ve never been to a music festival where cigarettes were sold inside the venue and most venues these days are moving towards being tobacco-free anyway, so I don’t know what they’re hoping to achieve with that,” Mr Sardo-Infirri said.

He said he understood the reluctance to sell flavoured cigarettes that could appeal to young people, but said he strongly disagreed with the regulation of flavoured papers used to hand-roll cigarettes.

Cancer Council WA research coordinator Kelly Kennigton said she supported the government’s attempt to put the interests of children and public health over those of the tobacco industry and their profits.

“Every year, 1400 people in WA die from their tobacco addiction, and thousands more suffer from associated chronic diseases,” Mrs Kennington said.

“Deadly products that kill two out of three of users should not be promoted at music festivals or any events that young people attend, nor should we allow products such as ‘split packs’ that make it easier to recruit young people to this deadly habit.”

Health Minister John Day said the Tobacco Products Control Amendment Bill 2016 would put emphasis on protecting minors.

“Underage sales assistants are more likely to sell tobacco products to minors, and they should not be put in this position in the first place,” Mr Day said.

Mr Sardo-Infirri said he saw the value in discouraging young people from taking up smoking.

“I wish I’d never started and I wish I didn’t smoke now,” he said.

“A lot of people were against the plain packaging when it came in and that seemed to have results, so if they think these laws will work, go for it.”

WA already has some of Australia’s tightest restrictions on tobacco promotion and public smoking.

The 2006 Tobacco Products Control Regulations prohibits smoking in enclosed public places like shopping centres, theatres and cinemas, airports, cafes and restaurants, pubs, bars, nightclubs, and sporting clubs.

In December 2013, the City of Perth banned smoking in major pedestrian areas like Hay St Mall, Murray St Mall, and Forrest Place.

Margaret River Main Street also became a smoke-free zone after proposal was passed last September.

Fruit and confectionary-flavoured cigarettes are already banned in South Australia, New South Wales, and Tasmania, and in WA retailers are not able to display them.

Split-pack cigarettes, designed to be split into two or more packs and therefore exempting the second and subsequent packs from showing the required health warnings, are likewise forbidden from being displayed but there is no direct ban on them – yet.

Mr Day said strong legislation was the foundation of tobacco control and there was more to be done.

He said most of the proposed provisions would have a six-month lead-in period with an education campaign for tobacco sellers.

Philip Morris predicts e-cigarettes to kill off traditional smokes

A BIG tobacco company says it sees a future without cigarettes as it pushes to overcome legislative hurdles to launch a smokeless cigarette in Australia.

The move by Philip Morris International to introduce its new product has so far been thwarted by the Federal Government, which refuses to follow the US, UK, Japan and parts of Europe in allowing the legal sale of e-cigarettes.

Health experts told the Herald Sun smokeless cigarettes were a good alternative to quitting smoking.

“For smokers who are unable to quit, switching to reduced-risk products is likely to substantially reduce their risk of smoking-related disease and death,” conjoint associate Professor Colin Mendelsohn said.

Australian Paul Riley, president of PMI in Japan, believes smokeless cigarettes such as the company’s iQOS product will one day sound the death knell for traditional cigarettes.

The device uses real tobacco, but instead of burning it to produce hazardous smoke and tar, it heats it to produce tobacco-flavoured vapour.

“Our goal in Japan is to switch every one of our users on to this product as quickly as possible,” Mr Riley said. “In the last 12 months it has moved quickly … it is a realistic vision.”

Prof Mendelsohn said although it was preferable for smokers to quit, he believed e-cigarettes were a first step.

“The first choice is always to give up all tobacco and nicotine completely if possible … iQOS heats tobacco to produce an aerosol without combustion, or smoke, and is a much safer alternative to smoking.”

Department of Health spokeswoman Kay McNiece said: “The Australian Government is taking a precautionary approach and is examining the policy and regulatory framework on e-cigarettes.”


In Nepal, health warnings cover 90 percent of cigarette packs, while Australia requires those packets be wrapped in drab, plain paper. Indonesia’s new ban on outdoor advertising brought down tobacco billboards depicting smiling, smoking youths. And India wants scary photos of rotting lungs and mouth tumors covering packets sold in the country.

Still, national drives to discourage smoking and cut back tobacco sales haven’t done enough, campaigners say. Smoking-related deaths are still rising worldwide, with 80 percent of them expected to occur in developing country populations by 2030.

“Most people in the United States think tobacco is over and done with, but it’s still the largest preventable cause of disease on the planet” killing 6 million people a year — or one person every six seconds, said John Stewart, deputy campaigns director at the Boston-based lobbying group Corporate Accountability International.

Starting Monday, representatives from at least 178 countries are meeting for five days in the Indian capital to discuss how they can further the fight against smoking and push back against tobacco company lobbyists.

Since they set down stiff regulations and guidelines in a landmark 2003 treaty called the Framework Convention on Tobacco Control — the first and only global treaty dealing with public health — most of the 180 signatories have ratified it and passed laws restricting tobacco advertising or sales.

Still, many governments remain entangled with powerful tobacco companies, while industry lobbyists continue attempts to stymie efforts to implement anti-smoking laws through bribery, misinformation and even suing national governments for lost profits, campaigners say.

“The tobacco industry is definitely feeling the heat,” Stewart said. “They’ve got their back against the wall.”

Indian courts are currently grappling with 62 lawsuits filed by tobacco companies or cigarette makers challenging laws requiring that 85 percent of all cigarette packets be covered with photos of medical horrors.

In Japan, a 10-percent hike in taxes on cigarettes has led to a 30-percent decline in smoking. But the country still has some of the lowest tax rates on cigarettes among industrialized nations, while its finance ministry owns 33 percent in Japan Tobacco.

The anti-tobacco campaign has had some success. It is widely accepted, at least among national leaders, that smoking causes cancer, cardiovascular and respiratory disease, along with a host of other harmful health impacts.

That awareness still has not trickled down to national populations, though. And campaigners say tobacco interests have shifted their focus to poorer, less educated populations in the developing world.

India — among the first to ratify the anti-tobacco treaty in 2004 — is still considered one of the biggest battlegrounds in the fight against the tobacco industry, public health specialists say.

Despite harsh laws passed more than a decade ago banning smoking in public and sales to children, smoking is still common across the country. A government survey in 2010 showed nearly 35 percent of adults were either smoking or chewing tobacco.

Meanwhile, more than 1 million Indians die each year from tobacco-related diseases that cost the country some $16 billion annually, according to the World Health Organization.

“The revenues that the government earns from tobacco taxes are far less than the billions that are spent on health care,” said Bhavna Mukhopadhyay of the Voluntary Health Association of India, a public health organization.

“Public health and the health of the tobacco industry cannot go hand in hand,” she said, noting that campaigners are now pushing for countries to make tobacco companies and their shareholders civilly and criminally liable for the harm done by tobacco.

Part of the trouble in India is “the Indian consumer is spoilt for choice,” she said, with cigarettes sold alongside chewing tobacco and cheap, hand-rolled smokes known as bidis.

The easy availability and wide choice means many smokers get hooked at a young age. Some are initiated early through the common, cultural practice of chewing something called gutka, which combines tobacco with spices, lime and betel nut and is widely sold as a mouth freshener.

Putting pictorial warnings on cigarette packets is an attempt to educate people about the risks.

“The idea was that even an illiterate person, or a child, would understand the message about the health risks from smoking,” said Monika Arora of the Public Health Foundation of India, who runs an anti-smoking campaign aimed at young Indians. Nirmala George, New Delhi, AP