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Plain packaging effective in reducing misperceptions of tobacco products among Australian Indigenous

Following the introduction of plain packaging on tobacco products in 2012, Australian Aboriginal and Torres Strait Islander people were 12 per cent less likely to think certain tobacco brands were less harmful than others, a new study found.

Plain packaging means tobacco company colours, logos and design elements are not allowed on tobacco products, but government health warnings still appear. Australia was the first country to implement plain packaging in December 2012 in an effort to curb national smoking rates. Canada plans to implement plain packaging as part of Prime Minister Trudeau’s Safer Kids Initiative.

The research, published today in the Australian and New Zealand Journal of Public Health, studied the effects of plain packaging on Australian Aboriginal and Torres Strait Islander people’s perceptions of different brands being less harmful or more prestigious than others.

“We know that brand imagery and design elements influence perceptions of consumer risk and status,” said Dr. Raglan Maddox, a postdoctoral fellow at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, specializing in Aboriginal tobacco use, public health and evaluation. “Colours, shapes and symbols on packaging contribute to beliefs that certain brands are more high-status, while using words like mild, light or slim can give consumers the impression that some tobacco products are less harmful than others.”

The study found plain packaging not only reduced overall misperceptions that there are healthier tobacco brands, but also found that participants under the age of 35 were 16.5 per cent less likely to view some brands as more prestigious than others. Research also indicates that smokers, especially those ages 18 to 29, found the new plain packs less appealing.

“These age-specific findings provide important insight for changing perceptions of status or prestige associated with tobacco brands in the younger indigenous population,” said Dr. Maddox. “Preventing uptake and eliminating tobacco use in this demographic is central to addressing the disproportionate burden of smoking-related death and disease, while also improving overall health and life expectancy.”

In 2013, approximately 42 per cent of Aboriginal and Torres Strait Islander people were smokers – a substantially higher rate than the general population. Tobacco-related illness is the most preventable cause of disease and death in both Australian Aboriginal and non-Aboriginal people, contributing to heart disease, chronic respiratory disease and various forms of cancer.

Dr. Maddox said the study adds to growing literature indicating the world’s first plain packaging initiative is associated with increased thoughts of smoking cessation, attempts to stop smoking and calls to cessation helplines.

“The findings are consistent with recent, broader research that smokers were more likely to correctly identify that cigarette brands are equally harmful and similar in prestige after plain packaging was implemented,” said Dr. Maddox. “The findings on Australian Aboriginal and Torres Strait Islander people further support plain packaging and health warnings as an effective strategy in reducing global tobacco use.”

As Canada and Australia are both Commonwealth countries with similar health and social systems, Dr. Maddox said he believes Australia’s documented success combined with this study’s findings could haves huge potential for Canadians – especially vulnerable populations, which include First Nations, Inuit and Métis people.

Both countries observe much higher rates of smoking among Indigenous people than non-Indigenous citizens. According to Statistics Canada, First Nations, Inuit and Métis people are twice as likely to smoke or use tobacco products as non- Indigenous people. Among those who smoke, the majority started between the ages of 13 and 16 years of age.


This study was conducted in conjunction with Winnunga Nimmityjah Aboriginal Health Service and received funding from the ACT Health Directorate and the University of Canberra.

About St. Michael’s Hospital

St. Michael’s Hospital provides compassionate care to all who enter its doors. The hospital also provides outstanding medical education to future health care professionals in 27 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, care of the homeless and global health are among the hospital’s recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing International Healthcare Education Centre, which make up the Li Ka Shing Knowledge Institute, research and education at St. Michael’s Hospital are recognized and make an impact around the world. Founded in 1892, the hospital is fully affiliated with the University of Toronto.

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