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When cigarettes come in plain brown packaging -- as they are now legally required to be sold in Australia -- most smokers said they thought more often about quitting as the cigarettes they smoked became "less satisfying."
"The use of plain packs with unbranded space [and] featuring larger health warnings as part of a comprehensive approach to tobacco control can help decrease tobacco use and its health consequences," said one U.S. expert, Patricia Folan, director of the Center for Tobacco Control at The North Shore-LIJ Health System in Great Neck, N.Y.
"Smokers who used the plain packs perceived their cigarettes to be of lower quality, rated quitting as a higher priority, and were more likely to report thoughts about quitting," said Folan, who was not involved in the new research.
In late 2012, Australia became the first and only country in the world to legislate plain brown packaging, accompanied by graphic health warnings that cover three-quarters of the front of the pack, for all tobacco products.
In order to assess the impact of the change, researchers interviewed 536 smokers shortly after the new law took effect and cigarettes with either plain packaging or branded packaging were available.
About 72 percent of the participants were buying the plain packs and nearly 28 percent were still buying branded packs with smaller health warnings.
There was little difference between the two groups in terms of how they viewed the health damage caused by smoking or how often they thought about those dangers, according to the study published online July 22 in BMJ Open.
However, compared to branded-pack smokers, those who bought the dowdier packs of cigarettes were 51 percent more likely to support the plain pack policy, 66 percent more likely to think their cigarettes were poorer quality than a year ago, and 70 percent more likely to find their cigarettes "less satisfying."
The plain pack smokers were also 81 percent more likely to have thought about quitting at least once a day during the previous week and to rate quitting as a higher priority in their lives, the researchers said.
That's important, the team wrote, because "frequency of thoughts about quitting has strong predictive validity in prospective studies for actually making a quit attempt."
In the United States, legal tussles over changes to cigarette packaging have made headlines over the past few years. In 2010, the U.S. Food and Drug Administration initially announced proposals for hard-hitting graphic imaging on tobacco products -- pictures of dying lung cancer patients, or diseased mouths and gums.
But those efforts have been stymied in the courts, with tobacco companies arguing that the mandated labeling violates free speech rights. In June, the FDA formally withdrew its 2010 proposals for tobacco product re-labeling.
Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, believes plainer packaging may be one useful alternative strategy.
"It's not surprising to observe that packaging cigarettes less attractively might reduce cigarette consumption," he said. "Test marketing in the U.S. would be welcome."
And Folan said the Australian data might rekindle hope for tobacco product re-labeling in the United States.
"Hopefully, the data from this and other studies will provide sufficient and compelling evidence to the U.S. courts, which will permit the FDA to regulate tobacco product packaging by mandating the graphic warning labels," she said.
-- Robert Preidt
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