An example of plain cigarette packaging the brand information is in a standard font, and the health warning dominates

Earlier this week an article announced that the UK is to bring in legislation that will force tobacco companies to sell their products in standardised plain packaging. This is similar to legislation Australia brought in last year.

Although there has been no official confirmation from the Department of Health (in fact, David Cameron stated the decision has not been made yet), the public consultation on plain packaging closed a while ago, so an official decision is likely to be reached soon.

At last glance there were more than 800 comments on the Guardian article. People are arguing strongly on both sides of the debate is plain packaging another chip at our free will, undermining our freedom of choice, or a move to protect the most vulnerable in our society from a highly addictive, deadly habit?

Let’s look at the evidence. What research has been conducted to assess whether plain packaging will make any difference to the uptake and maintenance of smoking habits, and indeed on shopkeepers who will be selling these non branded packets?

I’ll start with the money. When the potential for this legislation was announced in Australia, the Alliance of Australian Retailers employed Deloitte to investigate the impact that plain packaging would have on retailers. As declared on the resulting (non peer reviewed) report, the AAR are supported by British American Tobacco Australasia, Philip Morris and Imperial Tobacco Australia.

Deloitte consulted with retail operators, and predicted that plain packaging would increase each transaction time for purchasing cigarettes by between 15 and 45 seconds, because of the similarity of packets. They claimed that this would translate to losses of thousands of dollars annually for individual stores.

A group of public health scientists in Perth decided to test these claims, and designed an experiment whereby participants had to find certain brands in an array of plain versus branded cigarette packets. They found that, converse to the results predicted by Deloitte, their participants were quicker at locating the brand in question from the plain packet array, rather than among the branded packs. This was only initially once participants had learned where the brands were in the array, type of packaging made no difference.

This study wasn’t completely representative of real life. Firstly, none of the packets had health warnings. If plain packaging is brought in, the packets won’t be “plain”, they will have all branding removed. The brand and variant names will be written in a standardised font, with the majority of the pack being taken up with the health warning, which will remain in colour.

Also, the experiment wasn’t conducted in a shop, with a shop assistant as the participant, it was run in a room with a couple of experimenters. But, as the authors of the study conclude, this was “a modest experiment undertaken with no budget and a group of volunteers in the space of one week”, yet it suggests that one of the main arguments often presented against plain packaging is likely to be incorrect.

What about the important issue? Will plain packaging actually deter people from taking up smoking in particular will it deter children from starting? As you might expect, there are a number of studies that have shown that progressively plainer packages are rated as less attractive, by smokers and non smokers, and by adults and teenagers.

That’s pretty obvious. Of course they’re less attractive, but will that make kids less likely to start smoking? There is a study that has attempted to look at this, undertaken by some of my colleagues at University of Bristol (full disclosure, I am a member of the same research group as two of the authors of this paper).

This study used eye tracking technology to assess whether teenagers look at plain versus branded packets of cigarettes differently. Their “plain packets” were based very closely on what plain packets would look like in this country, and incorporated health warnings.

Images of the packets were shown on a computer screen, and participants had to look at the packets as they wished, but with the instruction that they would need to remember information about what they saw.

They found that teens who already smoke every day didn’t show any difference in where they looked between plain and branded packs they tended to avoid looking at the health warnings. But teens who smoke weekly or less spent more time looking at the health warnings on the plain packets compared with the branded ones. Teens who don’t smoke at all spent more time looking at the health warnings regardless of packaging.

If plain packaging will lead teens who experiment with cigarettes to look at the health warnings more, it’s possible that this would translate in to them being less drawn to smoking. However, this is a slight leap from these findings, as participants were not asked about their views on warnings.

Other studies have looked at this though. A group in Greece showed health warnings to almost 600 teenagers, comparing text versus graphic health warnings. Teens rated the graphic warnings as more likely to deter them from smoking, whether they were current smokers or not.

A study in Australia asked teenagers about their opinions on smoking before and after graphic health warnings were introduced. They found the warnings were noticed by most of the teens, and not only that, but they were read and understood. Teens also reported thinking more about stopping smoking if they already smoked, and feeling less likely to start if they didn’t.

So although there’s no evidence yet from Australia (where the legislation is now in place) to show whether plain packaging is working there, the studies that have been conducted to date certainly suggest that there might be a benefit in introducing it.

Coffin nails: the tobacco controversy in the 19th century

Classifying e-cigarettes as medicine does not make sense euranet plus inside
Although a few women shared the tobacco habit in nineteenth century America, it was overwhelming a male endeavor. The most popular ways for American men of the time to consume tobacco were pipes, cigars, and chewing tobacco. Snuff had largely gone out of fashion by mid century, except for occasional sniffs by high society youth. Pipes were a favorite of all social classes, and varied in style from expensive, elaborately carved wood or stone to simpler, moderately priced versions to cheap ones made of clay or corncob. Chewing tobacco was common throughout the century in rural and urban areas alike, requiring spittoons in the cities public buildings. It was popular among working class and poor Americans, but was shunned by polite society in the late nineteenth century.

American soldiers were introduced to cigars during the Mexican War (1846 1848) and they became a fad with men in the 1850s. Cigars ranged in price from cheap to expensive, but were associated for the rest of the century with affluence, respectability, and success in the male bastions of business, politics, and the military. Cigars were the most exclusively male of all tobacco products, while cigarettes, in contrast, were considered unmanly until the end of the nineteenth century. The manufacturing of cigarettes in the United States began in the early 1860s and mass production was achieved in the early 1880s. There were two basic kinds of cigarette products high end, expensive brands made of imported tobacco and low end, cheap brands made of domestic tobacco.

High end cigarettes were linked with the moral decadence of Europe, the Middle East, and Latin America, where the products were both manufactured and popular. Hand rolled cigarettes, also made from imported tobacco, implied the user had the leisure to indulge the habit, and was not participating in his manly duty to earn a living and provide for a family. Thus, the cigar represented the family man who gained wealth through hard work and self sacrifice, and who respected traditional morality and authority the cigarette symbolized the man whose inherited wealth allowed him to remain in a sort of perpetual, self centered adolescence unmarried, disrespectful of conventional morality and authority, and attracted to things foreign.

An article in the May 28, 1870 issue of Harper s Weekly mocked The Hero of a Fast Novel ( fast means immoral or socially improper). He was constantly pleasure seeking, and lived in luxury by spending other people s money or going into debt. The cigarette was as much an identifying mark of the fast youth as his expensive food and wine. When out shooting, these gentlemen, who are roughing it, toss the dogs foie gras and truffles, and drink delicate Burgundies to their perfumed cigarettes.

A cartoon in the October 14, 1882 issue depicted a Swell Struggling with the Cig rette Poisoner. Like the fast young man, a swell was wealthy, self indulgent, and egotistical. In the cartoon, he wore evening clothes and top hat for a riotous night on the town. His floral boutonniere may have mimicked the practice of Oscar Wilde, who toured the United States that year wearing or carrying lilies and sunflowers (that may be a lily pad in the swell s buttonhole). The text and image made it clear that the cartoonist considered cigarette smoking to be addictive and deadly. The multiple cigarette ribs of the snake signified chain smoking, which restricted his free will by encircling him. According to the caption (which may have been sarcastic) he struggled (or should have struggled) against its hold on his life. The skeletal view of the snake and the designation of cigarettes as poison delivered the powerful message that cigarette smoking is deadly.

Although cigarettes made with domestic tobacco had always been cheaper than those containing imported tobacco, two things lowered the price more. The first was the drastic reduction of the federal tax on cigarette manufacturers in 1883. Originally imposed to help pay for the Union war effort during the Civil War, two decades later Congress cut the tax by almost 29%, and manufacturers like James Buchanan Buck Duke of North Carolina, passed the savings along to customers. In the February 25, 1882 issue of Harper s Weekly, a cartoon by Thomas Nast criticized the call for the tax reduction. The artist presented two stylishly dressed young men in a tobacco haze. Their cigarette habit made them stupid and lazy, the opposite of the manly air they wanted to project.

The second important factor occurred when Duke contracted in 1883 with James Bonsack to perfect the latter s invention for mass producing cigarettes. On April 30, 1884, the machine lasted an entire ten hour shift, making 120,000 cigarettes. The device reduced manufacturing costs and, in turn, consumer prices as it increased production and availability. By the early 1890s, Duke had a near monopoly of the cigarette market via his American Tobacco Company (broken up by the U.S. Supreme Court in 1911).

The markets for cheap, domestic cigarettes in the late nineteenth century were primarily boys and immigrant men from southern and eastern Europe, where the habit was common. The low cost and convenience of cigarettes also encouraged urban working class men to take up the practice over the next few decades. Cigarettes could be smoked quickly while walking to and from work, on lunch breaks, and when the boss was not around. They were also less offensive than other tobacco product to nonsmokers in the congested and rapidly growing cities of America.

These groups of cigarette smokers reinforced the stereotype that the habit was unmanly. Boys were immature, and presumably did not have the responsibility of providing for a family (actually, some working class boys did, at least in part). In 1885, an editorial in The New York Times chastised men for smoking cigarettes and warned of the dangers it posed to the nation s political survival. A grown man has no possible excuse for thus imitating the small boy The decadence of Spain began when the Spaniards adopted cigarettes and if this pernicious habit obtains among adult Americans , then the ruin of the Republic is close at hand (The focus on Catholic Spain probably also reflected anti Catholic sentiment among the dominant Protestant population in the United States.)

Poor and working class men (which included most immigrants) were considered unsuccessful financially, and not socially (and sometimes, morally) respectable. Therefore, they did not fit the middle class ideal of American manhood in the late nineteenth century. A one sentence item in the Personal column of the July 12, 1888 issue of Harper s Weekly proclaimed, Washington is proud of the fact that not one Congressman smokes cigarettes. It is certain, though, that many used cigars, pipes, or chewing tobacco.

The public attitude against men smoking cigarettes began to change with the Spanish American War in 1898. Many of the young American soldiers, particularly those from rural areas, were introduced to cigarettes as they came in contact with residents of the (former) Spanish colonies of Cuba, Puerto Rico, Guam, and the Philippines, where cigarettes were smoked by most of the population. Although U.S. military officials approved enlisted men using pipes and chewing tobacco, they tried unsuccessfully to discourage cigarette smoking. In fact, American sailors threatened to mutiny if deprived of cigarettes. They had practical advantages over other tobacco products. They could be carried easily in a uniform pocket, smoked quickly, and did not spoil in humid weather like cigars. In cramped military quarters, particularly on long sea voyages, the milder cigarette odor would be less offensive to nonsmokers than strong cigar smoke.

At first, Harper s Weekly presented cigarette smoking as a Spanish practice. In the August 13, 1898 issue, at one point in a news story on a truce in the fighting in Cuba, the correspondent identified the tw
o sides by their respective choice of tobacco Meanwhile the little men in light blue Spanish soldiers sit calmly on the edge of their trenches and smoke cigarettes, while the big men in dark blue American soldiers sit on the edge of theirs and good humoredly cast tobacco juice toward the city of Santiago. However, in the next week s issue, in a news story on The Taking of Guam, the correspondent referred to American sailors aboard the U.S. transport, Australia, using cigarettes, cigars, and chewing tobacco. The situation was similar in Puerto Rico, from where Charles L. Hofmann of Battery A, Pennsylvania Light Artillery, wrote home, You can buy the best cigars here and their cigarettes are good and strong.

In the aftermath of the Spanish American War, E. S. Martin questioned, in his This Busy World column from the December 24, 1898 issue of Harper s Weekly, the presumption that cigarettes undermined American manhood. Instead, he connected the habit explicitly with American servicemen, who smoked so many cigarettes in Cuba that they ran out of supplies. He emphasized that cigarette smoking among American military personnel was simply a fact from the recent war, which every one must recall. In the February 25, 1899 issue, a feature article on Our New Possessions Puerto Rico, discussed the Tobacco Culture of the island, a new American territory after the war. The author argued that with minor changes to cigarettes made in Puerto Rico, they would find a ready market in the United States.

The years between the Spanish American War and America s entry into World War I in 1917 were a period of transition for the public attitude toward men and cigarette smoking. The notion in earlier decades that the foreign origin of high end cigarette made the manliness and morality of male smokers suspect appears to have diminished by the late 1890s (even before the Spanish American War). An advertisement for the Nestor cigarette brand in the March 19, 1898 issue of Harper s Weekly declared proudly that its product was THE MODERN EMBODIMENT OF ANCIENT ORIENTAL LUXURIOUSNESS so much for middle class respectability and the work ethic. A Nestor ad in the January 21, 1899 issue marketed to smokers of refined taste and featured a sketch of an Arab man (or perhaps a British man in Arab attire).

That there was still uncertainty, however, about cigarettes and American manhood is demonstrated in two other ads. In the September 3, 1898 issue, the Van Bibber brand of cigarettes were called LITTLE CIGARS, to associate them with the unquestionably acceptable tobacco product for men. In the February 18, 1899 issue, an illustrated ad for Lucke s Rolls cigars stated, They are not a smoke for boys or cigarette smokers. (Notice another Nestor ad at the top of the page.) The fact that the cigar ad insulted cigarette smokers also indicates that the cigar company was experiencing competition from cigarette manufacturers.

Historians have attributed a drop in cigarette sales for a few years in the late 1890s and early 1900s primarily to the return of economic prosperity, which allowed more male smokers to afford cigars over the cheaper cigarettes. In his This Busy World column from the August 19, 1899 issue of Harper s Weekly, E. S. Martin noted that after increasing for 12 years, domestic cigarette production dropped during the previous year. He observed, though, that the sale of luxury cigarettes had increased (evidence of the improved economy).

In the early twentieth century, military officials continued their unsuccessful attempts at suppressing cigarette smoking. In 1903, the Military Academy at West Point banned cigarettes (but promoted pipes) and soon court martialed two cadets for possession. However, the prohibition lapsed into disuse when the chief medical officer of West Point admitted in 1915 that a large percentage of cadets were habitual cigarette smokers. Similarly, intense opposition from sailors caused the U.S. Navy to reverse a 1907 ban on cigarettes for those less than 21 years old.

By the time the United States entered World War I in 1917, cigarette smoking seems to have been widespread in the military. The public association of cigarette smoking with the manly image of American servicemen, which had begun with the Spanish American War in 1898, was reinforced in World War I. The difference was that instead of military officials resisting the practice, as they had done in the earlier conflict, the U.S. military, federal government, and auxiliary associations officially approved, promoted, and distributed cigarettes among American military personnel. Whereas cigarettes had been linked previously with moral decadence and considered a gateway drug for the use of stronger substances, they were now viewed as a partial substitute for bad (or worse) behavior alcohol was banned to servicemen, and military camps had prostitute free zones around them.

Cigarette smoking would never again be considered unmanly, which was too bad for men. By 1955, over half of American men smoked cigarettes. Nine years later, the U.S. Surgeon General issued a report declaring that cigarette smoking caused cancer in men. Today, despite a lower percentage of male cigarette smokers than in the past, lung cancer (overwhelmingly caused by smoking) is the leading cause of cancer related deaths among American men. The habit also increases the risk of heart disease, strokes, and other types of cancer.