Coming up to a year after standardised ‘plain packaging’ was fully implemented in the UK on 20 May 2017, the Tobacco Manufacturers’ Association (TMA)  and now Japan Tobacco International (JTI)  have claimed that it’s a failure.
Why is Big Tobacco bothering, when it’s clear the UK is tough on tobacco, won its case in the courts and is not going to reverse the legislation? The reason is obvious, this is a last ditch and desperate attempt to delay and discourage the many other governments coming down the same track. Three countries have fully implemented plain packs to date (Australia, France and the United Kingdom), by the end of this year it will be six, with seven more having passed legislation and more following on behind. The dominoes are falling, markets around the world are going dark, and Big Tobacco is running scared. The WTO decision on the legality of plain packs is expected shortly, and the outcome, a defeat for the tobacco industry, has already been leaked .
JTI claim that plain packs aren’t supported by the public, citing a survey commissioned from Kantar TNS which it says is the ‘largest public opinion poll of its kind since plain packaging was introduced’. This is incorrect. The ASH smokefree GB survey undertaken earlier this year had a sample size of 12,767, which is five times bigger than the 2,464 in the JTI Kantar survey. Findings from the ASH survey confirm the levels of support found in previous annual smokefree GB surveys, with just under three fifths of the public supporting standardised plain packaging (58%) while only around one in ten oppose (11%). The public support plain packs, to suggest otherwise is ludicrous.
When it comes to the evidence that the policy has been ineffective, the report JTI commissioned from Europe Economics ignores the fact that it was always known that plain standardised packaging would have the biggest impact on discouraging young people from taking up smoking rather than in helping addicted adult smokers quit. This is a much smaller group than existing adult smokers, so any such effect will be small, particularly in the early years. In the first year or two of implementation most young people at the age of initiation will have been exposed throughout their life to the colourfully branded packaging as it was prior to the introduction of standardised plain packs. As with the advertising ban, it is in future years when young people grow up never having seen such packaging that we expect it to have greatest impact. This effect will be cumulative as young people grow up into adulthood in cohorts with lower smoking rates, and older smokers die off. The Europe Economics report only includes data up to January 2018 so it simply cannot capture any of this.
Furthermore, the ability of standardised packaging to produce immediate effects during the year that the legislation was phased in (i.e. not fully implemented) is predicated on the assumption that the policy was smoothly and quickly brought into effect by all parties. Evidence from the Institute for Social Marketing (University of Stirling), already shows that before, during, and after the implementation of standardised tobacco and the TPD, tobacco companies engaged in activities which may have disrupted and confounded the impact of the legislation on smoking attitudes and behaviour . This included introducing limited-edition fully-branded packs and re-usable tins, changed brand or variant names (e.g. including the addition of a colour descriptor, with colour often used by consumers as an indicator of product strength or harm), and continued innovation of their products (e.g. new filter designs). In essence, they used the implementation period to continue to create interest in their products.
In addition, the UK Government allowed tobacco companies and retailers twelve months, from May 2016 to May 2017, to introduce standardised packaging, which is longer than the two other countries (2 months in Australia, 9 months in France) that have introduced this measure. The report claims that ‘the penetration of TPD2+PP compliant products has increased gradually over the implementation period’. This is not consistent with further findings by researchers at the University of Stirling, analysing real-time data from independent and convenience (small) retailers , which instead shows that tobacco companies and retailers responded to the extended implementation period by continuing to sell fully-branded products for as long as they could, meaning that most of the leading brands of cigarettes and rolling tobacco in the UK were not sold in standardised packs until near the end of the twelve months. It is plausible that this staggered introduction of standardised packaging may have mitigated some of the immediate intended effects of the legislation by desensitising consumers to the new designs and graphic health warnings.
Once the legislation became mandatory for packs at point of sale, which was not until May 2017, the University of Stirling researchers found that 97% of tobacco sales volume  in small retailers was compliant with the TPD and standardised packaging legislation (rising to 99.5% ten weeks after full implementation). Given the aforementioned industry-led disruption during the transition period, research evaluating the impact of standardised packaging should reflect on how trends in smoking attitudes and behaviours change in the years after full implementation, not reactive conclusions based on limited time periods.
Governments need to apply the rule of thumb known as the ‘scream test’, if the industry is campaigning so hard to prevent it, clearly standardised ‘plain’ packaging does work, otherwise Big Tobacco wouldn’t care.
ASH thanks researchers from the Institute for Social Marketing, University of Stirling — part of the UK Centre for Tobacco and Alcohol Studies — for their analysis of the Europe Economics report for JTI.
The studies carried out by the University of Stirling were funded by Cancer Research UK.
 Tobacco Manufacturers’ Association, Plain packaging failing one year after full introduction, 14 May 2018
 Japan Tobacco International, Plain Packaging on Tobacco Backfires Within First Year in the UK, 17 May 2018
 Reuters, Australia wins landmark WTO tobacco packaging case — Bloomberg, 4 May 2017
 BMJ Tobacco Control, How tobacco companies in the UK prepared for and responded to standardised packaging of cigarettes and rolling tobacco, January 2018
 Nicotine and Tobacco Research, Introduction of Standardized Tobacco Packaging During a 12-Month Transition Period: Findings From Small Retailers in the United Kingdom, 12 January 2018
 BMJ Tobacco Control, Did independent and convenience (small) retailers comply with standardised tobacco packaging in the UK?, November 2017
15 April 2018
In a strongly worded submission to the Select Committee on Science and Technology ASH and the UK Centre for Tobacco and Alcohol studies warn that smoking on TV and in films encourages children to take up smoking . They point out that children in the UK are still exposed to significant amounts of smoking on screen and that it is the amount of smoking that is important, not whether it is glamourised or not.
The submission includes new survey results showing that 81% of 11-15 year olds and 88% of 16-18 year olds report seeing smoking in films. For TV the numbers reporting seeing smoking on TV were 68% of 11-15 year olds and 77% of 16-18 year olds.  One of the worst examples, included in the submission, was last summer’s reality TV programme Love Island. The series, which was very popular with teenagers, delivered an estimated 47 million gross tobacco impressions to children aged under 16.  The proportion of Oscar-listed films containing smoking this year was 86%, up from 60% four years ago, with smoking featuring by far and away most heavily in a PG rated British film, ‘Darkest Hour’.
Professor John Britton said:
“Seeing people smoking in the media can increase the likelihood that a young person takes up smoking by as much as 40%. It doesn’t matter whether the people smoking are heroes or villains, glamourous or otherwise. All smoking content is a role model which results in some young people becoming addicted to a lethal product for life.”
Deborah Arnott, chief executive of ASH, said:
“Our surveys show children reporting high awareness of smoking on screen, particularly in films and TV. Ofcom and the BBFC, which regulate these sectors, need to take the necessary steps to warn parents of the risks and protect our children from the harmful effects of tobacco imagery.”
The submission includes new figures calculated by Cancer Research UK which show that despite declines in smoking prevalence a large number of young people are still taking up smoking causing significant harm to their health and wellbeing. Between 2014 and 2016 around 127,000 children a year started smoking for the first time , equivalent to 17 classrooms of secondary school children a day. Research shows that over 60% of those who try smoking go on to become regular smokers.
Smoking remains the leading cause of preventable premature death, killing over half all long-term smokers. While much of the damage is long-term there are immediate impacts too. Young smokers have a lower level of lung function than those who have never smoked and smoking reduces the rate of lung growth. 
George Butterworth, Senior Policy Manager at Cancer Research UK, said:
“Smoking is an addiction of childhood, not an adult choice. New figures published by Cancer Research UK show that 127,000 children start smoking each year in the UK. The introduction of standardised packaging of tobacco products, backed up the complete ban on advertising, leaves smoking in the entertainment media as the main way smoking is promoted to children. Yet parents seem unaware of the risks.”
Now that all advertising, promotion and sponsorship is banned in the UK, smoking in the entertainment media has become an increasingly important factor in youth smoking initiation. Yet a Yougov survey for ASH found that parents remain unconcerned about such exposure with 42% saying that there is the right amount of smoking on TV, 31% saying they don’t know, and only 23% saying there is too much. When it comes to adults with children under 18 in their household concern is even lower, with 20% of adults with thinking there is too much smoking on TV, and 45% that it is the right amount. 
The relevant regulators are Ofcom (TV and video on demand) and the BBFC (film and videos/DVDs including video games). The ASH and UKCTAS recommendations to the regulators, which they would like to see the Select Committee endorse , are that:
ASH and UKCTAS have already shared the evidence with Ofcom and are having very constructive discussions with Ofcom. Ofcom has agreed to review the evidence we have provided it with and undertake its own analysis of the impact of smoking depictions on young people, preparatory to making any decisions about how to proceed. ASH and UKCTAS have written to the BBFC this week with a copy of our submission asking to meet to discuss our recommendations with them.
Notes and Links:
Action on Smoking and Health is a health charity working to eliminate the harm caused by tobacco use. For more information see: www.ash.org.uk/about-ash
ASH receives funding for its programme of work from Cancer Research UK and the British Heart Foundation.
ASH staff are available for interview and have an ISDN line. For more information contact ASH on 020 7404 0242 or out of hours Deborah Arnott on 07976 935 987
 Survey conducted by YouGov for ASH online, via parents for 11-15 year olds and directly with 16-18 year olds. The 2018 survey had a sample of 2291 and the figures have been weighted and are representative of all GB 11-18 year olds. The fieldwork was carried out between 28th February and 17th March.
 Barker AB, Opazo Breton M, Cranwell J, et al. Population exposure to smoking and tobacco branding in the UK reality show ‘Love Island’. Tobacco Control Published Online First: 05 February 2018. doi: 10.1136/tobaccocontrol-2017-054125
 Data calculated by the Statistical Information Team at Cancer Research UK using Smoking, Drinking and Drug Use in Young People in England 2016 data. Figures are the average per year between 2014 and 2016. Percentage of new smokers was calculated for each single-year age band, and ‘smoker’ was defined as ‘regular’, ‘occasional’ or ‘used to smoke’. For example, percentage of new smokers aged 13 in 2016, was calculated by subtracting the percentage of smokers aged 12 in 2015, from the percentage of smokers aged 13 in 2016. This calculation was used for ages 12, 13, 14 and 15; for age 11 all smokers were considered new smokers. 2015 figures were estimated as the average of 2014 and 2016, as no 2015 survey was carried out. Percentage of new smokers in England was applied to UK population estimates to obtain number of new UK smokers.
 National Statistics. Schools, pupils and their characteristics: January 2017. Figure G: Average one-teacher class size: secondary schools 20.8
 Max Birge, Stephen Duffy, Joanna Astrid Miler, Peter Hajek; What Proportion of People Who Try One Cigarette Become Daily Smokers? A Meta-Analysis of Representative Surveys, Nicotine & Tobacco Research, , ntx243, https://doi.org/10.1093/ntr/ntx243
 U.S. Department of Health and Human Services. The Health Consequences of Smoking: 50 Years of Progress. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2014
 Survey conducted online by YouGov for ASH. Fieldwork for 2018 survey was undertaken between 8th February and 6th March. Total sample size was 12767 GB adults and the figures have been weighted and are representative of all GB adults (aged 18+).