National Social Marketing Centre

Opinion: Will Plain Packaging Reduce Smoking Uptake In Children?

lukevdb, Wednesday, May 16, 2012 - 07:33

The government’s consultation on plain packaging for cigarettes is underway.  I welcome any measure intended to reduce the number of children smoking.  I have two young one’s of my own and certainly wouldn’t want them taking up the habit.


However, I’m not entirely convinced plain packaging will lead to a marked reduction in the number of children starting to smoke.  For a start, given the display bans that were introduced recently, a child would need X-Ray glasses to see the packaging in the first place, and that’s assuming they spot them over all the sweets and chocolates placed in easy view (and reach) at every kiosk in the country... 


More seriously, the foundation of any intervention designed to reduce smoking incidence ought to be based on a sound understanding of what factors influence the undesired behaviour.  In none of the literature I reviewed was cigarette packaging found or considered to be an influencing factor in smoking uptake amongst children.  A study published in the Journal of Public health[1] reported that variables measured at age 9 as predictors of smoking at age 11 were:


1.       Paternal smoking

2.       Fraternal smoking

3.       A best friend who smoked

4.       Knowing someone with a smoking related disease


Child smoking was also associated with:


1.       Maternal smoking

2.       Living in a low-income household

3.       Living in a deprived area.


Similarly, Action on Smoking (ASH) notes that smoking initiation is associated with a wide range of factors including:


1.       Parental and sibling smoking

2.       The ease of obtaining cigarettes

3.       Smoking by friends and peer group members

4.       Socio-economic status

5.       Exposure to tobacco marketing

6.       Depictions of smoking in films, television and other media[2]


Ideally, stop smoking measures targeting children should address those factors which are known to influence their behaviour.  A good example of just such an approach is Assist (A Stop Smoking in Schools Trial) programme[3] which was developed by the Cardiff Institute of Society Health and Ethics. The Institute recognised that children were responsive to messages they received from their peers and recruited and trained the most popular children in 59 schools across Wales and Western England as peer supporters.  The programme led to reductions in the likelihood of children taking up smoking immediately following the intervention when compared to schools using conventional smoking cessation programmes. 


Changing behaviour is a complex and challenging business.  Certainly introducing structural barriers can be effective.  The cigarette vending machine ban and increase of the legal age were sound policy interventions that have seemingly had an impact on smoking uptake amongst children and teens.  Child and youth smoking rates have been in decline (in 2010, 27 per cent of pupils (aged 11 to 15) had smoked at least once, as compared to 44 per cent in 2001[4] )  and the government (labour and conservative) should be applauded for taking a strong stance on the matter. 


However, in this particular case I’m somewhat more sceptical.  Jane Chisholm-Caunt, Secretary-General of the TMA has been quoted as saying there isn’t any evidence it will work, and that smoking is linked to a range of complex socio-economic factors.  She’s right, but has been widely vilified because public-opinion is very much with the Government’s on this one.  Of course, her job title doesn’t help.


That said, there can be no doubt smoking is one of the most serious public health issues we face and the Government is right to do all it can to reduce smoking rates across the board.  Doing so reduces financial costs associated with the treatment of smoking-related illnesses and more importantly (in my humble opinion) saves lives. 


Make no mistake, whatever the result of the consultation, plain packing will be introduced in the UK.  That’s all well and good.  However, in a few years time it will be interesting to see if its introduction can be shown to have had a quantifiable impact on smoking uptake in children.  Personally, I don’t think this particular measure will be all that effective, but I’d be very happy to be proven wrong. 


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[1] “Why do primary children smoke? A Longitudinal analysis of predictors of smoking” Cook et al. Public Health 118(4). Pp 247-255


[2] ASH Fact Sheet August 2011 [online] “On Young People and Smoking”

[3] “How peer pressure can prevent smoking”, Madeleine Brindley. The Western Mail, May 9, 2008.

[4] “Smoking, drinking and drug use among young people in England in 2010.” National Office of Statistics, July 28, 2011.

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