Objectives: To investigate whether the introduction of tobacco plain packaging in Australia from 1 October 2012 was associated with a change in the number of calls to the smoking cessation helpline, Quitline, and to compare this with the impact of the introduction of graphic health warnings from 1 March 2006.
Design and setting: Whole-of-population interrupted time-series analysis in New South Wales and the Australian Capital Territory between 1 March 2005 and October 2006 for the comparator, graphic health warnings, and October 2011 and April 2013 for the intervention of interest, tobacco plain packaging.
Results: There was a 78% increase in the number of calls to the Quitline associated with the introduction of plain packaging (baseline, 363/week; peak, 651/week [95% CI, 523–780/week; P < 0.001]). This peak occurred 4 weeks after the initial appearance of plain packaging and has been prolonged. The 2006 introduction of graphic health warnings had the same relative increase in calls (84%; baseline, 910/week; peak, 1673/week [95% CI, 1383–1963/week; P < 0.001]) but the impact of plain packaging has continued for longer.
Conclusions: There has been a sustained increase in calls to the Quitline after the introduction of tobacco plain packaging. This increase is not attributable to anti-tobacco advertising activity, cigarette price increases nor other identifiable causes. This is an important incremental step in comprehensive tobacco control.
- 1. Australian Commonwealth Government. Tobacco Plain Packaging Act 2011 (Cwlth) (No. 148, 2011). http://www.comlaw.gov.au/Details/C2011A00148 (accessed Oct 2013).
- 2. Pierce JP, Anderson DM, Romano RM, et al. Promoting smoking cessation in the United States: effect of public service announcements on the Cancer Information Service telephone line. J Natl Cancer Inst 1992; 84: 677-683.
- 3. Siahpush M, Wakefield M, Spittal M, Durkin S. Antismoking television advertising and socioeconomic variations in calls to Quitline. J Epidemiol Community Health 2007; 61: 298-301.
- 4. Chan SS, Wong DC, Fong DY, et al. Short-term impact of new smoke-free legislation on the utilization of a quitline in Hong Kong. Nicotine Tob Res 2009; 11: 356-361.
- 5. Miller CL, Wakefield M, Roberts L. Uptake and effectiveness of the Australian telephone Quitline service in the context of a mass media campaign. Tob Control 2003; 12 Suppl 2: ii53-ii58.
- 6. Farrelly MC, Davis KC, Nonnemaker JM, et al. Promoting calls to a quitline: quantifying the influence of message theme, strong negative emotions and graphic images in television advertisements. Tob Control 2011; 20: 279-284.
- 7. Wakefield MA, Hayes L, Durkin S, Borland R. Introduction effects of the Australian plain packaging policy on adult smokers: a cross-sectional study. BMJ Open 2013; 3: e003175.
- 8. Australian Commonwealth Government. Trade Practices (Consumer Product Information Standards) (Tobacco) Regulations 2004. http://www.comlaw.gov.au/Details/F2007C00131 (accessed Oct 2013).
- 9. von Elm E, Altman DG, Egger M, et al; STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007; 335: 806-808.
- 10. Wakefield MA, Durkin S, Spittal MJ, et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence. Am J Public Health 2008; 98: 1443-1450.
- 11. Australian Bureau of Statistics. Average weekly earnings, Australia, Nov 2012. (ABS Cat. No. 6302.0.) http://abs.gov.au/ausstats/abs@.nsf/mf/6302.0 (accessed Oct 2013).
- 12. Centre for Epidemiology and Evidence. Health statistics New South Wales. Sydney: NSW Ministry of Health. http://www.healthstats.nsw. gov.au (accessed Oct 2013).
- 13. Australian Bureau of Statistics. Australian Demographic Statistics, Dec 2012. (ABS Cat. No. 3101.0.) http://www.abs.gov.au/ausstats/abs@.nsf/mf/3101.0 (accessed Oct 2013).
- 14. Box GEP, Jenkins GM, Reinsel GC. Time series analysis: forecasting and control. 4th ed. Hoboken, NJ: John Wiley & Sons, 2008.
- 15. World Health Organization. WHO Framework Convention on Tobacco Control. Geneva: WHO, 2003. http://whqlibdoc.who.int/publications/2003/9241591013.pdf (accessed Oct 2013).
- 16. New South Wales Government. Tobacco Legislation Amendment Act 2012 (NSW) No 56. http://www.legislation.nsw.gov.au/sessionalview/sessional/act/2012-56.pdf (accessed Oct 2013).
- 17. Australian Capital Territory Government. Smoke-Free Public Places Act 2003 (ACT). http://www.l egislation.act.gov.au/a/2003-51/current/pdf/2003-51.pdf (accessed Oct 2013).
- 18. New South Wales Government. Tobacco retailing laws. Public Health (Tobacco) Act 2008 (NSW). http://www0.health.nsw.gov.au/publichealth/healthpromotion/tobacco/information_for_tobacco_retailers_and_consumers.asp (accessed Oct 2013).
- 19. Australian Capital Territory Government. Tobacco Amendment Act 2008. (repealed) http://www. legislation.act.gov.au/a/2008-50/default.asp (accessed Oct 2013).
- 20. Lagarde M. How to do (or not to do) . . . assessing the impact of a policy change with routine longitudinal data. Health Policy Plan 2012; 27: 76-83.
- 21. Hammond D, Wakefield M, Durkin S, Brennan E. Tobacco packaging and mass media campaigns: research needs for Articles 11 and 12 of the WHO Framework Convention on Tobacco Control. Nicotine Tob Res 2013; 15: 817-831.
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