Association between tobacco plain packaging and Quitline calls: a population-based, interrupted time-series analysis

Jane M Young, Ingrid Stacey, Timothy A Dobbins, Sally Dunlop, Anita L Dessaix and David C Currow
Med J Aust 2014; 200 (1): 29-32. || doi: 10.5694/mja13.11070


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.

Main outcome measure: Weekly number of calls to the Quitline, after adjusting for seasonal trends, anti-tobacco advertising, cigarette costliness and the number of smokers in the community.

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.

  • Jane M Young1
  • Ingrid Stacey2
  • Timothy A Dobbins1
  • Sally Dunlop2
  • Anita L Dessaix2
  • David C Currow2

  • 1 Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, Sydney, NSW.
  • 2 Cancer Institute NSW, Sydney, NSW.



We thank Donna Perez and James Kite for help with obtaining the data. This study was internally funded by the Cancer Institute NSW. Thanks also to Bruce Armstrong, Sanchia Aranda, and Rebecca Kenyon for their helpful comments on the manuscript.

Competing interests:

No relevant disclosures.

  • 1. Australian Commonwealth Government. Tobacco Plain Packaging Act 2011 (Cwlth) (No. 148, 2011). (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. (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.) (accessed Oct 2013).
  • 12. Centre for Epidemiology and Evidence. Health statistics New South Wales. Sydney: NSW Ministry of Health. http://www.healthstats.nsw. (accessed Oct 2013).
  • 13. Australian Bureau of Statistics. Australian Demographic Statistics, Dec 2012. (ABS Cat. No. 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. (accessed Oct 2013).
  • 16. New South Wales Government. Tobacco Legislation Amendment Act 2012 (NSW) No 56. (accessed Oct 2013).
  • 17. Australian Capital Territory Government. Smoke-Free Public Places Act 2003 (ACT). http://www.l (accessed Oct 2013).
  • 18. New South Wales Government. Tobacco retailing laws. Public Health (Tobacco) Act 2008 (NSW). (accessed Oct 2013).
  • 19. Australian Capital Territory Government. Tobacco Amendment Act 2008. (repealed) http://www. (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.


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.