Re-analysing tobacco industry funded research on the effect of plain packaging on minors in Australia: Same data but different results
More details
Hide details
OxyRomandie, Geneva, Switzerland
Sigma3 Services, Sàrl, Nyon, Switzerland
Pascal A. Diethelm   

OxyRomandie 2, rue de la Fontaine, CH-1204 Geneva, Switzerland
Publication date: 2017-11-16
Submission date: 2017-06-23
Final revision date: 2017-10-10
Acceptance date: 2017-10-11
Tob. Prev. Cessation 2017;3(November):130
Our objective was to re-analyse the data used in an industry-funded working paper to study the effect of plain packaging on youth smoking prevalence in Australia, allowing for other tobacco control measures introduced over the period 2001-2013, and using a more appropriate method of analysis.

Monthly smoking prevalence and sample sizes from repeat cross-sectional surveys were reconstructed from the working paper by reverse engineering of the industry-presented data, and analysed as a time series using logistic regression. Power analysis presented in the industry-funded working paper was re-calculated.

Smoking prevalence among minors in Australia declined from 11.6% to 5.6% over the 13-year period examined; an overall 52% relative reduction or an average annual reduction of 5.5% (95% confidence interval 4.6% to 6.4%). There was a 12.1% (-4.8% to 26.2%) relative reduction in smoking prevalence when plain packaging was introduced, though the reduction was not statistically significant. Re-calculated power values were much lower than those reported in the industry-funded paper, confirming the inconclusiveness of its findings, as pointed out in previous critiques.

Our findings suggest a decline of smoking prevalence in minors following the introduction of plain packaging in Australia. They differ substantially from those presented in an industry-funded study on the effects of plain packaging on smoking prevalence in minors in Australia, which used the same data.

Australian Government. Tobacco Plain Packaging Act 2011, An Act to discourage the use of tobacco products, and for related purposes, No. 148, 2011. Available at: (accessed August 2017).
Scollo M, Lindorff K, Coomber K, et al. Standardised packaging and new enlarged graphic health warnings for tobacco products in Australia — legislative requirements and implementation of the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information Standard, 2011. Tob. Control 2015;24:ii9–ii16. doi: 10.1136/tobaccocontrol-2014-052073
University of Bath. Industry Arguments Against Plain Packaging. TobaccoTactics. Available at: (accessed August 2017).
McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art.No.: CD011244. doi: 10.1002/14651858.CD011244.pub2
Kaul A and Wolf M. The (Possible) Effect of Plain Packaging on the Smoking Prevalence of Minors in Australia: A Trend Analysis. University of Zurich Department of Economics Working Paper Series. May 2014. Available at: (accessed August 2017).
Kaul A and Wolf M. The (Possible) Effect of Plain Packaging on Smoking Prevalence in Australia: A Trend Analysis. University of Zurich Department of Economics Working Paper, June 2014. Series. Available at: (accessed August 2017).
Services Agreement between Philip Morris International Management SA and The University of Zürich, Department of Economics. July 2013. Available at: (accessed August 2017).
Høring av forslag til innføring av standardiserte tobakkspakninger og gjennomføring av Tobakkskonvensjonen artikkel 5.3 i Norge. Høringssvar fra Philip Morris Norway AS og PM Tobakk Norge AS. Annex 8.1 Overview of the studies showing that there is no evidence that plain packaging has had the desired effect.pdf Available at: (accessed August 2017).
Justice Green. Approved Judgment [2016] EWHC 1169 (Admin) British American Tobacco & others vs. Department of Health. Queen’s Bench Division of the High Court Administrative Court 19th May 2016 Available from: (accessed August 2017).
Cancer Council Victoria M, Australia. Comments on Kaul & Wolf “The (possible) effect of plain packaging on the smoking prevalence of minors in Australia: a trend analysis”. Available at: (accessed August 2017).
Laverty AA, Watt HC, Arnott D, et al. Standardised packaging and tobacco-industry-funded research. The Lancet 2014; 383(9926): 1384. doi: 10.1016/s0140-6736(14)60499-2
Diethelm, P and McKee M, Tobacco industry-funded research on standardised packaging: there are none so blind as those who will not see! Tob Control Published Online First: 7 July 2014 doi: 10.1136/tobaccocontrol-2014-051734
Laverty AA, Diethelm P, Hopkinson NS, et al. Use and abuse of statistics in tobacco industry-funded research on standardised packaging. Tob Control Published Online First: 5 March 2015 doi: 10.1136/tobaccocontrol-2014-052051
Diethelm PA, Farley TM. Refuting tobacco-industry funded research: empirical data shows decline in smoking prevalence following introduction of plain packaging in Australia. Tob Prev Cessation 2015;1(November):6 27 November 2015. doi: 10.18332/tpc/60650
Kaul A and Wolf M. The (Possible) Effect of Plain Packaging on the Smoking Prevalence of Minors in Australia: A Trend Analysis. University of Zurich Department of Economics Working Paper Series No. 149. March 2014 (original paper); Available at: (accessed August 2017).
Kaul A and Wolf M. Sandardised packaging and tobacco-industry-funded research. The Lancet 2014;384(9939):233-34. doi: 10.1016/s0140-6736(14)61210-1
Roy Morgan Research. How we collect and process Single Source data in Australia. Melbourne (Australia). Roy Morgan Research. Available at: (accessed August 2017).
Wakefield MA, Durkin S, Spittal MJ, Siahpush M, Scollo M, Simpson JA, et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence. Am J Public Health. 2008;98: 1443-50. doi: 10.2105/AJPH.2007.128991
Wakefield MA, Coomber K, Durkin SJ, Scollo M, et al. Time series analysis of the impact of tobacco control policies on smoking prevalence among Australian adults, 2001-2011. Bull World Health Organ 2014; 92:413-422. doi: 10.2471/BLT.13.118448
Wheeler DJ and Chambers DS. Understanding Statistical Process Control. SPC Press, Knoxville, Tenn., 1992.
Hosmer DW, Lemeshow S. Applied Logistic Regression. Wiley Series in Probability and Statistics, 3r edition, April 2013 (copy of 2nd edition) Available at: (accessed August 2017)
Dunlop S, Perez D, Dessaix A, et al. Australia’s plain tobacco packs: anticipated and actual responses among adolescents and young adults 2010–2013. Tob Control. Published Online First: 12 December 2016. doi:10.1136/tobaccocontrol-2016-053166
Philip Morris International. Researchers Find No Evidence Plain Packaging ‘Experiment’ Has Cut Smoking. Media Release. Philip Morris International, 24 March 2014. Available at: (accessed August 2017).
Philip Morris Limited. Response to the Consultation on “Standardised Packaging”. 7 August 2014. Available (accessed August 2017).
Addressing NCDs: Challenges From Industry Market Promotion and Interferences
Viroj Tangcharoensathien, Orana Chandrasiri, Watinee Kunpeuk, Kamolphat Markchang, Nattanicha Pangkariya
International Journal of Health Policy and Management