• packaging and labelling
• public policy
• tobacco industry documents
• tobacco industry

In this issue of Tobacco Control, Persoskie  et al 1 demonstrate, yet again, that nothing about the design or packaging of tobacco products can be considered benign or incidental. Their analysis of internal tobacco industry documents shows that the industry has been aware for decades of the potential to manipulate package quantity—the number of cigarettes or cigars or amount of smokeless tobacco in a package—to achieve certain goals. These goals include enticing trial, inhibiting cessation, discouraging brand switching, maintaining brand identity, and preserving sales and profitability in the face of excise tax increases (which discourage consumption). Decisions about when and where to change pack size depend on the particular outcome companies are trying to achieve, the actions (or likely reactions) of competitors, and the demographic profile of smokers and potential smokers they are trying to influence.

Persoskie  et al’s work1 suggests that it may be time to rethink traditional approaches to regulating package quantity. Tobacco control advocates have characterised as ‘kiddie packs’ packages of factory-made cigarettes containing fewer than 20 cigarettes or roll-your-own packs containing less than 30 g of tobacco; the thinking is that their lower per-package cost encourages purchase by budget-conscious youth. Thus, policy-making centred on package quantity has typically mandated minimum pack quantities of 20 cigarettes (eg, the USA, UK, European Union and Canada). Some jurisdictions also mandate minimum pack quantities for other tobacco products, such as cigars and cigarillos (eg, Canada, Singapore, and New York City). These policies are sometimes combined with minimum price regulations to ensure that larger pack sizes command a consistently higher retail price and are not offset, for example, by tobacco company price discounts.2 The goal of minimum pack quantity regulations is to reduce the availability of cheap tobacco to youth and other price-sensitive consumers.

However, Persoskie  et al’s study1 shows that, from the tobacco industry’s perspective, the relationship between pack quantity and consumption is more complex than a simple relationship between small pack size and increased sales. Tobacco companies recognise a relationship between smaller pack quantities and purchase by youth (or what they call ‘younger smokers’); however, they also see smaller pack quantities as a potential threat, since they offer a convenient way for established smokers to reduce consumption, perhaps as a step toward quitting smoking entirely. In contrast, tobacco companies regard larger pack quantities as potentially helpful in maintaining sales volume in markets where smoking prevalence is declining. These findings suggest that minimum pack quantity policies involve a trade-off: on the one hand, they discourage youth from smoking initiation, but on the other, they eliminate a potential smoking reduction or cessation tool for established smokers. While such a trade-off may ultimately be unavoidable, Persoskie  et al’s work1 also suggests that it is worth considering a new approach to regulating pack quantity.

This new approach might involve rethinking 20 cigarettes as the ideal number in a cigarette pack. Based on Persoskie  et al’s findings, a preliminary case could be made for mandating smaller or larger pack sizes in order to discourage smoking.1 For example, tobacco company research with smokers highlighted some downsides to larger pack quantities, including incompatibility with an interest in smoking less, a greater likelihood of the product becoming stale and inconvenience in terms of carrying the product around. An increase in the legal per-pack quantity could be designed to maximise these downsides. Alternatively, smaller packs could be reconsidered, given tobacco companies’ observation that they sometimes reduced consumption by offering smokers a ‘convenient rationing unit’.1 Additional consumer research would be vital to determine the ideal legal pack quantity to accomplish tobacco control objectives and avoid unintended outcomes, such as encouraging smokers to increase their daily cigarette consumption to match a new, larger legal pack size, or facilitating impulse purchases through a smaller pack.3

Any regulation establishing a new legal pack quantity would have to be combined with minimum price regulation (per cigarette or per pack) to ensure that it discouraged consumption of tobacco products. Without it, larger pack sizes would not command a higher price—tobacco companies would simply follow their playbook of absorbing some or all of the increased cost—and smaller packs would command a lower price, preserving their appeal among youth and other price-sensitive smokers.

Other, complementary regulations could also be considered. For example, if a larger pack quantity was determined to be desirable, rather than requiring an immediate shift, the legal pack quantity could be increased annually, until a particular goal was reached. This might be useful in jurisdictions that face difficulties instituting regular tobacco tax increases, since minimum price per cigarette regulations would ensure that the price of the pack would steadily rise even in the absence of a tax hike. If it was determined that a smaller pack quantity at a high price was a better approach, the new regulation could be combined with a steady increase in the minimum age required to purchase tobacco, discouraging both tobacco uptake and continued use.

Ending the tobacco epidemic will likely require novel policy approaches.4 Persoskie  et al’s work1 points to an opportunity to consider how regulations governing tobacco package quantity could help advance the endgame. One advantage of this approach over others is that there is precedent in many jurisdictions for establishing a legal pack size; changing it may be less difficult than implementing a new policy. Determining the ideal pack quantity may pose more of a challenge, but the tobacco company documents reviewed here offer one place to start considering all the ways that size does matter.