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Background
Cigarette pack inserts are small cards inside the pack that provide information on the benefits of quitting and advice on how to quit. Canada is currently the only country to require inserts. Introduced in 2000, the original Canadian inserts featured textual messages about the benefits of quitting; these were updated in 2012 to include pictures.1 Research found that Canadian smokers who read the inserts at least a few times reported greater confidence in their ability to quit, more quit attempts and more quit attempts lasting 30 days or longer.1 2
Building on Australia’s successful comprehensive approach to tobacco control,3 the inside of packs represent an untapped opportunity for delivering supportive messages directly to all smokers. Pack inserts are inexpensive, with costs borne by the tobacco industry, and the positive and supportive information complements the motivating graphic warning labels on the outside of the pack. We assessed Australian adults’ support for introducing cigarette pack inserts; providing evidence of public support for innovative tobacco control policies can enhance interest and engagement among policy makers.4 5
Methods
In August 2019, we commissioned the Social Research Centre to undertake a study using their probability-based online panel, Life in Australia™, in which support was measured among a representative sample of 1996 Australians aged 18+ years. The population covered by the panel includes all Australian adults contactable via landline or mobile phones, including those without internet access. Participants completed the survey online (90%) or by telephone (10%). Among those invited, the completion rate was 77%. Weights were calculated and applied to all analyses.
We report the proportion who supported (strongly or somewhat), neither supported nor opposed, or opposed (strongly or somewhat) the introduction of pack inserts. A bivariate logistic regression assessed whether the proportion who supported inserts (vs all other responses) differed significantly by smoking status. Among current smokers, a multivariable logistic regression assessed whether support was predicted by demographic variables.
Results
Overall, 63% of Australian adults would support the introduction of pack inserts (table 1). Support was significantly higher among never and former smokers than among current smokers, but only 22% of current smokers were opposed. Support was largely consistent across smoker subgroups, with the exception that smokers aged 18–34 years were significantly more likely to be supportive than those aged 55+ years.
Australian adults’ support for introducing pack inserts into cigarette and tobacco packs sold in Australia
Discussion
The introduction of pack inserts into cigarette and tobacco packs sold in Australia would be widely supported, including by almost half of current smokers. Only a small minority, including 22% of smokers, are opposed. Lower levels of support among older smokers may reflect scepticism that inserts could assist these smokers to quit. In Canada, one-fifth of those aged 55+ years reported reading inserts at least once in the past month,1 and reading the inserts was associated with making more quit attempts and more sustained quit attempts independently of age and other established predictors of quitting activity.1 2
Pack inserts represent a novel opportunity for delivering accessible quitting support messages that potentially reach all Australian smokers each time they open a new cigarette pack or roll-your-own pouch. Australian research to develop effective inserts is under way, building on similar studies in Canada and the USA.6 7 The introduction of effective inserts would be received favourably by the Australian public.
Acknowledgments
We acknowledge the contribution of the Social Research Centre, whose probability-based online panel, Life in Australia™, was used to recruit respondents for this study. We acknowledge Michelle Scollo and Kylie Lindorff at Cancer Council Victoria for their input into the policy support question.
Footnotes
Contributors All authors (EB, EI, SJD and MAW) of this research letter directly participated in the planning, execution or analysis phases of the study, and have read and approved this, the final version of the research letter.
Funding This study was funded by Cancer Council Victoria.
Competing interests We are employed by a non-profit organisation that conducts public health interventions and advocacy aimed at reducing the harms of tobacco in the community, especially those pertaining to cancer.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.