Health text and picture warnings

Question 1: How far do you agree or disagree that the introduction of rotating combined (photo and text) health warnings on cigarette and hand rolling tobacco has encouraged smokers to quit?

• strongly agree
• agree
• neither agree or disagree
• disagree
• strongly disagree
• don’t know

Disagree. Despite a persistent belief that nannying consumers out of smoking, health warning labels haven’t proved to be effective in helping smokers quit. For example, in 2012, the US Court of Appeal stated the following: “The Food and Drug Administration has not provided a shred of evidence—much less the “substantial evidence”— showing that the graphic warnings will “directly advance” its interest in reducing the number of Americans who smoke.” Сonsumers are already knowledgeable about the harms and risks associated with smoking, which is why there isn’t much evidence to suggest that the warnings actually deter tobacco use.

It is especially difficult to establish a clear causal relationship between the introduction of health warning labels and its impact on the reduction of smoking rates. Furthermore, the potential causality is complicated by the distinction between heavy and non-heavy smokers, and how they respond to health warning labels. The very same applies to all sorts of marketing and branding bans.

A 2019 experiment published in Health Education Research found that the presence of graphic health warning labels did not influence participants’ purchase of cigarettes as a main effect. The said study also found that smokers who were highly dependent on nicotine dependence were slightly more likely to purchase cigarettes when graphic health warning labels were present. It might also be likely that health warning labels have the opposite effect and entice defensive reaction and, in the end, fail to achieve the expected goal of reducing the smoking rates.

Further scientific research in the United Kingdom would be necessary to determine whether a decline in adult smoking cessation can be related to display bans.

Tobacco products should not see any further scrutiny. The evidence regarding the effectiveness of health warning labels is, therefore, inconclusive. Adult consumers should be encouraged to make responsible choices bearing in mind the consequences of their actions. Long-shot policies based on respect for consumer choice such as education should be preferred over health warning labels. 

Question 2: How far do you agree or disagree that the introduction of rotating combined (photo and text) health warnings on cigarette and hand rolling tobacco has deterred young people from smoking?

Disagree.

First, taking into account the arguments mentioned above, health warnings on cigarettes haven’t proved to be successful in deterring smokers, especially heavy smokers, from smoking. Young people should be educated about smoking and freedom to choose so that they become responsible adult consumers later in life. 

For instance, a 2019 study conducted in Australia found that both smoking and non-smoking university students perceived current cigarette packaging warnings in Australia as having lost much of their effectiveness as tobacco control interventions. Non-smokers perceived health warnings on cigarettes as preventive and needed to raise awareness about smoking. Smokers, on the contrary, were pessimistic about such interventions.

Question 3: Should all tobacco products have a combined (photo and text) health warning on their packaging?

Characterising flavours

Question 4: How far do you agree or disagree that the prohibition of characterising flavours has helped smokers quit smoking?

Question 5: How far do you agree or disagree that the prohibition of characterising flavours has deterred young people from taking up smoking?

E-cigarettes

Question 6: How far do you agree or disagree that the current regulations on e-cigarettes have been proportionate in protecting young people from taking up use of these products?

A report commissioned by PHE in early 2020 affirmed that nearly two-thirds of 11-to-17-year-olds in the United Kingdom who currently vape more than once a month had bought products themselves. Numbers like this often lead to prohibitionist calls for further bans and restrictions on vaping products. However, it is crucial to strike a balance between the need to ensure that teens should not be able to purchase vaping products while encouraging adult smokers to quit.

Another report commissioned by the PHE showed that 38% of smokers believed that vaping is as harmful as smoking while 15% believed that vaping is more harmful. This misconception of risk is a huge concern, because it discourages many current smokers to switch to the less harmful alternative – vaping. It is crucial that smokers are educated about the possibility to switch and reduce health risks associated with conventional smoking. Marketing of vaping products needs to be encouraged so that consumers have access to the necessary information about vaping as means to quit.

Further bans of vaping products will drive more consumers to illegal products on the unregulated black market, where there is no guarantee of safety or quality. A larger black market will make it even easier for minors to purchase vaping products with no age verifications at all. 

However, the use of vaping products among adolescents isn’t widespread. Out of 11-18 year olds never smokers only 0.1% vape more than once a week. 

Question 7: How far do you agree or disagree that the current regulations have ensured that e-cigarettes are available for those smokers who wish to switch to these products?

Agree. The UK’s pro-vaping approach should be applauded: it saves lives, and other countries should follow the UK’s example. In particular, that concerns other European countries since as long as the UK continues to remain open to innovation aimed at reducing rates, there is a chance that they might choose to drift away from paternalism that doesn’t stand up to scrutiny. Despite calls to restrict access to vaping, in particular those that seek to frame vaping as a gateway to smoking, the UK should preserve its role as a global harm reduction advocate.

An analysis of 61 countries showed that 196 million smokers could switch to vaping if other countries treated vaping in the same way as the UK.

However, the UK should further improve its current regulatory framework to achieve its smoke-free 2030 goal (see question 8).

Question 8: What effect do you think the regulations have had on smokers considering switching to e-cigarettes?

Unfortunately, as was mentioned previously, 38% of smokers in the UK believe that vaping is as harmful as smoking while 15% believed that vaping is more harmful. Many regulations have made it more difficult for current smokers to obtain correct information about vaping. The EU Tobacco Products Directive has prevented switching efforts, and after Brexit, the UK has a unique chance to walk away from the EU’s restrictive approach. Excessive bans on advertising of vaping should be lifted in order to ensure smokers – especially heavy smokers – are able to gain all the necessary information about vaping. Significant communication efforts should be channeled to help raise awareness about vaping as a safe means to quit smoking.

Question 9: Do you consider the restrictions on e-cigarette advertising to be an effective way to discourage young people and non-smokers from using e-cigarettes?

Agree, we should not tolerate teen vaping, and any rise in numbers is concerning. Still, we cannot at the same time deprive millions of adult smokers of safer alternatives (according to Public Health England, vaping is at least 95% less harmful than traditional smoking) because of activities that are already illegal. All studies and surveys show that regular use among minors is rare, so the effort should be placed on helping adult smokers quit or for those who do not want to or are not able to quit to switch to vaping or similar alternatives. It is, therefore, crucial to distinguish between communication regarding age restrictions and access to e-cigarettes for minors as such and that aimed at adult smokers.

Novel tobacco products

Question 10: How far do you agree or disagree that the requirements of TRPR on novel tobacco products are proportionate?

Strongly agree, it is crucial that the ucomining legislation update distinguishes between TRPR and conventional tobacco. Vaping was initially invented as a safer alternative aimed at reducing health-associated risks and should be seen as such. We need an on-ramp for harm reduction that is vaping: endorse e-cigarettes as an effective tool to help smokers move to a safer alternative to consume nicotine and eventually quit if they desire to do so.

Enforcement

Question 11: Do you agree or disagree that the penalties for a breach of the regulations are an effective deterrent to ensure compliance with the regulations?

Agree. In the United Kingdom, a video game seller can be fined up to 20,000 GBP for selling age-restricted games to underaged customers. At the same time, a vendor selling vaping liquids to minors comes with a maximum fine of merely 2,500 GBP, an eighth compared to video games. Given that one study found that 5 out of 9 shops sell vaping products to minors, the UK’s fines might need to be adjusted upwards.

The UK should abstain from stricter regulation that target adults, and consequently discourage them from switching. Better and smarter enforcement of existing restrictions on sales should be the focus.

Other question

Question 12: How far do you agree or disagree that there has been an economic impact of TRPR, either positive, negative or both?

Anything else on TRPR?

Question 13: Is there anything else you would like to share on negative or positive impacts the regulations have had on topics not covered above? If so, please explain and include any evidence and research you may have to back your response.

As a global consumer group representing millions of consumers in Europe and globally, we have been working on spreading the harm reduction message to help spread awareness about vaping as a life-saving tool both among smokers and non-smokers. We applaud the UK’s progressive approach to vaping and believe it can do even better after Brexit. In particular, that concerns advertising restrictions and stricter enforcement of the rules concerned with teen vaping. 

We are hopeful that the UK doesn’t give in to scientifically unjustified calls against vaping, and remains an advocate of harm reduction. Added to that, it is also crucial to ensure that the upcoming legislation doesn’t unintentionally target adult smokers in pursuit of reducing vaping rates among teens. Although the UK is the example for Europe and the world, there is room for improvement.

SPoT requirements

Question 14: How far do you agree or disagree that the requirements on the packaging and labelling of tobacco products have been an effective way to protect young people from taking up smoking?

Neither agree or disagree. The only way to protect young people from taking up smoking is through education and enforcement of age restrictions. Moreover, plain packaging as a policy hasn’t proved to be effective in the long.

Question 15: How far do you agree or disagree that the requirements on the packaging and labelling of tobacco products have helped existing smokers quit?

Regardless of noble motives in place, the failures of plain packaging are numerous and evident. In 2012, Australia passed a nation-wide plain packaging decree. The goal was to reduce smoking rates. During the first years of the ban, more young people started to smoke. The smoking rates among Australians in the age range of 12-24-year-olds increased from 12 per cent in 2012 to 16 per cent in 2013. Little or no improvement was made among people aged 30 or older between 2013 and 2016. People aged 40–49 continued to be the age group most likely to smoke daily (16.9%) and the smoking rates among this age group went up from 16.2% in 2013. At the same time, Australia has seen an enormous increase in roll-your-own cigarettes: 26% in 2007, to 33% in 2013 and to 36% in 2016. 

Plain packaging, like taxation, is intended to push consumers away from particular products considered by governments to be harmful, unhealthy and detrimental to the wellbeing of society. What policymakers tend to overlook, though, is that demand for cigarettes is inelastic and thus neither taxes nor branding bans can substantially affect consumer behaviour. 

Question 16: SPoT regulations apply to cigarettes and hand rolling tobacco. How far do you agree or disagree that SPoT regulations should be restricted to cigarettes and hand rolling tobacco (and not other tobacco products)?

Pack size

Question 17: How far do you agree or disagree that the introduction of a minimum pack size or weight is an effective way to protect young people from taking up smoking?

The UK government should abstain from introduction of further interventions not only because those are costly and paternalistic, but also because they haven’t proved to be successful in achieving the set goal. Instead, the government should focus on endorsing vaping as a means to quit smoking

Appearance of cigarettes

Question 18: How far do you agree or disagree that the requirements on the appearance of cigarettes are proportionate?

Enforcement

Question 19: Do you agree or disagree that the penalties for a breach of the regulations are an effective deterrent to ensure compliance with the regulations?

• agree
• disagree
• don’t know

Other question

Question 20: How far do you agree or disagree that there has been an economic impact of SPoT, either positive, negative or both?

Anything else on SPoT?

Question 21: Is there anything else you would like to share on negative or positive impacts the regulations have had on topics not covered above? If so, please explain and include any evidence and research you may have to back your response.

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