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Jan 8, 2014

Australians still smoke 21 billion cigarettes a year. Why?

A report has found the government's campaign against the cigarette may have stalled. Smoking rates have levelled off after years of falling. Will the new, ugly plain packs have an effect?

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Australia has implemented some of the world’s boldest measures to reduce smoking. There’s just one problem: they seem to have stopped working.

A global study out today has found that after decades of declining, Australia’s rate of smoking has plateaued, and even increased slightly among women. There are almost 3 million smokers in Australia and between them they puff on 21 billion — yes, billion — cigarettes a year.

That’s the most recent data available, and it goes up to the end of 2012. As to whether the world’s first laws mandating the plain packaging of cigarettes have worked (they started in December 2012), those who have the data won’t release it. It’s a public policy secret. More on that later.

Today’s study, by the Institute for Health Metrics and Evaluation at the University of Washington, found global smoking rates have greatly decreased since 1980 (there’s some excellent interactive graphics in the report). But because there are so many more people than there were in 1980, more people smoke (there are now almost 1 billion). Smoking is very much in vogue in places like Indonesia and East Timor, where more than half the men smoke. Tobacco led to the deaths of 5.7 million people worldwide in 2012.

Australia gets a pretty good rap in the report, published in the Journal of the American Medical Association. The rate of smoking among men in 2012 — 18% — is well below the global average of 31%, and has been one of the fastest declines in the world.

Some 15% of Australian women smoke, compared with a global average of 6% (this gap reflects the cultural antipathy towards women smoking in many countries rather than a particular problem here). The rate of Australian women smoking has declined steadily over decades.

The report synthesises various research papers into smoking in Australia, including Australian Bureau of Statistics data. It found the Australian most likely to smoke is a man in his 30s, and the average smoker has 7000 fags per annum.

The big drop in people smoking is a medium-term success story, but since 2009 the rate of smoking in Australia has levelled off. This graph from the report shows the rate of change is now approaching zero:

Rate of change in the prevalence of smoking among Australians; women are pink, men green (standardised for age)

And here’s the graph showing the prevalence of smoking in Australia:

Australia has been at the forefront of efforts to reduce smoking: hiking up the excise, restricting advertising and where people can smoke, and bombarding citizens with quit campaigns. So what’s going on?

Alan Lopez, professor of public health at the University of Melbourne and one of the study’s authors, says the plateauing smoking rate is concerning. “It’s something to watch acutely,” he told Crikey from the United States.

He says Australia has bold tobacco control measures and strong public policy. “It ought to be having a greater effect than it currently is,” he said. When asked why it wasn’t, he responded: “It’s a very good question.”

Lopez notes  the plateauing of smoking rates is also a trend elsewhere. The Australian result could just be “a bump”, or it could be that the anti-tobacco campaign had run up against the brick wall of rusted-on smokers. “It’s getting harder and harder to chop away at that hardcore group of smokers,” he said.

It may be that the mandating of ugly olive-green plain packaging for cigarettes — with graphic warnings and no trademark — from December 2012 is driving down smoking rates again. Today’s report cuts out before those laws started, and there’s no more recent data available. While the government and the tobacco industry have data on cigarette sales, both claim “commercial in-confidence” in not releasing it.

Simon Chapman, professor of public health at the University of Sydney (and an anti-tobacco campaigner), called on the government to release the information: “The government now has 12 months of data, why is the government withholding data?”

British American Tobacco Australia spokesman Scott McIntyre told Crikey: “After a year of implementation the plain packaging experiment is not working and has had no impact on legal tobacco volumes.”

McIntyre claimed legal tobacco sales “remain stable”, but would not provide figures. He claimed smokers were switching to cheaper legal products and the black market. However, the fact that the tobacco lobby challenged the plain packaging laws in the High Court (it lost) indicates the industry may have had good reason to fear the laws.

Claims that tougher laws on cigarettes are leading to a black market boom are interesting. The tobacco industry hired KPMG to investigate. Consultants collected 12,000 empty cigarette packs from streets and bins (sounds like a fun job) to compile a new report last October. The industry spun it as a significant increase in sales of illegal cigarettes, but the data actually shows sales have been pretty stable at 12-13% (illicit consumption as a proportion of total consumption) since 2010. According to KPMG, illegal tobacco comes mainly in the form of illegally imported cigarettes, especially from South Korea, at an average $8.60 a packet. Sales of black-market chop chop (loose tobacco) are down.

Smoking rates might also fall due to a 12.5% increase in the excise from last month (it’s too early to tell). The former Labor government announced the excise would rise by 12.5% a year for four years from 2013. The Coalition criticised the move at the time but seem happy to keep the revenue.

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