Journal of Adolescent Health 54 (2014) 364

www.jahonline.org

Letter to the editor

Delayed Tobacco Plain Packaging: How Much More Evidence Do We Need?

To the Editors:

The article by Czoli and Hammond [1], “Cigarette packaging:youth perceptions of ’natural’ cigarettes, filter references, andcontraband tobacco,” provides an important perspective on howcigarette packaging and labeling can increase the appreciation ofcigarettes and may develop and encourage misconception aboutthe reduced harm of tobacco brands. I applaud the study for itssound methodological approach and for the integrated elementof experimental design. However, there were two potentialshortcomings: the non-representative sample and the socialdesirability bias. Both of those limitations were addressed by theauthors. Moreover, the social desirability bias in this case canonly drive the association to be underestimated; yet, the studyhas yielded a positive relation.

In fact, the results of this research are consistent with previousobservational and longitudinal studies that showed an associa-tion between exposure to tobacco labeling and smoking suscep-tibility among youth [2]. This study by Czoli and Hammond [1]should be an awakening call to policy makers who have failed sofar to endorse plain packaging, despite the excess of evidenceprovided by the literature. No doubt, this highlights how politicscan often interferewith public health. Australia has set a historicallandmark by becoming the first country to adopt tobacco plainpackaging. However, many national governments are reluctant infollowing the Australian example, and still seem to tangowith thetobacco industry.

1054-139X/$ e see front matter � 2014 Society for Adolescent Health and Medicinehttp://dx.doi.org/10.1016/j.jadohealth.2013.11.005

The industry has invested significant resources to targetyouth and promote brand image, and has developed a counter-attack strategy to challenge plain packaging legislation on thebasis of commercial free speech and the basis of intellectualproperty rights [3]. Public health policy makers will now knowwhat approaches will be used against tobacco control policies,and set up their strategies and legislation accordingly, becauseplain packaging would be an effective tobacco control action. Theresearch by Czoli and Hammond [1] will help enhance furtherconstruction of policies toward plain packaging in Canada andworldwide.

Ziyad Ben Taleb, M.D., D.O.M.H., M.P.H.Department of Epidemiology, Florida International University

Miami, Florida

References

[1] Czoli CD, Hammond D. Cigarette packaging: youth perceptions of “natural”cigarettes, filter references, and contraband tobacco. J Adolesc Health 2013Sep 4. pii:S1054-139X(13)00381-9. doi:10.1016/j.jadohealth.2013.07.016.[Epub ahead of print].

[2] Lovato C, Linn G, LF S, et al. Impact of tobacco advertising and promotion onincreasing adolescent smokingbehaviours. CochraneDatabaseSystRev2003;4.

[3] Zarocostas J. Australia’s proposals on plain packaging set new globalbenchmark in anti-smoking efforts. BMJ 2011;342.

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