Consultation on "Plain and Standardized Packaging" for Tobacco Products

Potential measures for regulating the appearance, shape and size of tobacco packages and of tobacco products

Document for consultation

May 2016

Executive Summary

Tobacco packaging is one of the few remaining channels available for the promotion of tobacco products. Independent research, across several countries, has consistently shown that plain and standardized packaging measures reduce the appeal of tobacco products, particularly among young people.

"Plain and standardized packaging" refers to packages without any distinctive or attractive features, that are similar in appearance and shape, and of the same ordinary colour. In recent years, this meaning has been extended to requiring a common appearance for the tobacco products these packages contain, such as cigarettes.

In 2012, Australia became the first country in the world to introduce plain and standardized packaging requirements, which apply to all tobacco products. Since then, the United Kingdom, France and Ireland have all adopted similar measures. Numerous other countries have indicated their intention to follow suit.

In Canada, the federal government and its provincial partners have taken a number of key measures to address tobacco use, including the mandating of large pictorial health warnings on cigarette and little cigar packages, the adoption of smoking bans in indoor public spaces and workplaces, as well as the sponsoring of prevention campaigns.  Despite decades of efforts, there are still over 5 million tobacco users in Canada (including 4.2 million current smokers). Tobacco use remains a significant public health issue, killing half of long-term users.  Approximately 37,000 Canadians die every year from tobacco-related illness.

Recognizing that more could be done in the area of tobacco control, the Government of Canada made a commitment in November 2015 to introduce plain and standardized packaging requirements for tobacco products. This would continue our efforts to protect Canadians from the devastating health, economic and social costs of tobacco use.

This document sets out measures under consideration that build on those introduced by Australia (currently the most comprehensive) to regulate the appearance, shape and size of packages of tobacco products (i.e. cigarettes, cigarette tobacco, cigars, pipe tobacco, tobacco sticks, smokeless tobacco, kreteks [clove cigarettes], bidis [thin roll of tobacco wrapped in a leaf], shisha, tubes, blunt wraps, rolling papers and others).  Specifically, the measures under consideration would: standardize the colour of all tobacco packages and limit the promotion that appears on them; standardize the shape and size of packages of cigarettes and single cigars; and, impose limits on how brand names are displayed on tobacco packages (e.g. font type, colour and size). Health warnings and other required package markings (e.g. tax stamp) would not be affected.

Other measures being considered include standardizing the appearance of cigarettes and other tobacco products that are rolled in cigarette paper (e.g. tobacco sticks, kreteks, tubes, rolling papers). Views are also being sought on measures that would go beyond Australia's, and not in place anywhere in the world, such as standardizing the size of cigarettes (e.g. length and diameter).

We invite all Canadians to review this document and the measures being considered, and to provide us with their feedback.

What do you think?

This document outlines measures being considered by Health Canada to regulate the appearance, shape and size of tobacco packages and of tobacco products. All interested Canadians are invited to submit their views.

Please do not include any personal information when providing feedback to Health Canada.

Health Canada will consider all responses received in the development of a regulatory proposal under the authority of the Tobacco Act.  The federal regulatory process, as applied to tobacco products, typically takes up to 2 years. Appendix B of this document provides an overview of the steps that would lead to the adoption of plain and standardized packaging requirements under the Tobacco Act.

Please see section VII for information on how to provide feedback.

I. The Health Burden of Tobacco Use

Tobacco use is the leading preventable cause of premature death in Canada. It is considered to have a role in causing over 40 diseases and other serious health outcomes.^{Footnote i}  Every year, 37,000 people die in Canada from tobacco use^{Footnote ii}, which is about one of every six deaths.^{Footnote iii} Canadians incur $4.4 billion in direct health costs and $17 billion in combined health and economic costs annually from tobacco use.^{Footnote iv}

Despite decades of efforts, there are over 5 million tobacco users in Canada (including 4.2 million current smokers or 15% of all Canadians 15 and older). Most tobacco use begins during adolescence: 85% of adult daily smokers (age 25+) began by the age of 18.^{Footnote v}

The decline in the rate of tobacco use among youth witnessed since 2003 has slowed down. For the period 2003-2010, the rate of past 30-day tobacco use for all tobacco products has dropped from 22% to 16% among 15 to 19 year-olds. However, in the following three-year period, the slope of this decline has mostly plateaued (see figure).^{Footnote vi}

Data Sources: 2003-2012 Canadian Tobacco Use Monitoring Surveys; 2013 Canadian Tobacco, Alcohol and Drugs Survey

Description - Figure: Past 30-day Tobacco Use (any tobacco product) for the Period 2003-2013

Past 30 Day Use of Any Tobacco Product (including cigarettes)
Estimated Percentage

	Year
	2003	2004	2005	2006	2007	2008	2009	2010	2011	2012	2013
Source: 2003-2012 Canadian Tobacco Use Monitoring Survey (CTUMS) 2013 Canadian Tobacco, Alcohol and Drugs Survey (CTADS)
Aged 15+	23	22	21	21	22	21	20	19	20	19	17
Aged 15-19	22	23	23	19	21	20	19	16	16	16	15
Aged 20-24	33	32	32	33	32	33	29	28	28	28	23

Given the devastating health, economic and social costs, Canada must continue to take decisive action to help protect young people and others from inducements to use tobacco products and the consequent dependence on them, and to help users quit. Towards this goal, key legislative and regulatory measures taken by the federal government and its provincial partners in their fight against tobacco use have included:

• Restrictions on most forms of promotional activity, especially those targeting young people
• Provincial and territorial restrictions on the display of tobacco products at retail
• Bans on most flavours that contributed to making cigarettes, blunt wraps and most cigars more attractive, particularly to youth.

Other past key measures include the mandating of pictorial health warnings that cover 75% of the front and back panels of cigarette and little cigar packages, the adoption of smoking bans in indoor public spaces and workplaces, as well as the sponsoring of prevention campaigns.

As a party to the World Health Organization Framework Convention on Tobacco Control, Canada strives to meet its obligations, including by adopting and implementing important tobacco control measures. Despite Canada's progress in implementing the critical measures contained in the Convention, crucial work remains to be done, particularly to further prevent inducements to tobacco use.

II. Products and Packaging: A Means to Promote Tobacco Use

The design and appearance of packages, and of tobacco products, are among the few remaining promotional channels available to the tobacco industry. They are used extensively to develop brand identity, create positive associations and expectations for consumers, and reduce the perception of risk and harm.

Reviews of tobacco industry research as well as independent studies have found that:

• Packages with rounded, octagonal or 'beveled' edges are consistently seen as conveying stylishness, elegance and class^{Footnote vii}
• Packages with novel openings and shapes are perceived as being more contemporary and modern^{Footnote viii}
• Slim and thin cigarette packages increase the attractiveness of packages, particularly among young women, and the cigarettes they contain are more likely to be perceived as milder and less harmful^{Footnote ix},^{Footnote x},^{Footnote xi}
• Slim diameter cigarettes can convey weaker or milder taste, and the false belief that they are less harmful^{Footnote xii},^{Footnote xiii},^{Footnote xiv}
• Packages  labelled "smooth" are falsely perceived as having a lower health risk than "regular" versions of the same brand^{Footnote xv} ,^{Footnote xvi}
• Tobacco products with lighter colours on packages have been associated with less harm, and perceived strength.^{Footnote xvii},^{Footnote xviii},^{Footnote xix},^{Footnote xx}

The promotion of tobacco through packages and products is particularly effective in adolescence and young adulthood, when brand loyalty and smoking behavior are beginning to be established.  Young adult smokers associate cigarette brand names and package design with positive personal characteristics, social identity and status.^{Footnote xxi} The 2012 report by the U.S. Surgeon General concluded that "the evidence reviewed […] strongly suggests that tobacco companies have changed the packaging and design of their products to increase their appeal to adolescents and young adults."^{Footnote xxii}

III. Plain and Standardized Packaging Measures Reduce the Appeal of Tobacco Products

"Plain and standardized packaging" refers to packages without any distinctive or attractive features, that are similar in appearance and shape, and of the same ordinary colour. In recent years, this meaning has been extended to requiring a common appearance for the tobacco products these packages contain, such as cigarettes.

In independent research spanning at least two decades and multiple countries, numerous studies have suggested that plain and standardized packaging requirements reduce the appeal of tobacco packages and the products they contain, particularly among young people. For example:

• A 2012 systematic review by the University of Stirling, in Scotland, identified 37 published studies demonstrating that plain and standardized tobacco packages were consistently less appealing than branded packages on features such as attractiveness, projected personality attributes (e.g. "cool" and "popular"), and even the quality of the smoking experience. Canadian studies were among those reviewed.^{Footnote xxiv}
• A 2014 review of 75 original articles, conducted on behalf of the Irish Department of Health, concluded that the "evidence unequivocally demonstrates that plain packaging is perceived as less attractive and less appealing, particularly among youth and young adults." The effects of plain and standardized packaging were observed in both non-smokers and smokers, including on measures of attractiveness, preference and intentions to smoke. Canadian studies were again among those reviewed.^{Footnote xxv}
• A survey of close to 6,000 youth (12-17 yrs.) in Australia, found that the introduction of plain and standardized packaging, coupled with increases in health warning sizes, significantly reduced brand appeal and positive character ratings for all brands tested.  This included whether brands were perceived as 'cool' or associated with perceived success.^{Footnote xxvi}

IV. Plain and Standardized Packaging Measures in Other Countries

The World Health Organization Framework Convention on Tobacco Control, to which Canada is a Party, is the first international treaty negotiated under the auspices of the World Health Organization. The Convention, which came into force in 2005, was developed in response to the globalization of the tobacco epidemic. It is an evidence-based treaty that reaffirms the right of all people to the highest standard of health. Guidelines adopted in 2010 for the implementation of articles 11 and 13 of the Convention recommend that Parties consider introducing plain packaging measures.

Australia's plain packaging legislation came into force in 2012. The United Kingdom, Ireland, and France have since adopted measures that are being implemented this year.  There are key similarities in the approaches taken, with some variation, including:

• Standardizing package appearance (i.e. standardized colour, font and finish; prohibitions on brand elements, such as logos, and on promotional information)
• Regulating package size and shape
• Standardizing cigarette appearance (typically white paper and either white or imitation cork for the tipping paper)
• In Australia and Ireland, packaging measures apply to all tobacco products, whereas in the UK and France, they only apply to cigarettes and roll-your-own tobacco.

Australian requirements mandate specific package dimensions (i.e. height, width and depth) and prohibit package designs with rounded or beveled edges.  Australia also goes furthest in regulating cigarette appearance by only permitting an optional alphanumeric code in small black text.  Other countries allow tobacco brand names to appear on the cigarettes themselves in a standardized font and colour.

V. Measures under Consideration

Health Canada is considering introducing plain and standardized packaging requirements that include those in place in Australia.  For the packaging, these are:

• A single ordinary colour on all packages of tobacco products (i.e. cigarettes, cigarette tobacco, cigars, pipe tobacco, tobacco sticks, smokeless tobacco, kreteks [clove cigarettes], bidis [thin roll of tobacco wrapped in a leaf], shisha, tubes, blunt wraps, rolling papers and others)
• A standard font type, size and colour for product brand names displayed on packages
• Restriction on the use of brand elements on packages
• Standard shape and size for cigarette packages and single cigar tubes.

For cigarettes and cigars, the Australian measures being considered are:

• Ordinary appearance of cigarettes, with no display of brand elements, but with an optional alphanumeric code
• Ordinary appearance of cigar bands, with standard font type, size and colour for the brand name displayed (appearance of actual cigar would not change).

Measures being considered for packaging that would go beyond Australia's include:

• Limits on the number of words in the brand name displayed
• Prescribed thickness for cigarette package walls
• No insertion of 'space fillers' in cigarette packages.

Measures being considered for tobacco products that would go beyond Australia's include:

• No distinctive colours or designs (e.g. grooves, hole or recess) in cigarette filters
• Single length and minimum diameter for cigarettes
• Single unattractive colour for cigarette and other products that are rolled in cigarette paper (e.g. tobacco sticks, kreteks [clove cigarettes], tubes, rolling papers).

Examples of cigarette, cigar, pipe tobacco and smokeless tobacco packages showing plain and standardized packaging features under consideration can be found in Appendix A.

Any measures adopted with regards to package appearance would not remove the current labelling requirements, including the obligation to display pictorial or text-based health warnings. Similarly, requirements for the tax stamp on tobacco products would not be affected.

VI. Potential Challenges in the Implementation of "Plain and Standardized Packaging" Measures

The decision to require plain and standardized packaging measures invites consideration of potential challenges relating to their implementation. In Australia, various stakeholders identified what they viewed as implementation challenges during the development of the government proposal. Health Canada is asking for your input with respect to some of them.

VII. We Want Your Feedback

Health Canada is seeking input from interested Canadians on the measures set out in this document.

Appendix A - Selected Tobacco Packages Showing "Plain and Standardized Packaging" Features under Consideration

Description - Cigarette package

Image of a slide and shell rectangular cigarette pack.  The pack is a drab dark brown with a health warning message covering  at least 75% of the front surface.  The warning message includes an image of a tongue with white abscesses and health information about oral cancer and the national quit line. There is a tax stamp on the bottom left of the pack. The phrases "Brand Name", "25 cigarettes" and "King Size" appear in a standardized font and colour (grey) below the warning message.

Description - Cigar package

Image on the left is the front of a rectangular cigar box in a drab dark brown.  The phrases "Brand Name/Nom de Marque" and "5 cigars/cigares" are in a standardized font and colour (grey). There is a tax stamp on the top left of the pack.

Image on the right is the back of a rectangular cigar box in a drab dark brown.  The bilingual graphic and health warning statement reads "Tobacco smoke hurts children.  Tobacco smoke can trigger asthma attacks in children/La fumée du tabac nuit aux enfants. La fumée du tabac peut provoquer des crises d'asthme chez les enfants " with an image of a child wearing an oxygen mask. There is a rectangular barcode.

Description - Cigar tubes

Image on the left is of a cigar tube in a drab dark brown.  The phrase "Brand Name"," Name and address of manufacturer" and "Alphanumeric code" are in a standardized font and colour (grey). There is a barcode.

Image on the right is of a cigar tube with a single band.  The band is in a drab dark brown with the phrase "Brand Name", Country of Manufacture" and "Alphanumeric code" are in a standardized font and colour (grey).

Description - Pipe tobacco package

Image on the left is the front of a rectangular shaped pipe tobacco package in a drab dark brown.  The phrases "Brand Name/Nom de Marque" are located in the centre in a standardized font and colour (grey).  The phrase "Pipe tobacco/Tabac à pipe" are located in the centre towards the bottom of the package in a standardized font and colour (grey).  The text "50 g" appears in the bottom right corner of the package in a standardized font and colour (grey).

Image on the right is the back of a rectangular pipe tobacco package in a drab dark brown.  The bilingual graphic and health warning statement reads "Tobacco smoke hurts children.  Tobacco smoke can trigger asthma attacks in children/La fumée du tabac nuit aux enfants. La fumée du tabac peut provoquer des crises d'asthme chez les enfants" with an image of a child wearing an oxygen mask. There is a barcode. The phrase "Name and address of manufacturer/ Nom et addresse du fabricant" are in a standardized font and colour (grey). There is a tax stamp on the top left of the pack.

Description - Smokeless tobacco package

Image of round smokeless tobacco can in a drab dark brown.  The phrase "Brand Name/Nom de Marque",  "25 g smokeless tobacco/tabac sans fumee", Brand Name/Nom de Marque" and "Name and address of manufacturer/Nom et addresse du fabricant" are in a standardized font and colour (grey). The health warning reads "This product is highly addictive" and on the right side "Ce produit crée une forte dépendance". There is a tax stamp on the left of the can along the side.

Appendix B - Overview of the Federal Regulatory Process

Regulations making under the Tobacco Act typically follows the following steps:

1. Public consultation, where the proposal is made public and comments are invited from interested parties
2. Prepublication of the proposed tobacco regulations, and its accompanying Regulatory Impact Assessment Statement, in the Canada Gazette, Part I, followed by a comment period of 30 or 75 days (the latter where the proposed regulations may affect international trade)
3. Laying of the proposed tobacco regulations before the House of Commons, for a period of no more than 30 sitting days
4. Registration of the regulations and final publication in the Canada Gazette, Part II.

Implementation of the regulations may happen 6 months after their registration, where a delay is necessary to meet Canada's trade obligations.