What's in a number?

Abstract

Many countries have adopted laws setting minimum cigarette pack sizes at 20 per pack. Going further to standardize pack sizes makes sense to disrupt brand marketing but a larger quantity per pack (e.g. carton size of 100 cigarettes per pack) would make purchasing cigarettes less affordable. It is a good question to ask, as increased standardization of the product and package are effective strategies to limit the marketing of cigarettes 3-9. Cigarette companies have experimented with different pack sizes, such as sampling packs with four cigarettes and starter packs with 10 cigarettes, but mostly cigarettes are sold in packs with 20 cigarettes; that has been the industry standard. Blackwell and colleagues 1 speculate that larger cigarette pack sizes might promote more smoking and be detrimental to public health in the same way as providing larger food and beverage portion sizes leads to an increased consumption of calories. However, I do not believe that this is likely to be the case with cigarette packaging, as research suggests that most addicted smokers self-titrate to their daily dose of nicotine 10, 11. zThe typical smoker needs approximately 20 cigarettes per day to satisfy their nicotine addiction. I recall a conversation I had many years ago with a former marketing director of a major US cigarette manufacturer, who explained to me that if public health authorities really wanted to disrupt the cigarette market, they should limit the sale of cigarettes to carton sizes (i.e. 100 cigarettes in a box). I was told this would accomplish several things, including making it much more expensive to purchase cigarettes, lowering the marketing appeal of cigarettes for retailers as customers would not be coming into their stores as frequently to buy them. It would also make it more difficult for stores to display many different cigarette brands around checkout counters, as 20 cigarette pack sizes are small enough to allow companies to display several different brand and brand variants around checkout counters in retail stores. Of course, larger pack sizes could encourage some smokers to smoke more cigarettes, which would be bad. However, I am inclined to believe that a standardized pack size of 100 cigarettes or greater would be more of a detriment to the cigarette industry than a benefit. If the goal of a standard pack size is to discourage smoking, I think public health authorities ought to seriously consider a much larger minimum package size than the current minimum standard of 20 cigarettes per package. Government regulators should not let cigarette companies define the optimum package sizes, as their financial motives are not in line with the goals of public health. In the end, I suspect the answer to the question to ‘what's in a number’ may turn out to be more important to tobacco control than we might once have appreciated. K.M.C. has received payment as a consultant to Pfizer, Inc. for service on an external advisory panel to assess ways to improve smoking cessation delivery in health-care settings. K.M.C. also has served as paid expert witness in litigation filed against the tobacco industry. K.M.C. receives funding support from grants from the US National Cancer Institute (P01 CA200512, P30 CA138313).