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In 2014, a population-wide, interrupted time-series analysis concludes there was a significant increase of calls to Quitline in some states [14] not attributable to other factors that would suggest plain packaging might encourage smokers to attempt or at least seek help with quitting smoking
Other peer-reviewed studies provide support for these findings.[3] A 2018 study in Public Finance Review examined littered packs of cigarettes across 132 communities in 38 states, finding that 21 percent of packs did not have proper local stamps.[4] As noted by LaFaive and Nesbit, primary authors of the Mackinac Center study, smuggling comes in different forms: casual smuggling, where smaller quantities of cigarettes are purchased in one area and then transported for personal consumption, and commercial smuggling, which is large-scale criminal activity that can involve counterfeit state tax stamps, counterfeit versions of legitimate brands, hijacked trucks, or officials turning a blind eye.[5] The Mackinac Center has cited numerous examples over the many editions of this report, including stories of a Maryland police officer running illicit cigarettes while on duty, a Virginia man hiring a contract killer over a cigarette smuggling dispute, and prison guards caught smuggling cigarettes into prisons
Because there are therapies with evidence of favourable benefit-to-harm profiles, using therapies with very uncertain evidence of effectiveness is an important opportunity cost in that a potentially effective intervention is not attempted
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