New evidence finds standardised cigarette packaging may reduce the number of people who smoke

Professor Linda Bauld
Professor Linda Bauld is co-author on the ground-breaking research
27 April 2017

A Cochrane Review published today finds standardised tobacco packaging may lead to a reduction in smoking prevalence and reduces the appeal of tobacco.

According to the World Health Organization, tobacco use kills more people worldwide than any other preventable cause of death. Global health experts believe the best way to reduce tobacco use is by stopping people starting to use tobacco, and encouraging and helping existing users to stop.

Restrictions

The introduction of standardised (or ‘plain’) packaging was recommended by the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC) guidelines. This recommendation was based on evidence around tobacco promotion in general and studies which examined the impact of changes in packaging on knowledge, attitudes, beliefs and behaviour. Standardised tobacco packaging places restrictions on the appearance of tobacco packs so that there is a uniform colour (and in some cases shape), with no logos or branding apart from health warnings and other government-mandated information; the brand name appears in a prescribed uniform font, colour, and size.

A number of countries have implemented, or are in the process of implementing, standardised tobacco packaging. Australia was the first country in the world to implement standardised packaging of tobacco products.  The laws, which took full effect there in December 2012, also required enlarged pictorial health warnings.

A team of Cochrane researchers from the UK and Canada have summarised results from studies that examine the impact of standardized packaging on tobacco attitudes and behaviour. They have today published their findings in the Cochrane Library.

They found 51 studies that looked at standardised packaging. The studies differed in the way they were done and also what they measured.  Only one country had implemented standardised packaging at the time of this review, so evidence that tobacco use prevalence may have decreased following standardized packaging comes from one large observational study. A reduction in smoking behaviour is supported by routinely collected data from the Australian government. There are data from a range of other studies to indicate that appeal is lower with standardized packaging and this may help to explain the observed decline in prevalence. Researchers did not find any evidence suggesting that standardized packaging may increase tobacco use. No studies directly measured whether standardised packs influence uptake, cessation or whether they prevent former smokers from taking up smoking again. 

The amount of evidence for standardised packaging has increased markedly since the publication of the WHO guidelines in 2008. However, given how recent these changes are, there is no data on long-term impact. The amount of evidence will continue to expand as more countries implement standardized packaging and as studies assessing the longer-term effects of the Australian policy become available.

Changing attitudes

Cochrane lead author, and Deputy Director of the UK Centre for Tobacco and Alcohol Studies, Professor Ann McNeill from King’s College London, said, “Evaluating the impact of standardised packaging on smoking behaviour is difficult to do; but the evidence available to us, whilst limited at this time, indicates that standardized packaging may reduce smoking prevalence. These findings are supported by evidence from a variety of other studies that have shown that standardised packaging reduces the promotional appeal of tobacco packs, in line with the regulatory objectives set. It would appear that the impact of standardized packaging may be affected by the detail of the regulations such as whether they ban descriptors, such as ‘smooth’ or ‘gold’, and control the shape of the tobacco pack.”

Co-author Jamie Hartmann-Boyce, from the Cochrane Tobacco Addiction Group, Oxford, UK, added: “Our evidence suggests that standardized packaging can change attitudes and beliefs about smoking, and the evidence we have so far suggests that standardized packaging may reduce smoking prevalence and increase quit attempts. We didn’t find any studies on whether changing tobacco packaging affects the number of young people starting to smoke, and we look forward to further research on this topic.”

Co-author Linda Bauld, professor of health policy and director of the Institute for Social Marketing at the University of Stirling, said: “We’ve been working for several years to investigate the potential impact of standardised tobacco packaging as a public health measure. We believe putting cigarettes into packs without branding makes tobacco products, and smoking in general, less appealing.

“This latest evidence suggests that standardised packaging can change attitudes and beliefs about smoking, which may encourage some smokers to think differently about their smoking and, along with other policies we already have in place, like smoke free laws and access to free stop smoking services, could contribute to reducing the number of people who smoke.”

Background information

Full citation: McNeill A, Gravely S, Hitchman SC, Bauld L, Hammond D, Hartmann-Boyce J. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No: CD011244. DOI:10.1002/14651858.CD011244.

About Cochrane

Cochrane is a global independent network of researchers, professionals, patients, carers, and people interested in health.

Cochrane produces reviews which study the best available evidence generated through research and make it easier to inform decisions about health. These are called systematic reviews.

Cochrane is a not-for-profit organization with collaborators from more than 130 countries working together to produce credible, accessible health information that is free from commercial sponsorship and other conflicts of interest. Our work is recognized as representing an international gold standard for high quality, trusted information.

Find out more at cochrane.org

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