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

April 26, 2017

A Cochrane Review published today finds standardized 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.

The introduction of standardized (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. Standardized 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, standardized tobacco packaging. Australia was the first country in the world to implement standardized 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 summarized 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 standardized packaging. The studies differed in the way they were done and also what they measured. Only one country had implemented standardized 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 standardized packs influence uptake, cessation or whether they prevent former smokers from taking up smoking again.

The amount of evidence for standardized packaging has increased markedly since the publication of the WHO guidelines in 2008. However, given its recency, there are 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.

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 standardized 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 standardized 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."
-end-
Additional 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.

Link to Study: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011244/full

Author Contact:

Media Spokesperson: Lead Author, Ann McNeill

Professor of Tobacco Addiction

UK Centre for Tobacco and Alcohol Studies

National Addiction Centre

Institute of Psychiatry

King's College London

London

UK

Contact: jack.stonebridge@kcl.ac.uk

About Journal

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

Follow us on twitter @cochranecollab

If you are a journalist or member of the press and wish to receive news alerts before their online publication or if you wish to arrange an interview with an author, please contact the Cochrane press office: pressoffice@cochrane.org

About Wiley

Wiley, a global company, helps people and organizations develop the skills and knowledge they need to succeed. Our online scientific, technical, medical, and scholarly journals, combined with our digital learning, assessment and certification solutions help universities, learned societies, businesses, governments and individuals increase the academic and professional impact of their work. For more than 200 years, we have delivered consistent performance to our stakeholders. The company's website can be accessed at http://www.wiley.com.

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