What do we want to know?
This systematic review outlines findings from 37 studies that provide evidence of the impacts of plain tobacco packaging. The review was conducted following the publication of the March 2011 White Paper Healthy Lives: Healthy People which set out a renewed Tobacco Control Plan for England. One of the key actions identified in the plan was to consult on possible options to reduce the promotional impact of tobacco packaging, including plain packaging. The Framework Convention on Tobacco Control (FCTC) proposes that plain packaging would have three benefits: it would reduce the attractiveness and appeal of tobacco products, it would increase the noticeability and effectiveness of health warnings and messages, and it would reduce the use of design techniques that may mislead consumers about the harmfulness of tobacco products. The review aimed to examine all available current evidence on the effects of plain packaging in these three areas.
Who wants to know?
This systematic review was commissioned to provide a comprehensive overview of evidence on the impact of plain packaging in order to inform a public consultation on the issue.
What did we find?
A total of 4,518 citations were identified following initial searching, and after screening and quality appraisal 37 studies were included. Data were extracted from each of these to inform a narrative synthesis organised around five main headings: appeal of cigarettes, packs and brands; salience of health warnings; perceptions of harm; smoking-related attitudes and behaviour; and barriers and facilitators to the introduction of plain packaging.
The report begins with an introduction that briefly describes how tobacco marketing and packaging have been regulated to date, and outlines the origins of plain packaging as a potential policy measure. A contextual section discusses how tobacco packaging has evolved and its multifunctional role in promoting tobacco products. Plain packaging has been shown to:
- reduce pack and product appeal, by making packs appear less attractive and of lower quality, and by weakening the positive smoker identity and personality attributes associated with branded packs;
- increase the salience of health warning, in terms of improving the recall and perceived seriousness and believability of warnings; and
- reduce the confusion about product harm that can result from branded packs.
Plain packaging was also perceived as likely to have a deterrent effect on the onset of smoking by young people and as likely to encourage existing smokers to quit. The review also found some evidence that non-smokers and, to a lesser extent, smokers, approved of the idea of plain packaging, with both groups feeling it would make smoking less attractive, particularly to young people.
How did we get these results?
We employed systematic review methodology and examined studies from 1980 to the present day. The review focused on primary research but did not put limits on study design. Some systematic reviews include only randomised controlled trials of interventions, but we were aware that this type of evidence cannot exist for plain packaging as plain packaging has not yet been implemented in any jurisdiction. The review therefore looked at all feasible study designs. We searched 21 electronic databases from the fields of health, public health, social science and social care. For the databases, a comprehensive search strategy was developed and tested. We also searched websites, Google Scholar and the tobacco industry’s legacy library. We carried out citation chasing and contacted experts to find further studies. Studies were managed by EPPI-Reviewer 4.0, the EPPI-Centre’s online review software.
The report should be cited as:
Moodie C, Stead M, Bauld L, McNeill A, Angus K, Hinds K, Kwan I, Thomas J, Hastings G, O’Mara-Eves A (2012) Plain tobacco packaging: a systematic review. London: Public Health Research Consortium.