This page contains the findings of systematic reviews undertaken by the EPPI-Centre Health Promotion and Public Health Reviews Reviews Facility
Access to tobacco
Smoking in pregnancy
- Smoking prevention interventions which use same-age or older peer leaders to teach skills to resist peer and other social pressures, have been demonstrated to be effective. The interventions were school-based and targeted at 11- to 13-year-olds. However these positive effects may not be generalisable to all groups of young people, especially those who are already at a higher risk of smoking in the future.
- It is not clear whether the use of peer leaders is essential to the success of this type of intervention. There is some evidence to suggest that it is the competence of the provider in facilitating learning in groups which is the important factor.
- Incentive schemes were found to be effective in reducing smoking behaviours in the context of school-based competitions. These findings were based on a small number of studies, none of which were conducted in the UK, but they are consistent with other systematic review evidence.
- A scoping review on the use of incentives  found eight primary studies on smoking in people with low socio-economic status, but no systematic reviews. It was concluded that a systematic review is needed in this area.
Plain packaging 
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.
Access to tobacco 
Data from over 9,000 young smokers in seven surveys revealed friends and shops to be the sources most used by young people in the UK. Shop-bought tobacco is far more likely to be purchased from independent newsagents and sweetshops than larger stores such as supermarkets. Access patterns are shaped by age, gender and whether young people are occasional or regular smokers.
Qualitative data from approximately 500 young people in six UK studies revealed that they find it easy to access cigarettes. Young people described friends, shops and proxy purchasing (asking others to buy cigarettes on their behalf) as their most significant access routes. They also indicated that access is facilitated by the sociability and visibility of access and the apparent complicity of adults, but risk, cost and young age or age-appearance act as barriers to obtaining cigarettes.
Four broad types of interventions targeting non-retail access have been evaluated: possession laws; retail interventions measuring non-retail access; school policies; and home access restrictions. The quality and relevance of this research is low: little methodologically strong research has been conducted in this area, and no UK studies were identified.
Smoking in pregnancy 
- Smoking in pregnancy increases the risk of babies having low birthweight and being born too early. Babies often struggle to cope with life outside the womb and can suffer ill health later in life.
- Smoking cessation programmes in pregnancy reduce the proportion of women who continue to smoke, and reduce low birthweight and preterm birth.
- One intervention strategy, rewards plus social support (two trials), resulted in a significantly greater smoking reduction than other strategies.
- Studies with more stringent quality criteria and process evaluations demonstrated greater impact (weighted mean difference in smoking).
- Programmes would benefit from the active involvement of pregnant smokers in design and evaluation.
- A scoping review on the use of incentives  found 13 primary studies and just one potentially systematic review on smoking in pregnancy. It was concluded that further systematic reviews are needed in this area.
1. A review of the effectiveness and appropriateness of peer-delivered health promotion interventions for young people (1999)
2. Smoking cessation programmes in pregnancy: systematically addressing development, implementation, women’s concerns and effectiveness (2004)
3. A systematic review of the evidence for incentive schemes to encourage positive health and other social behaviours in young people (2006)
4. Incentives to improve smoking, physical activity, dietary and weight management behaviours: a scoping review of the research evidence (2009)
5. Young people's access to tobacco: a mixed-methods systematic review (2011)
6. Plain tobacco packaging: a systematic review (2012)