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Plain cigarette packs may be helping to drive down smoking prevalence

Cochrane review finds that emerging evidence seems to back the measure

Caroline White

Thursday, 27 April 2017

Plain standardised cigarette packs may already be helping to drive down smoking prevalence, suggests a review* of the published evidence to date by the Cochrane Library.

The findings come as plain packs become the norm in the UK next month under the terms of the revised Tobacco Products Directive after retailers were given a year from May 2016 to sell off their old stock.

From May 21, all packs sold in the UK must be of a uniform colour, and in some cases, shape, with no logos apart from health warnings and other government information, while the brand name will have to appear in a prescribed font, colour, and size. Graphic health warnings will increase in size and will have to appear on the front as well as the back of packs.

The Cochrane researchers from the UK and Canada summarised the results of 51 relevant studies that looked at the impact of standardised packaging on attitudes to, and behaviour around, tobacco.

The studies differed in their design and what they measured. As only Australia had introduced standardised packaging at the time of the review, the evidence for an impact on smoking prevalence is based on one large observational study, but it is backed up by routinely collected data from the Australian government.

Data from the other studies indicate that standardised packs lower appeal, which may help to explain the observed fall in smoking prevalence, say the researchers.

None of the studies directly measured whether plain packs influence uptake, cessation, or whether they deter former smokers from taking up the habit again.

But the researchers didn’t find any evidence to suggest that plain packs are associated with an increase tobacco use.

The amount of evidence for plain packs has risen sharply since the publication of the WHO guidelines recommending the measure in 2008. But as yet, there are no data on long-term impact.

Cochrane lead author, and deputy director of the UK Centre for Tobacco and Alcohol Studies, Professor Ann McNeill, 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 [it] may reduce smoking prevalence.”

She added: “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 standardised 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, commented: “Our evidence suggests that standardised packaging can change attitudes and beliefs about smoking, and the evidence we have so far suggests that [it] 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.”

Deborah Arnott, chief executive of campaign group Action on Smoking and Health (ASH), commented: “Standard packs are a landmark public health policy the tobacco industry fought tooth and nail to prevent. As evidence grows it is easy to see why.

“Smokers already saying they feel differently about their pack of cigarettes and in years to come we expect to see fewer young people smoking as they are no longer seduced by glitzy, brightly coloured packs.”


* McNeill A, Bauld L, Birken M, et al. Tobacco packaging design for reducing tobacco use. Cochrane Database of Systematic Reviews 2017, Issue 4. Art. No: CD011244. DOI:10.1002/14651858.CD011244

Picture: Packaging compliant with TPD and standardised packaging regulations. Source: ASH.

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