Abstract
Background and ObjectivesStandardised or ‘plain’ tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm.MethodsElectronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted.ResultsStudies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample.ConclusionsThe evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm based upon package design; and will help make the legally required on-pack health warnings more salient.
Highlights
Smoking is the largest single cause of avoidable morbidity and mortality in much of the world, being a risk factor for six of the eight leading causes of death globally [1] and responsible for approximately five million deaths a year [2]
Contact was made with academics and market research groups known to have conducted research on standardised packaging, either currently or in the past; academics involved in research concerning tobacco packaging, not standardised packaging; and non-governmental organisations which have written on the topic of standardised packaging; two people known to be collating standardised packaging research within the European Commission and the Australian Department of Health and Ageing respectively
We focused on the studies employing quantitative methods only in order to facilitate comparisons and synthesis of results between studies
Summary
Smoking is the largest single cause of avoidable morbidity and mortality in much of the world, being a risk factor for six of the eight leading causes of death globally [1] and responsible for approximately five million deaths a year [2]. The European Commission estimates that the life years lost due to smoking related illness corresponds to 517 billion euros a year [6] In response to these risks the first global public health treaty, the Framework Convention on Tobacco Control (FCTC), was formally initiated at the 48th World Health Assembly in 1995. The objective of the FCTC, as outlined in Article 3, is ‘‘to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke’’ [7]. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm
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