Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2019 Jan 17;8(1):25.
doi: 10.1186/s13643-018-0933-0.

A systematic review of the perceptions of adolescents on graphic health warnings and plain packaging of cigarettes

Aaron Drovandi  1 , Peta-Ann Teague  2 , Beverley Glass  2 , Bunmi Malau-Aduli  2
Affiliations
Meta-Analysis

A systematic review of the perceptions of adolescents on graphic health warnings and plain packaging of cigarettes

Aaron Drovandi et al. Syst Rev. .

Abstract

Background: Graphic health warnings on tobacco packaging and the plain packaging of tobacco products are key tobacco control interventions. This systematic review investigates the perceptions of adolescents towards these packaging interventions.

Methods: Published, original-research, English-language articles from 1 January 2000 to 1 September 2017 were identified through a systematic literature search of the PubMed, CINAHL, PsycINFO, Web of Science, and Scopus databases. Articles describing investigations into the perceptions of adolescents aged 11 to 19 years towards graphic health warnings and/or plain-packaged cigarettes were included in this review.

Results: Nineteen articles, involving 15,935 adolescent participants, of which 72.85% were non-smokers or ex-smokers and 27.15% occasional or daily smokers, met the eligibility criteria. Graphic health warnings were perceived as more effective than text-only warnings, with warnings depicting lung cancer, and oral diseases being perceived as particularly effective. Health warnings increased viewer fear, anxiety, shock, and guilt and were considered effective in preventing non-smokers from experimenting with tobacco and prompting current smokers to quit. Plain packaging reduced the attractiveness and other positive attributes of cigarette packaging, with darker colours found to be the most effective. When used in combination, plain packaging increased the visibility of graphic health warnings, with participants also perceiving them as having an increased tar content and having more serious health risks, and increased thoughts of quitting amongst smokers.

Conclusions: Graphic health warnings and plain packaging appear to increase adolescent awareness of the dangers of tobacco use. Further research into the most effective warnings to use in combination with plain packaging is needed to ensure the greatest reduction in tobacco use and prevent tobacco-attributable morbidity and mortality in this vulnerable population.

Keywords: Health literacy; Public health; Tobacco control; Youth.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of systematic literature search
See this image and copyright information in PMC

References

    1. World Health Organization . WHO report on the global tobacco epidemic, 2017; monitoring tobacco use and prevention policies. Geneva: World Health Organization; 2017.
    1. Doll R, Peto R, Boreham J, Sutherland I. Mortality in relation to smoking: 50 years’ observations on male British doctors. BMJ. 2004;328(7455):1519. - PMC - PubMed
    1. Winstanley MH. 3.24 genetic influences on tobacco-caused disease. In: Scollo MM, Winstanley MH, editors. Tobacco in Australia: facts and issues. Cancer Council Victoria: Melbourne; 2011.
    1. Strand BH, Mishra G, Kuh D, Guralnik JM, Patel KV. Smoking history and physical performance in midlife: results from the British 1946 birth cohort. J Gerontol A Biol Sci Med Sci. 2010;66(1):142–149. - PMC - PubMed
    1. Jammer LD, Whalen CK, Loughlin SE, Mermelstein R, Audrain-McGovern J, Krishnan-Sarin S, et al. Tobacco use across the formative years: a road map to developmental vulnerabilities. Nicotine Tob Res. 2003;5(Suppl 1):S71–S87. - PubMed

Publication types

LinkOut - more resources