Perceived Influence of Plain Cigarette Packaging on Smoking Behavior: A Systematic Review

21 April 2022

By: Jetly, Kavita MBBS, MPH; Ismail, Aniza MD, PhD, MComm Health; Hassan, Noraryana MBBS, MPH; Mohammed Nawi, Azmawati MD, PhD, MComm Med Source: Public Health Management & Practice



Worldwide, the number of cigarette smokers is increasing. All tobacco products come in packs. Packaging and branding are important elements of advertising and promotion. The plain packaging concept introduced by the World Health Organization, where marketing elements such as branding appeal are removed from the cigarette pack, is said to be effective for reducing smoking habits. The objective of this systematic review was to determine the influence of plain packaging on smoking behavior.


This systematic review was conducted using 2 databases (Scopus and Web of Science). We did not search for unpublished reports. The search was performed from September 2020 to December 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The inclusion criteria were original article that used a qualitative or quantitative method, English-language article, published in 2016-2020, and availability of full-text article.


A total of 15 studies were included. All of the studies had adequate methodological quality. Most of the studies reported the effectiveness of plain packaging in preventing smoking initiation among nonsmokers. However, more studies reported no effect of plain packaging on smoking behavior among smokers. Furthermore, there was a greater impact of plain packaging on smoking behavior among female smokers and those who had recently started smoking.


Plain packaging is more effective for evoking negative smoking behavior among nonsmokers than among smokers. As many of the included studies did not stratify the results based on age group and gender, future research should address these issues.