Background:
Articles 11 and 13 of the WHO FCTC call for the elimination of logos, colours, brand images and promotional information on tobacco packaging that make tobacco products more attractive. We aimed to assess, using a systematic review, the effect of standardised tobacco packaging (STP) on tobacco attitudes and behaviours, including, for the first time, population-level outcomes from Australia where STP was implemented in 2012. The review was published in 2017, but not yet presented at a conference.

Methods:
Using standard Cochrane methods, we searched nine databases for peer-reviewed articles evaluating STP prior to January 2016, extracted relevant data and also assessed risk of bias.

Results:
We identified 51 peer-reviewed studies, with over 800,000 participants, a variety of methods and designs, and assessing a range behavioural and non-behavioural outcomes; these were conducted predominantly in high-income countries. We found that overall, STP had a positive effect on behavioural and non-behavioural outcomes; while we also found some null results, there were no negative effects. Australian evidence suggested that STP reduced smoking prevalence, but certainty this outcome was limited by the concurrent introduction of enhanced pictorial warnings. The impact on non-behavioural outcomes was clearer (e.g. STP consistently reduced the appeal of tobacco products), and provided plausible mechanisms of effect consistent with the finding on prevalence. The impact of STP was affected by the detail of the regulations (e.g. whether they banned descriptors and controlled pack shape).

Conclusions:
STP reduced the promotional appeal of tobacco packs in line with regulatory objectives, and the available evidence also showed it may reduce smoking prevalence. There is an urgent need for research to be conducted among low and middle-income countries where 80% of the world's smokers live. Cochrane reviews are evolving documents, updated as other studies become available.