Background:Kiddie/small packs contain less than 20 cigarette sticks in a pack.Kiddie packs were introduced by the tobacco industry to support moderation and encourage quit smoking among heavy smokers although this may in turn encourage underage smoking. Smaller packs may suggest lower costs and this may increase affordability among the younger generation. This concern has causedmany countries to ban the sale of single cigarette sticks or kiddie packs. Hence, a systematic review was conducted to identify the impact of kiddie packs on smoking as compared to regular cigarette packaging in the general population.
Methods:A database search was conductedin PubMed, EMBASE, CENTRAL, Web of Science and Scopus up to31stJanuary 2020. Other sources namely Google Scholar, as well as Journal of Substance Use and Tobacco Control were also searched.The results were analysed qualitatively, under four groups: initiation of smoking;urge /tendency to buy cigarettes; prevalence of smoking and attempt to reduce cigarette consumption. The methodological quality of all articles that were includedwas determined using a validated 16-item quality assessment tool (QATSDD). The literature search identified 2253 articles, of which20articles had met theinclusion criteria.
Discussion:Articles that we reviewed had some evidence that kiddie packs increase the urge/tendency to buy cigarettes and also increase the attempt to reduce cigarette consumption. However, we found no evidence on theimpact of kiddie packs on the initiation of smoking and the prevalence of smoking. The average quality score for all papers was 34.1%.Given the diverse study settings of the articles and despite the challenges of the methodological quality of some papers, this review will provideevidence that kiddie packs increase urge/tendency to buy cigarettes and also increase the attempt to reduce cigarette consumption. However, since most studies were of low quality, further high-quality studies are needed to come to a firm conclusion of the impact of kiddie packs on smoking.
Systematic review registration: PROSPEROCRD42018102325

Figure 1
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Posted 19 May, 2020
On 14 May, 2020
On 12 May, 2020
Posted 19 May, 2020
On 14 May, 2020
On 12 May, 2020
Background:Kiddie/small packs contain less than 20 cigarette sticks in a pack.Kiddie packs were introduced by the tobacco industry to support moderation and encourage quit smoking among heavy smokers although this may in turn encourage underage smoking. Smaller packs may suggest lower costs and this may increase affordability among the younger generation. This concern has causedmany countries to ban the sale of single cigarette sticks or kiddie packs. Hence, a systematic review was conducted to identify the impact of kiddie packs on smoking as compared to regular cigarette packaging in the general population.
Methods:A database search was conductedin PubMed, EMBASE, CENTRAL, Web of Science and Scopus up to31stJanuary 2020. Other sources namely Google Scholar, as well as Journal of Substance Use and Tobacco Control were also searched.The results were analysed qualitatively, under four groups: initiation of smoking;urge /tendency to buy cigarettes; prevalence of smoking and attempt to reduce cigarette consumption. The methodological quality of all articles that were includedwas determined using a validated 16-item quality assessment tool (QATSDD). The literature search identified 2253 articles, of which20articles had met theinclusion criteria.
Discussion:Articles that we reviewed had some evidence that kiddie packs increase the urge/tendency to buy cigarettes and also increase the attempt to reduce cigarette consumption. However, we found no evidence on theimpact of kiddie packs on the initiation of smoking and the prevalence of smoking. The average quality score for all papers was 34.1%.Given the diverse study settings of the articles and despite the challenges of the methodological quality of some papers, this review will provideevidence that kiddie packs increase urge/tendency to buy cigarettes and also increase the attempt to reduce cigarette consumption. However, since most studies were of low quality, further high-quality studies are needed to come to a firm conclusion of the impact of kiddie packs on smoking.
Systematic review registration: PROSPEROCRD42018102325

Figure 1
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