title: Child-resistant and tamper-resistant packaging: A systematic review to inform tobacco packaging regulation.
abstract: We aimed to investigate the effects of special packaging (child-resistant, adult-friendly) and tamper-resistant packaging on health and behavioral outcomes in order to identify research gaps and implications for packaging standards for tobacco products.
  
  
  
  We searched seven databases for keywords related to special and tamper-resistant packaging, consulted experts, and reviewed citations of potentially relevant studies. 733 unique papers were identified. Two coders independently screened each title and abstract for eligibility. They then reviewed the full text of the remaining papers for a second round of eligibility screening. Included studies investigated a causal relationship between type of packaging or packaging regulation and behavioral or health outcomes and had a study population composed of consumers. Studies were excluded on the basis of publication type, if they were not peer-reviewed, and if they had low external validity. Two reviewers independently coded each paper for study and methodological characteristics and limitations. Discrepancies were discussed and resolved.
  
  
  
  The review included eight studies: four assessing people's ability to access the contents of different packaging types and four evaluating the impact of packaging requirements on health-related outcomes. Child-resistant packaging was generally more difficult to open than non-child-resistant packaging. Child-resistant packaging requirements have been associated with reductions in child mortality.
  
  
  
  Child-resistant packaging holds the expectation to reduce tobacco product poisonings among children under six.
authors.affiliation: Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Jo
authors.affiliation: Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States. Electronic address: anita.ambs@fda.hhs.gov.
authors.forename: Anita
authors.initials: A
authors.lastname: Ambs
authors.affiliation: Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Dresler
authors.affiliation: Office of Science, Center for Tobacco Products (CTP), Food and Drug Administration (FDA), Rockville, MD, United States.
authors.forename: Cathy L
authors.initials: CL
authors.lastname: Backinger
mesh_terms: D006801:Humans; D019064:Product Packaging / Q000592:standards*; D012926:Social Control, Formal; D062789:Tobacco Products
keywords: Child safety; Child-resistant; Product packaging; Special packaging; Tamper-resistant