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Impact of plain packaging of cigarettes on the risk perception of Uruguayan smokers: an experimental study
  1. Jeffrey E Harris1,
  2. Gastón Ares2,
  3. Mariana Gerstenblüth3,
  4. Leandro Machin4,
  5. Patricia Triunfo3
  1. 1 Department of Economics, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
  2. 2 Instituto Polo Tecnológico de Pando, Facultad de Química, Universidad de la Republica Uruguay, Montevideo, Uruguay
  3. 3 Departamento de Economía, Facultad de Ciencias Sociales, Universidad de la Republica Uruguay, Montevideo, Uruguay
  4. 4 Centro de Investigación Básica en Psicología, Facultad de Psicología, Universidad de la Republica Uruguay, Montevideo, Uruguay
  1. Correspondence to Dr Jeffrey E Harris, Department of Economics, Massachusetts Institute of Technology, 77 Massachusetts Avenue E52-422, Cambridge, MA 02139, USA; jeffrey{at}


Background Uruguay, a South American country of 3.4 million inhabitants that has already banned tobacco advertising, prohibited such terms as light, mild and low-tar and required graphic warnings covering 80% of cigarette packs, is considering the imposition of plain, standardised packaging.

Methods We conducted an experimental choice-based conjoint analysis of the impact of alternative cigarette package designs on the risk perceptions of 180 adult current Uruguayan smokers. We compared plain packaging, with a standardised brand description and the dark brown background colour required on Australian cigarette packages, to two controls: the current package design with distinctive brand elements and colours; and a modified package design, with distinctive brand elements and the dark brown background colour. Graphic warnings were also varied.

Results Plain packaging significantly reduced the probability of perceiving the stimulus cigarettes as less harmful in comparison to the current package design (OR 0.398, 95% CI 0.333 to 0.476, p<0.001) and the modified package design (OR 0.729, 95% CI 0.626 to 0.849, p<0.001).

Conclusions Plain packaging enhanced the perceived risk of cigarette products even in a highly regulated setting such as Uruguay. Both the elimination of distinctive brand elements and the use of Australia’s dark brown background colour contributed to the observed effect.

  • Cigarettes
  • plain packaging
  • choice-based conjoint analysis
  • health warnings
  • risk perception
  • Uruguay

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  • Contributors All coauthors contributed to the conceptualisation and design of the study. GA and LM carried out the experimental procedures. GA, MG and JH were principally responsible for analysis of the data. GA, MG, JH and PT contributed to the drafting of the manuscript. All coauthors approved the final manuscript before submission.

  • Funding We gratefully acknowledge the financial support of the Unión Contra la Tuberculosis y Enfermedades Respiratorias through an unrestricted grant to the Tobacco Control Program of the Ministry of Public Health of Uruguay.

  • Competing interests None declared.

  • Ethics approval Ethics Committee of the School of Chemistry of the Universidad de la República, Uruguay.

  • Provenance and peer review Not commissioned; externally peer reviewed.