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Evaluating US smokers’ willingness to pay for different cigarette packaging designs before and after real-world exposure in a randomised trial
  1. Matthew Stone1,
  2. Claudiu Dimofte2,
  3. David Strong3,4,
  4. Kim Pulvers5,
  5. Noe C Crespo6,
  6. Eric C Leas3,4,
  7. John P Pierce3,4
  1. 1 Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
  2. 2 Marketing, San Diego State University, San Diego, California, USA
  3. 3 Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
  4. 4 Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
  5. 5 Psychology, California State University San Marcos, San Marcos, California, USA
  6. 6 School of Public Health, San Diego State University, San Diego, California, USA
  1. Correspondence to Dr Matthew Stone, Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; matthew.stone1{at}


Introduction Removal of tobacco industry branding from cigarette packs may reduce their appeal. Adding graphic warning labels (GWLs) should enhance this effect. We investigate whether willingness to pay for various packaging designs changes after 3 months’ use of: (1) US branded packs without GWLs (US), (2) non-branded packs without GWLs (Blank), and (3) rotating non-branded packs with GWLs (gangrene; throat cancer; neonatal baby) covering >75% of pack (GWL).

Methods Californian adult daily smokers not planning to quit (n=287; 56% female; mean age=39.6) completed a discrete choice purchase task before and after 3 months’ experience using one of three packaging options. Conjoint analysis and pre-post modelling evaluated the change in importance of pack attributes and willingness to pay for US, Blank or GWL (blindness; teeth; gangrene) pack designs.

Results Price determined ~70% of purchase choices, while pack design determined ~22%. Irrespective of intervention arm, US packaging generated appeal valuations compared with Blank packaging, while GWLs consistently provoked strong aversive valuations at baseline and follow-up. Compared with the US pack arm, using GWL packs for 3 months decreased willingness to pay for US packaging (β=−$0.38, 95% CI −0.76 to 0.00). Wear-out effects were detected in the discount needed to willingly purchase the gangrene-GWL pack (β=$0.49, 95% CI 0.16 to 0.82) and Blank pack (β=$0.42, 95% CI 0.09 to 0.74) but not for GWLs (blindness, teeth) not used in trial.

Conclusion Compared with US branded packs, the negative valuation of non-branded GWL packs attenuates with even 3 months’ use but does not generalise to non-used GWLs. This suggests that GWLs should be regularly refreshed. The appeal valuation of industry imagery suggests that the US plan to retain such imagery on packs may ameliorate the effect of GWLs.

  • price
  • packaging and labelling
  • public policy

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors DS and JPP were coprincipal investigators responsible for the study and data collection. MS, CD, DS and JPP helped conceptualise the study. MS conducted the analyses. MS prepared the tables and figures and wrote the majority of the manuscript with the help of JPP. CD, DS, JPP, ECL, NCC, and KP aided in interpreting the analysis and critically reviewed and revised the manuscript. DS and MS had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the manuscript. MS, DS, and JPP are guarantors for the study.

  • Funding This project was supported in part by the National Cancer Institute Grant (R01-CA190347) and the Tobacco-Related Disease Research Program Grant (28DT-0005).

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NCI or TRDRP.

  • Competing interests None declared.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.