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Evaluation of strategies to communicate harmful and potentially harmful constituent (HPHC) information through cigarette package inserts: a discrete choice experiment
  1. Ramzi G Salloum1,
  2. Jordan J Louviere2,
  3. Kayla R Getz1,
  4. Farahnaz Islam3,
  5. Dien Anshari3,4,
  6. Yoojin Cho3,
  7. Richard J O'Connor5,
  8. David Hammond6,
  9. James F Thrasher3
  1. 1Department of Health Outcomes and Policy and Institute for Child Health Policy, College of Medicine, University of Florida, Gainesville, Florida, USA
  2. 2Institute for Choice and School of Marketing, University of South Australia, Adelaide, South Australia, Australia
  3. 3Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  4. 4Department of Health Education and Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Depok, Jawa Barat, Indonesia
  5. 5Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
  6. 6School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
  1. Correspondence to Dr James F Thrasher, Discovery 534D, 915 Greene Street, Columbia, South Carolina 29208, USA; thrasher{at}


Background The US Food and Drug Administration (FDA) has regulatory authority to use inserts to communicate with consumers about harmful and potentially harmful constituents (HPHCs) in tobacco products; however, little is known about the most effective manner for presenting HPHC information.

Methods In a discrete choice experiment, participants evaluated eight choice sets, each of which showed two cigarette packages from four different brands and tar levels (high vs low), accompanied by an insert that included between-subject manipulations (ie, listing of HPHCs vs grouping by disease outcome and numeric values ascribed to HPHCs vs no numbers) and within-subject manipulations (ie, 1 of 4 warning topics; statement linking an HPHC with disease vs statement with no HPHC link). For each choice set, participants were asked: (1) which package is more harmful and (2) which motivates them to not smoke; each with a 'no difference' option. Alternative-specific logit models regressed choice on attribute levels.

Results 1212 participants were recruited from an online consumer panel (725 18–29-year-old smokers and susceptible non-smokers and 487 30–64-year-old smokers). Participants were more likely to endorse high-tar products as more harmful than low-tar products, with a greater effect when numeric HPHC information was present. Compared with a simple warning statement, the statement linking HPHCs with disease encouraged quit motivation.

Conclusions Numeric HPHC information on inserts appears to produce misunderstandings that some cigarettes are less harmful than others. Furthermore, brief narratives that link HPHCs to smoking-related disease may promote cessation versus communications that do not explicitly link HPHCs to disease.

  • packaging and labelling
  • public policy
  • carcinogens

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  • Contributors JFT conceptualised and designed the project and obtained research funding. JFT, RGS and JJL contributed to the design of this study. RGS, JJL, KRG and FI were responsible for data analysis reported in this paper. All authors contributed to the interpretation of the findings. All authors contributed to successive drafts and approved the final manuscript.

  • Competing interests None declared.

  • Ethics approval University of South Carolina Institutional Review Board.

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