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Assessing cigarette packaging and labelling policy effects on early adolescents: results from a discrete choice experiment
  1. Inti Barrientos-Gutierrez1,
  2. Farahnaz Islam2,
  3. Yoo Jin Cho3,
  4. Ramzi George Salloum4,
  5. Jordan Louviere5,
  6. Edna Arillo-Santillán1,
  7. Luz Myriam Reynales-Shigematsu1,
  8. Joaquin Barnoya6,
  9. Belen Saenz de Miera Juarez7,
  10. James Hardin2,
  11. James F. Thrasher1,3
  1. 1Tobacco Research Department, National Institute of Public Health, Cuernavaca, Mexico
  2. 2Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA
  3. 3Department of Health Promotion, Education and Behavior, University of South Carolina, Columbia, South Carolina, USA
  4. 4Health Outcomes and Policy, University of Florida, Gainesville, Florida, USA
  5. 5School of Marketing, University of South Australia, Adelaide, South Australia, Australia
  6. 6Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, St. Louis, Mississippi, USA
  7. 7Department of Economics, Universidad Autonoma de Baja California Sur, La Paz, Mexico
  1. Correspondence to Dr James F. Thrasher, Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia SC 29208, South Carolina, USA; thrasher{at}


Introduction Cigarette packaging is a primary channel for tobacco advertising, particularly in countries where traditional channels are restricted. The current study evaluated the independent and interactive effects of cigarette packaging and health warning label (HWL) characteristics on perceived appeal of cigarette brands for early adolescents in Mexico.

Methods A discrete choice experiment (DCE) was conducted with early adolescents, aged 12–14 years (n=4251). The DCE involved a 3×25 design with six attributes: brand (Marlboro, Pall Mall, Camel), tobacco flavour (regular, menthol), flavour capsule (none, 1 or 2 capsules), presence of descriptive terms, branding (vs plain packaging), HWL size (30%, 75%) and HWL content (emphysema vs mouth cancer). Participants viewed eight sets of three cigarette packs and selected a pack in each set that: (1) is most/least attractive, (2) they are most/least interested in trying or (3) is most/least harmful, with a no difference option.

Results Participants perceived packs as less attractive, less interesting to try and more harmful if they had plain packaging or had larger HWLs, with the effect being most pronounced when plain packaging is combined with larger HWLs. For attractiveness, plain packaging had the biggest influence on choice (43%), followed by HWL size (19%). Interest in trying was most influenced by brand name (34%), followed by plain packaging (29%). Perceived harm was most influenced by brand name (30%), followed by HWL size (29%).

Conclusion Increasing the size of HWLs and implementing plain packaging appear to reduce the appeal of cigarettes to early adolescents. Countries should adopt these policies to minimise the impact of tobacco marketing.

  • packaging and labelling
  • advertising and promotion
  • prevention
  • low/middle income country
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  • Contributors JT and JL designed the study. JT, IBG, EAS and LMRS collected the data. FI performed the data analysis. JT and YJC helped with the interpretation of results. IBG and FI wrote the first draft. YJC widely edited the manuscript. RGS, JB and BSdMJ provided critical feedback on the manuscript. The final version of this paper has been reviewed and approved by all coauthors.

  • Funding Data collection for this study was supported by a grant from the Fogarty International Center and National Cancer Institute of the National Institutes of Health (R01 TW009274). Data analyses and manuscript writing were supported by a grant from the Fogarty International Institute (R01 TW010652).

  • Disclaimer The funding agencies played no role in study design, in the collection, analysis and interpretation of data, in the writing of the report and in the decision to submit the article for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

  • Data availability statement Data are available upon reasonable request.

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