Standardised packs and larger health warnings: visual attention and perceptions among Colombian smokers and non-smokers.

Carlos Sillero‐Rejon,Ricardo M Tamayo,Sally Adams,Olivia M Maynard,Alvaro Arturo Clavijo‐Alvarez,Osama Mahmoud

doi:10.1111/add.15779

Abstract

AimsTo measure how cigarette packaging (standardised packaging and branded packaging) and health warning size affect visual attention and pack preferences among Colombian smokers and non‐smokers.DesignTo explore visual attention, we used an eye‐tracking experiment where non‐smokers, weekly smokers and daily smokers were shown cigarette packs varying in warning size (30%‐pictorial on top of the text, 30%‐pictorial and text side‐by‐side, 50%, 70%) and packaging (standardised packaging, branded packaging). We used a discrete choice experiment (DCE) to examine the impact of warning size, packaging and brand name on preferences to try, taste perceptions and perceptions of harm.SettingEye‐tracking laboratory, Universidad Nacional de Colombia, Bogotá, Colombia.ParticipantsParticipants (n = 175) were 18 to 40 years old.MeasurementsFor the eye‐tracking experiment, our primary outcome measure was the number of fixations toward the health warning compared with the branding. For the DCE, outcome measures were preferences to try, taste perceptions and harm perceptions.FindingsWe observed greater visual attention to warning labels on standardised versus branded packages (F[3,167] = 22.87, P < 0.001) and when warnings were larger (F[9,161] = 147.17, P < 0.001); as warning size increased, the difference in visual attention to warnings between standardised and branded packaging decreased (F[9,161] = 4.44, P < 0.001). Non‐smokers visually attended toward the warnings more than smokers, but as warning size increased these differences decreased (F[6,334] = 2.92, P = 0.009). For the DCE, conditional trials showed that increasing the warning size from 30% to 70% reduced preferences to try (odds ratio [OR] = 0.48, 95% CI = [0.42,0.54], P < 0.001), taste perceptions (OR = 0.61, 95% CI = [0.54,0.68], P < 0.001); and increased harm perceptions (OR = 0.78, 95% CI = [0.76,0.80], P < 0.001). Compared with branded packaging, standardised packaging reduced our DCE outcome measures with ORs ranging from OR = 0.25 (95% CI = [0.17,0.38], P < 0.001) to OR = 0.79 (95% CI = [0.67,0.93], P < 0.001) across two brands. These effects were more pronounced among non‐smokers, males and younger participants. Unconditional trials showed similar results.ConclusionsStandardised cigarette packaging and larger health warnings appear to decrease positive pack perceptions and have the potential to reduce the demand for cigarette products in Colombia.

Highlights

Smoking causes 10% of all deaths among Colombian adults and the prevalence of smoking among children is higher than in other middleincome countries [1,2]
Standardised cigarette packaging and larger health warnings appear to decrease positive pack perceptions and have the potential to reduce the demand for cigarette products in Colombia
Visual attention to warnings is greater on standardised than branded packs There was clear evidence of the effect of packaging, such that there was greater visual attention to health warnings when they were placed on standardised (M = 27.26, SD = 38.66) than branded packs (M = 16.73, SD = 37.53)

Summary

Introduction

Smoking causes 10% of all deaths among Colombian adults and the prevalence of smoking among children is higher than in other middleincome countries [1,2]. In Colombia, standardised packaging has yet to be introduced and pictorial warnings (which have featured on packs since 2010 and are changed annually) cover only 30% of the pack surface, thereby only complying with the WHO minimum requirements [5] In countries where these measures have been implemented, there is evidence that they (i) make smoking less appealing, especially among young people [6,7,8], (ii) increase warning noticeability [7,9,10], (iii) prevent people from being misled about the health risks of smoking [7,10,11] and (iv) lead to smoking cessation [8,12,13]. Eye-tracking research can provide insight into how warning size impacts attention and interacts with other factors such as standardised packaging [18]

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Results

Conclusion