Aims

To 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.

Design

To 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.

Setting

Eye-tracking laboratory, Universidad Nacional de Colombia, Bogotá, Colombia.

Participants

Participants (n=175) were aged 18-40 years.

Measurements

For the eye-tracking experiment, our primary outcome measure was the number of fixations towards the health warning compared with the branding. For the DCE, outcome measures were preferences to try, taste perceptions and harm perceptions.

Findings

We observed greater visual attention to warning labels on standardised versus branded packages (F(3,167)=22.87, p<.001) and when warnings were larger (F(9,161)=147.17, p<.001); as warning size increased, the difference in visual attention to warnings between standardised and branded packaging decreased (F(9,161)=4.44, p<.001). Non-smokers visually attended towards the warnings more than smokers, but as warning size increased these differences decreased (F(6,334)=2.92, p=.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%confidence interval [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 odds ratios ranged 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.

Conclusions

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.