Tobacco control policies that influence Filipino adults who smoke: Results from a discrete choice experiment

In the Philippines, approximately 13 million adults smoke. Policies to raise cigarette taxes, increase health warning label (HWL) size, and restrict menthol could reduce smoking.

We conducted an online discrete choice experiment (DCE) in November 2023 to assess hypothetical policy responses among 886 Filipino adults who smoke across three regions of the Philippines (Luzon, Visayas, Mindanao). The DCE included ten choice sets of three cigarette packs. Packs varied on excise tax [60 (ref.), 70, 80, 90 pesos (PHP)], packaging [domestic packs: 50% HWL branded (ref.), 50% HWL plain, 85% HWL branded, 85% HWL plain; foreign pack, no HWL], and flavor [tobacco (ref.), menthol]. Participants were randomly assigned to see one choice set using a programmed 1:1 randomization ratio and asked to select which pack: 1) they would choose, 2) would make them most consider quitting, and 3) would be less harmful.

Participants had lower odds of choosing packs with a 70 (adjusted odds ratio, AOR=0.58; 95% CI: 0.45-0.74), 80 (AOR=0.33; 95% CI: 0.25-0.43), or 90 (AOR=0.24; 95% CI: 0.18-0.33) PHP excise tax, and higher odds (AOR=4.02; 95% CI: 2.86-5.66) of choosing the foreign branded pack with no HWL. For quitting, participants had higher odds of selecting packs with an 80 (AOR=1.53; 95% CI: 1.18-1.99) or 90 (AOR=1.94; 95% CI: 1.50-2.51) PHP tax and 3.40 (95% CI: 2.58-4.46) and 3.30 (95% CI: 2.42-4.49) higher odds of selecting a branded or plain pack with 85% HWL coverage, respectively. Participants had lower odds of thinking packs with a 70 (AOR=0.69; 95% CI: 0.52-0.92), 80 (AOR=0.73; 95% CI: 0.56-0.96), or 90 (AOR=0.67; 95% CI: 0.50-0.89) PHP excise tax were less harmful and higher odds (AOR=5.21; 95% CI: 3.70-7.32) of thinking the foreign pack was less harmful.

Results suggest raising the excise tax to at least 80 PHP and implementing 85% HWLs may encourage smoking cessation in the Philippines. Our findings can be used by policymakers and advocates in the Philippines to implement strong tobacco control policies to protect public health.