Preferences on cigarette plain packaging among adults who smoke and adults who do not smoke: a discrete choice...

Chile has one of the highest smoking prevalence rates in the Americas, particularly among women, yet plain packaging legislation has been repeatedly blocked in Parliament over the past decade.

An online discrete choice experiment (DCE) was conducted with 1029 participants (731 adults who smoke and 298 who do not). Each choice set presented three packages varying in price, packaging design (branded or plain), stick design (branded or with warnings) and origin (licit or illicit), plus an opt-out option. A latent class model was used to identify distinct preference groups.

Among adults who smoke, two classes were identified. Class I (40% membership) was price-sensitive for both licit and illicit packages and preferred plain over branded packaging and sticks with health warnings over branded sticks. Class II (60%) was not significantly price-sensitive, preferred branded packaging and branded sticks and showed a negative preference for illicit packages over not smoking. Among adults who do not smoke, two classes were also identified: one preferring branded packaging and sticks, and the other showing no significant preference for design attributes. Combining a 50% price increase with plain packaging and warning sticks reduced predicted package uptake among adults who smoke by 7.7 percentage points (-12.0 for licit and +4.2 for illicit).

The study demonstrates that a combination of price-based and packaging-focused policies is crucial for effective tobacco control. Because distinct consumer groups respond differently to interventions, implementing both price increases and design-based warnings is necessary to achieve a broader reduction in tobacco consumption.