BACKGROUND: Despite growing evidence supporting plain packaging, only 19 countries had implemented this policy by 2021. Chile, with the highest smoking prevalence among women in Latin America, has yet to adopt plain packaging. This study aims to estimate the effect of plain packaging and health warning labels on smokers' cigarette uptake and non-smokers' intention to try.
METHODS: Seven hundred thirty-one smokers and 298, 18 and older, non-smokers participated in an online nationally representative discrete choice experiment (DCE). Participants chose between three cigarette packages (licit and illicit) and an opt-out option. Licit package attributes were price, packaging design (branded or plain), and stick design (branded or with health warnings). Illicit packages had only the price attribute. We estimated the preference for attributes using a latent class model with two classes was used to estimate attribute preferences. Using the estimated coefficients, we simulated the effect of policy scenarios of a 50% price increase, the adoption of plain packaging, and warning sticks.
RESULTS: We found that, among smokers, 40% decreased cigarette uptake with plain packaging and warning stick policies, while 60% decreased with price policies. For non-smokers, both groups reduced uptake with price policies; 44% decreased with packaging and stick policies, and 56% did not. Implementing a 50% price increase with plain packaging and warning sticks reduced cigarette uptake by 4.3% among smokers (95% CI: 1.2%–7.4%). Among non-smokers, the reduction was 4.3%, but not significant (95% CI: −9.6%–18.2%). A limited substitution effect between licit and illicit packages was observed.
CONCLUSIONS: Price increases, plain packaging, and sticks with health warnings reduce cigarette uptake. Both price policies and stick and packaging are necessary to minimise uptake, as some individuals react to price and others to packaging and stick policies. Measures to reduce the illicit trade in tobacco products are essential to maximise the effectiveness of these policies.