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

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

Research output: Contribution to journalArticlepeer-review

5 Citations (SciVal)


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 18 to 40 years old. Measurements: For 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. Findings: We 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. 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.

Original languageEnglish
Pages (from-to)1737-1747
Number of pages11
Issue number6
Early online date9 Dec 2021
Publication statusPublished - 30 Jun 2022

Bibliographical note

Funding Information:
C.S.R. time is supported by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service (NHS) Foundation Trust. Funding for the research came from a University of Bristol GCRF Pump Priming Call (2018–2019) awarded to O.M. entitled ‘Eye‐tracking to evaluate the impact of Colombian tobacco control policies’.


  • Colombia
  • South America
  • discrete choice
  • eye-tracking
  • health warnings
  • plain packaging
  • standardised packaging
  • tobacco

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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