IMPACTS OF DIFFERENT ATTRIBUTES OF GRAPHIC HEALTH WARNINGS LABELS ON PREFERENCES OF SMOKERS AND REDUCTION IN TOBACCO DEMAND IN VIETNAM
Independent thesis Advanced level (degree of Master (One Year)), 10 credits / 15 HE creditsStudent thesis
Introduction: Vietnam is one of the lower middle income countries having the highest prevalence of smoking in the world. Health warning labels on tobacco packages were considered as a cost-effectiveness method to reduce the prevalence of smoking, encourage smoking cessation and prevent new smokers. As a party of Framework Convention on Tobacco Control of World Health Organization, Vietnam released policies on establishing graphic health warning labels on tobacco packages since May 1, 2013. The baseline data of the project “Assessing health, economic and social equity impacts of graphic health warning label interventions in Viet Nam” was used as a secondary data to analyze in my thesis. This study was conducted on June and July, 2014 in order to provide information about different health warning labels and evaluate current graphic health warning labels on market. Specifically, two main objectives of the study are: to quantify the relative importance of the different attributes of graphic health warning labels on tobacco packages on preferences of smokers in Vietnam and to estimate the impacts of the graphic health warning labels on the reduction in tobacco demand among smokers in Vietnam.
Method: A discrete choice experiment was used as a study design for this study. Information of 1366 smokers, aged from 15 to 65, was collected through face to face interviews. There were nine Blocks, each with nine choice set questions and one block was randomly assigned to each respondent. Sample size was calculated to get the equal number of each block. Each choice set question contained two tobacco packs displaying a combination between different levels of 4 attributes: Type of message content (Text only, Abstract, Human suffering, Damaged teeth and Lung cancer); Size (30%, 50%, 85%); Position (Lower and Upper position) and Cost (2 000 VND; 12 000 VND; 45 000 VND ; 100 000 VND). In each choice set question, respondent chose which package they prefer to buy or none of them. Conditional logistic regression model was used to analysis the outcomes.
Result: The results showed that all attributes played important role in smokers’ preference. “Type of message content” and “Cost” had the most influence on smokers’ preference with the relative importance being about 4 times higher than “Size” and 11 times higher than “Position”. In term of “Type of message content”, smokers preferred tobacco package with “Text only” warning label than graphic health warning labels (Coefficient: 0.97, p<0.05, 95% CI: 0.90 to 1.05) and “Human suffering” was preferred less than other graphic health warning labels (Coefficient: -0.16; p<0.05 ; 95% CI: -0.23 to -0.010). Furthermore, smokers were more interested in health warning labels covering 50% or less on display area of tobacco package than the one covering 85%. The coefficient of covering 30% and 50% were 0.20 and 0.02, respectively. Cost was also added in Discrete choice experiment, therefore, marginal willingness to pay can be calculated. The result of conditional logistic regression model indicated that on average, respondents were willing to pay about 59 000 VND for a tobacco package with text only health warning label. To trade-off between levels of “Type of message content” on tobacco package, respondent were willing to pay 47 000 VND to exchange “Lung cancer” warning label to “Damaged teeth” warning label, about 9 600 VND to exchange “Human suffering” warning label to “Abstract” warning label and 2 400 VND to exchange “Abstract” warning label to “Text only” warning label. Lastly, health warning labels had effects on reducing smoking demand and these impacts were different among respondents who had different socioeconomic characteristic. The tobacco package with lung cancer picture had the most effect on reducing tobacco demand among smokers with 10% reduced of smoking demand, comparing with the old tobacco package with text only health warning labels. To specify, the graphic health warning labels had the strongest effect on aged 45-65 with 10.8% difference between old and new package, while it had less effect on the younger aged, with the reduction on tobacco demand of aged 25-44 and 15-24 were 9.9% and 8.9%, respectively.
Conclusion: Type of message content and cost were most important with smokers’ preference and Text only health warning label was preferred than graphic health warning. Increasing size of health warning labels may reduce smokers’ interest on smoking while changing position of health warning labels does not bring significant influence on smokers’ preference.
Key words: Graphic health warning label, tobacco packages, smokers’ preferences, Vietnam, FCTC, Discrete choice experiment, marginal willingness to pay, smoking demand, etc.
Place, publisher, year, edition, pages
2015. , 46 p.
, Centre for Public Health Report Series, ISSN 1651-341x ; 2015:49
Graphic health warning label, tobacco packages, smokers’ preferences, Vietnam, FCTC, Discrete choice experiment, marginal willingness to pay, smoking demand
Medical and Health Sciences Public Health, Global Health, Social Medicine and Epidemiology
IdentifiersURN: urn:nbn:se:umu:diva-119529OAI: oai:DiVA.org:umu-119529DiVA: diva2:922031
Centre of Health Systems Research – Hanoi Medical University, Vietnam
Master's Programme in Public Health (one-year)
2015-05-25, A311, Caring Sciences Building, Umea, 09:30 (English)
Nilsson, Maria, Associate ProfessorHoang Van, Minh, Associate Professor
Dahlblom, Kjerstin, Forskare
ProjectsAssessing health, economic and social equity impacts of graphic health warning label interventions in Viet Nam