Evaluation of in-pack efficacy inserts: two discrete choice studies from Aotearoa New Zealand

BACKGROUND: Efficacy inserts aim to increase confidence in quitting and resulting benefits. We tested three efficacy insert elements (images, headline formats and explanatory messages) representing three themes: price, health and family and explored how priority groups (Māori, people aged under 35 and people with children under 16) responded to these. METHODS: Two online, discrete choice experiments with 970 people who smoked daily or who had recently quit assessed how varied images, and statement and question headlines, affected confidence in making a quit attempt and the perceived helpfulness of informational and testimonial messages. We used Conditional Logit Models with interactions to estimate priority groups' responses in both experiments. RESULTS: In experiment 1, health and family themed images generated greater confidence in quitting than price themed images, and question formats were more effective than statement formats. Māori, people under 35 and people with young children responded more strongly to the family theme than non-Māori, people older than 35 and people without young children. In experiment two, themes were less impactful than message execution; the price theme was most impactful, and informational messages were seen as more helpful than testimonials. Priority groups perceived family themes as more helpful than did non-priority groups, and Māori and people with young children responded more strongly than non-priority groups to testimonial executions. CONCLUSIONS: In-pack efficacy inserts are a low-cost intervention for increasing quitting efficacy among people who smoke. Population groups' varied responses to different themes mean policy makers should consider implementing pack inserts with diverse themes.