Bigger warnings, higher taxes: the combo that makes smokers quit

By Francis Allan L. Angelo

A 23 percent increase in the cigarette excise tax — raising the rate from PHP 69.46 to PHP 90.00 per pack — could motivate roughly 5.5 million Filipinos who smoke to consider quitting, according to new peer-reviewed research published this week in the journal Tobacco Induced Diseases.

The study, conducted by researchers from the Johns Hopkins Bloomberg School of Public Health’s Institute for Global Tobacco Control, surveyed 886 Filipino adults who smoke across the three primary regions of the Philippines — Luzon, Visayas, and Mindanao — and found that higher prices through taxation and larger health warning labels with graphic images covering 85 percent of the cigarette pack prompted respondents to say they would start thinking about quitting.

“If the excise tax on cigarettes were increased to PHP 90.00 per pack—a 23% increase from its current rate—roughly 5.5 million more Filipinos who smoke might consider quitting,” estimated Lauren Czaplicki, Ph.D., lead author and associate scientist at the IGTC at the Johns Hopkins Bloomberg School of Public Health.

“The price of a pack of cigarettes and what it looks like both inform purchasing decisions, so raising taxes and making graphic warnings large, bold, and difficult to ignore raise the chance that someone will stop smoking or, even better, never start—that’s what makes these two measures so effective at deterring smoking and encouraging people to quit, especially when deployed in tandem,” Czaplicki said.

More than 13 million Filipinos smoke cigarettes, the country’s most prevalent form of tobacco use. While rates of cigarette smoking have decreased over time, from 27.0 percent in 2009 to 17.4 percent in 2021, tobacco use in the Philippines remains among the highest in the Western Pacific, causing nearly 100,000 preventable deaths among Filipinos every year.

Smokers are asking higher taxes

In what the study’s authors and advocates describe as a rare case of a constituency essentially asking for a tax hike, the Filipino smokers surveyed indicated that higher prices and larger warnings would help them quit.

“The Filipinos surveyed are essentially saying, ‘Taxes should be raised to help me stop smoking,’ and ‘Larger health warnings will discourage me from smoking,’ so tobacco consumers themselves are telling Philippine policymakers how to help them quit smoking,” said Dr. Ulysses Dorotheo, executive director of the Southeast Asia Tobacco Control Alliance.

“Higher prices and much larger pictorial warning images make cigarettes less appealing and can strengthen the resolve to stop smoking and live longer, healthier, and free of smoking,” Dorotheo said.

“Government must be made aware of this evidence showing that a substantial number of people who smoke would quit if the tobacco tax rates would increase by 23%, from the current PHP 69.46 to PHP 90.00,” said Filomeno Sta. Ana III, executive director of Action for Economic Reforms. “In other words, creating a financial barrier makes quitting easier while making it harder for youth to purchase and consume harmful products—so it’s sound policy for the government to continue imposing higher taxes to make cigarettes less affordable.”

Currently in the Philippines, taxes represent only 51 percent of the price of a pack of cigarettes, even as the excise tax rate increases by 5 percent every year beginning in 2024, as mandated by Republic Act No. 11467.

The illicit pack loophole

The study exposed a significant enforcement gap: foreign cigarette packs sold without the legally mandated graphic health warning labels are perceived as less harmful by smokers, effectively undermining domestic tobacco control policies.

The research found that smokers were over five times more likely to perceive a branded foreign pack without a health warning label as the least harmful option compared to a branded domestic pack that featured a 50 percent warning label. The absence of these labels on illicit or foreign packs diminishes the consumer’s perception of the product’s actual danger.

The study noted that a track and trace program helps reduce the illicit trade of foreign cigarette packs. By curbing the availability of these illegal products, such a program would prevent them from undermining national tobacco control policies that rely on strict packaging regulations and price increases through excise taxes.

The menthol blind spot

Nearly three-quarters of the surveyed smokers reported that their last purchased pack was menthol, yet the Philippines has no restrictions on the sale of flavored cigarettes — and the study results did not show significant differences in hypothetical quitting behaviors based on flavor.

The researchers emphasized that more country-specific studies are needed to understand how Filipino smokers would actually respond to a national menthol ban, even though there is a growing global evidence base supporting the effectiveness of such bans. Each study participant was shown images of cigarette packs that varied by price, warning label size and branding, and flavor — either unflavored tobacco or menthol.

Plain packaging

Plain packaging laws require cigarette packs to be sold with no branding and a single color presentation. Countries including Australia, the United Kingdom, and France have implemented such laws, which work by removing the marketing appeal of the pack itself.

The research found that using plain packaging, especially when combined with larger health warning labels such as 85 percent coverage, is more effective at motivating quit attempts than standard branded packs with smaller warnings. Plain packaging has also been found to be particularly effective at reducing smoking initiation among those who do not yet smoke.

Implemented in 2016, Republic Act No. 10643 requires graphic warning labels printed on cigarette packs covering 50 percent of the front and back principal display surfaces and 30 percent of the sides. The graphic health warning labels currently in rotation on Philippine cigarette packs include explicit images of nose cancer.

The study found that expanding health warning label coverage from the current 50 percent to 85 percent of the pack significantly increased the likelihood that smokers would think about quitting. Survey participants had over three times higher odds of selecting packs with 85 percent health warning label coverage — whether on branded or plain packaging — as the ones that would most make them consider quitting, compared to standard packs with 50 percent coverage.

What a cigarette box is actually doing to your brain

The study revealed that branding on a cigarette pack actively lowers a smoker’s perception of harm, while graphic warnings amplify it. The presence or absence of health warning labels plays a decisive role in how harmful a smoker believes the product is.

Smokers were over five times more likely to view a branded foreign pack with no health warning label as less harmful compared to a branded domestic pack featuring a 50 percent health warning label. Conversely, ensuring that packs carry at least a 50 percent health warning label effectively increases the smoker’s perception of the product’s harm and reduces the appeal of illicit or unlabeled packs.

The findings suggest that cigarette packaging design functions as a tool that can either engineer addiction through marketing appeal or engineer its way back out through regulation — a dynamic that underscores the importance of packaging policy as a public health lever.

Which lever works harder: taxes or health warnings?

The study deployed both policy levers — taxation and packaging — but found that they work through different mechanisms. Increasing excise taxes creates a financial barrier that directly decreases a smoker’s intention to purchase a pack and increases their likelihood of considering cessation. Larger health warning labels, meanwhile, amplify the perception of harm and strengthen the emotional case for quitting.

Deployed together, higher prices and strict packaging laws deter smoking and increase the chance that young people never start. The results correlate with a similar study conducted in Vietnam and underscore the importance of embracing policies aligned with the World Health Organization’s Framework Convention on Tobacco Control, which the Philippines ratified in 2005.

Raising the price of cigarette packs through taxes and expanding the size of health warning labels on cigarette packaging are two of the most effective ways to reduce tobacco use, according to the WHO. These prevention measures are also requirements of the FCTC.

The researchers noted, however, that additional studies are needed to provide deeper insights into exactly how tax increases and packaging policies influence the appeal of cigarettes specifically among youth and nonsmokers.