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Cohen JE, Amalia B, Luo W, McWhirter KJ, Masanga BC, Pankow JF. Eugenol, menthol and other flavour chemicals in kreteks and 'white' cigarettes purchased in Indonesia. Tob Control 2024; 33:637-640. [PMID: 37094935 DOI: 10.1136/tc-2022-057827] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 04/12/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Flavoured tobacco products are not restricted in Indonesia, a country with about 68 million adults who smoke. Most use clove-mixed tobacco cigarettes ('kreteks'); non-clove ('white') cigarettes are also available. Although the use of flavour chemicals has been identified by WHO as promoting tobacco use, little has been reported for Indonesia about the levels of flavourants in either kreteks or 'white cigarettes'. METHODS 22 kretek brand variants and nine 'white' cigarette brand variants were purchased in Indonesia during 2021/2022; one of the kretek packs contained three colour-coded variants, giving a total sample number of 24 for the kreteks. Chemical analyses gave the mg/stick (=mg/(filter+rod)) values for 180 individual flavour chemicals that included eugenol (a clove-flavoured compound), four other clove-related compounds and menthol. RESULTS Eugenol was present at significant levels in all 24 kreteks (2.8-33.8 mg/stick), but was essentially absent in all of the cigarettes. Menthol was present in 14 of 24 kreteks, with levels ranging from 2.8 to 12.9 mg/stick, and in five of the nine cigarettes, with levels ranging from 3.6 to 10.8 mg/stick. Other flavour chemicals were also found in many of the kretek and cigarette samples. CONCLUSIONS In this small sample, we found numerous variations of flavoured tobacco products offered by multinational and national companies in Indonesia. Given the body of evidence that flavours make tobacco products more appealing, regulation of clove-related compounds, menthol and other flavour chemicals should be considered in Indonesia.
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Affiliation(s)
- Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Beladenta Amalia
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Wentai Luo
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon, USA
| | - Kevin J McWhirter
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon, USA
| | - Braden C Masanga
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon, USA
| | - James F Pankow
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon, USA
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Ackary SJ, Cabrera PJD, Santiago AJA, Amul GGH. An analysis of flavor descriptors on tobacco products in the Philippines: Regulatory implications and lessons for low- and middle-income countries. Global Health 2024; 20:67. [PMID: 39252089 PMCID: PMC11385504 DOI: 10.1186/s12992-024-01072-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Accepted: 09/02/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Historically, tobacco companies have used flavored tobacco products to enhance the appeal of tobacco consumption, encourage initiation and experimentation of tobacco use, and contribute to sustained tobacco use. While flavored tobacco products are regulated in several countries, there is no existing regulation on flavored tobacco products in the Philippines, specifically for cigarettes and cigars. This study aims to update evidence on the flavored tobacco product landscape in the Philippines by assessing both the flavor descriptors and flavor imagery featured on cigarette and cigar packaging. RESULTS We collected 106 cigarette and cigar products from four major cities in the National Capital Region, Balanced Luzon, Visayas, and Mindanao. Of these 106 cigarette and cigar products, 62 (58.49%) had flavor descriptors. Three crushable capsule products did not feature any flavor descriptor but were included for flavor imagery examination. We identified five categories of flavor descriptors: menthol, concept descriptors, tobacco, beverages, and other flavors. Out of 62 packs, ten featured more than one flavor descriptor on the packaging. Menthol flavor descriptors comprised the majority of flavor descriptors. Imagery and other graphic elements closely resonate with and enhance the flavor descriptors found on these packs. CONCLUSIONS This study aimed to update the evidence on the flavored tobacco product landscape in the Philippines and address their absence of regulation. Regulating flavored tobacco products requires a comprehensive policy approach complemented by complete enforcement. Flavor substances, flavor descriptors, and flavor imagery must be regulated altogether; however, it is ideal to enforce a ban on flavored tobacco products in compliance with the WHO FCTC, to which the Philippines is a signatory. Policymakers should consider plain packaging as an intervention to eliminate the appeals associated with flavored tobacco products.
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Affiliation(s)
- Samantha J Ackary
- School of Government, Ateneo de Manila University, Quezon City, Philippines.
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van der Eijk Y, Tan GPP, Makhbal B. Is It Time to Ban Flavored Cigarettes in Asia-Pacific Countries? A Scoping Review. Asia Pac J Public Health 2024; 36:542-549. [PMID: 39054851 DOI: 10.1177/10105395241266042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
Flavored cigarettes encourage youth smoking and deter quitting. No country in Asia-Pacific, a region with some of the world's highest smoking rates, has regulated tobacco flavors. We examined market data, academic literature, and gray literature to describe what is known on flavored cigarettes in the Asia-Pacific region. Of the 12 countries for which market data were available, ten had substantial flavored cigarette market shares ranging from 10% to 97%. With no regulations and growing markets for flavor capsule variants, the tobacco industry's ongoing promotion of flavored cigarettes, which targets primarily youth and women, is expected to drive further increases in smoking prevalence. There are significant research and monitoring gaps on the industry's marketing tactics and use of flavored cigarettes in the region. Given the large market shares, Asia-Pacific countries stand to benefit substantially from a tobacco flavors ban.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Kyriakos CN, Erinoso O, Driezen P, Thrasher JF, Katanoda K, Quah ACK, Tabuchi T, Perez CDA, Seo HG, Kim SY, Nordin ASA, Hairi FM, Fong GT, Filippidis FT. Prevalence and perceptions of flavour capsule cigarettes among adults who smoke in Brazil, Japan, Republic of Korea, Malaysia and Mexico: findings from the ITC surveys. BMJ Open 2024; 14:e083080. [PMID: 38642995 PMCID: PMC11033647 DOI: 10.1136/bmjopen-2023-083080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 04/02/2024] [Indexed: 04/22/2024] Open
Abstract
INTRODUCTION The global market of flavour capsule cigarettes (FCCs) has grown significantly over the past decade; however, prevalence data exist for only a few countries. This study examined prevalence and perceptions of FCCs among adults who smoke across five countries. METHODS Cross-sectional data among adults who smoked cigarettes came from the International Tobacco Control Policy Evaluation Project Surveys-Brazil (2016/2017), Japan (2021), Republic of Korea (2021), Malaysia (2020) and Mexico (2021). FCCs use was measured based on reporting one's usual/current brand or favourite variety has flavour capsule(s). Perceptions of the harmfulness of one's usual brand versus other brands were compared between those who used capsules versus no capsules. Adjusted logistic regression models examined correlates of FCC use. RESULTS There were substantial differences in the prevalence of FCC use among adults who smoke across the five countries: Mexico (50.3% in 2021), Republic of Korea (31.8% in 2021), Malaysia (26.5% in 2020), Japan (21.6% in 2021) and Brazil (6.7% in 2016/2017). Correlates of FCC use varied across countries. Capsule use was positively associated with being female in Japan and Mexico, younger age in Japan, Republic of Korea and Malaysia, high education in Brazil, Japan and Mexico, non-daily smoking in Republic of Korea, and having plans to quit in Japan and Republic of Korea. There was no consistent pattern of consumer perceptions of brand harmfulness. CONCLUSION Our study documented the high prevalence of FCCs in some countries, pointing to the need to develop and implement regulatory strategies to control these attractive products.
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Affiliation(s)
- Christina N Kyriakos
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | | | - Pete Driezen
- School of Public Health Sciences, University of Waterloo, Waterloo, Ontario, Canada
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Kota Katanoda
- Division of Cancer Statistics Integration, Center for Cancer Control and Information Services, National Cancer Center Japan, Chuo-ku, Japan
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Cristina de Abreu Perez
- National School of Public Health Sérgio Arouca, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Hong Gwan Seo
- Department of Family Medicine, National Cancer Center, Goyang, South Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Su Young Kim
- National Tobacco Control Center, Korean Health Promotion Institute, Seoul, South Korea
| | - Amer Siddiq Amer Nordin
- Nicotine Addiction Research Group, Centre of Addiction Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Psychological Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Farizah Mohd Hairi
- Nicotine Addiction Research Group, Centre of Addiction Sciences, Universiti Malaya, Kuala Lumpur, Malaysia
- Department of Social and Preventive Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Geoffrey T Fong
- School of Public Health Sciences and Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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Barker HE, Czaplicki L, Cui Y, Shen R, Nian Q, Xie M, Cohen JE. Exposure to and Appeal of Tobacco Ads and Displays in China: A Qualitative Exploration of Chinese Youth Perceptions. Nicotine Tob Res 2024; 26:427-434. [PMID: 37788378 PMCID: PMC10959156 DOI: 10.1093/ntr/ntad192] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Adolescents are uniquely vulnerable to nicotine addiction, and smoking is common among male adolescents in China. Although China implemented a ban on cigarette and e-cigarette advertising in public places, Chinese youth remain exposed to this marketing, which may contribute to future use. AIMS AND METHODS From December 2021 to January 2022, we conducted 20 online focus group discussions with 119 adolescents in 10 Chinese cities to explore sources of tobacco marketing exposure, defined as exposure to cigarette and e-cigarette ads and product displays, and what features made marketing attractive. RESULTS All groups discussed exposure to tobacco ads/displays in public places, including locations near their home or school. Nearly all groups discussed that exposure to online tobacco ads was common, particularly exposure to e-cigarette commercial ads and posts made by classmates or friends selling e-cigarettes. Most groups identified how eye-catching colors, imagery, product packaging, and price promotions featured in e-cigarette ads/displays attracted their attention. CONCLUSIONS Results suggest Chinese adolescents are exposed to cigarette and e-cigarette ads and displays, many of which are placed in youth-friendly locations and contain youth-appealing features. IMPLICATIONS Only a handful of studies have examined the influence of cigarette and e-cigarette advertising on youth in the context of China. Prior research has established the relationship between youth exposure to tobacco marketing and increased susceptibility to future use. Our findings emphasize the importance of effectively enforcing and expanding restrictions on cigarette and e-cigarette marketing in order to protect youth from exposure and future smoking/vaping initiation.
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Affiliation(s)
- Hannah E Barker
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Yuxian Cui
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Rachel Shen
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Marn Xie
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
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Cohen JE, Czaplicki L, Crespi E, Brown JL, Luo W, McWhirter KJ, Masanga BC, Pankow JF. Menthol and Other Flavor Chemicals in Cigarettes from Vietnam and the Philippines. Nicotine Tob Res 2024; 26:385-391. [PMID: 37578845 PMCID: PMC10882432 DOI: 10.1093/ntr/ntad146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 06/08/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Tobacco product flavors can increase product appeal, adolescent initiation and experimentation, and difficulty quitting. Flavored tobacco products are not restricted in Vietnam or the Philippines despite the high smoking prevalence among those 15 years of age and older (24% and 23%, respectively). There are no published reports to our knowledge on the levels of flavor chemicals in the cigarettes sold in these two countries. METHODS Cigarettes were purchased in Vietnam (32 brand variants) and the Philippines (19 brand variants) during 2020. Chemical analyses gave the mg/filter, mg/rod, and mg/stick (= mg/(filter + rod)) values for 180 individual flavor chemicals. Values were calculated for menthol, clove-related compounds, and "other flavor chemicals" (OFCs). RESULTS Five flavor groupings were found among the brand variants purchased in Vietnam: menthol + OFCs (n = 15), OFCs only (n = 8), nonflavored (n = 7), menthol + OFCs with a clove flavorant (n = 1) and menthol only (n = 1). Three flavor groupings were found among the brand variants purchased in the Philippines: menthol + OFCs (n = 10), nonflavored (n = 5), and menthol only (n = 4). CONCLUSIONS A range of flavored cigarette products are being offered by tobacco companies in Vietnam and the Philippines, presumably to maximize cigarette sales. Regulation of flavor chemicals should be considered in these two countries. IMPLICATIONS Article 9 of the WHO Framework Convention on Tobacco Control (FCTC), ratified by both Vietnam and the Philippines, states that "there is no justification for permitting the use of ingredients, such as flavoring agents, which help make tobacco products attractive." Flavors increase product appeal, adolescent initiation and experimentation, and difficulty quitting. These analyses found that cigarettes purchased in Vietnam and the Philippines contained menthol and other flavor chemicals. Tobacco companies are offering multiple flavor chemical profiles and nominally nonflavored versions in these countries; regulation of flavor chemicals should be considered in these two countries.
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Affiliation(s)
- Joanna E Cohen
- Institute for Global Tobacco Control (IGTC), Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Lauren Czaplicki
- Institute for Global Tobacco Control (IGTC), Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Elizabeth Crespi
- Institute for Global Tobacco Control (IGTC), Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Jennifer L Brown
- Institute for Global Tobacco Control (IGTC), Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Wentai Luo
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon 97207, USA
| | - Kevin J McWhirter
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon 97207, USA
| | - Braden C Masanga
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon 97207, USA
| | - James F Pankow
- Department of Civil and Environmental Engineering, Portland State University, Portland, Oregon 97207, USA
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Brown JL, Rosen D, Carmona MG, Parra N, Hurley M, Cohen JE. Spinning a global web: tactics used by Big Tobacco to attract children at tobacco points-of-sale. Tob Control 2023; 32:645-651. [PMID: 35641117 PMCID: PMC10447380 DOI: 10.1136/tobaccocontrol-2021-057095] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/08/2022] [Indexed: 11/03/2022]
Abstract
Most of the published literature on cigarette advertising and promotion at points-of-sale is on research conducted in high-income countries. We report findings from monitoring cigarette advertising and promotion at points-of-sale near schools and playgrounds in 42 countries, the majority low-income and middle-income. Four strategies were detected across most of these countries: (1) display of cigarettes near snacks, sweets and sugary drinks, (2) placement of cigarette advertisements near the eye-level of children, (3) advertisements and display of flavoured cigarettes and (4) sale of single sticks of cigarettes. These advertising and promotional tactics target children and youth and demonstrate that multinational tobacco companies use similar strategies to promote cigarettes at points-of-sale. The widespread violations of existing laws and regulations, the exploitation of regulatory loopholes and lack of existing tobacco control policies that apply to points-of-sale call for adoption and enactment of provisions recommended by the WHO Framework Convention on Tobacco Control such as comprehensive bans on tobacco advertisement, promotion and sponsorship, bans on sale of single cigarette sticks and regulation of flavours. These strategies will help to protect children and youth from exposure to tobacco advertising.
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Affiliation(s)
- Jennifer L Brown
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Debra Rosen
- International Communications, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Maria G Carmona
- International Research, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Natalia Parra
- International Communications, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Mark Hurley
- International Communications, Campaign for Tobacco-Free Kids, Washington, DC, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Rajani NB, Qi D, Chang K, Kyriakos CN, Filippidis FT. Price differences between capsule, menthol non-capsule and unflavoured cigarettes in 65 countries in 2018. Prev Med Rep 2023; 34:102252. [PMID: 37252069 PMCID: PMC10220479 DOI: 10.1016/j.pmedr.2023.102252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
The global consumption of flavoured cigarettes, particularly capsule and menthol non-capsule cigarettes, has been rising rapidly. Their attractiveness has been fuelled by perceptions of improved palatability, along with industry marketing tactics such as lower price points in some regions. This study aimed to compare prices of unflavoured, capsule, and menthol non-capsule cigarettes across 65 countries by analysing 2018 cigarette price data from Euromonitor Passport. Median prices of capsule and menthol non-capsule cigarettes were each compared to unflavoured cigarettes at the country-level. Countries were included in the analysis if they contained price data for capsule or menthol non-capsule and unflavoured cigarettes (n = 65). The median price of capsule cigarettes was the same as unflavoured cigarettes in 12 out of 50 countries and not statistically different in another 31 countries (p > 0.05). Capsule cigarettes were more expensive than unflavoured cigarettes in five countries and cheaper in two (p < 0.05). The median price of menthol non-capsule cigarettes was the same as unflavoured cigarettes in 6 out of 51 countries and not statistically different in another 39 countries (p > 0.05). Menthol non-capsule cigarettes were more expensive than unflavoured cigarettes in five countries and cheaper in one country (p < 0.05). There was no pattern found in the pricing of capsule or menthol non-capsule cigarettes, suggesting variability in the tobacco industry's pricing strategies across countries. Tailoring tobacco control policies to match national market conditions, particularly in countries with significant market shares of capsule and menthol non-capsule cigarettes could help address the public health threat posed by the tobacco epidemic.
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Affiliation(s)
- Nikita B Rajani
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Dickson Qi
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Kiara Chang
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
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Grilo G, Brown JL, Cohen JE, Smith KC. Shared perceptions of flavored cigarette pack design among young adults who smoke in Mexico and the Philippines. Tob Induc Dis 2023; 21:98. [PMID: 37502348 PMCID: PMC10369500 DOI: 10.18332/tid/168376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/14/2023] [Accepted: 06/17/2023] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Tobacco industry documents reveal companies' knowledge of a similar young adult market across countries in terms of attitudes and lifestyle aspirations. Some tobacco companies, therefore, use similar marketing approaches across different jurisdictions. We examined young adults' perceptions of flavored cigarette packs, including those containing flavor capsules, in Mexico and the Philippines. METHODS We conducted a secondary analysis of five focus groups held in Mexico and four in the Philippines with young adults who smoke (aged 18-24 years), separated by gender, in which participants interacted with cigarette packs purchased locally. Transcribed and translated data were thematically analyzed and compared between countries. RESULTS Three major themes were identified: 1) Flavor capsules cigarettes are recognizable via pack design through imagery on the pack that is understood to signify capsules; 2) Colors signal flavor and make the pack attractive; and 3) Young adults who smoke identify the target audience for these products as young people and those who are beginning to smoke. CONCLUSIONS Young adults who smoke in Mexico and the Philippines interpreted flavored cigarette pack design similarly and thought that young people are the main audience for these products. This suggests a successful marketing approach creating shared perceptions of flavored cigarette packs in different world regions. It is likely that similar tactics are used in other countries around the world. Therefore, jurisdictions might use evidence from other jurisdictions to support the implementation of evidence-based tobacco control policies. These findings also support the implementation of plain and standardized packaging and flavor bans that would also limit product innovation such as capsules.
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Affiliation(s)
- Graziele Grilo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Jennifer L. Brown
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Joanna E. Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States
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van der Eijk Y, Teo KW, Tan GPP, Chua WM. Tobacco industry strategies for flavour capsule cigarettes: analysis of patents and internal industry documents. Tob Control 2023; 32:e53-e61. [PMID: 34611048 DOI: 10.1136/tobaccocontrol-2021-056792] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 09/08/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The global market for flavour capsule variants (FCVs), cigarettes with a crushable flavour capsule, has grown exponentially. To inform further regulatory efforts, it is important to understand tobacco industry strategies for FCVs. METHODS Analysis of data from 65 patents and 179 internal tobacco industry documents, retrieved via snowball searches in Patsnap and the Truth Tobacco Industry Documents Library, describing tobacco industry developments related to FCVs. We used an inductive coding method to identify themes relating to FCV features or developments. RESULTS Tobacco companies were developing FCVs since the 1960s, with little market success until the 2000s following the launch of Camel Crush, a brand which targeted millennials (in their teens or early 20s at the time). Tobacco companies have patented, but not yet marketed, FCVs with microcapsule surface coatings, adjustable or heat-triggered flavour release systems, airflow manipulation features, transparent filters to visualise flavour release, and various flavours and additives for capsules including nicotine/tobacco extracts for an on-demand nicotine hit. Tobacco companies developed FCVs purported to be reduced harm, although their own tests showed that FCVs have higher toxicant concentrations. They have also developed loose flavour capsule units designed to fit into cigarettes, packs, or recessed filters to enable users to customise cigarettes and circumvent tobacco flavour bans. CONCLUSIONS To prevent tobacco companies from targeting young people and exploiting regulatory loopholes, regulations on tobacco products should ban flavours and consider the broad variety of FCV designs, additives and loose products designed to impart flavour into tobacco products.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ken Wah Teo
- Preventive Medicine, National University Health System, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Wee Meng Chua
- Department of Biological Sciences, National University of Singapore, Singapore
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Brown JL, Grilo G, Cohen JE, Clegg Smith K, Reynales-Shigematsu LM, Flores Escartin MG, Moran MB. Colours, capsules and concept flavour names on cigarette packs appeal to youth in Mexico. Tob Control 2023; 32:e16-e22. [PMID: 35017261 PMCID: PMC10086463 DOI: 10.1136/tobaccocontrol-2021-056905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/24/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Flavoured cigarettes are popular in Mexico. We examined how cigarette packaging design features used to communicate flavour influence perceptions of appeal, harm, perceived interest and pack preference among Mexico City residents. METHODS We conducted an experimental survey. Participants aged 13-34 years were randomly assigned to one of three conditions, viewed packs with systematically manipulated design features (colour, capsule image and flavour name) and answered questions on appeal, perceived harm, perceived interest and pack preference. Data were analysed using mixed effects and conditional logistic regression. RESULTS 1500 adolescents and 950 adults participated. Regardless of flavour, cigarette packs with a background colour and capsule image were more appealing to adolescents (OR=13.19, 95% CI 11.53 to 15.10; OR=1.68, 95% CI 1.45 to 1.88) and adults (OR=4.18, 95% CI 3.73 to 4.69; OR=1.66, 95% CI 1.49 to 1.85) than packs without. Among adolescents, 'Tropical Burst' named packs were more appealing (OR=1.43, 95% CI 1.20 to 1.72) than packs without a flavour name and among adults, 'Arctic Air' named packs were more appealing (OR=1.20, 95% CI 1.02 to 1.14). Adolescents and adults reported a preference for trying packs that displayed a flavour name, background colour or capsule image (b=0.104, b=0.702, b=1.316, p<0.001 and b=0.126, b=0.619, b=0.775, p<0.001). CONCLUSIONS Colours and flavour capsule images appeal to adolescents and adults in Mexico. Mexico should consider adopting plain packaging to reduce appeal and interest.
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Affiliation(s)
- Jennifer L Brown
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Graziele Grilo
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Katherine Clegg Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Prevención y Control de Tabaquismo, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Maria Guadalupe Flores Escartin
- Departamento de Prevención y Control de Tabaquismo, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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12
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Kyriakos CN, Zatoński MZ, Filippidis FT. Flavour capsule cigarette use and perceptions: a systematic review. Tob Control 2023; 32:e83-e94. [PMID: 34607888 PMCID: PMC10086486 DOI: 10.1136/tobaccocontrol-2021-056837] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 09/01/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This systematic review on flavour capsule cigarettes aims to examine prevalence, correlates of use, behaviours and perceptions of these products globally. DATA SOURCES A search of original, peer-reviewed research without restrictions in publication year, population, study design or language, using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 30 April 2021. STUDY SELECTION Studies were included if they presented original, human subjects research on flavour capsule cigarettes. DATA EXTRACTION Two authors independently extracted data on main outcome results and assessed risk of bias using a validated quality assessment tool (QATSDD). DATA SYNTHESIS Of 842 unduplicated database records and four studies from citation searching screened, 20 studies were included in the review. Studies reported data from 2009 to 2019 across eight countries, the majority of which used cross-sectional or focus group study designs. Current capsule use among smokers was highest in Chile and Mexico (40%) and was associated with younger age, and in some countries, with being female. Capsule cigarettes are perceived as tasting better, being smoother on the throat, more fun to smoke, and more attractive compared with non-capsule cigarettes, particularly among susceptible non-smokers and non-daily smokers. CONCLUSION Findings call for the adoption of comprehensive tobacco control policies that account for flavour capsules and similar iterations, which can increase appeal through flavours and innovative features. Continued monitoring and research of these products is critical, with particular attention to low-income and middle-income countries, which make up a disproportionately larger share of the capsule market.
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Affiliation(s)
- Christina N Kyriakos
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | - Mateusz Zygmunt Zatoński
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- European Observatory of Health Inequalities, Calisia University, Kalisz, Poland
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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13
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Kyriakos CN, Zatoński MZ, Filippidis FT. Marketing of flavour capsule cigarettes: a systematic review. Tob Control 2023; 32:e103-e112. [PMID: 35042725 DOI: 10.1136/tobaccocontrol-2021-057082] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 01/05/2022] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This systematic review aims to identify marketing elements of flavour capsule variants (FCVs), cigarettes that release flavour when a capsule(s) embedded in the filter is crushed. DATA SOURCES A search of original research without restrictions in publication year, population, study design or language using a combination of cigarette and capsule terms was conducted across four databases (Medline, Embase, Web of Science and Scopus), indexed until 13 December 2021, along with a citation search. STUDY SELECTION Studies were included if they presented original research relevant to marketing features of FCVs. DATA EXTRACTION One author performed data extraction and coded outcomes based on '4Ps' of marketing mix theory: product, place, price and promotion. The second author conducted a cross-check. DATA SYNTHESIS Of 2436 unduplicated database records and 30 records from other sources, 40 studies were included in the review. Studies were published between 2009 and 2021. Study methodologies primarily included content analysis of cigarette packs/sticks, review of tobacco industry documents and content analysis of advertising information. Findings suggest FCVs are marketed using a mix of strategies, particularly characterised by product innovation, timing market launches around tobacco policies, point-of-sale advertising and packaging to communicate a high-tech, customisable and flavourful product. CONCLUSION Findings illuminate the marketing strategies of FCVs that are likely driving their global growth, particularly among young people and in low and middle-income countries. Comprehensive tobacco control regulations are needed to close loopholes and curb industry efforts to circumvent existing policies in order to mitigate uptake of FCVs and other product innovations.
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Affiliation(s)
- Christina N Kyriakos
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
| | - Mateusz Zygmunt Zatoński
- Department for Health, University of Bath, Bath, UK
- European Observatory of Health Inequalities, Calisia University, Kalisz, Poland
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London School of Public Health, London, UK
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14
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Stubbs T, White V, Yong HH, Toumbourou J. Tobacco industry influence in low- and middle-income
countries in the ASEAN region: Qualitative interviews with
tobacco control experts during the COVID-19 pandemic. Tob Induc Dis 2022; 20:108. [DOI: 10.18332/tid/155391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 10/04/2022] [Accepted: 10/13/2022] [Indexed: 12/12/2022] Open
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Kowitt SD, Yockey RA, Lee JGL, Jarman KL, Gourdet CK, Ranney LM. The Impact of Cannabis Packaging Characteristics on Perceptions and Intentions. Am J Prev Med 2022; 63:751-759. [PMID: 35835626 PMCID: PMC9588761 DOI: 10.1016/j.amepre.2022.04.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022]
Abstract
INTRODUCTION As cannabis increasingly becomes a consumer product in the U.S., its product packaging has become critically important to regulators. This study examined the influence of recreational cannabis packaging characteristics. METHODS Five online between-subjects experiments were conducted in April 2021, and data were analyzed in May 2021-July 2021. Experiments randomized participants to view different (1) types of cannabis, (2) visual displays of tetrahydrocannabinol content, (3) cannabis packages designed around brand personality research, (4) health warnings, and (5) health claims. Outcomes included cognitive, affective, and behavioral responses. RESULTS A total of 841 adults from the U.S. (49% male, 50% young adults, 44% White, 17% Hispanic) were included in the study. Edible gummies were perceived as healthier (β=0.32, 95% CI=0.03, 0.62), less grown up (β= -0.58, 95% CI= -0.86, -0.28), and more socially acceptable to consume (β=0.30, 95% CI=0.01, 0.59) than cannabis concentrate in a medical dropper. Participants also had more interest in trying edible gummies (β=1.33, 95% CI=1.04, 1.62) and trying a free sample (β=1.30, 95% CI=1.01, 1.60) than trying cannabis concentrate. Cannabis packages with a helps-you-relax health claim elicited more happy (β=0.34, 95% CI=0.04, 0.64) and good (β=0.37, 95% CI=0.07, 0.67) feelings than cannabis packages without this claim. Minimal effects were found for visual displays of tetrahydrocannabinol content and health warnings. CONCLUSIONS Edibles are a unique type of cannabis that should be given special consideration under state laws, and lawmakers should consider limiting and governing the use of both implicit and explicit health claims on recreational cannabis packages when implementing laws.
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Affiliation(s)
- Sarah D Kowitt
- Department of Family Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - R Andrew Yockey
- Department of Biostatistics and Epidemiology, The University of North Texas Health Science Center at Fort Worth, Fort Worth, Texas
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina
| | - Kristen L Jarman
- Department of Family Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Leah M Ranney
- Department of Family Medicine, UNC School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Stubbs T, White V, Yong HH, Chhordaphea C, Toumbourou JW. Influence of cigarette packet branding and colours on young male smokers' recognition, appeal and harm perceptions of tobacco brands in Cambodia: a mixed-methods study. BMJ Open 2022; 12:e064202. [PMID: 36130742 PMCID: PMC9494600 DOI: 10.1136/bmjopen-2022-064202] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES To explore how cigarette packet branding and colours influence young male smokers' perceptions of tobacco brands in Cambodia. DESIGN Mixed-methods study. SETTING Worksites, living accommodations, a university and public locations in Phnom Penh, Cambodia. PARTICIPANTS 147 male Cambodian smokers (18-24 years). INTERVENTIONS Participants were shown mock-up pictures of different cigarette packet branding and colour variations and asked to respond to close-ended and short-response questions. OUTCOME MEASURES Brand recognition, appeal and harm perceptions of cigarette packet branding and colours. RESULTS When shown three packets with brand names removed, 98.6% of participants recognised packet one as Mevius brand, 21.1% recognised packet two as Marlboro and 38.8% recognised packet three as 555. For the three fully-branded and three matching plain packets, most participants selected a fully-branded packet as the most appealing taste (83.0%) and most appealing to youth (81.7%). Participants described their chosen brand as appealing due to beliefs about its superior taste/quality, reduced harm and symbolic attitudes surrounding tobacco brands and smokers of different brands in a social status hierarchy. When shown six different colours of unbranded packets, participants selected the blue packet (51.0%) as the most appealing for taste, the white packet as the least harmful (25.2%), and the red (15.0%) and black (12.9%) packets as the most harmful to health. They described their associations of packet colours with abstract imagery concerning smoking-related harms and their future well-being. CONCLUSIONS Findings suggest that packet branding and colours influence young male smokers' recognition, appeal and harm perceptions of tobacco brands in Cambodia and remain an influential marketing tool for tobacco companies where advertising is banned. Consequently, Cambodia and other low and middle-income countries in Southeast Asia should implement plain packaging.
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Affiliation(s)
- Thomas Stubbs
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Victoria White
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Hua-Hie Yong
- School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Chhea Chhordaphea
- National Center for Health Promotion, Ministry of Health, Phnom Penh, Cambodia
| | - John W Toumbourou
- Centre for Drug use, Addictive and Anti-social behaviour Research, School of Psychology, Faculty of Health, Deakin University, Burwood, Victoria, Australia
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Moodie C, Page N, Moore G. Prevalence of Menthol and Menthol Capsule Cigarette Use Among 11-16 Year Olds in Wales Prior to a Ban on Characterizing Flavors in Cigarettes: Findings From the 2019 Student Health and Wellbeing Survey. Nicotine Tob Res 2022; 24:1257-1263. [PMID: 35272351 PMCID: PMC9278836 DOI: 10.1093/ntr/ntac040] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 01/07/2022] [Accepted: 02/25/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The use of flavored cigarettes has increased in many countries because of the inclusion of one or more frangible flavor-changing capsules in the filter. Research suggests that these "capsule" cigarettes appeal most to youth, but little is known about how prevalent their use is among children. METHODS A cross-sectional school survey was conducted between September and December 2019 with 11-16 year-olds (N = 119 388) from 198 secondary schools across Wales; the sample represented approximately two-thirds of all 11-16 year-olds in the country. The sample was asked about smoking behavior, with a quarter (N = 26 950) also asked about awareness of menthol cigarettes, and use of menthol and menthol capsule cigarettes if a current smoker (N = 1447). RESULTS Current smoking prevalence was 5.7% among the entire sample and 5.9% among the analytical sample (those also asked about menthol and menthol capsule cigarettes). For the analytical sample, almost all current smokers (93.2%) were aware of menthol cigarettes, with three-fifths (60.5%) reporting having used menthol cigarettes in the past 30 days (42.3% capsule cigarettes, 18.2% noncapsule cigarettes). In comparison to nonmenthol smokers, those using menthol cigarettes (capsule and noncapsule) were more likely to be frequent smokers, with those using menthol capsule cigarettes more likely to have smoked for longer. CONCLUSIONS While past research suggests that flavored cigarettes appeal to youth, this study shows just how popular these products, and capsule cigarettes, in particular, were among young smokers in Wales. It also raises questions about why capsule cigarettes have received such limited public health attention. IMPLICATIONS That three in five 11-16 year-old smokers reported using menthol cigarettes in the past 30 days highlights how appealing these products are to young people, particularly capsule cigarettes, used by seventy percent of menthol smokers. Capsule cigarettes are one of the most successful tobacco product innovations in decades, even in countries with comprehensive bans on tobacco marketing and standardized packaging. The dearth of research on capsule cigarettes is a failure of global public health. Evaluation of the ban on characterizing flavors in the United Kingdom and across the European Union is critical.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirling, Scotland
| | - Nicholas Page
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, Wales
| | - Graham Moore
- Centre for Development, Evaluation, Complexity and Implementation in Public Health Improvement (DECIPHer), Cardiff University, Cardiff, Wales
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18
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van der Eijk Y. Standardised cigarettes: the next step for tobacco policy? Tob Control 2022:tobaccocontrol-2022-057417. [PMID: 35768214 DOI: 10.1136/tc-2022-057417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
As tobacco marketing restrictions intensify, tobacco companies increasingly turn to the cigarette product itself as a marketing medium with new flavours, capsules, novelty filter features and attractive cigarette stick designs. This paper considers a 'standardised cigarettes' policy as a potential next step in restricting tobacco marketing. This policy would remove from cigarette products all the elements that increase their appeal and addictiveness: added flavours, nicotine, and visual designs and branding. The result would be a cigarette that is flavourless, not especially addicting, and visually off-putting. This paper discusses what a standardised cigarettes policy might look like from a regulatory standpoint, and how it fits into current policy obligations under the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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19
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van der Eijk Y. It is time to ban flavor capsule cigarettes. Tob Prev Cessat 2022; 8:22. [PMID: 35795261 PMCID: PMC9179177 DOI: 10.18332/tpc/150334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/18/2022] [Accepted: 05/23/2022] [Indexed: 11/24/2022]
Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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20
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Zatoński M, Silver K, Plummer S, Hiscock R. Menthol and flavored tobacco products in LMICs: A growing menace. Tob Induc Dis 2022; 20:39. [PMID: 35498956 PMCID: PMC9007155 DOI: 10.18332/tid/146366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/02/2022] [Accepted: 02/02/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION High income jurisdictions are banning menthol/flavored cigarettes and other tobacco products because they attract young people and create dependence. This study explores the importance of menthol and other flavored tobacco products for tobacco markets in low- and middle-income countries (LMICs), identifies countries where the menthol/flavor share is particularly high or rapidly growing, and identifies strategies tobacco companies are using to develop menthol/flavor markets. METHODS Research involved analysis of menthol/flavor market data from 2005 to 2019, a systematic review of academic literature, and a scoping exercise with our advocate contacts in LMICs. RESULTS The median menthol/capsule market share of the cigarette market grew significantly (p<0.05) between 2005 and 2019, both in lower and upper middle-income countries [lower: 2.5% (IQR: 0.5-4.0) to 6.5% (IQR: 3.6-15.9); and upper: 4.0% (IQR: 0.8-9.8) to 12.3% (IQR: 3.5-24.3)]. Countries with both high market share and high market share growth were Russia, Guatemala, Peru and Nigeria. No market data were available on low-income countries, but the academic literature suggested high prevalence of menthol use in Zambia. Tobacco industry strategies underpinning growth of menthol/flavored tobacco use in LMICs included in-store marketing and display, colorful packs and non-conventional flavor names. CONCLUSIONS Menthol/flavor tobacco products are a growing problem in LMICs. In addition to menthol/flavor bans, we recommend marketing bans, point of sale display bans and standardized packaging.
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Affiliation(s)
- Mateusz Zatoński
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom
| | - Karin Silver
- Tobacco-Tactics, Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom
| | - Sarah Plummer
- Department for Health, University of Bath, Bath, United Kingdom
| | - Rosemary Hiscock
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, United Kingdom
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21
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Evaluating the public health impact of partial and full tobacco flavour bans: A simulation study. THE LANCET REGIONAL HEALTH - WESTERN PACIFIC 2022; 21:100414. [PMID: 35252911 PMCID: PMC8891712 DOI: 10.1016/j.lanwpc.2022.100414] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background Methods Findings Interpretations Funding
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22
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van der Eijk Y, Lin L, Gan L, Teo O, Subramaniam M, Lee JK. "The Menthol One Is More Friendly": Young Singaporeans' Perspectives on Flavored Cigarettes. Asia Pac J Public Health 2021; 34:236-243. [PMID: 34911349 DOI: 10.1177/10105395211065307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Over half of the cigarettes sold in Singapore contain added flavors such as menthol. We conducted nine focus group discussions (n = 46) with young (age 20-25) current smokers in Singapore to understand the role of flavors in smoking initiation. We found that flavors triggered the curiosity to experiment with tobacco and e-cigarette products and played an important role in the formation of early cigarette preferences. Menthol-flavored cigarettes were the most appealing to participants due to their smoothness and cooling sensation, described as pleasant against Singapore's hot and humid climate. While some participants believed that flavored and nonflavored cigarettes were equally harmful, others believed that flavored variants had a lower nicotine content and were therefore less harmful, or that the added chemicals in flavored cigarettes could result in higher toxicant exposures. Thus, among young people in Singapore, flavors appear to play an important role in smoking initiation and there appear to be various misperceptions regarding their harmfulness.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lavinia Lin
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Lydia Gan
- National University of Singapore, Singapore
| | - Odelia Teo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Mythily Subramaniam
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Institute of Mental Health, Singapore
| | - Jeong Kyu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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23
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Czaplicki L, Welding K, Cohen JE, Smith KC. Feminine Appeals on Cigarette Packs Sold in 14 Countries. Int J Public Health 2021; 66:1604027. [PMID: 34475810 PMCID: PMC8406490 DOI: 10.3389/ijph.2021.1604027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: Limited research has examined feminine marketing appeals on cigarette packs in low-and middle-income countries (LMICs). We reviewed a systematically collected sample of cigarette packs sold across 14 LMICs in 2013 (Wave 1) and 2015–2017 (Wave 2). Methods: Packs in Wave 1 (n = 3,240) and Wave 2 (n = 2,336) were coded for feminine imagery and descriptors (flowers, fashion, women/girls, color “pink”). We examined trends in feminine appeals over time, including co-occurrence with other pack features (slim or lipstick shape, flavor, reduced harm, and reduced odor claims). Results: The proportion of unique feminine cigarette packs significantly decreased from 8.6% (n = 278) in Wave 1 to 5.9% (n = 137) in Wave 2 (p < 0.001). Among all feminine packs, flower-and fashion-related features were most common; a substantial proportion also used flavor and reduced odor appeals. Conclusion: While there was a notable presence of feminine packs, the decline observed may reflect global trends toward marketing gender-neutral cigarettes to women and a general contempt for using traditional femininity to market products directly to women. Plain packaging standards may reduce the influence of branding on smoking among women.
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Affiliation(s)
- Lauren Czaplicki
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Kevin Welding
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Katherine Clegg Smith
- Department of Health, Behavior, and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Affiliation(s)
- Jeffrey Willett
- American Heart Association, 7272 Greenville Ave, Dallas, TX 75231, USA
| | - Stephan Achenbach
- European Society of Cardiology, The European Heart House, Les Templiers, 2035 route des colles, CS 80179 Biot, 06903 Sophia Antipolis Cedex, France
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18 91054, Erlangen, Germany
| | - Fausto J Pinto
- World Heart Federation, Rue de Malatrex 32, 1201 Geneva, Switzerland
- AIDFM Hospital de Santa Maria c/o Luísa Buscardini, Av. Prof. Egas Moniz Piso, 01 1649-028 Lisboa, Portugal
| | - Athena Poppas
- American College of Cardiology, 2400 N Street NW, Washington, DC 20037, USA
- Brown University, Lifespan Cardiovascular Institute, 2 Dudley St., Ste. 360 Providence, RI 02905-3248, USA
| | - Mitchell S V Elkind
- American Heart Association, 7272 Greenville Ave, Dallas, TX 75231, USA
- Department of Neurology, Columbia University, 710 W 168th St, New York, NY 10032, USA
- Department of Epidemiology, Columbia University, 710 W 168th St, New York, NY 10032, USA
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Willett J, Achenbach S, Pinto FJ, Poppas A, Elkind MSV. The Tobacco Endgame: Eradicating a Worsening Epidemic A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology. J Am Coll Cardiol 2021; 78:77-81. [PMID: 34052093 DOI: 10.1016/j.jacc.2021.04.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Jeffrey Willett
- Vice President of Integrated Tobacco Strategy, American Heart Association, Dallas, Texas, USA
| | - Stephan Achenbach
- President, European Society of Cardiology, Sophia Antipolis, France; Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Fausto J Pinto
- President, World Heart Federation, Geneva, Switzerland; AIDFM, Hospital de Santa Maria, Lisboa, Portugal
| | - Athena Poppas
- President, American College of Cardiology, Washington, DC, USA; Brown University, Lifespan Cardiovascular Institute, Providence, Rhode Island, USA
| | - Mitchell S V Elkind
- President, American Heart Association, Dallas, Texas, USA; Departments of Neurology and Epidemiology, Columbia University, New York, New York, USA.
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van der Eijk Y, Ng XY, Lee JK. Cross-sectional survey of flavored cigarette use among adult smokers in Singapore. Tob Induc Dis 2021; 19:42. [PMID: 34131420 PMCID: PMC8173988 DOI: 10.18332/tid/135321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Singapore, a city-state with a multi-ethnic Asian population, has one of the world's largest market shares for cigarettes with added flavors, such as menthol and fruit, which increase the appeal of smoking. Little is known on the sociodemographic or smoking-related traits associated with flavored cigarette use in the Asian context. METHODS A cross-sectional survey was conducted in January-March 2020 of 1123 Singaporean adult (aged 21-69 years) current smokers using a self-completed online or postal questionnaire. We used descriptive statistics and bivariate analyses to compare the answers of flavored and non-flavored cigarette users and fitted a multivariate logistic regression model to identify correlates of flavored cigarette use. RESULTS Of the respondents, 85.2% reported ever use and 52.7% of respondents with a regular brand reported current use of flavored cigarettes. Older age 40-49 years (AOR= 0.63) age ≥50 years (AOR=0.60), Indian ethnicity (AOR=0.39), and a moderate (AOR=0.57) or high (AOR=0.34) dependence level were correlated with non-flavored cigarette use, while female gender (AOR=2.53) and a later initiation age (16-20 years: AOR=1.72; age ≥21 years: AOR=2.19) were correlated with flavored cigarette use. CONCLUSIONS Consistent with findings from other countries, flavored cigarette use in Singapore is associated with being younger in age, female, of a certain ethnicity (Malay or Chinese), and having a lower nicotine dependence level.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xian Yi Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jeong Kyu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Willett J, Achenbach S, Pinto FJ, Poppas A, Elkind MSV. The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology. Glob Heart 2021; 16:40. [PMID: 34211826 PMCID: PMC8162290 DOI: 10.5334/gh.1061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 04/22/2021] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jeffrey Willett
- Integrated Tobacco Strategy, American Heart Association, Dallas, TX, US
| | - Stephan Achenbach
- European Society of Cardiology, FR
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, DE
| | - Fausto J. Pinto
- World Heart Federation, CH
- AIDFM, Hospital de Santa Maria, Lisboa, PT
| | - Athena Poppas
- American College of Cardiology, US
- Brown University, Lifespan Cardiovascular Institute, Providence, RI, US
| | - Mitchell S. V. Elkind
- American Heart Association, US
- Departments of Neurology and Epidemiology, Columbia University, New York, US
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Willett J, Achenbach S, Pinto FJ, Poppas A, Elkind MSV. The Tobacco Endgame-Eradicating a Worsening Epidemic: A Joint Opinion From the American Heart Association, World Heart Federation, American College of Cardiology, and the European Society of Cardiology. Circulation 2021; 144:e1-e5. [PMID: 34036792 DOI: 10.1161/circulationaha.121.054369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Jeffrey Willett
- Vice President of Integrated Tobacco Strategy, American Heart Association, Dallas, TX (J.W.)
| | - Stephan Achenbach
- President, European Society of Cardiology (S.A.).,Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Germany (S.A.)
| | - Fausto J Pinto
- President, World Heart Federation (F.J.P.).,AIDFM, Hospital de Santa Maria, Lisboa, Portugal (F.J.P.)
| | - Athena Poppas
- President, American College of Cardiology (A.P.).,Brown University, Lifespan Cardiovascular Institute, Providence, RI (A.P.)
| | - Mitchell S V Elkind
- President, American Heart Association (M.S.V.E.).,Departments of Neurology and Epidemiology, Columbia University, New York, NY (M.S.V.E.)
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