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Zavala-Arciniega L, Cook S, Hirschtick JL, Xie Y, Mukerjee R, Arenberg D, Barnes GD, Levy DT, Meza R, Fleischer NL. Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth. BMC Public Health 2024; 24:2159. [PMID: 39118071 PMCID: PMC11312221 DOI: 10.1186/s12889-024-19582-8] [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: 12/22/2023] [Accepted: 07/24/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND The health consequences of polytobacco use are not well understood. We evaluated prospective associations between exclusive, dual, and polytobacco use and diagnosed bronchitis, pneumonia, or chronic cough among US youth. METHODS Data came from Waves 1-5 of the Population Assessment of Tobacco and Health Study. We categorized time-varying past 30-day tobacco use into seven categories: (1) non-current use; exclusive use of 2) cigarettes, 3) e-cigarettes, and 4) other combustible products (OC; pipes, hookah, and cigars); dual use of 5) e-cigarettes + cigarettes or e-cigarettes + OC, and 6) cigarettes + OC; and 7) polyuse of all three products. The outcome was parent-reported diagnosis of bronchitis, pneumonia, or chronic cough among youth. We conducted weighted multilevel Poisson models (person n = 17,517, 43,290 observations) to examine the longitudinal exposure-outcome relationship, adjusting for covariates: sex, age, race and ethnicity, parental education, body mass index, secondhand smoke exposure, and household use of combustible products. RESULTS Compared to nonuse, exclusive cigarette use (Risk Ratio (RR) = 1.83, 95% CI 1.25-2.68), exclusive e-cigarette use (RR = 1.53, 95% CI 1.08-2.15), combustible product + e-cigarette dual use (RR = 1.90, 95% CI 1.18-3.04), cigarettes + OC dual use (RR = 1.96, 95% CI 1.11-3.48), and polytobacco use (RR = 3.06 95% CI 1.67-5.63) were associated with a higher risk of bronchitis, pneumonia, or chronic cough. In additional analyses, we found that the risk ratio for polytobacco use was higher compared to exclusive e-cigarette use (RR 2.01 CI 95% 1.02-3.95), but not higher compared to exclusive cigarette use (RR 1.67 CI 95% 0.85-3.28). CONCLUSION We found that exclusive, dual, and poly tobacco use were all associated with higher risk of bronchitis, pneumonia, or chronic cough compared to non-current use.
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Affiliation(s)
- Luis Zavala-Arciniega
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Steven Cook
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Jana L Hirschtick
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Yanmei Xie
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Richa Mukerjee
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Douglas Arenberg
- Division of Pulmonary & Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Geoffrey D Barnes
- Division of Cardiovascular Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
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Chew A, Davila G, Moodie C, Thrasher J, Barnoya J. Iluma-nating: IQOS variant enters the Guatemalan market. Tob Control 2024:tc-2024-058722. [PMID: 38858067 DOI: 10.1136/tc-2024-058722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/29/2024] [Indexed: 06/12/2024]
Affiliation(s)
- Aiken Chew
- Instituto de Investigación en Ciencias Naturales y Tecnología, Vicerrectora de Investigación y Proyección, Universidad Rafael Landívar, Guatemala, Guatemala
| | - Gustavo Davila
- Instituto de Investigación en Ciencias Naturales y Tecnología, Vicerrectora de Investigación y Proyección, Universidad Rafael Landívar, Guatemala, Guatemala
| | - Crawford Moodie
- Department of Marketing, Institute for Social Marketing, Stirling, UK
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joaquin Barnoya
- Instituto de Investigación en Ciencias Naturales y Tecnología, Vicerrectora de Investigación y Proyección, Universidad Rafael Landívar, Guatemala, Guatemala
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Mus S, Barrientos I, Vidaña-Pérez D, Monzon J, Barnoya J, Page MK, Block AC, Goniewicz ML, O’Connor RJ, Thrasher JF. Chemicals in Cigarette Flavor Capsules From Guatemala and Mexico. Nicotine Tob Res 2024; 26:545-551. [PMID: 37930843 PMCID: PMC11033577 DOI: 10.1093/ntr/ntad216] [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: 04/30/2023] [Revised: 09/06/2023] [Accepted: 10/22/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND The global market share for cigarettes with flavor capsules has grown exponentially over the last decade, particularly in Latin America. When smoking, consumers crush a liquid capsule in the filter that flavors the smoke. Little is known about the chemical constituents of the liquids in capsules or their potential health risks. METHODS Based on consumer data and availability in Mexico and Guatemala, 31 flavor capsule brands were purchased (19 and 12, respectively) in 2020. Since some cigarettes included multiple capsules in a stick (up to 2) or pack (up to 4), the final analytic sample included 50 capsules. We conducted qualitative and quantitative analyses using gas chromatography with mass spectrometry (GC-MS, Agilent Technologies, Inc). RESULTS The qualitative analysis detected 296 compounds (range = 9-67 per capsule), and all capsules contained menthol. Among the compounds detected in more than half the sample were limonene, menthone, benzaldehyde, eucalyptol, and triacetin. Traces of nicotine were found in 22% of the capsules. In the quantitative analysis, menthol concentrations were 33 times greater than the next most common compound (limonene). Benzyl alcohol and vanillin were also found in high concentrations. Comparing same-brand varieties across countries showed substantial variability in the concentration of menthol and other compounds. CONCLUSIONS Menthol is an omnipresent constituent in capsule cigarettes, perhaps because of its anesthetizing and reinforcing addictive properties. Other compounds found are toxic, potentially carcinogenic, and may enhance addictiveness. Variance in the presence and concentrations of such compounds highlights the importance of product standards to regulate capsule content. IMPLICATIONS This study evaluated the chemical content of capsule cigarettes from two Latin American countries that have two of the highest market shares for capsule cigarettes worldwide. Compared to other studies, our assessment included brand varieties from two countries to compare the differences in chemical content by country. Our results yield that menthol is found in all capsules, and that other chemicals found may prolong nicotine exposure and therefore reinforce the addictive properties of cigarettes.
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Affiliation(s)
- Sophia Mus
- Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Inti Barrientos
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
| | - Desirée Vidaña-Pérez
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - José Monzon
- Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Joaquin Barnoya
- Unidad de Cirugía Cardiovascular de Guatemala, UNICAR, Guatemala City, Guatemala
| | - Michelle K Page
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Ashleigh C Block
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Richard J O’Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - James F Thrasher
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Monzon J, Barnoya J, Mus S, Davila G, Vidaña-Pérez D, Thrasher JF. Changes in substance use among adolescents before and during the COVID-19 pandemic in Guatemala. Front Psychiatry 2024; 15:1331962. [PMID: 38487580 PMCID: PMC10937547 DOI: 10.3389/fpsyt.2024.1331962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/25/2024] [Indexed: 03/17/2024] Open
Abstract
Objectives Due to the COVID-19 pandemic, on March 16th, schools had to be closed in Guatemala and went to online teaching. We sought to analyze the change in substance use among high school students in Guatemala associated with the lockdown. Methods Data from two surveys (2019, n=2096, and 2020, n=1606) of a student cohort in private high schools in Guatemala City was used. Logistic models for past 30-day cigarette, e-cigarette, marijuana, and alcohol (including binge drinking) were used, regressing these on survey wave, while adjusting for sex, scholastic performance, high school year of student, parental education, substance use, and household member tobacco use. Results Prevalence declined for smoking (10% to 3%, p<0.001), e-cigarette (31% to 14%, p<0.001), marijuana (4.3% to 1.9%, p<0.001), and alcohol use (47% to 38.5%, p<0.001), and binge drinking (24% to 13%, p<0.001). Adjusted models showed wave 2 associated with lower odds of using cigarettes (AOR=0.44, 95%CI=0.32-0.62), e-cigarettes (AOR=0.41, 95% CI=0.35-0.49, p<0.001), and binge drinking (AOR=0.73, 95%CI=0.59-0.89; p=0.002). Conclusion Among Guatemalan adolescents, COVID-19 restrictions were associated with a significant decrease in smoking, e-cigarette use, and binge drinking.
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Affiliation(s)
- Jose Monzon
- Health Sciences School, Rafael Landívar University, Guatemala City, Guatemala
- Research Department, Cardiovascular Surgery Unit of Guatemala (UNICAR), Guatemala City, Guatemala
| | - Joaquin Barnoya
- Research Department, Cardiovascular Surgery Unit of Guatemala (UNICAR), Guatemala City, Guatemala
- Research Department, Integra Cancer Institute, Guatemala City, Guatemala
| | - Sophia Mus
- Research Department, Cardiovascular Surgery Unit of Guatemala (UNICAR), Guatemala City, Guatemala
| | - Gustavo Davila
- Research Department, Cardiovascular Surgery Unit of Guatemala (UNICAR), Guatemala City, Guatemala
| | - Desirée Vidaña-Pérez
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - James F. Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
- Center for Population Health Research, National Institute of Public Health (Mexico), Cuernavaca, Mexico
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Zavala-Arciniega L, Cook S, Hirschtick J, Xie Y, Mukerjee R, Arenberg D, Barnes GD, Levy DT, Meza R, Fleischer N. Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth. RESEARCH SQUARE 2024:rs.3.rs-3793149. [PMID: 38343856 PMCID: PMC10854317 DOI: 10.21203/rs.3.rs-3793149/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/21/2024]
Abstract
Background The health consequences of polytobacco use are still well not understand. We evaluated prospective associations between exclusive, dual, and polytobacco use and diagnosed bronchitis, pneumonia, or chronic cough among US youth. Methods Data came from Waves 1-5 of the Population Assessment of Tobacco and Health Study. We categorized time-varying past 30-day tobacco use into seven categories: (1) non-current use; exclusive use of 2) cigarettes, 3) electronic nicotine delivery systems (ENDS), or 4) other combustible products (OC; pipes, hookah, and cigars); dual use of 5) ENDS + cigarettes or ENDS + OC 6) cigarettes + OC; or 7) polyuse of all three products. The outcome was incident diagnosis of bronchitis, pneumonia, or chronic cough. We conducted weighted multilevel Poisson models (person n = 17,517, 43,290 observations) to examine the longitudinal exposure-outcome relationship, adjusting for covariates: sex, age, race and ethnicity, parental education, body mass index, secondhand smoke exposure, and household use of combustible products. Results Compared to nonuse, exclusive cigarette use (Incidence Rate Ratio (IRR) = 1.83, 95% CI 1.25-2.68), exclusive ENDS use (IRR = 1.53, 95% CI 1.08-2.15), combustible product + ENDS dual use (IRR = 1.90, 95% CI 1.18-3.04), cigarettes + OC dual use (IRR = 1.96, 95% CI 1.11-3.48), and polytobacco use (IRR = 3.06 95% CI 1.67-5.63) were associated with a higher incidence of bronchitis, pneumonia, or chronic cough. Conclusion We found that exclusive, dual, and poly tobacco use was associated with higher incidence of bronchitis, pneumonia, or chronic cough; Moreover, the incidence rate ratio for polytobacco use was higher than the incidence rate ratio for exclusive use compared to non-current use.
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Affiliation(s)
| | - Steven Cook
- University of Michigan School of Public Health
| | | | - Yanmei Xie
- University of Michigan School of Public Health
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Monzon J, Mus S, Davila G, Barnoya J, Kim M, Thrasher J. Lil Solid: a more affordable option for heated tobacco products in Guatemala. Tob Control 2023:tc-2023-057954. [PMID: 38050166 PMCID: PMC11109015 DOI: 10.1136/tc-2023-057954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/18/2023] [Indexed: 12/06/2023]
Affiliation(s)
- Jose Monzon
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
- Health Sciences School, Rafael Landivar University, Guatemala City, Guatemala, Guatemala
| | - Sophia Mus
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Gustavo Davila
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Joaquin Barnoya
- Departamento de Investigacion, Unidad de Cirugia Cardiovascular de Guatemala, Guatemala, Guatemala
| | - Minji Kim
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - James Thrasher
- Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, South Carolina, USA
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Bar-Zeev Y, Berg CJ, Khayat A, Romm KF, Wysota CN, Abroms LC, Elbaz D, Levine H. IQOS marketing strategies at point-of-sales: a cross-sectional survey with retailers. Tob Control 2023; 32:e198-e204. [PMID: 35140170 PMCID: PMC9360187 DOI: 10.1136/tobaccocontrol-2021-057083] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The point-of-sale (POS) is adapting to marketing restrictions, societal changes and the inclusion of new products, such as heated tobacco products (eg, Philip Morris International's (PMI) IQOS device and HEETS sticks). We aimed to assess (1) PMI's influences on IQOS/HEETS POS marketing and (2) the implications of the new legislation (POS display ban and plain packaging) for retailers. METHODS A cross-sectional survey of 43 IQOS/HEETS POS owners/managers in five Israeli cities assessed POS and participant characteristics, marketing strategies, attitudes towards IQOS, and POS implications of the legislation and COVID-19, including industry reactions. Bivariate analysis explored differences between POS selling of the IQOS device versus POS selling of HEETS only. RESULTS A higher proportion of those carrying IQOS (n=15) (vs HEETS only) had special displays (100% vs 17.9%, p<0.001) and interacted with specific IQOS salespersons (73.3% vs 28.6%, p=0.013). Common promotions were financial incentives based on HEETS sales for retailers (37.5%) and price discounts on HEETS for customers (48.7%). Most indicated positive attitudes towards IQOS (72.1%; eg, 'less harmful'), opposition to the legislation (62.7%), limited government assistance to implement the legislation (62.8%), and industry provision of display cases and/or signage to comply with the legislation (67.4%). CONCLUSION PMI uses similar tactics to promote IQOS at POS as they previously used for combustible products, including direct promotional activities with retailers, and circumvented legislation by using special displays and signage. Governments need to ban these measures and support retailers with clear practical guidance regarding the implementation of marketing restrictions at POS.
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Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Katelyn F Romm
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Chritina N Wysota
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
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Crosbie E, Severini G, Beem A, Tran B, Sebrie EM. New tobacco and nicotine products in Latin America and the Caribbean: assessing the market and regulatory environment. Tob Control 2023; 32:458-466. [PMID: 34916305 DOI: 10.1136/tobaccocontrol-2021-056959] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 11/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To document the regulatory environment of new tobacco and nicotine products (NTNPs), including electronic nicotine delivery systems (ENDS) and heated tobacco products (HTPs), in Latin America and the Caribbean (LAC). METHODS Review of market research reports and databases, regulatory websites, Campaign for Tobacco-Free Kids, relevant published literature and the 2021 WHO Report on the Global Tobacco Epidemic. RESULTS ENDS entered the LAC market in the 2010s and are now available in most LAC countries. A majority of LAC countries (n=18) have either banned the commercialisation of ENDS (n=7) or regulated ENDS as tobacco products (n=7), medicinal products (n=1) or consumer products (n=3). The remaining LAC countries (n=15) do not regulate ENDS. HTPs were first introduced in 2017 and have been officially launched in five countries (Colombia, Guatemala, Dominican Republic, Mexico and Costa Rica). Few countries have banned HTP commercialisation (n=3) or regulated commercialisation and use (n=7), while the majority of countries have existing legislation that applies to HTPs (n=19). A few countries (n=4) have no tobacco control legislation and therefore do not regulate HTPs. CONCLUSION NTNPs are emerging products in the LAC region. Governments should follow WHO guidance and the decisions of the Conference of Parties to the WHO Framework Convention on Tobacco Control and ban or regulate NTNPs as tobacco products; otherwise NTNPs could create a new generation of tobacco and nicotine users.
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Affiliation(s)
- Eric Crosbie
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
| | | | | | - Brian Tran
- School of Public Health, University of Nevada, Reno, Reno, NV, USA
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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: 9] [Impact Index Per Article: 9.0] [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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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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Mus S, Monzon J, Islam F, Thrasher JF, Barnoya J. First tobacco product tried and current use of cigarettes and electronic cigarettes among adolescents from Guatemala City. SALUD PUBLICA DE MEXICO 2023; 65:46-53. [PMID: 36750072 PMCID: PMC11091932 DOI: 10.21149/13972] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/13/2022] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To assess how first experimenting with ciga-rettes or e-cigarettes is associated with current use in Gua-temala, a middle-income country with weak tobacco control and no e-cigarette regulations. MATERIALS AND METHODS We surveyed students from private schools in Guatemala City, limiting analyses to ever users (n=1 026). Multinomial logistic models regressed current product use on first product used, adjusting for sociodemographics and friends and family use. RESULTS The most common first product used was e-cigarettes (56%), followed by flavored cigarettes (24%) and regular cigarettes (20%). At the time of the survey, 4% were exclusive smokers, 37% were exclusive e-cigarette users, 18% dual users, and 40% had ever tried either but were not current users. Compared to those who first tried cigarettes, students who first tried e-cigarettes were less likely to be current smokers (RR=0.19 [CI: 0.11,0.31]) or dual users (RR=0.26 [CI: 0.14,0.49]) and students who first tried flavored cigarettes were more likely to be current smokers (RR=1.66 [CI=1.13,2.42]). CONCLUSIONS In our sample, Guatemalan adolescents from private schools more frequently experiment and continue to use e-cigarettes than cigarettes. There is urgent need to implement e-cigarette restrictions in addition to tobacco control policy implementation.
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Affiliation(s)
- Sophia Mus
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala. Guatemala City, Guatemala.
| | - Jose Monzon
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala. Guatemala City, Guatemala.
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina. Columbia, South Carolina, USA.
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina. Columbia, South Carolina, USA/Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Cuernavaca, Morelos, Mexico.
| | - Joaquin Barnoya
- Departamento de Investigación, Unidad de Cirugía Cardiovascular de Guatemala/Integra Cancer Institute. Guatemala City, Guatemala.
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Bigwanto M, Muhammad F, Widad SM, Yudha L. Product variety and regulation avoidance in the sale of new tobacco products: findings from a point-of-sale survey in Indonesia. Subst Abuse Treat Prev Policy 2022; 17:78. [PMID: 36494852 PMCID: PMC9733199 DOI: 10.1186/s13011-022-00507-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Since the imposition of the 2018 excise tax, new tobacco products (electronic nicotine delivery system, heated tobacco products, and nicotine pouches) have been considered legal, and their sale has grown rapidly in Indonesia. This study aims to assess the variety of new tobacco products available on the market and evaluate the point-of-sale (POS) environment. METHODS Data collection was carried out by 12 trained surveyors between March 7 and 13, 2022, in three provinces that had the most e-cigarette users: Yogyakarta, East Kalimantan, and Jakarta. All the vape stores with a Google rating of 4.5 stars or higher and a minimum of 100 reviews were included. In addition to vape stores, the nearest retail stores were included. The data collected included information about available products, product displays, and whether the POS followed tobacco-control measures, such as health warnings and smoke-free regulations. RESULTS A total of 27 vape stores and 35 retail stores were observed. The available liquid volumes ranged from 15 to 100 ml, with nicotine levels from 3 to 50 mg. No stores sold flavorless products, and all the products were sold without pictorial health warnings (PHWs). Most of the vape stores (92.6%) reported selling products that used cartoon images or public figures, and most (96.3%) allowed customers to use the products inside the store. Five vape stores and four retail stores reported that they did not require customers to undergo an identity-verification process to buy products. More than half (55.6%) of the vape stores and 46.6% of the retail stores reported that they were located less than 500 m from a school. CONCLUSION The available products were widely varied, and they were easy to access through online and offline stores. The new tobacco products had successfully avoided several tobacco-control measures, including smoke-free regulations and the appearance of PHWs on the products. The government needs to impose regulations sufficient to prevent youth from consuming new tobacco products.
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Affiliation(s)
- Mouhamad Bigwanto
- grid.5591.80000 0001 2294 6276Doctoral School of Psychology, Eötvös Loránd University, Izabella u. 46, 1064 Budapest, Hungary ,grid.5591.80000 0001 2294 6276Institute of Psychology, Eötvös Loránd University, Izabella u. 46, 1064 Budapest, Hungary ,grid.443454.60000 0001 0177 9026Faculty of Health Sciences, Universitas Muhammadiyah Prof. Dr. HAMKA, Jl. Limau II, Jakarta, 12210 Indonesia
| | - Fathi Muhammad
- National Committee on Tobacco Control, Jl. Teuku Umar No.8, Jakarta, 10350 Indonesia
| | - Sarah Muthia Widad
- National Committee on Tobacco Control, Jl. Teuku Umar No.8, Jakarta, 10350 Indonesia
| | - Laksmana Yudha
- National Committee on Tobacco Control, Jl. Teuku Umar No.8, Jakarta, 10350 Indonesia
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Grilo G, Cohen J, Welding K, Reynales-Shigematsu L, Flores Escartin MG, Madar A, Clegg Smith K. ‘Green Zing’ and a selection of color concept descriptors on
IQOS HEETS in Mexico. Tob Induc Dis 2022; 20:102. [DOI: 10.18332/tid/155881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 10/18/2022] [Indexed: 11/19/2022] Open
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Cartujano-Barrera F, Cox LS, Castro EM, Lara D, Quiñones Z, McIntosh S, Ossip DJ, Cupertino AP. Cigarro or Cigarrillo? The Pressing Need to Use Culturally and Linguistically Appropriate Terminology for Tobacco Control Among Spanish-speaking Latinos. Nicotine Tob Res 2022; 24:1840-1841. [PMID: 35536746 DOI: 10.1093/ntr/ntac123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Lisa Sanderson Cox
- Department of Population Health, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eida M Castro
- Department of Psychiatry and Human Behavior, Ponce Health Sciences University, Ponce, PR, USA
| | - Daimarelys Lara
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Zahira Quiñones
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Deborah J Ossip
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
| | - Ana Paula Cupertino
- Department of Public Health Sciences, University of Rochester Medical Center, Rochester, NY, USA
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Kyriakos CN, Qi D, Chang K, Laverty AA, Filippidis FT. Global market trends of flavor capsule cigarettes and
menthol (non-capsule) cigarettes: An ecological analysis
using commercial data across 78 countries, 2010–2020. Tob Induc Dis 2022; 20:85. [PMID: 36304063 PMCID: PMC9549585 DOI: 10.18332/tid/153974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/23/2022] [Accepted: 09/09/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This study describes market trends of flavor capsule cigarettes (FCCs) and menthol (non-capsule) cigarettes (MNCCs) across 78 countries from 2010 to 2020 and examines country-level factors associated with market shares of these products. METHODS Market share and retail volume data came from the Euromonitor Passport database and country-level data came from the World Health Organization (WHO), World Bank, and International Monetary Fund. Multivariable linear fixed effects panel regression analyses were conducted to evaluate the relationship between predictor variables and the market shares of menthol (non-capsule) cigarettes and flavor capsule cigarettes. RESULTS The overall market share (i.e. the percentage retail volume out of total retail volume of all cigarette types) increased from 0.23% in 2010 to 4.5% in 2020 for FCCs and decreased from 5.0% to 3.8% for MNCCs. Market shares of FCCs grew most rapidly in the Americas region and among upper middle-income countries. Market shares of MNCCs remained stable across most regions and were highest in the Western Pacific and Africa regions. The overall market share of FCCs was positively associated with the unemployment rate (β=0.28; 95% CI: 0.12–0.44, p=0.001), and inversely associated with the percent of the population aged 15–29 years (β= -0.57, 95% CI: -0.98 – -0.15, p=0.008), percent of urban population (β= -0.88; 95% CI: -1.28 – -0.48, p<0.001), GDP PPP per capita (β= -0.13; 95% CI: -0.24 – -0.03, p=0.015), and age-standardized prevalence of cigarette smoking (β= -0.93; 95% CI: -1.38 – -0.49, p<0.001). In contrast, the overall market share of MNCCs was positively associated with urbanicity (β=0.24; 95% CI: 0.08–0.40, p=0.003), and negatively associated with the unemployment rate (β= -0.09; 95% CI: -0.17 – -0.02, p=0.014). CONCLUSIONS Global sales of flavor capsule cigarettes grew substantially in the last decade, surpassing menthol (non-capsule) cigarettes, which also continued to be high in many regions. There is a need for increased efforts to address flavors and novel tobacco products, features that are known to appeal to youth.
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Affiliation(s)
- Christina N. Kyriakos
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Dickson Qi
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Kiara Chang
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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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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Mus S, Monzon J, Thrasher JF, Barnoya J. E-cigarette vending machines: a new access channel for youth in Guatemala City. Tob Control 2022:tobaccocontrol-2021-057102. [PMID: 35064013 PMCID: PMC9300763 DOI: 10.1136/tobaccocontrol-2021-057102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/07/2022] [Indexed: 11/04/2022]
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18
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Chew A, Mus S, Rohloff P, Barnoya J. The Relationship between Corner Stores and the Ultra-processed Food and Beverage Industry in Guatemala: Stocking, Advertising, and Trust. JOURNAL OF HUNGER & ENVIRONMENTAL NUTRITION 2022. [DOI: 10.1080/19320248.2021.2002748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aiken Chew
- Department of Research, Cardiovascular Surgery Unit of Guatemala, Guatemala City, Guatemala
| | - Sophia Mus
- Department of Research, Cardiovascular Surgery Unit of Guatemala, Guatemala City, Guatemala
| | - Peter Rohloff
- Wuqu’ Kawoq, Maya Health Alliance, Santiago Sacatepéquez, Guatemala
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Grilo G, Crespi E, Cohen JE. A scoping review on disparities in exposure to advertising for e-cigarettes and heated tobacco products and implications for advancing a health equity research agenda. Int J Equity Health 2021; 20:238. [PMID: 34717629 PMCID: PMC8557615 DOI: 10.1186/s12939-021-01576-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/19/2021] [Indexed: 01/13/2023] Open
Abstract
Background Disparities in exposure to and density of tobacco advertising are well established; however, it is still unclear how e-cigarette and heated tobacco product (HTP) advertising vary by age, education, sex, gender identity, race/ethnicity, sexual orientation, socioeconomic status (SES), and/or urban/rural area. Through a scoping review, we sought to identify potential disparities in exposure to e-cigarette and HTP advertising and promotion across populations. Methods In January 2020, a systematic literature search was conducted in five databases: PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. The search was updated in October 2020. Articles reporting on exposure to e-cigarette and/or HTP advertising and promotion across age, education, sex, gender identity, race/ethnicity, sexual orientation, SES, and/or urban/rural areas were included for full-text review (n = 25). Of those, 15 were deemed relevant for data extraction. Results The majority of the studies were from the U.S. (n = 12) and cross-sectional (n = 14). Studies were published between 2014 and 2020 and focused on determining causal relationships that underlie disparities; only one study assessed HTP advertising and promotion. Exposure to e-cigarette and HTP advertising was assessed at the individual-level (e.g., recall seeing ads on television) and at the neighborhood-level (e.g., ad density at the point-of-sale). Studies addressed differences across age (n = 6), education (n = 2), sex (n = 6), gender identity and sexual orientation (n = 3), race/ethnicity (n = 11), SES (n = 5), and urban/rural (n = 2). The following populations were more likely to be exposed to e-cigarette advertising: youth, those with more than a high school diploma, males, sexual and gender minorities, Whites, and urban residents. At the neighborhood-level, e-cigarette advertisements were more prevalent in non-White neighborhoods. Conclusions Exposure to e-cigarette/HTP advertising varies based on sociodemographic characteristics, although the literature is limited especially regarding HTPs. Higher exposure among youth might increase tobacco-related disparities since it can lead to nicotine/tobacco use. Research should incorporate and apply a health equity lens from its inception to obtain data to inform the elimination of those disparities.
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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, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA.
| | - Elizabeth Crespi
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 2213 McElderry Street, Fourth Floor, Baltimore, MD, 21205, USA
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20
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Bar-Zeev Y, Berg CJ, Abroms LC, Rodnay M, Elbaz D, Khayat A, Levine H. Assessment of IQOS Marketing Strategies at Points-of-Sale in Israel at a Time of Regulatory Transition. Nicotine Tob Res 2021; 24:100-108. [PMID: 34216461 DOI: 10.1093/ntr/ntab142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION IQOS, a tobacco heating system, and accompanying tobacco sticks (HEETS) entered the Israeli market in 2016, prior to rapid regulatory change. This study assessed IQOS marketing strategies and regulatory compliance at IQOS/HEETS point-of-sale (POS) in Israel in December 17, 2019-January 7, 2020, after the ban on advertisement went into effect in March 8, 2019. METHODS Research staff audited 80 randomly-selected IQOS/HEETS POS in 4 cities using a structured form to assess store types, product placement, price, promotional strategies, and regulatory compliance. POS data was linked to neighbourhood characteristics, including socioeconomic status (SES), ethnicity, and proximity (under 300 meters) to schools. RESULTS Almost half of the stores (48.7%) were convenience stores. HEETS were visible to the customers in 46.1% of POS, 35% carried at least four HEETS colours, 20.0% had IQOS/HEETS special displays, and 13.8% displayed HEETS near youth-oriented merchandise. Mean HEETS pack price was 8.7 USD (range: 7.5-11.3 USD), 27% more than the least expensive cigarette pack, and 39% less than the most expensive cigarette. HEETS promotions were uncommon. Compliance with the newly-introduced advertisement ban was fairly high for HEETS (94.8%). Only one POS was located in a low-SES area; 68.7% were in close proximity to a school. CONCLUSION The relatively limited IQOS/HEETS marketing at POS suggests that, with regulatory changes, online or other forms of marketing might be prioritized. IQOS may be promoted to higher SES populations, as indicated by pricing and POS neighbourhood characteristics. Access near schools and placement near youth-oriented merchandise are potential concerns necessitating further research. IMPLICATIONS Globally, the point-of-sale is considered the least regulated channel for advertising and marketing of tobacco products. Assessing IQOS marketing strategies at the point-of-sale provides valuable findings that can inform regulatory efforts in Israel and other countries as well. Limited IQOS/HEETS marketing at point-of-sale suggests that primary marketing strategies may shift to online or other forms/channels as regulatory contexts become more progressive/restrictive. Ongoing surveillance of IQOS via online marketing and point-of-sales, specifically with regard to product placement and proximity to schools, is needed.
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Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, NW, Washington, USA
| | - Lorien C Abroms
- Milken Institute School of Public Health, George Washington University, NW, Washington, USA
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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Monzón J, Islam F, Mus S, Thrasher JF, Barnoya J. Effects of tobacco product type and characteristics on appeal and perceived harm: Results from a discrete choice experiment among Guatemalan adolescents. Prev Med 2021; 148:106590. [PMID: 33930431 PMCID: PMC8645268 DOI: 10.1016/j.ypmed.2021.106590] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/16/2021] [Accepted: 04/25/2021] [Indexed: 11/29/2022]
Abstract
Guatemala is one of the few countries where both heated tobacco products (HTPs) and electronic cigarettes (e-cigarettes) remain unregulated. We used a discrete choice experiment (DCE) administered to 2038 high school students to assess how tobacco product attributes influence their appeal among Guatemalan adolescents. Participants were randomly assigned to evaluate 4 of 32 contrasting sets, each containing 3 packs (1 of each product type). Experimental manipulations included: product type, brand, nicotine content and flavor. Participants then indicated which product they were most and least interested in trying and would be most and least harmful to their health. Conditional logistic regression models were used to assess the impact of product characteristics on choice. Product type accounted for almost 90% of variation in choices. Respondents were less interested in trying HTPs (B = -0.93; p < 0.001) and viewed them as more harmful (B = 2.77; p < 0.001) compared to cigarettes. They were more interested in trying e-cigarettes (B = 1.22; p < 0.001), which were also perceived as less harmful (B = -1.47; p < 0.001) compared to cigarettes. Products without nicotine were of more interest for trying (B = 0.14; p < 0.001) and perceived as more harmful (B = 0.20; p < 0.001) than those with. Students were more interested in trying a flavor compared to regular tobacco and among the flavors, berry was the highest rated one (B = 0.28; p < 0.001). Finally, in this country with weak tobacco control, e-cigarettes appear to be more appealing and perceived as less harmful than HTPs and cigarettes. Packaging and flavoring regulations are urgently needed on these products as they are a marketing strategy targeting adolescents.
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Affiliation(s)
- Jose Monzón
- Instituto de Investigación en Ciencias de la Salud (IECIS), Rafael Landívar University, Guatemala City, Guatemala
| | - Farahnaz Islam
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Sophia Mus
- Instituto de Investigación en Ciencias de la Salud (IECIS), Rafael Landívar University, Guatemala City, Guatemala
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Joaquin Barnoya
- Instituto de Investigación en Ciencias de la Salud (IECIS), Rafael Landívar University, Guatemala City, Guatemala; Unidad de Cirugía Cardiovascular de Guatemala (UNICAR), Guatemala City, Guatemala.
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