Colours, capsules and concept flavour names on cigarette packs appeal to youth in Mexico

BackgroundFlavoured 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.MethodsWe 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.Results1500 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).ConclusionsColours and flavour capsule images appeal to adolescents and adults in Mexico. Mexico should consider adopting plain packaging to reduce appeal and interest.

A Qualitative Study of Pictorial Health Warnings on Malaysian Cigarette Packs: How Do the Adults Understand Them?

The WHO recommended pictorial health warnings (PHWs) on cigarette packs in 2003 to educate and warn the public of smoking effects. Malaysia too has implemented this policy since 2009. This study explored the public’s understanding of the gazetted PHWs depicted on cigarette packs available in Malaysia. A qualitative study using four focus group discussions (FGDs) was conducted among smokers and non-smokers aged 18–40 in Malacca, Peninsular Malaysia. Thematic analyses were performed using the Atlas Ti version 8.0 software. Six themes have emerged reflecting the public’s understanding of the existing PHWs in Malaysia, namely, (i) awareness and exposures, (ii) recall and attention, (iii) perceived goals, (iv) perceived target groups, (v) attitude in understanding, and (vi) knowledge and meaning of PHWs. All participants were aware of the PHWs depicted on legal cigarettes but not seen on most illicit cigarettes. PHWs were perceived to give awareness and warning about the smoking effects targeting smokers and non-smokers. Participants understood the lung and oral health-related images easily than other body parts such as gangrene foot, miscarriages, etc. Besides enforcement on illicit cigarettes without PHWs, policymakers or relevant authorities should emphasize creating relevant and clear pictorial messages in educating the public to avoid confusion affecting the public’s understanding of the PHWs.

The estimated effect of graphic warning labels on smoker’s intention to quit in Shanghai, China: a cross-sectional study

Background Tobacco consumption is the leading cause of death worldwide. Overwhelming studies demonstrate graphic warning labels (GWLs) on cigarette packs are effective in eliciting negative response to tobacco smoking, modifying beliefs about tobacco dangers, and increasing reported intention to quit, but the estimated effect of GWLs on smoking cessation intention among smokers is still limited in China. In this study, we aim to understand the smoking intensity, smoking duration and smoking cessation intention among current smokers, and to explore how their smoking cessation intention would be influenced by the GWLs in Shanghai. Methods From January to June 2021, we totally recruited 1104 current smokers in Songjiang district and Fengxian district of Shanghai by multistage sampling design. We used Android pad assisted electronic questionnaire for data collection, and then implemented logistic regression for odds ratio (OR) and 95% confidence interval (CI) calculation to explore how smoking cessation intention would be influenced by the GWLs among current smokers. Results One thousand one hundred four current smokers included 914 males (82.79%), with an average age of 43.61 years. 58.06% of current smokers reported smoking cessation intention due to GWLs. Logistic regression indicated a higher percentage of smoking cessation intention due to GWLs was among female smokers [OR = 2.41, 95% CI (1.61–3.59)], smokers with smoking intensity < 20 cigarette/day [OR = 1.92, 95% CI (1.44–2.55)], smokers with tobacco burden < 20% [OR = 1.94, 95% CI (1.35–2.79)], and among smokers had plan to quit in a year [OR = 6.58, 95% CI (4.71–9.18). Smokers with higher individual monthly income had lower percentage of smoking cessation intention (OR were 0.35, 0.46 and 0.41). Meanwhile, among 642 current smokers without plan to quit in a year, approximately 40% of them reported smoking cessation intention due to GWLs. Conclusions Smoking cessation intention due to the assumed GWLs on cigarette packs is high among current smokers in Shanghai, especially in female smokers, smokers with light tobacco burden and mild nicotine dependence. Incorporating smoking intensity as well as smoking burden into the implementation of GWLs as tobacco control measures would discourage smoking in China.

Straw cigarette branding: misleading descriptors and a new Marlboro man

BackgroundStraw cigarettes are hand-rolled tobacco in a corn straw, common in Brazil and believed to be less harmful by consumers. Traditionally consumed in rural areas and by men, a recent increase in use among young people in urban areas was observed. This study assessed marketing appeals of straw cigarette packaging in Brazil.MethodsFollowing a systematic protocol, unique straw cigarette packs were purchased in 2013, 2016 and 2019 from three cities: Manaus, Salvador and São Paulo. Packs were double-coded for the absence/presence of marketing appeals (ie, luxury/quality, masculinity, classic/timeless, flavours and less harm).ResultsThe number of unique straw cigarette packs purchased as part of the overall sample increased in the most recent collection: 2.3% (n=3), 1.3% (n=2) and 15.5% (n=27) in 2013, 2016 and 2019, respectively. Across the years, all packs presented luxury/quality elements (eg, images of crests); 93.8% (n=30) included the word ‘artisanal’. Masculine appeal (eg, images of men) was present on 56.3% (n=18) of packs. Almost half had classic/timeless elements, including the words ‘tradition’/‘original’. In 2019, 59.3% (n=16) of the packs were flavoured compared with none in previous years. Over a quarter of all packs presented a less harm appeal (eg, ‘smooth’).ConclusionWe identified an increase in availability of unique straw cigarette packs, strong branding and use of misleading descriptors on the packs. The adoption of plain packaging and the implementation of Brazil’s additive ban could help to reduce the appeal of straw cigarettes and curb the current increase in use among youth.

Tobacco industry compliance with the EU track and tracing system in Lithuania

BackgroundThe European Union (EU)-wide tobacco tracking and tracing system (T&T system) became operational on 20 May 2019, allowing a transitional period and gradual installation of the system until May 2020. This study attempts to assess the EU T&T system using a sample of discarded cigarette packs collected in Lithuania.MethodsThe empty pack survey was conducted between September 2019 and September 2020, covering both the transitional period and the period of full implementation. The study employed a two-stage cluster design by first randomly selecting 65 well-defined population clusters (30 cities and 35 towns) representing both urban and rural areas in all 10 counties in Lithuania. Second, we randomly selected 358 polling districts (routes) in each cluster.ResultsThe fieldworkers walked at least 1074 km and collected 5727 discarded empty cigarette packs. None of the packs found during the EU T&T transitional period had a unique identifier (UI). After the full implementation of the EU T&T system, 32.0% of the collected packs were still without a UI. 5.8% of licit packs were without a UI after the May 2020 deadline. Most of the legal non-compliant packs (131, or 69.7%) were intended for the Lithuanian market. Close to 85% of packs that had duty-free markings were non-compliant.ConclusionThe tobacco industry most likely disregarded the EU T&T transitional period as no packs with UIs were found up until the full implementation. Packs without UIs were still found 4 months after the full implementation of the EU T&T system.

Description of Smoking Behaviour in Young Girls

Smoking is one of the lifestyle phenomena in most people today. Smoking habits are common in adolescence. This study aims to find out the description of smoking behavior in young girls This research is descriptive qualitative research. The informants in this study were 4 young girls who performed smoking behavior. Data collection is done by interview method. The description of smoking behavior in young girls occurs for the following reasons, namely trial and error, curiosity, and the influence of friends. The response of a friend knowing the informant smoked is not responding and just so so. The informant's efforts in quitting smoking are by reducing the cigarettes and reducing gatherings with a friend. Information about the dangers of smoking contained in advertisements and cigarette packs is still ignored by informants, therefore, there needs to be cross-sectoral cooperation to improve understanding of the dangers of smoking. The reason of informant to start smoking is try, curiosity and the influence of friends, the response of friends know the informant smoking does not respond and just so so, the efforts of informants on quitting smoking are by reducing the cigarettes and reduced gathering with friends. There needs to be cross-sectoral cooperation to improve understanding of the dangers of smoking.

Native owned and grown or demeaning and offensive? American Indian adults’ perspectives on Natural American Spirit branded cigarettes

IntroductionOwned by a major US tobacco company with no American Indian/Alaska Native (AI/AN) tribal affiliation, Natural American Spirit (NAS) cigarette packs feature an American Indian warrior, thunderbird and peace pipe. The current study examined AI/AN adults’ perceptions of NAS cigarette packs in the US, which have not been reported on prior.MethodsAI/AN adults were recruited via Qualtrics national panels (n=500; 64% female, age M=39.9 years, 47% current smokers) in 2020. After viewing NAS pack images online (front, back and sides), participants were asked about NAS tribal affiliation, health perceptions and purchase intentions. Participants also wrote-in what the NAS pack logos meant to them.ResultsMost participants (65%) believed NAS is AI/AN-owned and/or grown on tribal lands. Among current smokers, beliefs of an AI/AN affiliation were associated with misperceptions of NAS being a healthier cigarette and with greater intention to purchase NAS cigarettes (p’s<0.01). Participants who did not believe NAS was grown or owned by AI/AN tribes were more likely to describe the NAS warrior logo as cultural misappropriation (17%) than participants who believed NAS was AI/AN tribally affiliated (4%, p<0.001).ConclusionsThe findings indicate a dichotomy in beliefs among surveyed AI/AN adults regarding NAS brand cigarettes. A majority held the misconception that NAS is tribally affiliated, while an informed and concerned minority characterised the branding as cultural misappropriation. The current packaging is reasonably expected to result in beliefs that NAS cigarettes are AI/AN tribally affiliated, and these beliefs may be associated with misperceptions of lesser harm.

Characteristics of Cheyenne Little Filtered Cigar Instagram Ads, 2019-2020 (Preprint)

BACKGROUND Little filtered cigar (LFC) marketing has often blurred the line between cigar and cigarette, and little is known about LFC marketing on social media. OBJECTIVE This study examined the characteristics of Instagram posts by Cheyenne—a popular LFC brand—from 2019-2020. METHODS A content analysis of 323 images posted in 2019 and 2020 on Cheyenne’s official Instagram account was conducted. Descriptive statistics were examined, and Chi-square and Fisher’s exact tests were used to test differences by year. RESULTS Most posts (76.0%) showed 1 pack and/or LFC stick, which look highly similar to cigarette packs and sticks, and the pack was often flavored (62.2%). Images of lit LFC sticks increased from 2019 (12.2%) to 2020 (26.7%, P=.005). Warning labels were present on the ad in 79.9% of posts, but were always presented at the bottom, and used the same single warning statement that they are not a safe alternative to cigarettes. The depiction of people nearly doubled from 2019 (18.1%) to 2020 (34.8%, P=.001), and women (51%) were more commonly depicted than men (32%). Popular depictions and themes included the outdoors (57.6%) and seasonal imagery (36.2%) among others. CONCLUSIONS Cheyenne actively used Instagram to market its product and grow its brand. Posts seemed designed to promote the similarity of their LFC to cigarettes, through depictions of cig-a-like packs/sticks. Although warning labels were highly prevalent on Cheyenne Instagram posts, the warnings were not compliant with FDA warning guidelines and might have been counterproductive by emphasizing their viability as cigarette alternatives rather than their dangerous health effects. Future surveillance is needed, and regulation of LFC advertising on social media may be warranted.

Development and testing of relative risk-based health messages for electronic cigarette products

Background Health messages on e-cigarette packs emphasise nicotine addiction or harms using similar wording to warnings on cigarette packs. These may not be appropriate for e-cigarettes which constitute a reduced risk alternative for smokers. This research aimed to (1) develop and test a selection of relative risk messages for e-cigarette products; (2) compare these to the two current EU Tobacco Products Directive (TPD) nicotine addiction messages; and (3) explore differences between smokers, non-smokers and dual users. Method Twenty-six messages focusing on either harm-reduction or cessation were developed and rated by multidisciplinary experts for accuracy, persuasiveness and clarity. The eight highest ranking messages were compared alongside the TPD messages in a sample of 983 European residents (316 smokers, 327 non-smokers, 340 dual users) on understandability, believability and convincingness. Results On all three constructs combined, the two TPD messages rated the highest, closely followed by four relative risk messages “Completely switching to e-cigarettes lowers your risk of smoking related diseases”, “Use of this product is much less harmful than smoking”, “Completely switching to e-cigarettes is a healthier alternative to smoking”, and “This product presents substantially lower risks to health than cigarettes” which did not differ statistically from the TPD messages. Non-smokers rated TPD1 significantly higher overall than dual users. Dual users rated “This product is a safer alternative to smoking” significantly higher than non-smokers. Messages did not differ on understandability. Conclusions These alternative messages provide a useful resource for future research and for policy makers considering updating e-cigarette product labelling.

Claims of reduced odor on tobacco packs in low- and middle-income countries

Introduction Cigarettes designed to have less smoke smell were developed by the tobacco industry to supposedly reduce negative qualities. Cigarettes with marketing claims communicating these designs have been sold in high-income countries and marketing of “less smoke smell” terms on cigarette packaging can promote cigarette use. It is unclear to what extent they have been marketed in low- and middle-income countries (LMICs). Methods The Tobacco Pack Surveillance System (TPackSS) systemically collected tobacco packs available in 14 LMICs with high tobacco use between 2013-2017. We coded 4,354 packs for marketing appeals, including claims related to smoke smell. We describe “less smoke smell” and similar claims found on these packs and compare across country and tobacco manufacturers. Results Phrases communicating less smoke smell were present on packs purchased in nine of 14 LMICs, including Bangladesh, Brazil, China, India, Mexico, Philippines, Russia, Ukraine, and Vietnam. The most commonly (74.1%) used terminology was “less smoke smell”, "LSS" or a combination of the two. Packs from Russia had the most prevalent use (11.8%) of such claims. Companies using these terms across 21 brands included Japan Tobacco International (JTI), British American Tobacco (BAT), Philip Morris International (PMI) and other smaller companies. JTI accounted for 70.9% of packs with such terms. Conclusion Some of the world’s largest tobacco companies are communicating less smoke smell on packs in LMICs. Less smoke smell and similar phrases on packaging should be prohibited because they can enhance the appeal of cigarettes. Implications Tobacco companies are using “less smoke smell” and similar phrases on cigarette packs in LMICs. These claims have the potential to increase the appeal of smoking and promote cigarette use. Countries should consider policies to restrict attractive labeling claims, in accordance with the WHO Framework Convention on Tobacco Control (FCTC) Article 13 guidelines, which recommends restrictions on attractive design elements on tobacco packaging.