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Assessing tobacco company adaptation to standardised packaging: identifying circumventions and closing loopholes

Journal: BMJ Open ManuscriptFor ID peerbmjopen-2018-028506 review only Article Type: Research

Date Submitted by the 17-Dec-2018 Author:

Complete List of Authors: Evans-Reeves, Karen; University of Bath, Tobacco Control Research Group, UK Centre for Tobacco and Alcohol Studies, Department for Health Hiscock, Rosemary; University of Bath, Tobacco Control Research Group, UK Centre for Tobacco and Alcohol Studies, Department for Health Lauber, Kathrin; University of Bath, Tobacco Control Research Group, UK Centre for Tobacco and Alcohol Studies, Department for Health Gilmore, Anna; Tobacco Control Research Group, UK Centre for Tobacco and Alcohol Studies, Department for Health, University of Bath

PUBLIC HEALTH, PREVENTIVE MEDICINE, TOBACCO, STANDARDISED Keywords: PACKAGING

Note: The following files were submitted by the author for peer review, but cannot be converted to PDF. http://bmjopen.bmj.com/ You must view these files (e.g. movies) online.

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1 2 3 4 Assessing tobacco company adaptation to standardised BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 packaging: identifying circumventions and closing 7 8 9 loopholes 10 11 12 Karen A Evans-Reeves1, email [email protected] 13 14 Rosemary Hiscock1*, email [email protected] 15 16 Kathrin Lauber1, email [email protected] 17 18 Anna B Gilmore1, emailFor [email protected] peer review only 19 20 1Tobacco Control Research Group, University of Bath and UK Centre of Tobacco and Alcohol Studies, 21 Bath, UK 22 23 *Corresponding author: +44 (0)1225 388388 24 25 26 27 Key words: tobacco, tobacco industry, standardised packaging, plain packs 28 29 30 Word count: 4251 31 32 33 34 35 36 37

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Abstract 6 7 Objectives: UK standardised packaging legislation was introduced alongside pack size and 8 9 product descriptor restrictions of the European Union Tobacco Products Directive to end 10 11 12 tobacco marketing and misinformation via the pack. This paper aims to assess compliance 13 14 with the restrictions and identify attempts to continue to market tobacco products and 15 16 17 perpetuate misperceptions of harm post-legislation. 18 For peer review only 19 20 Design, setting and intervention: A prospective study of the introduction of standardised 21 22 packaging of tobacco products to the UK. 23 24 25 Participants and outcomes: We analysed Nielsen sales data to assess whether the legally 26 27 28 required changes in pack branding, size and name were implemented by the deadline. To 29 30 explore any adaptations to products and packaging we analysed data from monthly pack 31 32 purchases of factory-made and roll-your-own cigarettes, tobacco adverts from retail trade 33 34 35 magazines and articles on tobacco from commercial literature (e.g. trade, market analyst 36 37 and tobacco company publications).

38 http://bmjopen.bmj.com/ 39 40 Results: While compliance was good (99% by November 2017), tobacco companies used 41 42 43 the one-year sell-through to their advantage by communicating brand name changes and 44 45 providing financial incentives for retailers to buy large volumes of branded packs. They made

46 on October 4, 2021 by guest. Protected copyright. 47 adaptations to tobacco products to enable continued marketing and brand differentiation. For 48 49 50 example, companies included colours (either to convey the historical colour of the pack or a 51 52 characteristic) arguably enabling continued misperceptions about the relative harms of 53 54 55 products. In addition, innovations to exemptions of the legislation, namely filters, packaging 56 57 edges, seals, multipack outers, RYO accessories, cigars and pipe tobacco were all marketed 58 59 to retailers. 60

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1 2 3 4 Conclusions: Tobacco companies adapted to packaging restrictions by innovating their BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 marketing activities. These findings should enable policy makers globally to close loopholes. 7 8 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Article Summary 6 7 8 Strengths and limitations of the study 9 10 11  The strength of this paper lies both in the detail and depth of each analysis including 12 13 14 our systematic analysis of retail press adverts (n=195) and commercial literature 15 16 articles and reports (n= 396) alongside pack purchases of the top selling brands and 17 18 For peer review only 19 detailed sales information from Nielsen. 20 21  Using multiple data sources has, in many instances, enabled findings to be verified 22 23 by more than one source and enabled a greater understanding of the tobacco 24 25 26 industry’s motives for any changes made to their products and packaging. 27 28  Resources prevented us from acquiring Nielsen data on cigars or pipe tobacco and 29 30 31 from purchasing more than one brand per price segment in the pack purchasing 32 33 study element but we were able to compensate, to some extent, by using information 34 35 available from other sources. 36 37

38  We assumed that 30g RYO packs were always in standardised packs and that larger http://bmjopen.bmj.com/ 39 40 packs would switch to standardised packs at the same time; the temporal patterns of 41 42 43 switching names and sizes are similar to FM (where standardised packaging was 44 45 indicated) and it is therefore reasonable to assume that branding was removed at the

46 on October 4, 2021 by guest. Protected copyright. 47 same time. 48 49 50  Although, we do not know the extent to which Nielsen variant name changes lag 51 52 behind and even reflect those printed on packs in retailers, the main name change 53 54 55 patterns found in the Nielsen data were similar to those found in a UK convenience 56 57 store study and an evaluation of the introduction of standardised packaging in 58 59 Australia. 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 7 Funding: This work was supported by Cancer Research UK grant number C27260/A23168. 8 9 The authors are members of the UK Centre for Tobacco & Alcohol Studies, a UK Clinical 10 11 Research Collaboration Public Health Research Centre of Excellence whose work is 12 13 14 supported by funding from the Medical Research Council, British Heart Foundation, Cancer 15 16 Research UK, Economic and Social Research Council, and the National Institute for Health 17 18 For peer review only 19 Research under the auspices of the UK Clinical Research Collaboration (MR/K023195/1). 20 21 22 23 24 25 Competing Interests: The authors have no competing interests. 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Background 6 7 8 Standardised tobacco packaging, one of the most significant policy threats to the tobacco 9

10 th 11 industry in recent years, came into force in the UK on May 20 2016. From this date all new 12 13 factory made (FM) cigarettes and roll your own (RYO) tobacco, manufactured or imported for 14 15 UK consumption were to be sold in standardised packaging. Tobacco companies were 16 17 18 given until May 20thFor 2017 to peercomply with reviewthe law; a period onlyreferred to as the ‘sell-through’. 19 20 During this time, companies were not permitted to print any new branded packets(1, 2). The 21 22 23 UK legislation(1) was implemented in concert with the revision of the 2001 European Union 24 25 (EU) Tobacco Products Directive (TPD)(3) which placed further restrictions on packaging 26 27 and naming of brands (Box 1)(3). 28 29 30 After Australia became the first country to introduce standardised packaging in December 31 32 33 2012, tobacco companies responded with more evocative and descriptive tobacco product 34 35 names, including colours to represent the previous pack colour, thereby continuing the 36 37 connotations associated with these colours(4, 5) . Simultaneously companies reduced the 38 http://bmjopen.bmj.com/ 39 40 total number of brands sold and renewed their focus on value for money brands by 41 42 increasing the number and length of cigarettes in a pack and introducing menthol variants in 43 44 45 this price range.(6)

46 on October 4, 2021 by guest. Protected copyright. 47 48 While the UK and EU legislation combined closed some of loopholes in the Australian 49 50 legislation, by prohibiting evocative names and requiring minimum pack sizes for both 51 52 53 cigarettes and RYO,(7) concerns remain. The current legislation does not permits the use of 54 55 colour descriptors, bevelled edges on packs and cigarette filter technology innovations. 56 57 Furthermore, cigars, cigarillos and pipe tobacco are exempt from the legislation and are still 58 59 60

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1 2 3 4 sold in branded packaging, while wholesaler multipacks are still allowed branded ‘outer’ BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 wraps. 7 8 9 Recently published research suggests that, prior to the full implementation of standardised 10 11 packaging in the UK, tobacco companies added smaller pack sizes such as 17 sticks to their 12 13 14 brand variant portfolios,(8) introduced colour descriptors to brand variant names and made 15 16 product changes, particularly to filters.(9) Examples of name change patterns associated 17 18 For peer review only 19 with UK standardised packaging restrictions have been described qualitatively(7, 9, 10) but 20 21 not quantitatively. The scale of these name changes and if/how these changes were 22 23 communicated to the public is not clear from published research. Previous work has also 24 25 26 only explored up to two months post-legislation. 27 28 29 Therefore, the purpose of this paper was to use mixed methods to combine data from four 30 31 different data sources up to 7 months post full-implementation to systematically and 32 33 34 rigorously examine how compliant tobacco companies were with the legislation, and to 35 36 explore any attempts they made to circumvent. We assess how their marketing has adapted 37

38 http://bmjopen.bmj.com/ including, changes to products or packaging that would endure after the legislation was fully 39 40 41 implemented, and whether and how products are being marketed to retailers and 42 43 consumers. The findings of this paper have global significance as they can help close 44 45 loopholes during the design and implementation of standardised packaging legislation in 46 on October 4, 2021 by guest. Protected copyright. 47 48 other jurisdictions. 49 50 51 BOX 1. Summary of restrictions UK Standardised packaging legislation and the European 52 53 Union Tobacco Products Directive Revision (implemented 20 May 2016 – 20 May 2017) 54 55 56 57 UK STANDARDARDISED PACKAGING EU TOBACCO PRODUCTS DIRECTIVE 58 59 60

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1 2 3 4 PACK EXTERNAL COLOUR: External PACKAGING OPENING: A unit packet of BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 packaging of cigarettes or RYO tobacco is cigarettes may consist of carton or soft 7 8 Pantone 448C (matt finish) material and shall not have an opening that 9 10 11 can be reclosed or re-sealed after it is first 12 13 opened, other than the flip-top lid and 14 15 16 shoulder box with a hinged lid. For packets 17 18 For peer reviewwith a flip-top only lid and hinged lid, the lid shall 19 20 be hinged only at the back of the unit 21 22 23 packet. 24 25 PACK INTERNAL COLOUR: Internal colour PACK SIZE: Cigarette packs must contain a 26 27 28 of cigarette or RYO packaging must be minimum of 20 cigarettes & RYO tobacco 29 30 white or Pantone 448C (matt finish) must contain at least 30 grams of tobacco 31 32 33 34 35 NOISE AND SMELL: Packaging must not IMPRESSION CREATION: There must be 36 37 make a noise or produce a smell that is not no packaging elements that create an

38 http://bmjopen.bmj.com/ 39 40 normally associated with the packaging erroneous impression about the 41 42 characteristics, health effects, risks or 43 44 emissions of tobacco 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 PACKAGING EVOLUTION: The packaging TOBACCO INGREDIENTS: No description 50 51 52 must not change after retail sale, for of nicotine, tar or carbon monoxide content 53 54 example, heat activated inks, of a tobacco product 55 56 embellishments designed to appear 57 58 59 gradually over time, scratch panels etc. 60

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1 2 3 4 PACKAGING SHAPE: Cigarette packets FLAVOUR: No reference to taste, smell or BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 must be made of carton or soft material and any flavourings or additives or the absence 7 8 be cuboid in shape & RYO may be in a of any such thing 9 10 11 cuboid box, a cylinder or a pouch 12 13 (bevelled or rounded edges are permitted) 14 15 16 17 18 STICK DESIGN: CigaretteFor stickpeer paper mustreview ENVIRONMENT: only No suggestion that a 19 20 be plain white (matt finish), the filter must particular tobacco product has improved 21 22 23 only be coloured in such a way as to imitate biodegradability or other environmental 24 25 cork. The stick may have the brand name advantages 26 27 28 and variant printed in black Helvetica type 29 30 no larger than 8 point in normal weighted 31 32 regular typeface not more than 38 mm from 33 34 35 the filter end of the cigarette. The start of 36 37 each word can be an upper case letter but

38 http://bmjopen.bmj.com/ 39 40 the rest of the word must be lower-case 41 42 43 44 RESEMBLANCE: No resemblance to a 45

46 on October 4, 2021 by guest. Protected copyright. 47 food or cosmetic product 48 49 50 51 PROMOTION: No suggestion of economic 52 53 54 advantage of one product over another – no 55 56 price marked packs 57 58 59 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 7 Methods 8 9 10 Data Sources 11 12 We utilised four data sources, 1) purchases of eight top-selling tobacco brands; 2) tobacco 13 14 adverts in retail trade publications; 3) other commercial literature: retail press articles and 15 16 17 advertorials, tobacco company annual reports and Euromonitor market analyst reports; and 18 For peer review only 19 4) Nielsen data. While compliance with the legislation was primarily assessed using the 20 21 22 Nielsen data, the evidence collected from each data source was utilised to assess whether, 23 24 and how, tobacco companies adapted to the legislation and continued to market their 25 26 products. We triangulated data from these different datasets not only to verify the existence 27 28 29 of adaptations but also, their purpose. 30 31 32 Pack Purchasing and observation 33 34 We conducted monthly pack purchases between March 2016 and May 2017 to assess visual 35 36 and sensory changes over time in the leading FM and RYO products (Table 1) at price 37

38 http://bmjopen.bmj.com/ points previously identified.(8) 39 40 41 42 Additionally, we observed price lists of cigar and pipe tobacco brands available in-store and 43 44 the appearance of ‘outers’ (the cover wrap used to bind multiple packs together for 45

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1 2 3 4 Table 1. Pack purchases of the top selling brand in each price segment BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Price segment Top selling products Co 7 8 (average price 4 9 10 per pack/stick) 11

12 1 13 [ref Nielsen 14 15 paper] 16 17 March 2016 name & pack size May 2017 equivalent name & pack size 18 For peer review only 19 20 21 FM 22 23 Premium Marlboro Gold (20s) Marlboro Gold (20s) PM 24 25 (£6.76/£0.42) I 26 2 27 Midprice L&B Original Lambert & Butler Silver Lambert & Butler Original Silver (20s) IM 28

29 (£5.61/£0.36) (20s) Mayfair King Size (20s) T 30 31 Mayfair King Size (19s) JTI 32 33 Value L&B Blue Lambert & Butler Real Blue L&B Blue Real Blue(20s) IM 34 35 (£5.10/£0.33) (19s) T 36 37 Subvalue Carlton Red (19s) Carlton Red (20s) IM

38 http://bmjopen.bmj.com/ 3 39 (£4.68/£0.29) Rothmans of London (17s) Rothmans Blue (20s) T 40 BA 41 42 T 43 44 5 45 RYO

46 on October 4, 2021 by guest. Protected copyright. 47 Premium Golden Virginia The Original (25g) Golden Virginia The Original (30g) IM 48 49 (£6.97/£0.17) T 50 51 Midprice Amber Leaf (25g) Amber Leaf Original (30g) JTI 52 53 (£5.81/£0.15) 54 55 1 weighted average price per pack/stick of all products sold within tobacco industry price segments as described 56 57 by previous analysis (Dec 2015 prices – inflation adjusted to 2008 values). One RYO stick was estimated to be 58 59 0.5g tobacco.(8, 11) 60

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1 2

3 2 Midprice was originally two major segments: Lambert & Butler was the leading upper midprice product and BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 5 Mayfair the leading lower midprice product 6 7 8 3 None of the top selling brands in each price range was owned by British American Tobacco. For completeness 9 10 we added Rothman’s of London (a subvalue brand) - the top selling brand for British American Tobacco. 11 12 4 13 Tobacco company’ abbreviations: BAT British American Tobacco, IMT Imperial Tobacco, JTI Japan Tobacco 14 International, PMI Philip Morris International 15 16 17 5 No RYO value segment (average pack/stick price: £4.28/£0.14) product was purchased due to lower sales 18 For peer review only 19 20 volumes even of the leading brand (Gold Leaf) in this segment. 21 22 23 24 Advertisements in the retail press 25 26 We searched hard copies of retail and wholesale publications The Grocer, Wholesale News 27 28 29 and Retail Newsagent between January 2015 and December 2017 for all tobacco adverts. 30 31 32 We coded 195 adverts for the attributes marketed to retailers, eg, new brand variant, 33 34 packaging, filter, limited edition, price, retailer profit. We examined the distribution of these 35 36 37 marketing themes by price segment (Table S1). We separately assessed advertorials for

38 http://bmjopen.bmj.com/ 39 relevance to standardised packaging and noted the main messages communicated. 40 41 42 Commercial literature review 43 44 We searched online retail publications (The Grocer, Wholesale News, betterretailing.com 45

46 (which includes Retail Newsagent and Retail Express, talkingretail.com), to identify articles on October 4, 2021 by guest. Protected copyright. 47 48 49 relevant to tobacco packaging and marketing (Jan 2015 – Dec 2017; Table 2). We also 50 51 included two reviews of 2017 published in 2018, Euromonitor reports on tobacco, and 52 53 tobacco company annual reports covering this period. We used NVivo 10, to code articles for 54 55 56 any evidence of circumvention of the legislation and used quotes taken from the commercial 57 58 literature as examples of each circumvention (Table S2). 59 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 7 8 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 Table 2 Commercial literature review January 2015 to December 2017 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Source Search terms (depends on Total available Total 7 8 search procedure of website) examined 9 RETAILER 10 11 MAGAZINES 12 Convenience & 13 14 independents 15 16 Betterretailing.com: “tobacco” 350 181 17 Retail Newsagent 18 For peer review only 19 Retail Express 20 21 TalkingRetail.com “tobacco” 50 49 22 23 24 Wholesalers &FMCG 25 Wholesale News "tobacco" or "cigarette" or 54 30 26 27 "ryo" or "roll+your+own" or 28 29 "hand+rolled" or "cigar" or 30 "cigarillo" 31 32 The Grocer "tobacco" or "cigarette" or 820 104 33 "ryo" or "roll+your+own" or 34 35 "hand+rolled" or "cigar" or 36 37 "cigarillo"

38 http://bmjopen.bmj.com/ 39 40 INDUSTRY ANALYST 41 42 Euromonitor Passport “tobacco” NA 20 43 44 45 TOBACCO COMPANY

46 on October 4, 2021 by guest. Protected copyright. 47 Annual reports from the Annual reports 12 12 48 big four tobacco 49 50 companies: JTI, IMT, 51 BAT and PMI 52 53 TOTAL 1286 396 54 55 56 Nielsen Data 57 58 59 60

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1 2 3 4 Nielsen collates data on tobacco sales from nearly 90% of UK supermarkets and a stratified BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 sample of 15% of convenience stores. (8) Using a hierarchical structure Nielsen records for 7 8 each product, the tobacco brand, brand family, brand variant and then specific features of 9 10 11 the pack denoted by a unique serial number known as a SKU (e.g. size, pricemarked) (8). In 12 13 November 2017 there were 71 brands, 97 families, 241 variants, and 1022 SKUs (Table 3). 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 Table 3 Hierarchical brand architecture available in the Nielsen data BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 N (UK market) 7 8 9 Hierarchy of Nielsen Example July 2014 Nov 10 11 data 2017 12 13 BRAND Marlboro 44 71 14 15 BRAND FAMILY Marlboro Bright Leaf 114 97 16 17 Products with the same 18 For peer review only 19 brand name but sold at 20 21 different price points 22 23 BRAND VARIANT Marlboro Bright Leaf Platinum 282 241 24 25 Product at same price 26 point but with different 27 28 length (e.g. superkings, 29 30 kingsize), flavour or 31 32 other characteristics 33 34 Stock Keeping Unit Marlboro Bright Leaf Platinum 10s multipack 930 1022 35 36 (SKU) Each individual not price marked 37 barcoded product

38 http://bmjopen.bmj.com/ 39 including specific pack 40 41 characteristics: pack 42 43 size, whether the pack is 44 price-marked, and, for 45

46 FM but not RYO, on October 4, 2021 by guest. Protected copyright. 47 48 whether standardised or 49 50 branded 51 52 53 54 Data Analysis 55 56 Compliance 57 58 59 60

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1 2 3 4 Nielsen sales data were used to examine compliance with the removal of branding, BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 pricemarking and small pack sizes (Box 1), between July 2016 (when the first standardised 7 8 packs first were sold(10) and November 2017. For FM, Nielsen identifies which packs are 9 10 11 standardised and which branded. For RYO it does not. However, as 30g packs of RYO were 12 13 negligible prior to standardised pack legislation RYO packs of 30g or more were treated as 14 15 16 standardised. 17 18 Name changes For peer review only 19 20 We identified the number, names and price segments of all brand variants whose name 21 22 23 changed between July 2014 and November 2017. We coded and counted whether each 24 25 name change was required for compliance with the legislation and recorded the type of 26 27 28 name change eg colour added or adjective added. 29 30 31 32 33 34 35 36 37

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1 2 3

Innovation targeting BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 5 To understand whether innovations were targeted at particular price segments, we 6 7 8 compared the distribution of name changes and new variants in November 2017 with the 9 10 distribution of price segments prior to the decision to implement legislation in July 2014. 11 12 13 Differences in the number of variants were tested using chi-square tests and Fishers exact 14 15 tests (when the expected number of cases was less than 5). To achieve sufficient numbers 16 17 for analysis, price segments were merged into four categories: (1) FM premium and 18 For peer review only 19 20 midprice, (2) FM value and subvalue, (3) RYO premium and midprice, (4) RYO value. 21 22 23 24 25 26 Patient and Public Involvement 27 28 KER and RH led a focus group with smokers and former smokers from the UKCTAS 29 30 University of Nottingham Smokers Panel (now known as the Tobacco & Nicotine Discussion 31 32 33 Group) in October 2017. The group were asked to discuss their thoughts on and 34 35 experiences of the move to standardised packs. 36 37

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46 on October 4, 2021 by guest. Protected copyright. 47 48 Four main strategies were identified from multiple data sources. We present the evidence 49 50 for each in turn. 51 52 53 Strategy 1: Keep branded packets on the market as long as possible 54 55 56 Six months into the year-long sell-through period, 96% of FM and 82% RYO were still sold in 57 58 branded packs (Figure 1 & table S3). Most FM (70%) and RYO (65%) packs switched to 59 60

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1 2 3 4 standardised packs between January and April 2017. One month after full-implementation, BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 1% FM and 2% RYO were sold in non-compliant packs, declining to 1% FM and negligible 7 8 RYO by November 2017. 9 10 11 12 13 14 15 16 The commercial literature suggests that tobacco companies produced greater volumes of 17 18 their branded FM andFor RYO tobaccopeer prior review to the May 2016 onlymanufacturing deadline to keep 19 20 branded packaging on the market for as long as possible during the sell-through.(12) 21 22 23 Tobacco companies offered cash incentives and promotions on branded packs to retailers to 24 25 encourage sales and loyalty to their products. By early 2017 this was described as a price- 26 27 28 war between the manufacturers (13, 14) . To allay retailers’ concerns about being left with 29 30 non-compliant stock after the deadline, tobacco companies offered to buy them back (Table 31 32 S2; Strategy 1.3).(15) 33 34 35 36 37 Strategy 2: Maintaining brand variant differentiation through name changes

38 http://bmjopen.bmj.com/ 39 40 A third (35%; 123/ 353) of variants changed name between July 2014 and November 2017. 41 42 Of those, less than half changed name to comply with legislation (42%, n=52/123) and most 43 44 of these removed flavour names as the legislation required but substituted with other names, 45

46 on October 4, 2021 by guest. Protected copyright. 47 most often a colour (Table 4). Most notably, FM smooth became bright or sky blue, with 48 49 RYO smooth changing to yellow and menthol for both FM and RYO changing to green. 50 51 52 Of the variants which changed name when it was not necessary for legislative compliance 53 54 55 (N=71/123, 58%), colours were introduced for the first time as a substitute for the previous 56 57 pack colour, eg. Marlboro with the red chevron on the pack became Marlboro Red. Similarly, 58 59 to distinguish brand variants from one another and to continue previous brand variant 60

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1 2 3 4 identities, other adjectives were added to brand names, most notably adjectives BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 accompanied a colour, e.g. real blue, bright silver, legendary black. In addition, during the 7 8 study period, 23 new variants appeared in the Nielsen dataset with names which included 9 10 11 elements that went beyond the purpose of practical information: ‘signature’, ‘ome’, ‘silver 12 13 strand’ in May 2015, ‘Eagle,’ and ‘Colours’’ in November 2015 and ‘Chill’ in May 2016 and 14 15 16 two different brands added ‘Black Russian’ variants in November 2015 and January 2017. 17 18 Lastly two new GoldenFor Virginia peer RYO variants review appeared on only the market in November 2015 19 20 named ‘Midnight’ and ‘Sunrise’. Commercial literature revealed that these indicated rich and 21 22 23 smooth flavours respectively. (16). The first brand variant in a brand family sometimes had 24 25 ‘original’ added e.g. Amber Leaf RYO became Amber Leaf original. 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 Table 4. FM and RYO brand variant name changes (July 2014 to November 2017) BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 N Additions/substitutions 7 8 Legally required actions 9 10 11 Taste removed Replacement 12 13 Menthol Colour 20 green 14 15 No replacement 2 16 17 18 Smooth For peer reviewColour + adjective only12 bright blue/yellow, sky 19 blue 20 21 22 Adjective 5 bright, sky 23 24 Colour 3 blue, yellow 25 26 Other Substitution 1 fine 27 28 other taste (‘fresh burst’, ‘fresh Other Substitution 3 crushball, dual 29 30 taste’, ‘ice capsule’, ‘subtle flavour‘) 31 No replacement 1 32 33 Environmental advantages removed 34 35 ‘Natural’ Other Substitution 2 blue, king size 36 37 No replacement 3

38 http://bmjopen.bmj.com/ 39 40 Total 52 41 42 Discretionary actions only 43 44 colour+adjective added 9 original silver/blue/black, 45

46 real blue/red on October 4, 2021 by guest. Protected copyright. 47 48 adjective added 8 bright, real, legendary 49 50 51 colour added 7 blue, red, black 52 53 ‘original’ added 6 54 55 size (king size, superkings) removed 6 56 57 58 Mixed & miscellaneous 35 59 60

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1 2 3 4 Total 71 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Grand total 12 7 8 3 9 10 11 12 In October 2016, five months into the sell-through period and before IMT had made any of 13 14 its legally required name changes to its products, the company outlined its brand renaming 15 16 17 strategy in an advertorial in the retail press.(17) The advertorial explained that all products 18 For peer review only 19 traditionally presented as full flavour would become ‘real’ or ‘original’ and be associated 20 21 primarily with the colour red. Those previously denoted as ‘smooth’ would change to ‘bright’ 22 23 24 and become associated with the colour blue. Menthol would become green and capsule 25 26 would become Crushball (Table S2: Strategy 2). IMT also provided retailers with materials 27 28 29 to help explain changes to consumers.(17) Some companies also advertised name changes 30 31 directly to consumers through pack inserts (eg. BAT’s Rothmans of London included a pack 32 33 insert to warn its smokers that it was to become Rothman’s Blue). 34 35 36 37

38 http://bmjopen.bmj.com/ 39 Strategy 3. Focus on lower price segments 40 41 During the study period, 68% of new variants recorded by Nielsen were FM and 32% RYO. 42 43 Given that in July 2014, 81% variants on the UK market were FM and 19% were RYO (Table 44 45

46 5), more new RYO variants were introduced than expected (p=.018). on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 Half (50%) of all new variants were introduced in the FM value and subvalue price 52 53 segments, 22% FM premium and midprice, 15% RYO premium and midprice and 13% RYO 54 55 value. However, prior to the decision to implement standardised packaging (July 2014), the 56 57 58 distribution of the market was 50% FM premium and midprice, 35% FM value and subvalue, 59 60

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1 2 3 4 8% RYO premium and midprice and 7% RYO value. Thus new variants were under- BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 represented among FM premium and midprice brands (p=.001). 7 8 9 10 11 Similarly, compared with July 2014, name changes in the study period were overrepresented 12 13 among FM value and subvalue (p=.048) and under-represented among FM premium and 14 15 16 midprice brands (p=.002). 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 Table 5 Comparison of distribution of variants prior to the decision to enact legislation (July BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 2014), variants with name changes and new variants that entered the market. 6 7 8 Name changes 9 10 Baseline distribution of (July 2014 – New variants 11 variants (July 2014) November) (November 2018) 12 N % N % P* N % P* 13 14 Tobacco Type 15 FM 12 .527 .018 16 17 225 81% 5 79% 48 68% 18 ForRYO peer54 review19% 35 21%only 23 32% 19 20 Price segment 21 FM premium & midprice 103 50% 48 33% .002 10 22% .001 22 23 FM value & sub value 72 35% 66 45% .048 23 50% .054 24 RYO premium & midprice .097 .164 25 17 8% 20 14% 7 15% # 26 27 RYO value .735 .602 28 15 7% 12 8% 6 13% # 29 30 *Chi square comparing with July 2014 distribution 31 # 32 Fishers exact test comparing with July 2014 distribution 33 34 35 Nearly two-thirds of the adverts captured from the retail press, 124/195 (64%) advertised 36 37 value or subvalue brands. Similarly, for new products, the majority of adverts (30/38; 79%)

38 http://bmjopen.bmj.com/ 39 40 were for value or subvalue brands. Only one advert was a new premium offering. 41 42 43 44 45 The commercial literature found tobacco companies innovating within lower price segments,

46 on October 4, 2021 by guest. Protected copyright. 47 48 introducing packs with fewer cigarettes prior to the sell-through (18-20) followed by a price- 49 50 war in the lower priced segments with some manufacturers reportedly selling at a loss to 51 52 gain market share.(13) By the end of 2017 tobacco companies stated that smokers expected 53 54 55 better quality products in lower price segments after standardised packaging and Minimum 56 57 Excise Tax (MET) legislation raised the price of the cheaper brands and so ‘premium 58 59 60 features’ in lower priced cigarettes appeared (Table S2: Strategy 3).(19, 21) For example, a

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1 2 3 4 redesign to Chesterfield (subvalue) was advertised to retailers in December 2017, citing a BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 new ‘firm’ filter and, as with premium brand Marlboro, a new bevelled edge box.(20, 22) 7 8 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 Strategy 4. Innovating exemptions to the legislation BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 The commercial literature and pack purchase study suggested that tobacco companies 7 8 9 continued to innovate and market their tobacco products by focusing on exemptions to the 10 11 legislation (Table S2: Strategy 4). 12 13 14 Pack modifications that endured post-legislation 15 16 During the sell-through, the pack purchase and commercial literature review 17 18 For peer review only 19 revealed that FM Marlboro 10s and RYO Amber Leaf, Golden Virginia and Cutter’s 20 21 Choice were sold in reusable tins, arguably allowing consumers to decant cigarettes 22 23 24 bought post-legislation into branded tins. Selling RYO in tins is not novel but 25 26 cigarettes have rarely been sold in tins previously. 27 28 29 30 31 32 Pack purchases found that best-selling premium brand family Marlboro changed 33 34 significantly in July 2016 (two months into sell-through), with the introduction of 35 36 37 bevelled pack edges and a pro-seal closing mechanism (Figure 2). Both features

38 http://bmjopen.bmj.com/ 39 40 fundamentally changed the tactile nature of the pack which endured after full- 41 42 implementation in May 2017 (Video 1). To be compliant with the legislation, these 43 44 45 packs must have been printed prior to May 2016.

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 Extra Sticks 50 51 Given that there is no restriction on the maximum number of sticks per pack, packs with 52 53 more than 20 continued post-legislation. Following full-implementation sales of packs with 23 54 and 24 sticks increased from 7 to 11 million packs. 55 56 Branded Outers 57 58 59 The retail literature and in person observations revealed that multipack wholesale outers are 60

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1 2 3 4 branded (Figure 3). Outers can be seen by customers during tobacco product gantry BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 restocking. Adverts in the retail press showed images of branded tobacco products including 7 8 branded outers post-legislation. 9 10 11 12 13 RYO accessories 14 15 Increased innovation was observed among RYO accessories post legislation with retail 16 17 press articles in November 2017 and February 2018 referring to “‘ultra slim’ and slim filters 18 For peer review only 19 20 and papers, biodegradable filters, and menthol tips” (Table S2; Strategy 4.4). (21, 23) 21 22 Cigars 23 24 Cigars, which can be sold in branded packs, single sticks without pictorial health warnings, 25 26 at a relatively low price and with good profit margin, were identified as an opportunity for 27 28 29 growth.(20, 24-27) Euromonitor’s models suggested growth in cigars and cigarillos sales 30 31 volumes (390 to 494 milllion units) and value (£292 to £348 million) from 2015 to 18 (Table 32 33 34 S4). Towards the end of 2017, JTI and cigar company Ritmeester were holding social events 35 36 to build relationships with retailers (Table S2; Strategy 4.5). (20) 37

38 http://bmjopen.bmj.com/ 39 Pipe Tobacco 40 41 The retail literature revealed that one small tobacco manufacturer, Gawith Hoggarth, 42 43 deliberately marketed pipe tobacco as RYO to circumvent the minimum pack size 44 45

46 restrictions on RYO (Table S2; Strategy 4.6).(28) on October 4, 2021 by guest. Protected copyright. 47 48 49 50 Discussion 51 52 UK Standardised Packaging legislation and the EU TPD placed restrictions on tobacco 53 54 55 packaging and marketing in the UK. Overall, compliance with the restrictions (removal of 56 57 branding, small pack sizes and non-compliant names) was good. However, clarity is needed 58 59 60 about the legality of isolated incidents such as the compliance of the Marlboro resealable

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1 2 3 4 pack and Gawith Hoggath’s marketing of its Kendal pipe tobacco as RYO. Technical BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 compliance aside, this paper identified four key strategies of tobacco companies which have 7 8 arguably enabled them to continue marketing tobacco post-legislation. 9 10 11 Firstly, the retail literature suggests that tobacco companies used the 12-month sell-through 12 13 14 to their advantage, keeping branded stock on the market as long as possible, and using the 15 16 time to communicate name changes to retailers and customers. Ahead of the sell-through 17 18 For peer review only 19 companies increased production of branded packs, introduced smaller pack sizes to enable 20 21 more affordable offerings, and encouraged retailers to buy large quantities of branded stock 22 23 at reduced prices. Other countries had a shorter sell through period with three-months for 24 25 26 Australia and New Zealand (29, 30) and seven months for France (31). Other countries 27 28 considering the legislation should resist calls for a lengthy sell-through. 29 30 31 32 33 Second, although compliant with legally required name removals, tobacco companies 34 35 implemented a standard name change formula that maintained the brand identity and 36 37

38 differentiation of the three broad flavour categories (1) full flavour; (2) smooth; (3) http://bmjopen.bmj.com/ 39 40 menthol.(17) In 2002 terms such as ‘mild’ and ‘light’ were prohibited to curb misperceptions 41 42 43 of relative harm. However, the continuation of the colours of the previous packs such as the 44 45 gold and white pack for Marlboro ‘lights’ and the introduction of terms such as smooth for

46 on October 4, 2021 by guest. Protected copyright. 47 other brands sustained these misperceptions.(32, 33) In line with the power of colour in 48 49 50 brand identity, this study shows that tobacco companies changed ‘full-flavour’ variants to 51 52 red, original, or real; menthol variants to green; and smooth variants to bright and blue (or 53 54 55 yellow for RYO). As in 2002, the current restrictions on tobacco product name were 56 57 designed disrupt misperceptions of relative harms based on flavour descriptions but yet 58 59 again, tobacco companies have adapted to ensure that such misperceptions are likely to 60

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1 2 3 4 endure. Therefore there is a case to be made to follow the example of Uruguay where only BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 one brand variant is permitted per brand and no new brands are allowed. 7 8 9 Third, Nielsen data and the commercial literature revealed that tobacco companies were 10 11 fighting fervently for market share in the cheaper price segments with a price war pre- 12 13 14 implementation, more adverts, name changes, extra sticks in packs and new brand variants 15 16 introduced in lower price segments over the study period. This taken in concert with our 17 18 For peer review only 19 fourth finding that tobacco companies are targeting tobacco products, features and 20 21 accessories not covered by the UK or EU legislation for innovation and growth provides a 22 23 case for expanding the legislation to include: standardised packaging for cigars, cigarillos, 24 25 26 pipe tobacco, wholesale outer wraps, standardised pack edges, maximum pack sizes and 27 28 prohibitions for innovations to filters, pack seals RYO papers. 29 30 31 The strength of this paper lies both in the detail and depth of each analysis including our 32 33 34 systematic analysis of retail press adverts (n=195) and commercial literature articles and 35 36 reports (n= 396) alongside pack purchases of the top selling brands and detailed sales 37

38 http://bmjopen.bmj.com/ information from Nielsen. Using multiple data sources has, in many instances, enabled 39 40 41 findings to be verified by more than one source and enabled a greater understanding of the 42 43 tobacco industry’s motives for any changes made to their products and packaging. 44 45 Nevertheless, despite evidence from an IMT whistleblower(34) and PMI’s own words(35) our 46 on October 4, 2021 by guest. Protected copyright. 47 48 data did not reveal price mark stickers on tobacco products, this is likely to be because we 49 50 bought our eight brands from a large supermarket and not a convenience store and because 51 52 53 this industry strategy was not highlighted in the retail literature due to the questionable 54 55 legality of this strategy.(36) 56 57 58 59 60

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1 2 3 4 Resources prevented us from acquiring Nielsen data on cigars or pipe tobacco and from BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 purchasing more than one brand per price segment in the pack purchasing study element. 7 8 However, the retail literature alerted us that cigars and other products will be targeted as 9 10 11 growth opportunities and, although not able to fully capture the sensory nature of brands, our 12 13 analysis of the adverts ensured that we would see many, if not all, innovations being 14 15 16 promoted to retailers. 17 18 For peer review only 19 Nielsen data does not record whether RYO products are sold in standardised packs. We 20 21 assumed that 30g packs were always in standardised packs and that larger packs would 22 23 switch to standardised packs at the same time. It is possible that this did not occur. 24 25 26 However the temporal patterns of switching names and sizes are similar for FM and RYO 27 28 and it is therefore reasonable to assume that branding was removed at the same time. 29 30 31 Nielsen model prices and volumes for the UK based on a census of the major supermarket 32 33 sales and a rolling sample of convenience stores. Although, we do not know the extent to 34 35 which Nielsen variant name changes lag behind and even reflect those printed on packs in 36 37

38 retailers, the main name change patterns found in the Nielsen data were similar to those http://bmjopen.bmj.com/ 39 40 found in a UK convenience store study(37) and an evaluation of the introduction of 41 42 43 standardised packaging in Australia. 44 45 Given that the tobacco industry is attempting to circumvent standardised packaging 46 on October 4, 2021 by guest. Protected copyright. 47 48 legislation, it is incumbent on other countries considering the policy to make regulations as 49 50 comprehensive as possible to prevent the exploitation of continued marketing opportunities. 51 52 53 In summary, this paper suggests that long sell-through periods should be avoided and that 54 55 restricting tobacco products to one brand variant per brand and an extending regulations to 56 57 58 include other tobacco products, features and accessories should be considered. 59 60

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1 2 3 4 Author contributions: AG designed the study with contributions from KER and RH. KER led BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 the writing of the paper and designed, conducted and analysed the pack purchase element 7 8 of the study. RH analysed the Nielsen data in addition to downloading and analysing the 9 10 11 commercial literature. KL collated the retail literature adverts, involving visits to the British 12 13 Library and analysed the data. All authors read and approved the manuscript. The authors 14 15 16 would like to thank Dr Rob Branston who read and commented upon a near final draft and 17 18 Ilhan Marsal who helpedFor with peer early preparation review of the adverts only and pack purchased data. 19 20 21 Data statement: Where suitable data sets have deposited in the University of Bath data 22 23 archive. 24 25 26 27 28 29 30 31 32 33 34 35 36 37

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1 2 3 4 References BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 1. legislation.gov.uk. The standardised packaging of tobacco products regulations. In: Uk 7 Government, editor. 829; 2015. 8 2. Department of Health. Tobacco packaging guidance, guidance for retailers, manufacturers 9 and distributors of tobacco products, enforcement agencies and the public on changes to tobacco 10 packaging from 20 may 2016. Guidance; 2016. 11 3. Official Journal of the European Union. Directive 2014/40/eu of the european parliament 12 and of the council of 3 april 2014. In: European Union, editor.; 2014. 13 14 4. Scollo M, Occleston J, Bayly M, Lindorff K, Wakefield M. Tobacco product developments 15 coinciding with the implementation of plain packaging in australia. Tobacco Control. 2014 April 30, 16 2014. 17 5. Scollo M, Bayly M, White S, Lindorff K, Wakefield M. Tobacco product developments in the 18 australian market in theFor 4 years peer following plain review packaging. Tobacco only Control. 2017. 19 6. Scollo M, Zacher M, Coomber K, Bayly M, Wakefield M. Changes in use of types of tobacco 20 products by pack sizes and price segments, prices paid and consumption following the introduction 21 of plain packaging in australia. Tobacco Control. 2015 April 1, 2015;24(Suppl 2):ii66-ii75. 22 23 7. Moodie C, Hoek J, Scheffels J, Gallopel-Morvan K, Lindorff K. Plain packaging: Legislative 24 differences in australia, france, the uk, new zealand and norway, and options for strengthening 25 regulations. Tob Control. 2018 Aug 1. 26 8. Hiscock R, Branston JR, McNeill A, Hitchman SC, Partos TR, Gilmore AB. Tobacco industry 27 strategies undermine government tax policy: Evidence from commercial data. Tobacco Control. 28 2017;27:488-97. 29 9. Moodie C, Angus K, Mitchell D, Critchlow N. How tobacco comapnies in the uk prepared for 30 and responded to standardised packaging of cigarettes and rolling tobacco. Tobacco Control 2018. 31 32 10. Breton MO, Britton J, Huang Y, Bogdanovica I. Cigarette brand diversity and price changes 33 during the implementation of plain packaging in the united kingdom. Addiction. 2018. 34 11. Branston JR, McNeill A, Gilmore AB, Hiscock R, Partos TR. Keeping smoking affordable in 35 higher tax environments via smoking thinner roll-your-own cigarettes: Findings from the 36 international tobacco control four country survey 2006–15. Drug and Alcohol Dependence. 37 2018;193:110-16.

38 12. Retail Newsagent. Explained: Retailer's questions about eutpd ii. Retail Newsagent; 10 May http://bmjopen.bmj.com/ 39 2016. 40 13. BetterRetailing.com. Value brands price war hits retail profits. Retail Express 17 February 41 42 2017 [cited; Available from: https://www.betterretailing.com/value-brands-price-war-hits-retail- 43 profits 44 14. Retail Newsagent. Cash incentives and price cuts drive tobacco sales. Retail Newsagent; 26 45 May 2016.

46 15. Samrai G. Wholesalers: Tobacco suppliers will help retailers with branded stock post-eutpd on October 4, 2021 by guest. Protected copyright. 47 ii. Retail Newsagent; 2 March 2017. 48 16. Imperial tobacco unveils gv midnight and sunrise. Talking Retail; 17 July 2015. 49 17. Imperial Tobacco. Partnering for success through eutpd ii and standardised packaging: Part 50 51 4. New pack descriptors under eutpd ii. Retail Newsagent. 28 October 2016:20-21. 52 18. O'Donnell T. The fat lady sings: Tobacco category report 2016. The Grocer; 11 February 53 2016. 54 19. Selwood D. Pall mall cigarettes get taste plus filter in range upgrade. The Grocer; 18 April 55 2016. 56 20. Yau A. The latest developments from the biggest tobacco brands. Retail Newsagent; 5 April 57 2018. 58 21. Pendleton R. A tightening stranglehold: Tobacco category report 2018. The Grocer; 9 59 February 2018. 60

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22. Philip Morris International. Stock up now: Chesterfield with new premium features. Retail BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 Newsagent. 15 December 2017. 5 6 23. Cronin E. Rizla launches new natura paper and tips range. Talking Retail; 3 August 2017. 7 24. Appleby S. New tobacco law, means new opportunity for cigars sales. Retail Express; 6 June 8 2016. 9 25. Dillon C. Three things you can learn from ritmeester's cigar seminars. Retail Express; 17 10 September 2017. 11 26. Dillon C. Ritmeester launches single stick panatellas. Retail Express; 15 January 2015. 12 27. Lee J. Know the value of the tobacco market to keep sales strong. Retail Express; 22 August 13 2017. 14 28. Gockelen-Kozlowski T. Tobacco firms adapt to deal with latest eutpd laws. Retail 15 16 Newsagent; 25 May 2017. 17 29. Ministry of Health (New Zealand). Tobacco standardised packaging. 2017 13th June 2017 18 [cited; Available from:For https://www.health.govt.nz/our-work/preventative-health-wellness/tobaccopeer review only 19 control/plain-packaging 20 30. Scollo M, Lindorff K, Coomber K, Bayly M, Wakefield M. Standardised packaging and new 21 enlarged graphic health warnings for tobacco products in australia—legislative requirements and 22 implementation of the tobacco plain packaging act 2011 and the 23 competition and consumer (tobacco) information standard, 24 25 2011. Tobacco Control. 2015;24(Suppl 2):ii9. 26 31. Tobacco Labelling Resource Centre. France. 2013 [cited; Available from: 27 http://www.tobaccolabels.ca/countries/france/ 28 32. Mutti S, Hammond D, Borland R, Cummings MK, O'Connor RJ, Fong GT. Beyond light and 29 mild: Cigarette brand descriptors and perceptions of risk in the international tobacco control (itc) 30 four country survey. Addiction. 2011;106(6):1166-1175. 31 33. Bansal-Travers M, O'Connor RJ, Fix BV, Cummings MK. What do cigarette pack colors 32 communicate to smokers in the u.S.? American Journal of Preventive Medicine. 2011;40(6):683-89. 33 34. Doward J. How tobacco firms flout uk law on plain packaging. 9 April 2017 [cited 12 34 35 November 2018]; Available from: https://www.theguardian.com/society/2017/apr/09/tobacco- 36 companies-flout-law-plain-packaging 37 35. Nixon P. Re: Price marking on packs. Letter from Peter Nixon, Philip Morris International to

38 Deborah Arnott, Action for Smoking and Health ed; 15 May 2017. http://bmjopen.bmj.com/ 39 36. Leigh Day. Re: Price marking on tobacco packaging. Legal opinion of Leigh Day to Action for 40 Smoking and Health ed; 3 March 2017. 41 37. Critchlow N, Stead M, Moodie C, Eadie D, MacKintosh AM. Introduction of standardized 42 tobacco packaging during a 12-month tranistion period: Findings from small retailers in the united 43 44 kingdom. Nicotine & Tobacco research. 2018. 45 38. Yau A. Premium features sell cigarettes. Retail Newsagent; 4 December 2017.

46 39. Euromonitor. Passport: Philip morris intenrational inc in tobacco (world). July 2017. on October 4, 2021 by guest. Protected copyright. 47 40. Cronin E. Imperial tobacco unveils new innovations for 2018. Talking Retail; 24 November 48 2017. 49 41. Marlboro launches ducati promotion. Talking Retail; 31 July 2015. 50 42. Whitlock K. Imperial tobacco launches jps triple flow. Wholesale News. November 2015. 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 Figure 2. Proportion of (a) FM sticks and (b) RYO* (by weight) sold in standardised packaging over time 30 31 85x60mm (300 x 300 DPI) 32 33

34 http://bmjopen.bmj.com/ 35 36 37 38 39 40 41

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33

34 http://bmjopen.bmj.com/ 35 36 Figure 3. The evolution of Marlboro Gold packaging from a straight edge pack to a branded bevelled edge 37 pack with a new internal packet with pro-seal sealing mechanism, to standardised packaging maintaining these innovations 38 39 103x94mm (300 x 300 DPI) 40 41

42 on October 4, 2021 by guest. Protected copyright. 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml Page 37 of 47 BMJ Open BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from

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42 Figure 4. Branded outers post May 2016 (full-implementation) on October 4, 2021 by guest. Protected copyright. 43 44 256x283mm (300 x 300 DPI) 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open Page 38 of 47

1 2 3

Supplementary file material for “Assessing tobacco company adaptation to standardised packaging: BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 identifying circumventions and closing loopholes” 5

6 7 8 Table S1. Tobacco advert characteristics by price segment (n= 195) 1 9 2 3 10 Characteristics of advert Subvalue Value Midprice Premium 11 Type of tobacco 12 FM 22 78 42 21 13 RYO n/a 24 13 16 14 Characteristics promoted 15 New brand variant4 7 23 5 1 16 New packaging 4 25 17 16 17 Limited Edition 0 4 5 5 18 For peer review only 19 Filter 0 16 0 6 20 Price 19 68 14 4 21 Retailer profit 1 42 21 5 22 1 Totals do not add up to 195 adverts as many adverts promoted more than one type of tobacco, more than one price 23 segment and more than one characteristic in the same advert. 24 2 25 Does not include pipe tobacco or cigars/cigarillos as we have no data on price segment for these products. 26 3 FM only. This price segment does not exist for RYO. 27 28 4 There were 38 adverts in total for a new brand variant yet 2 of the adverts could not be categorised by price segment. 29 30 31 32 Characteristics promoted Cigars/ cigarillos Pipe 33 New brand variant 0 0 34 New packaging 0 0 35 Limited Edition 2 0 36 Filter 0 0 37 Price 2 1 38 Retailer profit 6 1 http://bmjopen.bmj.com/ 39

40 41 42 43 44 45

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1 2 3 Table S2 Industry strategies to circumvent standardised packaging and exploit loopholes implied by commercial literature 4 5 Industry strategy Tactic Quote from the commercial literature 6 1. Keep branded packaging on 1.1 Over-producing branded “BAT has had to produce higher stocks prior to the 20 May 2016 manufacturing deadline in order to avoid 7 the market throughout the packs before the sell-off out of stocks [branded]…The TPD explicitly provides for transitional provisions to allow product 8 sell-off period manufactured before 20 May 2016 to be sold until 20 May 2017.” Ron Ridderbeek, head of legal and 9 external affairs at British American Tobacco [Retail Newsagent, 10 May 2016] 10 11 1.2 Introducing smaller pack “Tinkering with pack sizes is a proven wheeze for oﬀ setting the impact of tobacco’s growing tax burden on 12 sizes just beforeFor the sell-off peerprice per pack. review JTI has managed to hit the £6.50only price point by launching 17-packs of Sovereign Blue, Sky 13 Blue, Green and Dual. And it’s just in time; from May, pack sizes will be limited to a minimum of 20 cigs.” 14 Japan Tobacco International [The Grocer, 11 February 2016] 15 16 “Launching next month as the European Union Tobacco Productive Directive comes into force, [Pall Mall’s] 17

redesign - available in 10-pack and 18-pack King Size and Super Kinghttp://bmjopen.bmj.com/ 18s - will include the new Taste Plus 18 Filter … price-marked packs are set to be available at the current [price].” [The Grocer, 18 April 2016] 19 20 1.3 Providing financial “Retailers have reported a “massive” increase in cigarette sales as tobacco manufacturers cut prices and 21 incentives to retailers to sell a offer cash incentives to bolster brands at a time when new plain packaging and smaller pack regulations are 22 particular company’s brands set to shake up the industry. … An independent retailer… said: “I have seen a massive increase in sales. We 23 were also given PoS including shelf wobblers to encourage as many customers as possible to buy the brand. 24 I think this is a really smart way of driving sales and is something that retailers will respond to.” Meanwhile, 25

Imperial Tobacco will knock 10p off the price of four of its biggest on October 4, 2021 by guest. Protected copyright. tobacco brands - Lambert & Butler, JPS, 26 Players and Gold Leaf - from 1 June, while maintaining cash margins... [A retailer who] has been trialling the 27 new Imperial prices at his store… said: “We sold up to one and a half extra outers a week because of the 28 lower price.” [Retail Newsagent, 26 May 2016] 29 30 31 “A value brands price war on cigarettes is hurting retailers’ margins and could lead to stores being 32 “lumbered” with a heap of unwanted, unsaleable stock [with legislation changes;] tobacco suppliers have 33 been dropping the prices of cigarette packs at the value end of the market… some manufacturers… selling 34 value cigarettes at a loss to gain market share… Last runs of branded packs are price-marked lowly and [a 35 retailer] told Retail Express that the actions of suppliers will have grave consequences for unsuspecting 36 retailers. 37 38 “Situations will arise where retailers are taken in by the low, price-marked RRPs and buy in bulk, thinking 39 that consumers will jump at the chance to catch the last batches of cheap packs…Come May 20, they’ll find 40 themselves lumbered with packs of cigarettes they can no longer sell, as supply will outstrip demand…It’s a 41 42 2

43 For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from

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1 2 3 unique situation, but the suppliers have stock they need to get rid of. They’re cutting the prices down and 4 loss-leading on them [but]Independent retailers certainly can’t afford to loss-lead. “…[Another retailer] 5 said: “… Companies downtrading to push their own agendas does not help us at all. I’ve even heard that 6 certain wholesalers were offered better percentages to buy in these packs, which would obviously be 7 recouped at the other end.””[Better Retailing, 17 February 2017] 8 9 ““The tobacco suppliers will themselves take back any branded packs after the May cut-off,” [wholesaler 10 manager] told RN. “They have teams of people calling on retailers and they are notifying them as to the 11 process. They are saying if they have any branded stock left to call their local rep and they will come in and 12 For peerreplace it.” [Retail review Newsagent, 2 March 2017] only 13

14 2. Maintain brand “We recognise that consumers use brand and colour when asking for their pack of cigarettes.” Therefore, 15 differentiation through generally, those products traditionally presented as ‘full flavour’ would have ‘real’ or ‘original’ added to 16 systematic name changes their names and be denoted predominantly by the colour ‘red’. All brand variants with the flavour 17 descriptor ‘smooth’ would change to ‘bright’ and have ‘blue’ added,http://bmjopen.bmj.com/ ‘menthol’ would become ‘green’ and 18 ‘capsule’ would become ‘crushball’.” [Retail Newsagent, 28 October 2016] 19 20 3. Focusing on lower price Introducing premium features “Living in a post-EUTPD II world… [a retailer reported] “Customers have become more price-sensitive since 21 segments into cheaper price segments legislation banned the sale of 10- packs and they are more concerned about how much they can get for 22 their money these days”…To help retailers tap into the trend for budget tobacco, JTI has relaunched 23 Scottish brand Kensitas Club King Size and dropped its RRP “ Yau A. The latest developments from the 24 biggest tobacco brands. [Retail Newsagent, 5 April 2018] 25 4. Promote products by 4.1 Bevelled edges and “In order to re-engage disengaged cash-strapped smokers migrating to lower-priced brands and categories, 26 innovating exemptions to resealable packs manufacturers have been “adding value” to their brands through innovation, on October 4, 2021 by guest. Protected copyright. both on the pack and via the 27 the legislation product itself… PMI concentrated on areas such as pack size (extra-large pack sizes), pack type (resealable), 28 cigarette length (compact), microslims, filter type (with a focus on recessed filters) and flavour capsules 29 (including the world’s first recessed filter capsule and the world’s first double capsule – menthol and 30 peppermint). Pack innovation: Tactile finishes, including raised surfaces such as embossing and bevelled 31 edges… (39)1 [Euromonitor, July 2016] 32 4.2 Menthol “JPS Green Edge will replace it and feature a menthol inner liner within the packaging, which the company 33 claims will be “more effective at transferring flavour to the cigarettes than traditional menthol tips””. 34 Imperial Tobacco [Talking Retail, 24 November 2017] 35 36 1 37 This Euromonitor report was published two months into the sell-off period. We did find evidence of embossing and raised surfaces on packets prior to the full 38 implementation of the legislation but these changes were lost when standardised packaging came into effect. During the sell-off, filter innovations, capsule innovations, 39 bevelled edges and a pack resealing mechanism on one brand were observed – these changes were able to carry through when packs became standardised. In this study 40 we did not observe extra length cigarettes, a greater volume of cigarettes or microslims. 41 42 3

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1 2 3 4 4.3 Filters (another way to Marlboro Touch, previously known as Marlboro Gold Touch, now has a soft touch pack and firm filter 5 create the perception that keeping the consistency with the rest of the Marlboro range. The firm filter allows adult smokers a cleaner 6 some products are healthier way to stub out their cigarette, as well as adding an overall feeling of quality, without having an impact 7 than others?) upon taste.” [Talking Retail, 31 July 2015] 8 9 “Launching …as the European Union Tobacco Productive Directive comes into force, [Pall Mall’s] redesign… 10 will include the new Taste Plus Filter that aims to create a firmer in-hand feel and improve filtration” [The 11 Grocer, 18 April 2016] 12 For peer review only 13 “…JPS Triple Flow… "a revolution in cigarette technology." Triple Flow uses "unique" "easy draw" channels, 14 with a new, "high quality smooth" tobacco blend enhanced by a mineral filter that provides "a fuller 15 smoking experience". Each cigarette is also wrapped in a special paper, designed to actively reduce the 16 amount of smoke emitted - which may result in less smell, says Imperial. Brand portfolio manager Emma 17 Stew said: "Smooth blends now account for almost a quarter [ITUKhttp://bmjopen.bmj.com/ estimates September 2015] of factory 18 made cigarette (FMC) sales, and Triple Flow has been designed to offer the ultimate smooth smoking 19 20 experience. ‘With its next generation features and distinctive packaging, there is nothing like it in the 21 market’” [Wholesale News November 2015] 22 23 4.4 RYO papers and filter tips Imperial Tobacco brand manager Jamie Burns-Smith said: “Natura taps into an increasing consumer desire 24 for responsibly sourced products. Crafted from 100% hemp, Natura papers and tips are the perfect 25 sustainable way to enjoy an authentic tobacco taste. Imperial Tobacco has also launched Rizla Menthol 26 Tips, as the company claims “menthol tips are the fastest-growing on October 4, 2021 by guest. Protected copyright. segment of the tips market”. [Talking 27 Retail, 3 August 2017] 28 29 4.5 Cigars “Break, as they are cigarillos, are exempt. We can do packs of less than 20, and we can do flavours… Cigars 30 won’t be a standard colour pack, and will still have product name branding… you can sell individually and in 31 10 packs” Jens Christiansen, Scandinavian Tobacco Group’s head of marketing & public affairs [Retail 32 Express, 6 June 2016] 33 34 “Cigars benefit from the fact they can be sold in 10-packs, while also being exempt from certain branding 35 restrictions. Scandinavian Tobacco Group (STG) is using this to its advantage and its marketing this year… 36 the packaging stands out when compared to traditional cigarettes… and the investment made by 37 companies such as STG to raise awareness and education in the convenience trade really helps... 38 Ritmeester’s says miniature cigars have traditionally been products that are better known among tobacco 39 enthusiasts. As a result, it is offering samples of its Royal Dutch range to retailers to increase awareness… 40 41 42 4

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1 2 3 “I find the curry socials Ritmeester holds with retailers and the trade press very useful. It’s a hands-on, but 4 informal way of learning about the latest developments in the cigar market. There isn’t as much awareness 5 about cigars as cigarettes. These opportunities give us a chance to learn about how we can upsell to 6 smokers who want value.” [Retailer]” [Retail Newsagent, 5 April 2018] 7 8 “If a smoker only has £5 on them, they cannot buy from your gantry, but if you present them with cigars 9 they can.” Ritmeester [Retail Express, 17 September 2017] 10 11 “[Retailer] says he struggles with selling Mini Moods. [Ritmeester’s] Lyles explains: “It might be because 12 For peeryou’re aiming themreview at cigar smokers, but it’s only primarily aimed at cigarette smokers. Because of the double 13 filter, it makes for a smoother smoke.” … Cigars are now the cheapest product in a gantry. Lyles says: “If a 14 smoker only has £5 on them, they cannot buy from your gantry, but if you present them with cigars they 15 can.” [Retail Express, 17 September 2017] 16

17 “’The margins we make on miniature cigars are 30% when sold at http://bmjopen.bmj.com/ RRP’ [Retailer]” [Retail Newsagent, 5 April 18 2018] 19

20 21 4.6 Pipe tobacco sold as RYO “The sell-through period for branded RYO and cigarettes ended last week, with products now sold in 22 minimum formats and carrying larger health warnings as part of the new tobacco legislation. Yet, UK 23 tobacco manufacturer Gawith Hoggarth is promoting its Kendal brand as a product which is cut to pipe 24 tobacco regulations but can also be used as hand-rolling tobacco. “We’ve cut the tobacco to the thinnest 25 width we are allowed to which means we can sell it in branded packaging and in 12.5g pouches,” said the 26 company’s area sales manager Martin Bobbette. The company hopes on October 4, 2021 by guest. Protected copyright. retailers will recommend the product 27 to smokers who ask for “whatever is cheapest”” [Retail Newsagent, 25 May 2017] 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 5

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BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 Table S3 Compliance with standardised packaging over time1 5 6 change from non-compliant 7 % standardised packs previous month total sticks sold sticks sold 8 Jul-16 0% 2,574,340,308 2,574,204,015 9 Aug-16 0% 0% 2,620,104,622 2,610,727,340 10 Sep-16 1% 1% 2,424,692,602 2,397,886,927 11 Oct-16 3% 2% 2,491,577,487 2,423,864,794 12 Nov-16 4% 1% 2,424,660,803 2,323,057,266 13 Dec-16 9% 4% 2,593,371,625 2,370,713,888 14 15 Jan-17 21% 12% 2,316,632,301 1,829,871,306 16 Feb-17 45% 24% 2,184,811,712 1,204,205,686 17 Mar-17 64% 20% 2,402,514,817 852,983,422 18 Apr-17 For peer79% review14% only2,386,041,031 506,014,392 19 May-17 91% 12% 2,475,338,965 228,361,777 20 Jun-17 97% 6% 2,359,196,539 81,803,934 21 Jul-17 98% 1% 2,461,000,857 53,453,290 22 Aug-17 98% 0% 2,412,267,420 43,336,437 23 Sep-17 99% 0% 2,267,864,526 29,804,540 24 25 Oct-17 99% 0% 2,303,639,526 27,803,694 26 Nov-17 99% 0% 2,231,013,199 25,718,138 27 28 non-compliant* 29 total thousands of (thousands of kg 30 RYO kg sold sold) 31 Aug-16 1% 552287 546963 32 Sep-16 1% 0% 521917 516721 33 34 Oct-16 11% 10% 528560 469493 35 Nov-16 18% 7% 518188 424040 36 Dec-16 26% 8% 541359 400109 37 Jan-17 44% 18% 516174 288710

38 Feb-17 55% 11% 490464 218940 http://bmjopen.bmj.com/ 39 Mar-17 75% 20% 539695 132601 40 Apr-17 91% 16% 534343 45509 41 May-17 97% 5% 557734 19294 42 43 Jun-17 98% 2% 539118 9037 44 Jul-17 99% 1% 559731 5908 45 Aug-17 99% 0% 560994 4609

46 Sep-17 99% 0% 536870 2984 on October 4, 2021 by guest. Protected copyright. 47 Oct-17 99% 0% 542052 2802 48 Nov-17 100% 0% 530219 2511 49 *RYO estimated to be sold in standardised packaging if sold in 30g or larger not pricemarked pack and (a) 30g pack of same variant on the 50 market or (b) if 30g pack never available, pack on the market at end of analysis period) 51 52 53 54 55 56 57 58 59 60

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BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 Table S3 Menthol and capsule innovation 5 6 7 Present at start New Variant Total 8 N % N % N % 9 Menthol* 10 FM premium 9 28% 2 20% 11 26.2 11 12 FM midprice 8 25% 0 0% 8 19.0 13 FM value 8 25% 4 40% 12 28.6 14 FM subvalue 3 9% 3 30% 6 14.3 15 16 no price segment 4 13% 1 10% 5 11.9 17 32 76.2% 10 23.8% 42 100.0 18 For peer review only 19 20 Capsule** 21 FM premium 2 15% 0 0% 2 10.5 22 FM midprice 2 15% 0 0% 2 10.5 23 24 FM value 9 69% 3 50% 12 63.2 25 FM subvalue 0 0% 3 50% 3 15.8 26 Total 13 68.4% 6 31.6% 19 100.0 27 *Menthol: variant name includes ‘menthol’ or ‘green’ 28 **Capsule: variant name includes ‘capsule’, ‘crushball’, ‘dual’, ‘duo’, ‘demand’, ‘click on’ or ‘burst’ 29 30 31 32 Table S4 Euromonitor estimates of the growth of cigars and cigariillos 33 34 value constant £ mln value current £ mln volume million units 35 2015 291.8 289.9 390.4 36 37 2016 282.5 282.5 382.8

38 2017 324.5 332.6 451.6 estimate http://bmjopen.bmj.com/ 39 2018 347.8 366.3 493.8 estimate 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Original protocol of the study 6 This paper is one of four covered by the original protocol. We have extracted sections relevant to this 7 8 paper below and provided notes on where the eventual paper diverged. 9 10 11 Extracts from original protocol 12 13 14 Intended output 15 16 17 Changes in the number, names and visual appearance of packs (Research Question 1 (see below)): led 18 by KER. A first draft willFor be produced peer by December review 2017 based ononly analysis of the pack data and made 19 available to CRUK at this point. Additional analyses of Nielsen and HMRC data1 and the commercial 20 literature ((see below) will contribute to a final paper on this topic which will be produced in 21 22 December 2018. 23 24 25 Research Question 1: Changes in the number, names and visual appearance of brands and brand 26 variants. 27 28 Pack purchasing data 29 30 Photographs will be taken of each surface of each pack and entered into NVivo for visual analysis2. We 31 will use this to examine changes in packaging colours, shapes, product descriptors and fonts over 32 33 time. We will specifically aim to explore whether these changes might be aimed to reassure smokers 34 that standardised packaging does not mean compromises in taste or quality. An analysis of relevant 35 articles in the commercial literature will be used to triangulate our findings. 36 37 Nielsen & HMRC1 data

38 http://bmjopen.bmj.com/ 39 Building on evidence from Australia that a number of new brand variants were released by the 40 tobacco industry prior to the enactment of standardised packaging, we will use both HMRC1 and 41 Nielsen data to provide a descriptive analysis of changes in the names and numbers of brand variants 42 on the market, identifying the price segments within which the new brand variants sit. We will 43 44 specifically seek to examine whether more descriptive brand names are introduced given that the 45 pack design will no longer be able to convey messages of flavour, for example. The Nielsen interim

46 extract (see below) will be used for this analysis which will be supported with our commercial on October 4, 2021 by guest. Protected copyright. 47 literature review. We will present our findings using descriptive statistics and graphs. 48 49 50 51 Data sources: 52 53 Pack purchasing 54 55 Australian evidence suggests there were changes in the packaging of cigarettes prior to standardised 56 packaging that would not be recorded in Nielsen data which only records brand variant names, price 57 and volumes. For these reasons we propose to complement our Nielsen data with bespoke collected 58 data. 59 60

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1 2 3

We plan to buy, on a monthly basis, a leading brand from each of the four FMC price segments BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 (premium, mid price, economy and ultra low price) and three RYO price segments (premium, mid 5 3 6 price and economy) , to record changes over time in visual appearance of the packaging (including 7 the font used for brand names, brand descriptors, colours, pack shapes) prior to standardised 8 packaging becoming compulsory. We will supplement this with screen shots of brand variants from 9 my supermarket.com, first using the purchased products to determine if the online pictures are 10 regularly updated2. 11 12 Robustness 13 14 This data will be collected by our research team. Collection will take place on the same day each 15 month and from the same store. Store visits will also be used to explore changes in sale of pipe 16 17 tobacco and whether RYO tobacco is being sold as pipe tobacco and if so, such products will be 18 purchased too. For peer review only 19 20 Availability and coverage

21 4 22 We will collect data from January 2016 until May 2017 (the month when full implementation starts). 23 Commercial literature 24 25 We will update two reviews of the commercial literature we have recently undertaken applying the 26 27 same review methodology. Specifically, we will review the following sources, identifying and 28 reviewing articles on pricing, price segmentation, new brand variants and impacts of plain packaging 29 on, inter alia, volumes and consumer behaviour. 30 31 We will use this literature in four ways. First, [not relevant to this paper]. Second, to record any 32 discussion of standardised packaging and its impacts. This will be important in alerting us to any new 33 lines of inquiry that might be needed to defend against emergent tobacco industry arguments. Third, 34 it will be used to triangulate our findings, including those on pack appearance and new brand variants 35 36 because the commercial literature is often used to flag new products or changes to existing products. 37 Finally, [not relevant to this paper].

38 http://bmjopen.bmj.com/ 39 The literature review will cover the period from January 2015 to December 2017 and will include the 40 following sources5: 41 42 • Retail publications: 43 o The Grocer 44 o Retail News 45 o The Wholesaler

46 on October 4, 2021 by guest. Protected copyright. 47 o Convenience Store 48 o Asian Trader 49 • Market and financial analyst reports: 50 o Euromonitor reports 51 52 o Citigroup reports 53 o Redburn reports 54 • Tobacco company reports including: 55 o Annual reports 56 o Tobacco company presentations to analysts 57 58 59 Nielsen data6 60

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As extracts cover three year periods we propose to only use data over a three year period in any BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 particular analysis. 5 6 1) Interim extract 7 8 Dates: Sept 2014 to August 2017 (20 months pre-implementation period data, twelve months 9 transition period, and three months full implementation period data). 10 11 This extract will be used for Research Question 1… Doing this on an interim extract will enable us to 12 proceed more quickly with our analysis. 13 14 15 Notes on changes from protocol 16 1. HMRC data was only included as a possibility. We were eventually unable to obtain HMRC data. 17 18 2. The visual changes Forin the purchased peer packs reviewwere limited. Instead only, we developed the novel advert 19 analysis. 20 21 3. We included an extra BAT FM brand in order to include brands from all major tobacco companies 22 rather than a brand from the small RYO value segment. 23 24 4. Funding was not confirmed until March 2016 when we started the purchasing. 25 26 5. Some sources were changed due to our understanding of work being undertaken by other research 27 groups and due to insufficient focus on the UK market and/or standardised packaging in scoping 28 work. 29 30 6. To understand product name changes we eventually compared product names in nine different 31 Nielsen extracts in order to look for changes. At the time of analysis, the extract available to us 32 allowed us to end our analyses in November 2017 giving us three extra months than was expected. 33 34 35 36 37

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46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

For peer review only - http://bmjopen.bmj.com/site/about/guidelines.xhtml BMJ Open BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from

A prospective longitudinal study of tobacco company adaptation to standardised packaging in the UK: identifying circumventions and closing loopholes ForJournal: peerBMJ Open review only Manuscript ID bmjopen-2018-028506.R1

Article Type: Original research

Date Submitted by the 05-Jun-2019 Author:

Complete List of Authors: Evans-Reeves, Karen; University of Bath, Tobacco Control Research Group, Department for Health Hiscock, Rosemary; University of Bath, Tobacco Control Research Group, Department for Health Lauber, Kathrin; University of Bath, Tobacco Control Research Group, Department for Health Gilmore, Anna; University of Bath, Tobacco Control Research Group, Department for Health

Primary Subject Smoking and tobacco Heading:

Secondary Subject Heading: Public health

PUBLIC HEALTH, PREVENTIVE MEDICINE, TOBACCO, STANDARDISED http://bmjopen.bmj.com/ Keywords: PACKAGING

Note: The following files were submitted by the author for peer review, but cannot be converted to PDF. You must view these files (e.g. movies) online.

Video 1.MP4 on October 4, 2021 by guest. Protected copyright.

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1 2 3 4 A prospective longitudinal study of tobacco company BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 adaptation to standardised packaging in the UK: 7 8 9 identifying circumventions and closing loopholes 10 11 12 Karen A Evans-Reeves1, email [email protected] 13 14 Rosemary Hiscock1*, email [email protected] 15 16 Kathrin Lauber1, email [email protected] 17 18 Anna B Gilmore1, emailFor [email protected] peer review only 19 20 1Tobacco Control Research Group, University of Bath and UK Centre of Tobacco and Alcohol Studies, 21 Bath, UK 22 23 *Corresponding author: +44 (0)1225 388388 24 25 26 27 Key words: tobacco, tobacco industry, standardised packaging, plain packs 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Abstract 6 7 Objectives: UK standardised packaging legislation was introduced alongside pack size and 8 9 product descriptor restrictions of the European Union Tobacco Products Directive to end 10 11 12 tobacco marketing and misinformation via the pack. This paper aims to assess compliance 13 14 with the restrictions and identify attempts to continue to market tobacco products and 15 16 17 perpetuate misperceptions of harm post-legislation. 18 For peer review only 19 20 Design, setting and intervention: A prospective study of the introduction of standardised 21 22 packaging of tobacco products to the UK. 23 24 25 Participants and outcomes: We analysed commercial sales data to assess whether the 26 27 28 legally required changes in pack branding, size and name were implemented. To explore 29 30 any adaptations to products and packaging we analysed sales data, monthly pack 31 32 purchases of factory-made cigarettes (FM) and roll-your-own tobacco (RYO) , tobacco 33 34 35 advertisements from retail trade magazines and articles on tobacco from commercial 36 37 literature (retail trade, market analyst and tobacco company publications).

38 http://bmjopen.bmj.com/ 39 40 Results: One month post full implementation of the UK and EU policies, 97% FM and 98% 41 42 43 RYO was sold in compliant packaging. Nevertheless tobacco companies made adaptations 44 45 to tobacco products which enabled continued brand differentiation after the legislation came

46 on October 4, 2021 by guest. Protected copyright. 47 into force. For example, flavour names previously associated with low tar were 48 49 50 systematically changed to colour names arguably facilitating continued misperceptions about 51 52 the relative harms of products. Tobacco companies used the one-year sell-through to their 53 54 55 advantage by communicating brand name changes and providing financial incentives for 56 57 retailers to buy large volumes of branded packs. In addition, tobacco companies continued 58 59 to market their products to retailers and customers by innovating exemptions to the 60

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1 2 3 4 legislation, namely, filters, packaging edges, seals, multipack outers, RYO accessories, BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 cigars and pipe tobacco. 7 8 9 Conclusions: Tobacco companies adapted to packaging restrictions by innovating their 10 11 tobacco products and marketing activities. These findings should enable policy makers 12 13 14 globally to close loopholes and increase the potential efficacy of standardised packaging 15 16 policies. 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Article Summary 6 7 8 Strengths and limitations of the study 9 10 11 12 Strengths 13 14 15  The strength of this paper lies both in the detail and depth of each analysis including 16 17 our systematic analysis of retail-press advertisements (n=195) and commercial 18 For peer review only 19 20 literature articles and reports (n= 396) alongside pack purchases of eight top-selling 21 22 brands and detailed sales information from Nielsen. 23 24  Using multiple data sources has enabled findings to be verified by more than one 25 26 27 source and enabled a greater understanding of the tobacco industry’s motives for 28 29 changes and innovations to their products and packaging. This insight would not 30 31 have been possible using one dataset in isolation. 32 33 34  By using the commercial literature we were able to plug gaps in our knowledge, for 35 36 example, we did not have Nielsen data on cigars or pipe tobacco but information in 37

38 http://bmjopen.bmj.com/ 39 the retail and commercial literature revealed that these products were targets for 40 41 innovation. 42 43 44 Limitations 45

46 on October 4, 2021 by guest. Protected copyright. 47  Nielsen data did not tell us whether RYO packs were in branded or standardised 48 49 50 packaging. Given that a minimum of RYO pack size of 30g was a requirement of the 51 52 TPD we assumed that new 30g RYO packs would switch to standardised packs at 53 54 the same time. 55 56 57  We do not know the extent to which Nielsen variant name changes lag behind and 58 59 even reflect those printed on packs in retailers. However, we are reassured that the 60

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1 2 3 4 main name change patterns found in the Nielsen data were similar to those found in BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 a previous UK convenience store study. 7 8 9 Funding: This work was supported by Cancer Research UK grant number C27260/A23168. 10 11 The authors are members of the UK Centre for Tobacco & Alcohol Studies, a UK Clinical 12 13 14 Research Collaboration Public Health Research Centre of Excellence whose work is 15 16 supported by funding from the Medical Research Council, British Heart Foundation, Cancer 17 18 For peer review only 19 Research UK, Economic and Social Research Council, and the National Institute for Health 20 21 Research under the auspices of the UK Clinical Research Collaboration (MR/K023195/1). 22 23 24 25 26 27 Competing Interests: The authors have no competing interests. 28 29 30 31 32 33 34 35 36 37

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46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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10 th 11 industry in recent years, came into force in the UK on May 20 2016. From this date all new 12 13 factory made (FM) cigarettes and roll your own (RYO) tobacco, manufactured or imported for 14 15 UK consumption were to be sold in standardised packaging. Tobacco companies were 16 17 18 given until May 20thFor 2017 to peercomply with reviewthe law; a period onlyreferred to as the ‘sell-through’. 19 20 During this time, companies were not permitted to print any new branded packets(1, 2). The 21 22 23 UK legislation(1) was implemented in concert with the revision of the 2001 European Union 24 25 (EU) Tobacco Products Directive (TPD)(3) which placed further restrictions on packaging 26 27 and naming of brands (Box 1)(3). 28 29 30 After Australia became the first country to introduce standardised packaging in December 31 32 33 2012, tobacco companies responded with more evocative and descriptive tobacco product 34 35 names, including colours to represent the previous pack colour, thereby continuing the 36 37 connotations associated with these colours(4, 5). Simultaneously companies reduced the 38 http://bmjopen.bmj.com/ 39 40 total number of brands sold and renewed their focus on value for money brands by 41 42 increasing the number and length of cigarettes in a pack and introducing menthol variants in 43 44 45 this price range.(6) In response to standardised packaging in New Zealand and other

46 on October 4, 2021 by guest. Protected copyright. 47 markets there has been a significant increase in flavour capsule variants (FCVs) across all 48 49 50 market price points,(7) which may threaten standardised packaging’s effect on deterring 51 52 smoking initiation given that these products appeal more to non-smokers and non-daily 53 54 smokers than to daily smokers.(8, 9) 55 56 57 While the UK and EU legislation combined closed some of loopholes in the Australian 58 59 60 legislation, by prohibiting product names that create an erroneous impression about the

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1 2 3 4 health effects and requiring minimum pack sizes for both cigarettes and RYO,(10) concerns BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 remain. The current legislation permits the use of colour descriptors, bevelled edges on 7 8 packs, cigarette filter technology innovations and the TPD ban on menthol flavouring 9 10 11 (including capsule technology) does not come into force until May 2020. Furthermore, cigars, 12 13 cigarillos and pipe tobacco and RYO filter tips are exempt from the legislation and are still 14 15 16 sold in branded packaging, while wholesaler multipacks are still allowed branded ‘outer’ 17 18 wraps. For peer review only 19 20 21 Recently published research suggests that, prior to the full implementation of standardised 22 23 packaging in the UK, tobacco companies added smaller pack sizes such as 17 sticks to their 24 25 26 brand variant portfolios,(11) introduced colour descriptors to brand family and brand variant 27 28 names and made product changes, particularly to FM cigarette filters.(12) Examples of 29 30 31 name change patterns associated with UK standardised packaging restrictions have been 32 33 described qualitatively (10, 12, 13) but not quantitatively. The scale of these name changes 34 35 and if/how these changes were communicated to the public is not clear from published 36 37

38 research. Previous work has also only explored up to two months post-legislation. http://bmjopen.bmj.com/ 39 40 41 Therefore, the purpose of this paper was to use mixed methods to combine data from four 42 43 different data sources up to seven months post full-implementation to systematically and 44 45 rigorously examine how compliant tobacco companies were with the legislation, and to 46 on October 4, 2021 by guest. Protected copyright. 47 48 explore any attempts they made to circumvent including any actions to reduce the immediate 49 50 impact of the legislation during the sell-through. We assessed how the sell-through period 51 52 53 was used, how and if tobacco company marketing adapted including any changes to 54 55 products or packaging that would endure after the legislation was fully implemented, and 56 57 58 whether and how products were marketed to retailers and consumers. The findings of this 59 60

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1 2 3 4 paper have global significance as they can help close loopholes during the design and BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 implementation of standardised packaging legislation in other jurisdictions. 7 8 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 BOX 1. Summary of restrictions UK Standardised packaging legislation and the European BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Union Tobacco Products Directive Revision (implemented 20 May 2016 – 20 May 2017) 7 8 9 EU TOBACCO PRODUCTS DIRECTIVE 10 11 PACKAGING OPENING: A unit packet of cigarettes may consist of carton or soft material 12 13 and shall not have an opening that can be reclosed or re-sealed after it is first opened, 14 15 other than the flip-top lid and shoulder box with a hinged lid. For packets with a flip-top lid 16 and hinged lid, the lid shall be hinged only at the back of the unit packet. 17 18 PACK SIZE: CigaretteFor packs peer must contain review a minimum of only20 cigarettes & RYO tobacco 19 20 must contain at least 30 grams of tobacco. 21 22 IMPRESSION CREATION: There must be no packaging elements that create an 23 24 erroneous impression about the characteristics, health effects, risks or emissions of 25 26 tobacco. 27 TOBACCO INGREDIENTS: No description of nicotine, tar or carbon monoxide content of 28 29 a tobacco product. 30 31 FLAVOUR DESCRIPTION: No reference to taste, smell or any flavourings or additives or 32 33 the absence of any such thing. 34 35 FLAVOURINGS (May 2020): No flavourings in any components such as filters, papers, 36 37 packages, capsules or any technical features allowing modification of the smell or taste of

38 http://bmjopen.bmj.com/ tobacco products. 39 40 ENVIRONMENT: No suggestion that a particular tobacco product has improved 41 42 biodegradability or other environmental advantages. 43 44 RESEMBLANCE: No resemblance to a food or cosmetic product. 45

46 PROMOTION: No suggestion of economic advantage of one product over another – no on October 4, 2021 by guest. Protected copyright. 47 48 price marked packs. 49 UK STANDARDARDISED PACKAGING 50 51 PACK EXTERNAL COLOUR: External packaging of cigarettes or RYO tobacco is 52 53 Pantone 448C (matt finish). 54 55 PACK INTERNAL COLOUR: Internal colour of cigarette or RYO packaging must be white 56 57 or Pantone 448C (matt finish). 58 59 60

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1 2 3 4 NOISE AND SMELL: Packaging must not make a noise or produce a smell that is not BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 normally associated with the packaging. 6 7 PACKAGING EVOLUTION: The packaging must not change after retail sale, for example, 8 9 heat activated inks, embellishments designed to appear gradually over time, scratch 10 11 panels etc. 12 13 PACKAGING SHAPE: Cigarette packets must be made of carton or soft material and be 14 15 cuboid in shape & RYO may be in a cuboid box, a cylinder or a pouch (bevelled or 16 rounded edges are permitted). 17 18 STICK DESIGN: CigaretteFor stickpeer paper mustreview be plain white only (matt finish), the filter must only 19 20 be coloured in such a way as to imitate cork. The stick may have the brand name and 21 22 variant printed in black Helvetica type no larger than 8 point in normal weighted regular 23 24 typeface not more than 38 mm from the filter end of the cigarette. The start of each word 25 26 can be an upper case letter but the rest of the word must be lower-case. 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 Methods 6 7 Data Sources 8 9 10 We utilised four data sources, 1) purchases of eight top-selling tobacco brands; 2) tobacco 11 12 advertisements in popular retail trade publications; 3) other commercial literature: retail press 13 14 articles and advertorials, tobacco company annual reports and Euromonitor market analyst 15 16 17 reports; and 4) Nielsen data.(Figure 1) While compliance with the legislation was primarily 18 For peer review only 19 assessed using the Nielsen data, the evidence collected from each data source was utilised 20 21 22 to assess whether, and how, tobacco companies adapted to the legislation and continued to 23 24 market their products. We triangulated data from these different datasets, to verify the 25 26 existence and purpose of adaptations. 27 28 29 Pack Purchasing and observation 30 31 We conducted monthly pack purchases between March 2016 and May 2017 to assess visual 32 33 34 and sensory changes over time in the top-selling FM and RYO products (Table 1) for 35 36 different price segments defined from commercial literature and Nielsen data tobacco price 37

38 http://bmjopen.bmj.com/ 39 data of sales between 2008 and early 2016(11). We purchased packs from five different FM 40 41 price segments and two different RYO price segments. We also included BAT’s top selling 42 43 brand in the UK as an addition as BAT did not have a top-selling brand in any of the 44 45 identified price-segments. 46 on October 4, 2021 by guest. Protected copyright. 47 48 49 Additionally, we observed price lists of cigar and pipe tobacco brands available in-store and 50 51 the appearance of ‘outers’ (the cover wrap used to bind multiple packs of RYO or FM 52 53 54 together for distribution) where visible. 55 56 57 58 59 60

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1 2 3 4 Table 1. Pack purchase data of the top selling brand in each price segment BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Price segment Top selling products name & packsize Co 7 8 (average price 4 9 10 per pack/stick) 11

12 1 13 [ref Nielsen 14 15 paper] 16 17 March 2016 (start of sell-through) May 2017 (full-implementation) 18 For peer review only 19 20 21 FM 22 23 Premium Marlboro Gold (20s) Marlboro Gold (20s) PM 24 25 (£6.76/£0.42) I 26 2 27 Midprice L&B Original Lambert & Butler Silver Lambert & Butler Original Silver (20s) IM 28

38 http://bmjopen.bmj.com/ 3 39 (£4.68/£0.29) Rothmans of London (17s) Rothmans Blue (20s) T 40 BA 41 42 T 43 44 5 45 RYO

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1 2

3 2 Midprice was originally two major segments: Lambert & Butler was the leading upper midprice product and BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 5 Mayfair the leading lower midprice product 6 7 8 3 None of the top selling brands in each price range was owned by British American Tobacco. For completeness 9 10 we added Rothman’s of London (a subvalue brand) - the top selling brand for British American Tobacco. 11 12 4 13 Tobacco company’ abbreviations: BAT British American Tobacco, IMT Imperial Tobacco, JTI Japan Tobacco 14 International, PMI Philip Morris International 15 16 17 5 No RYO value segment (average pack/stick price: £4.28/£0.14) product was purchased due to lower sales 18 For peer review only 19 20 volumes even of the leading brand (Gold Leaf) in this segment. 21 22 23 24 Advertisements in the retail press 25 26 We searched hard copies of the most widely circulated paid for retail and wholesale 27 28 29 publications The Grocer, Wholesale News and Retail Newsagent between January 2015 and 30 31 December 2017 for all tobacco advertisements. 32 33 34 We coded 195 advertisements for the attributes marketed to retailers, e.g., new brand 35 36 37 variant, packaging, filter, limited edition, price, retailer profit. We examined the distribution of

38 http://bmjopen.bmj.com/ 39 these marketing themes by price segment (Table S1). We separately assessed advertorials 40 41 for relevance to standardised packaging and noted the main messages communicated. 42 43 44 Commercial literature review 45

46 We searched high circulation online retail publications (The Grocer, Wholesale News, on October 4, 2021 by guest. Protected copyright. 47 48 49 betterretailing.com (which includes Retail Newsagent and Retail Express, talkingretail.com), 50 51 to identify articles relevant to tobacco packaging and marketing (Jan 2015 – Dec 2017; Table 52 53 2). We also included two reviews of 2017 published in 2018, Euromonitor reports on 54 55 56 tobacco, and tobacco company annual reports covering this period. We used NVivo 10, to 57 58 59 60

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1 2 3 4 code articles for any evidence of circumvention of the legislation and used quotes taken from BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 the commercial literature as examples of each circumvention (Table S2). 7 8 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 Table 2 Commercial literature review January 2015 to December 2017 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Source Search terms (depends on Articles/reports Articles/reports 7 8 search procedure of website) found included in 9 final analysis 10 11 RETAILER 12 MAGAZINES 13 14 Convenience & 15 16 independents 17 Betterretailing.com: “tobacco” 350 181 18 For peer review only 19 Retail Newsagent 20 21 Retail Express 22 TalkingRetail.com “tobacco” 50 49 23 24 25 Wholesalers &FMCG 26 27 Wholesale News "tobacco" or "cigarette" or 54 30 28 29 "ryo" or "roll+your+own" or 30 "hand+rolled" or "cigar" or 31 32 "cigarillo" 33 The Grocer "tobacco" or "cigarette" or 820 104 34 35 "ryo" or "roll+your+own" or 36 37 "hand+rolled" or "cigar" or

38 "cigarillo" http://bmjopen.bmj.com/ 39 40 41 42 INDUSTRY ANALYST 43 Euromonitor Passport “tobacco” NA 20 44 45

46 on October 4, 2021 by guest. Protected copyright. TOBACCO COMPANY 47 48 Annual reports from the Annual reports 12 12 49 50 big four tobacco 51 companies: JTI, IMT, 52 53 BAT and PMI 54 55 TOTAL 1286 396 56 57 58 Nielsen Data 59 60

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1 2 3 4 Nielsen collates data on tobacco sales from nearly 90% of UK supermarkets and a stratified BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 sample of 15% of convenience stores(11). For each product, Nielsen records hierarchically 7 8 the tobacco brand, brand family, brand variant and then specific features of the pack 9 10 11 denoted by a unique serial number known as a SKU (e.g. size, pricemarked)(11). In 12 13 November 2017 there were 71 brands, 97 families, 241 variants, and 1022 SKUs (Table 3). 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 Table 3 Hierarchical brand architecture available from the Nielsen data BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 N (UK market) 7 8 9 Hierarchy of Nielsen Example July 2014 Nov 10 11 data 2017 12 13 BRAND Marlboro 44 71 14 15 BRAND FAMILY Marlboro Bright Leaf 114 97 16 17 Products with the same 18 For peer review only 19 brand name but sold at 20 21 different price points 22 23 BRAND VARIANT Marlboro Bright Leaf Platinum 282 241 24 25 Product at same price 26 point but with different 27 28 length (e.g. superkings, 29 30 kingsize), flavour or 31 32 other characteristics 33 34 Stock Keeping Unit Marlboro Bright Leaf Platinum 10s multipack 930 1022 35 36 (SKU) Each individual not price marked 37 barcoded product

38 http://bmjopen.bmj.com/ 39 including specific pack 40 41 characteristics: pack 42 43 size, whether the pack is 44 price-marked, and, for 45

46 FM but not RYO, on October 4, 2021 by guest. Protected copyright. 47 48 whether standardised or 49 50 branded 51 52 53 54 Data Analysis 55 56 Compliance 57 58 59 60

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1 2 3 4 Monthly Nielsen sales data were used to examine compliance with the removal of branding, BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 pricemarking and small pack sizes (Box 1), between July 2016 (when the first standardised 7 8 packs first were sold)(13) and November 2017. For FM, Nielsen data identifies which packs 9 10 11 are standardised and which branded. For RYO they do not. However, as 30g packs of RYO 12 13 were negligible prior to standardised pack legislation RYO packs of 30g or more were 14 15 16 treated as standardised. 17 18 Name changes For peer review only 19 20 We identified the number, names and price segments of all brand variants whose name 21 22 23 changed between July 2014 and November 2017. July 2014 was used as a starting point for 24 25 this analysis as we wanted a time before standardised packaging was passed by the 26 27 28 Government in January 2015. We coded and counted whether each name change was 29 30 required for compliance with the legislation and recorded the type of name change eg colour 31 32 added or adjective added. 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3

Innovation targeting BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 5 To understand whether innovations were targeted at particular price segments, we 6 7 8 compared the distribution of name changes and new variants in November 2017 with the 9 10 distribution of price segments prior to the decision to implement legislation in July 2014. 11 12 13 Differences in the number of variants were tested using chi-square tests and Fishers exact 14 15 tests (when the expected number of cases was less than five). To achieve sufficient 16 17 numbers for analysis, price segments were merged into four categories: (1) FM premium 18 For peer review only 19 20 and midprice, (2) FM value and subvalue, (3) RYO premium and midprice, (4) RYO value. 21 22 23 24 25 26 Patient and Public Involvement 27 28 KER and RH discussed standardised packaging policy with the UK Centre for Tobacco and 29 30 Alcohol Studies University of Nottingham panel of smokers and former smokers (now known 31 32 33 as the Tobacco & Nicotine Discussion Group) in October 2017. The group were asked to 34 35 discuss their thoughts on and experiences of the policy and whether they had noticed any 36 37 changes to tobacco products and packs both in the sell-off period and thereafter. These

38 http://bmjopen.bmj.com/ 39 40 discussions helped inform our research questions but we did not include these discussions 41 42 in our analysis. Our study did not involve human subjects and therefore we did not seek any 43 44 45 further involvement from the panel.

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 Results 53 54 Four main strategies were identified from multiple data sources. We present the evidence 55 56 57 for each in turn. 58 59 60 Strategy 1: Keep branded packets on the market as long as possible

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Six months into the year-long sell-through period, 96% of FM and 82% RYO were still sold in 7 8 branded packs (Figure 2 & table S3). Most FM (70%) and RYO (65%) packs switched to 9 10 11 standardised packs between January and April 2017. One month after the full- 12 13 14 implementation of the UK and EU policies, 97% of cigarettes and 98% of RYO were 15 16 sold in compliant packaging. By November 2017, non-compliant sales declined to 1% 17 18 For peer review only 19 of FM and negligible volumes of RYO. 20 21 22 23 24 25 26 The commercial literature suggests that tobacco companies produced greater volumes of 27 28 their branded FM and RYO tobacco prior to the May 2016 manufacturing deadline to keep 29 30 31 branded packaging on the market for as long as possible during the sell-through(15). Both 32 33 the Nielsen data and the adverts and the commercial literature revealed an increase in small 34 35 pack sizes ahead of the sell-through period. Tobacco companies offered incentives and 36 37

38 promotions on branded packs to retailers to encourage sales and loyalty to their products, http://bmjopen.bmj.com/ 39 40 examples included cash rewards and loyalty points for selling particular brands. By early 41 42 43 2017 manufacturers were described as being in a price-war(16, 17). To allay retailers’ 44 45 concerns about being left with non-compliant stock after the deadline, tobacco companies

46 on October 4, 2021 by guest. Protected copyright. 47 offered to buy them back (Table S2; Strategy 1.3)(18). 48 49 50 Overall, tobacco companies decreased the number of brand families and brand variants 51 52 53 between July 2014 and November 2017 as they were consolidating their portfolios and 54 55 focusing on the brands which could offer growth. The increase in SKU between 2014 and 56 57 58 2017 reflects (a) the pre-standardised packs increase in small pack sizes, innovations such 59 60 as flavours and capsules (b) the addition of standardised packs FM SKU and 30g RYO SKU

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1 2 3 4 and (c) that many SKU in branded packs remained on the market in November 2017 but BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 selling only tiny volumes. 7 8 9 10 11 12 Strategy 2: Maintaining brand variant differentiation through name changes 13 14 One third (35%; 123/ 353) of variants changed name between July 2014 and November 15 16 17 2017. Less than half of these changed name to comply with legislation (42%, n=52/123) and 18 For peer review only 19 most of these removed flavour names as the legislation required but substituted with other 20 21 names, most often a colour (Table 4). Most notably, FM smooth became bright or sky blue, 22 23 24 with RYO smooth changing to yellow and menthol for both FM and RYO changing to green. 25 26 27 Of the variants which changed name when it was not necessary for legislative compliance 28 29 (N=71/123, 58%), colours were introduced for the first time as a substitute for the previous 30 31 32 pack colour, eg. Marlboro with the red chevron on the pack became Marlboro Red. Similarly, 33 34 to distinguish brand variants from one another and to continue previous brand variant 35 36 identities, other adjectives were added to brand names, most notably adjectives 37

38 http://bmjopen.bmj.com/ 39 accompanied a colour, e.g. real blue, bright silver, legendary black. In addition, during the 40 41 study period, 23 new variants appeared in the Nielsen dataset with names which included 42 43 44 elements that were novel: ‘signature’, ‘ome’, ‘silver strand’ in May 2015, ‘Eagle,’ and 45

46 ‘Colours’’ in November 2015 and ‘Chill’ in May 2016 and two different brands added ‘Black on October 4, 2021 by guest. Protected copyright. 47 48 Russian’ variants in November 2015 and January 2017. Lastly, two new Golden Virginia 49 50 51 RYO variants appeared on the market in November 2015 named ‘Midnight’ and ‘Sunrise’. 52 53 Commercial literature revealed that these indicated rich and smooth flavours 54 55 56 respectively(19). The first brand variant in a brand family sometimes had ‘original’ added e.g. 57 58 Amber Leaf RYO became Amber Leaf original. 59 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 Table 4. Nielsen data FM and RYO brand variant name changes from (July 2014 - 7 8 November 2017) 9 10 11 N Additions/substitutions 12 13 Legally required actions 14 15 16 Taste removed Replacement 17 18 Menthol For peer reviewColour 20onlygreen 19 20 No replacement 2 21 22 Smooth Colour + adjective 12 bright blue/yellow, sky blue 23 24 25 Adjective 5 bright, sky 26 27 Colour 3 blue, yellow 28 29 Other Substitution 1 fine 30 31 32 other taste (‘fresh burst’, ‘fresh Other Substitution 3 crushball, dual 33 taste’, ‘ice capsule’, ‘subtle 34 No replacement 1 35 flavour‘) 36 37 Environmental advantages

38 http://bmjopen.bmj.com/ 39 removed 40 41 ‘Natural’ Other Substitution 2 blue, king size 42 43 No replacement 3 44 45 Total 52

46 on October 4, 2021 by guest. Protected copyright. 47 48 Discretionary actions only 49 50 colour+adjective added 9 original silver/blue/black, real blue/red 51 52 adjective added 8 bright, real, legendary 53 54 55 colour added 7 blue, red, black 56 57 ‘original’ added 6 58 59 60

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1 2 3 4 size (king size, superkings) 6 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 removed 6 7 8 Mixed & miscellaneous 35 Mixed: e.g. colour added and size 9 removed 10 11 Miscellaneous: e.g. location added or 12 13 removed e.g Rothman’s of London 14 15 became Rothman’s Blue 16 17 Total 71 18 For peer review only 19 Grand total 12 20 21 3 22 23 24 25 In October 2016, five months into the sell-through period and before IMT had made any of its 26 27 legally required name changes to its products, the company outlined its brand renaming 28 29 30 strategy in an advertorial in the retail press(20). The advertorial explained that all products 31 32 traditionally presented as full flavour would become ‘real’ or ‘original’ and be associated 33 34 35 primarily with the colour red. Those previously denoted as ‘smooth’ would change to ‘bright’ 36 37 and become associated with the colour blue. Menthol would become green and capsule

38 http://bmjopen.bmj.com/ 39 would become Crushball (Table S2: Strategy 2). IMT also provided retailers with materials 40 41 42 to help explain changes to consumers(20). Some companies also advertised name changes 43 44 directly to consumers through pack inserts (eg. BAT’s Rothmans of London included a pack 45

46 on October 4, 2021 by guest. Protected copyright. 47 insert to warn its smokers that it was to become Rothman’s Blue). 48 49 50 51 52 Strategy 3. Focus on lower price segments 53 54 During the study period, 68% of new variants recorded by Nielsen were FM and 32% RYO. 55 56 57 Given that in July 2014, 81% variants on the UK market were FM and 19% were RYO (Table 58 59 5), more new RYO variants were introduced than expected (p=.018). 60

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1 2 3 4 BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 7 8 Half (50%) of all new variants were introduced in the FM value and subvalue price 9 10 11 segments, 22% FM premium and midprice, 15% RYO premium and midprice and 13% RYO 12 13 value. However, prior to the decision to implement standardised packaging (July 2014), the 14 15 16 distribution of the market was 50% FM premium and midprice, 35% FM value and subvalue, 17 18 8% RYO premium andFor midprice peer and 7% reviewRYO value. Thus only new variants were under- 19 20 represented among FM premium and midprice brands (p=.001). 21 22 23 Similarly, compared with July 2014, name changes in the study period were overrepresented 24 25 among FM value and subvalue (p=.048) and under-represented among FM premium and 26 27 28 midprice brands (p=.002). 29 30 31 32 33 34 35 Companies introduced more menthol and flavoured capsule variants to the lower price 36 37

38 segments which traditionally offered fewer of these products compared to premium and http://bmjopen.bmj.com/ 39 40 midprice segments. Since July 2014, 13 menthol or flavoured capsule variants were 41 42 43 introduced to the value and subvalue price segments compared to just two new brand 44 45 variants in the premium and midprice range (Table S4). Overall, the number of brand

46 on October 4, 2021 by guest. Protected copyright. 47 families and brand variants declined. Tobacco companies reported concentrating on fewer 48 49 50 brand families so that they could improve the “quality of growth” and “cut the level of 51 52 complexity and cost in the business.”(21) 53 54 55 56 57 58 59 60

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1 2 3 4 Table 5 Nielsen data. Price segmentation of new variants and variant names changes BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 between July 2014 and November 2017 compared to July 2014 baseline. 6 7 8 9 Name changes New variants 10 Baseline distribution of (July 2014 – November (July 2014 – November 11 variants (July 2014) 2017) 2017) 12 13 N % N % P* N % P* 14 Tobacco Type 15 16 FM 12 .527 .018 17 225 81% 5 79% 48 68% 18 For peer review only 19 RYO 54 19% 35 21% 23 32% 20 Price segment 21 22 FM premium & midprice 103 50% 48 33% .002 10 22% .001 23 FM value & sub value 72 35% 66 45% .048 23 50% .054 24 25 RYO premium & midprice .097 .164 26 17 8% 20 14% 7 15% # 27 RYO value .735 .602 28 29 15 7% 12 8% 6 13% # 30 31 *Chi square comparing with July 2014 distribution 32 #Fishers exact test comparing with July 2014 distribution 33 34 35 Nearly two-thirds of the advertisements captured from the retail press, 124/195 (64%) 36 37

38 advertised value or subvalue brands. Similarly, for new products, the majority of http://bmjopen.bmj.com/ 39 40 advertisements (30/38; 79%) were for value or subvalue brands. Only one advert was a new 41 42 43 premium offering. 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 The commercial literature found tobacco companies innovating within lower price segments, 49 50 51 introducing packs with fewer cigarettes prior to the sell-through (22-24) followed by a price- 52 53 war in the lower priced segments with some manufacturers reportedly selling at a loss to 54 55 gain market share(16). By the end of 2017 tobacco companies stated that smokers expected 56 57 58 better quality products in lower price segments after standardised packaging and Minimum 59 60 Excise Tax (MET) legislation raised the price of the cheaper brands and so ‘premium

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1 2 3 4 features’ in lower priced cigarettes appeared (Table S2: Strategy 3)(23, 25). For example, a BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 redesign to Chesterfield (subvalue) was advertised to retailers in December 2017, citing a 7 8 new ‘firm’ filter and, as with premium brand Marlboro, a new bevelled edge box(24, 26). 9 10 11 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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38 http://bmjopen.bmj.com/ 39 40 fundamentally changed the tactile nature of the pack which endured after full- 41 42 implementation in May 2017 (Supplementary Video 1). To be compliant with the 43 44 45 legislation, these packs must have been printed prior to May 2016.

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 Extra Sticks 50 51 Given that there is no restriction on the maximum number of sticks per pack, packs with 52 53 more than 20 continued post-legislation. During the sell-through (May 2016 - May 2017) 54 55 56 sales of packs with 23 and 24 sticks increased from 7 to 18 million sticks. Sales peaked at 57 58 25 million sticks in August 2017 and declined to 21 million sticks in November 2017. 59 60

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1 2 3

Branded Outers BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 5 The retail literature and in person observations revealed that multipack wholesale outers for 6 7 8 FM and RYO are branded (Figure 4). Outers can be seen by customers during tobacco 9 10 product gantry restocking. Advertisements in the retail press showed images of branded 11 12 13 tobacco products including branded outers post-legislation. 14 15 16 17 RYO accessories 18 For peer review only 19 Increased innovation was observed among RYO accessories post legislation with retail 20 21 22 press articles in November 2017 and February 2018 referring to “‘ultra slim’ and slim filters 23 24 and papers, biodegradable filters, and menthol tips” (Table S2; Strategy 4.4) (25, 27). 25 26 27 28 Cigars 29 30 Cigars, which can be sold in branded packs, single sticks without pictorial health warnings, 31 32 33 at a relatively low price and with good profit margin, were identified as an opportunity for 34 35 growth (19, 24, 28-30). Euromonitor’s models suggested growth in cigars and cigarillos sales 36 37 volumes (390 to 494 million units) and value (£292 to £348 million) from 2015 to 18 (Table

38 http://bmjopen.bmj.com/ 39 40 S5). Towards the end of 2017, JTI and cigar company Ritmeester were holding social events 41 42 to build relationships with retailers (Table S2; Strategy 4.5) (24). 43 44 45 Pipe Tobacco

46 on October 4, 2021 by guest. Protected copyright. 47 The retail literature revealed that one small tobacco manufacturer, Gawith Hoggarth, 48 49 50 deliberately marketed pipe tobacco as RYO to circumvent the minimum pack size 51 52 restrictions on RYO (Table S2; Strategy 4.6)(31). 53 54 55 56 Discussion 57 58 59 60

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1 2 3 4 UK Standardised Packaging legislation and the EU TPD placed restrictions on tobacco BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 packaging and marketing in the UK. Overall, although compliance with the restrictions 7 8 (removal of branding, small pack sizes and non-compliant names) was not 100% one month 9 10 11 after full implementation, the majority of non-compliance could be explained by less popular 12 13 tobacco products that were not widely circulated. However, clarity is needed about the 14 15 16 legality of isolated incidents such as the compliance of the Marlboro resealable pack and 17 18 Gawith Hoggath’s marketingFor peer of its Kendal review pipe tobacco as only RYO (Video 1). 19 20 21 Technical compliance aside, this paper identified four key strategies use by tobacco 22 23 companies to circumvent the legislation. 24 25 26 Firstly, the retail literature suggests that tobacco companies used the 12-month sell-through 27 28 29 to their advantage, keeping branded stock on the market as long as possible, and using the 30 31 time to communicate name changes and new brand variants to retailers and customers. 32 33 34 Ahead of the sell-through companies increased production of branded packs, introduced 35 36 smaller pack sizes to enable more affordable offerings, and encouraged retailers to buy 37

38 http://bmjopen.bmj.com/ large quantities of branded stock at reduced prices. Other countries had a shorter sell- 39 40 41 through period with three-months for Australia and New Zealand (32, 33) and seven months 42 43 for France (34). Governments considering the policy in other countries should therefore 44 45 consider mandating a short sell-through period. 46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 Second, although compliant with legally required name removals, tobacco companies 51 52 53 implemented a standard name change formula that maintained the brand identity and 54 55 differentiation of the three broad flavour categories (1) full flavour; (2) smooth; (3) 56 57 58 menthol(20). In 2002 terms such as ‘mild’ and ‘light’ were prohibited to curb misperceptions 59 60 of relative harm. However, the continuation of the colours of the previous packs such as the

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1 2 3 4 gold and white pack for Marlboro ‘lights’ and the introduction of terms such as smooth for BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 other brands sustained these misperceptions(35, 36). In line with the power of colour in 7 8 brand identity,(36-38) this study shows that tobacco companies changed ‘full-flavour’ 9 10 11 variants to red, original, or real; menthol variants to green; and smooth variants to bright and 12 13 blue (or yellow for RYO). As in 2002, the current restrictions on tobacco product name were 14 15 16 designed disrupt misperceptions of relative harms based on flavour descriptions. However, 17 18 by maintaining the broadFor flavour peer categories review such misperceptions only are likely to endure. 19 20 Additionally, cigarette packs with filter descriptions such as ‘advanced’ and ‘firm’ filter are 21 22 23 perceived as less harmful by existing smokers and therefore perpetuate the perceptions that 24 25 some tobacco brand variants are less harmful than others(39). Given that companies 26 27 28 continue to innovate their product names and descriptions it may be considered necessary 29 30 to follow the example of Uruguay where only one brand variant is permitted per brand and 31 32 no new brands are allowed(40). 33 34 35 Third, Nielsen data and the commercial literature revealed that tobacco companies were 36 37

38 fighting fervently for market share in the cheaper price segments with a price war pre http://bmjopen.bmj.com/ 39 40 implementation. In the lower price segments, tobacco companies implemented more name 41 42 43 changes, introduced more new brand variants(including menthol and flavour capsules) and 44 45 more RYO variants and placed more advertisements for lower priced products then they did

46 on October 4, 2021 by guest. Protected copyright. 47 for premium and midprice products. Other work suggests that RYO is a lower cost 48 49 50 alternative to smokers who may otherwise quit and so this may explain the introduction of 51 52 more RYO offerings in lower price segments (41-43). Similarly, menthol and particularly 53 54 55 flavour-capsule variants appeal more to non-smokers and non-daily smokers compared to 56 57 smokers and may therefore recruit non-smokers and increase overall smoking prevalence 58 59 (8). Flavoured cigarettes including capsule flavourings will be outlawed in the EU by May 60

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1 2 3 4 2020. With the UK set to leave the EU in 2019, the tobacco industry may utilise this BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 opportunity to try and roll back tobacco control regulations made under the EU TPD. 7 8 9 Our fourth finding that tobacco companies are innovating tobacco products, features and 10 11 accessories not covered by the UK or EU legislation for growth provides may provide a 12 13 14 rationale for expanding the legislation to include products such as RYO filters and papers, 15 16 standardised packaging for cigars, cigarillos, pipe tobacco, wholesale outer wraps, 17 18 For peer review only 19 standardised pack edges, maximum pack sizes and prohibitions for innovations to pack 20 21 seals. Tobacco companies, such as Imperial Tobacco in the UK have recently introduced a 22 23 whole series of flavour capsule variants to their Rizla filter tip product offerings for RYO 24 25 26 tobacco. 27 28 29 The strength of this paper lies both in the detail and depth of each analysis including our 30 31 systematic analysis of retail press advertisements (n=195) and commercial literature articles 32 33 34 and reports (n= 396) alongside pack purchases of the top selling brands and detailed sales 35 36 information from Nielsen. Using multiple data sources enabled findings to be verified by 37

38 http://bmjopen.bmj.com/ more than one source and enabled a greater understanding of the tobacco industry’s 39 40 41 motives for any changes made to their products and packaging. In addition to the evidence 42 43 presented by others [1, 13, 14], by following these data sources up to seven months post- 44 45 legislation we were able to observe tobacco companies increased focus on innovations to 46 on October 4, 2021 by guest. Protected copyright. 47 48 exemptions to the legislation that offered opportunities for growth e.g. RYO filters and 49 50 accessories and cigars. 51 52 53 Nevertheless, despite evidence from an IMT whistleblower (44) and PMI’s own words (45), 54 55 56 our data did not reveal price mark stickers on tobacco products. This is likely to be because 57 58 we bought our eight brands from a large supermarket and not a convenience store and 59 60

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1 2 3 4 because this industry strategy was not highlighted in the retail literature due to the BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 questionable legality of this strategy(46). 7 8 9 Resources prevented us from acquiring Nielsen data on cigars or pipe tobacco and from 10 11 purchasing more than one brand per price segment in the pack purchasing study element. 12 13 14 However, the retail literature alerted us that cigars and other products were targeted as 15 16 growth opportunities and, although not able to fully capture the sensory nature of brands, our 17 18 For peer review only 19 analysis of the advertisements ensured that we saw many, if not all, innovations being 20 21 promoted to retailers. 22 23 24 Nielsen data do not record whether RYO products are sold in standardised packs. We 25 26 assumed that 30g packs were always in standardised packs and that larger packs would 27 28 29 switch to standardised packs at the same time. It is possible that this did not occur. 30 31 However the temporal patterns of name changes and pack sizes in the Nielsen data were 32 33 34 similar for FM and RYO and it is therefore reasonable to assume that branding was removed 35 36 at the same time. Nielsen model prices and volumes for the UK based on a census of the 37

38 http://bmjopen.bmj.com/ major supermarket sales and a rolling sample of convenience stores. Although, we do not 39 40 41 know the extent to which Nielsen variant name changes lag behind and even reflect those 42 43 printed on packs in retailers, the main name change patterns found in the Nielsen data were 44 45 similar to those found in a UK convenience store study(47) and two evaluations of the 46 on October 4, 2021 by guest. Protected copyright. 47 48 introduction of standardised packaging in Australia(4, 5). 49 50 51 Given that the tobacco industry is attempting to circumvent standardised packaging 52 53 legislation, other countries considering the policy should consider how to make regulations 54 55 56 as comprehensive as possible to prevent the exploitation of continued marketing 57 58 opportunities. In summary, the evidence in this paper suggests a number of possible policy 59 60

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1 2 3 4 options, namely that long sell-through periods should be avoided and that restricting tobacco BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 products to one brand variant per brand may be the only comprehensive way to prevent 7 8 misperceptions of harm and an that extending regulations to include other tobacco products, 9 10 11 features and accessories should be considered. 12 13 14 15 16 17 18 For peer review only 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37

38 http://bmjopen.bmj.com/ 39 40 41 42 43 44 45

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1 2 3 4 Author contributions: AG designed the study with contributions from KER and RH. KER led BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 the writing of the paper and designed, conducted and analysed the pack purchase element 7 8 of the study. RH analysed the Nielsen data in addition to downloading and analysing the 9 10 11 commercial literature. KL collated the retail literature advertisements, involving visits to the 12 13 British Library and analysed the data. All authors read and approved the manuscript. 14 15 16 17 18 For peer review only 19 Acknowledgements: The authors would like to thank Dr Rob Branston who read and 20 21 22 commented upon a near final draft and Ilhan Marsal who helped with early preparation of the 23 24 advertisements and pack purchased data. We would also like to acknowledge Nielsen (UK) 25 26 and Public Health England for provision of the sales data. 27 28 29 30 31 32 33 Data statement: 34 1. The Nielsen dataset: cannot be accessed by others as it is paid for data and we do 35 36 37 not have permissions to republish these.

38 http://bmjopen.bmj.com/ 39 2. Pack purchasing: qualitative observational data are available from the University of 40 41 Bath data archive 42 43 44 3. Retail press advertisements: the coded dataset is available from the University of 45

46 Bath data archive on October 4, 2021 by guest. Protected copyright. 47 48 49 4. Commercial literature: full articles were analysed in NVivo software. As the majority 50 51 of documents came from paid for publications we are not permitted to publish these 52 53 articles. Tobacco company annual reports are publicly available on tobacco company 54 55 56 websites. 57 58 59 60

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1 2 3 4 References BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 5 6 1. The standardised packaging of tobacco products regulations 2015, No.829, (19 March 2015). 7 Available from: https://www.legislation.gov.uk/uksi/2015/829/pdfs/uksi_20150829_en.pdf. 8 2. Department of Health. Tobacco Packaging Guidance: Guidance for retailers, manufacturers 9 and distributors of tobacco products, enforcement agencies and the public on changes to tobacco 10 packaging from 20 May 2016 2016 [updated May 2017, cited 8 January 2018]. Available from: 11 https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/596139/Tobacco_ 12 Packaging_Guidance.pdf. 13 14 3. Directive 2014/40/EU of the European Parliament and of the Council of 3 April 2014, (2014). 15 Available from: http://eur-lex.europa.eu/legal- 16 content/EN/TXT/PDF/?uri=OJ:JOL_2014_127_R_0001&from=EN. 17 4. Scollo M, Occleston J, Bayly M, et al. Tobacco product developments coinciding with the 18 implementation of plainFor packaging peer in Australia. review Tobacco Control only. 2014;24:e116-e22. 19 5. Scollo M, Bayly M, White S, et al. Tobacco product developments in the Australian market in 20 the 4 years following plain packaging. Tobacco Control. 2018;27:580-4. 21 6. Scollo M, Zacher M, Coomber K, et al. Changes in use of types of tobacco products by pack 22 23 sizes and price segments, prices paid and consumption following the introduction of plain packaging 24 in Australia. Tobacco Control. 2015;24(Suppl 2):ii66-ii75. 25 7. Haggart K, Hoek J, Blank M-L. Flavour capsule variants' performance in a "dark market": 26 Implications for standardised packaging. Nicotine & Tobacco Research. 2018;158. 27 8. Hoek J, Gendall P, Eckert C, et al. Young adult susceptible non-smokers’ and smokers’ 28 responses to capsule cigarettes. Tobacco Control. 2018;0:1-8. 29 9. Moodie C, Ford A, Dobbie F, et al. The Power of Product Innovation: Smokers’ Perceptions of 30 Capsule Cigarettes. Nicotine & Tobacco Research. 2017;20(9):1157-60. 31 32 10. Moodie C, Hoek J, Scheffels J, et al. Plain packaging: legislative differences in Australia, 33 France, the UK, New Zealand and Norway, and options for strengthening regulations. Tob Control. 34 2018. 35 11. Hiscock R, Branston JR, McNeill A, et al. Tobacco industry strategies undermine government 36 tax policy: evidence from commercial data. Tobacco Control. 2017;27:488-97. 37 12. Moodie C, Angus K, Mitchell D, et al. How tobacco comapnies in the UK prepared for and

38 responded to standardised packaging of cigarettes and rolling tobacco. Tobacco Control 2018. http://bmjopen.bmj.com/ 39 13. Breton MO, Britton J, Huang Y, et al. Cigarette brand diversity and price changes during the 40 implementation of plain packaging in the United Kingdom. Addiction. 2018. 41 42 14. Branston JR, McNeill A, Gilmore AB, et al. Keeping smoking affordable in higher tax 43 environments via smoking thinner roll-your-own cigarettes: Findings from the International Tobacco 44 Control Four Country Survey 2006–15. Drug and Alcohol Dependence. 2018;193:110-16. 45 15. Explained: Retailer's questions about EUTPD II: Retail Newsagent; 10 May 2016 [18 April

46 2018]. Available from: https://www.betterretailing.com/questions-about-eutpd2. on October 4, 2021 by guest. Protected copyright. 47 16. Value brands price war hits retail profits: BetterRetailing; 17 February 2017 [18 April 2018]. 48 Available from: https://www.betterretailing.com/value-brands-price-war-hits-retail-profits. 49 17. Cash incentives and price cuts drive tobacco sales: Retail Newsagent; 26 May 2016 [20 April 50 51 2018]. Available from: https://www.betterretailing.com/tobacco-cashandcuts. 52 18. Samrai G. Wholesalers: tobacco suppliers will help retailers with branded stock post-EUTPD 53 II: Retail Newsagent; 2 March 2017 [18 April 2018]. Available from: 54 https://www.betterretailing.com/tobacco-suppliers-branded-stock. 55 19. Dillon C. Three things you can learn from Ritmeester's cigar seminars: Retail Express; 17 56 September 2017 [24 April 2018]. Available from: https://www.betterretailing.com/ritmeesters- 57 seminar. 58 20. Imperial Tobacco. Partnering for Success through EUTPD II and standardised packaging: Part 59 4. New pack descriptors under EUTPD II. Retail Newsagent. 28 October 2016:20-1. 60

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21. Imperial Brands. Annual report and accounts 2017: Investing for growth 2017 [29 May BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 2019]. Available from: https://www.imperialbrandsplc.com/content/dam/imperial- 5 6 brands/corporate/investors/annual-report-and-accounts/online-annual-report- 7 pdfs/Annual_Report_2017_Final_PDF_Web_Ready_171207.pdf 8 22. O'Donnell T. The fat lady sings: tobacco category report 2016: The Grocer; 11 February 2016 9 [19 April 2018]. Available from: https://mweb02.thegrocer.co.uk/reports/category-reports/the-fat- 10 lady-sings-tobacco-category-report-2016/531520.article. 11 23. Selwood D. Pall Mall cigarettes get taste plus filter in range upgrade 18 April 2016 [20 April 12 2018]. Available from: https://www.thegrocer.co.uk/buying-and-supplying/marketing/pall-mall-cigs- 13 get-taste-plus-filter-in-range-upgrade/534748.article. 14 24. Yau A. The latest developments from the biggest tobacco brands: Retail Newsagent; 5 April 15 16 2018 [20 April 2018]. Available from: https://www.betterretailing.com/developments-from-the- 17 biggest-tobacco-brands. 18 25. Pendleton R.For A tightening peer stranglehold: review tobacco category only report 2018: The Grocer; 9 19 February 2018 [19 April 2018]. Available from: https://www.thegrocer.co.uk/buying-and- 20 supplying/categories/tobacco/an-ever-tightening-stranglehold-tobacco-category-report- 21 2018/563080.article. 22 26. Philip Morris International. Stock up now: Chesterfield with new premium features. Retail 23 Newsagent. 15 December 2017. 24 25 27. Cronin E. Rizla launches new Natura paper and tips range: Talking Retail; 3 August 2017 [4 26 April 2018]. Available from: https://www.talkingretail.com/products-news/tobacco/rizla-launches- 27 new-natura-paper-tips-range-03-08-2017/. 28 28. Appleby S. New tobacco law, means new opportunity for cigars sales: Retail Express; 6 June 29 2016 [24 April 2018]. Available from: https://www.betterretailing.com/cigar-market. 30 29. Dillon C. Ritmeester launches single stick Panatellas: Retail Express; 15 January 2015 [23 31 April 2018]. Available from: https://www.betterretailing.com/ritmeester-single-royal-dutch- 32 panatellas. 33 30. Lee J. Know the value of the tobacco market to keep sales strong. Retail Express. 22 August 34 35 2017. 36 31. Gockelen-Kozlowski T. Tobacco firms adapt to deal with latest EUTPD laws: Retail 37 Newsagent; 25 May 2017 [20 April 2018]. Available from: https://www.betterretailing.com/tobacco-

38 legislation. http://bmjopen.bmj.com/ 39 32. Ministry of Health (New Zealand). Tobacco standardised packaging 2017 [updated 13th June 40 2017, cited 16th March 2018]. Available from: https://www.health.govt.nz/our-work/preventative- 41 health-wellness/tobacco-control/plain-packaging. 42 33. Scollo M, Lindorff K, Coomber K, et al. Standardised packaging and new enlarged graphic 43 44 health warnings for tobacco products in Australia—legislative requirements and implementation of 45 the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information

46 Standard. Tobacco Control. 2015;24(Suppl 2):ii9. on October 4, 2021 by guest. Protected copyright. 47 34. Tobacco Labelling Resource Centre. France 2013 [cited 2018 16th March]. Available from: 48 http://www.tobaccolabels.ca/countries/france/. 49 35. Mutti S, Hammond D, Borland R, et al. Beyond light and mild: cigarette brand descriptors 50 and perceptions of risk in the International Tobacco Control (ITC) Four Country Survey. Addiction. 51 2011;106(6):1166-75. 52 53 36. Bansal-Travers M, O'Connor RJ, Fix BV, et al. What do cigarette pack colors communicate to 54 smokers in the U.S.? American Journal of Preventive Medicine. 2011;40(6):683-89. 55 37. Hoek J, Gendall P, Eckert C, et al. Effects of brand variants on smokers’ choice behaviours 56 and risk perceptions. Tobacco Control. 2016;25(2):160-5. 57 38. Greenland SJ. Cigarette brand variant portfolio strategy and the use of colour in a darkening 58 market. Tobacco Control. 2015;24:e65-e71. 59 60

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39. Borland R, Savvas S. The effects of variant descriptors on the potential effectiveness of plain BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 packaging. Tobacco Control. 2014;23:58-63. 5 6 40. Hoek J, Gendall P. Policy options for extending standardized tobacco packaging. Bulletin of 7 the World Health Organization. 2017;95(10):726. 8 41. Bayly M, Scollo MM, Wakefield MA. Who uses rollies? Trends in product offerings, price and 9 use of roll-your-own tobacco in Australia. Tobacco Control. 2018:1-8. 10 42. Curti D, Shang C, Ridgeway W, et al. The use of legal, illegal and roll-your-own cigarettes to 11 increasing tobacco excise taxes and comprehensive tobacco control policies: findings from the ITC 12 Uruguay Survey. Tobacco Control. 2015;24:iii17-iii24. 13 43. Hoek J, Ferguson S, Court E, et al. Qualitative exploration of young adult RYO smokers' 14 practices. Tobacco Control. 2017;26(5):563-8. 15 16 44. Doward J. How tobacco firms flout UK law on plain packaging: The Observer; 9 April 2017 [12 17 November 2018]. Available from: https://www.theguardian.com/society/2017/apr/09/tobacco- 18 companies-flout-law-plain-packagingFor peer. review only 19 45. Nixon P. Re: Price marking on packs of Work. Letter from Peter Nixon, Philip Morris 20 International to Deborah Arnott, Action for Smoking and Health. [Personal Communication]. 15 May 21 2017. 22 46. Leigh Day. Re: Price marking on tobacco packaging of Work. Legal opinion of Leigh Day to 23 Action for Smoking and Health. [Personal Communication]. 3 March 2017. 24 25 47. Critchlow N, Stead M, Moodie C, et al. Introduction of standardized tobacco packaging 26 during a 12-month tranistion period: findings from small retailers in the United Kingdom. Nicotine & 27 Tobacco Research. 2018. 28 29 30 31 32 Figure captions 33 34 Figure 1. Timeline of data collection by data source 35 36 Figure 2. Proportion of (a) FM sticks and (b) RYO* (by weight) sold in standardised packaging over 37 time

38 http://bmjopen.bmj.com/ 39 Figure 3. The evolution of Marlboro Gold packaging from a straight edge pack to a branded bevelled 40 41 edge pack with a new internal packet with pro-seal sealing mechanism, to standardised packaging 42 maintaining these innovations 43 44 Figure 4. Branded outers post May 2016 (full-implementation) 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 For peer review only 17 18 19 20 21 22 23 24 25 Figure 1. Timeline of data collection by data source 26 27 338x190mm (96 x 96 DPI) 28 29 30 31 32 33

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1 2 3 Supplementary file material for “Assessing tobacco company adaptation to standardised packaging: identifying circumventions and closing loopholes” 4 5

6 1 7 Table S1. Tobacco advert characteristics by price segment (n= 195) 8 9 FM & RYO Cigars/ cigarillos Pipe 2 3 10 Characteristics of advert Subvalue Value Midprice Premium 11 Type of tobacco 12 FM 22 For78 peer42 review21 only 13 RYO n/a 24 13 16 14 15 Characteristics promoted 16 New brand variant4 7 23 5 1 0 0 17 18 New packaging 4 25 17 16 0 0 http://bmjopen.bmj.com/ 19 Limited Edition 0 4 5 5 2 0 20 Filter 0 16 0 6 0 0 21 Price 19 68 14 4 2 1 22 Retailer profit 1 42 21 5 6 1 23 1 Totals do not add up to 195 adverts as many adverts promoted more than one type of tobacco, more than one price segment and more than one characteristic in the same advert. 24 25 2 Does not include cigars/cigarillos or pipe tobacco or as we have no data on price segment for these products. on October 4, 2021 by guest. Protected copyright. 26 3 FM only. This price segment does not exist for RYO. 27 28 4 There were 38 adverts in total for a new brand variant but 2 of the adverts could not be categorised by price segment. 29 30 31 32 33 34 35 36 37 38 39 40 41 42 1

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14 2. Maintain brand “We recognise that consumers use brand and colour when asking for their pack of cigarettes.” Therefore, 15 differentiation through generally, those products traditionally presented as ‘full flavour’ would have ‘real’ or ‘original’ added to 16 systematic name changes their names and be denoted predominantly by the colour ‘red’. All brand variants with the flavour 17 descriptor ‘smooth’ would change to ‘bright’ and have ‘blue’ added,http://bmjopen.bmj.com/ ‘menthol’ would become ‘green’ and 18 ‘capsule’ would become ‘crushball’.” [Retail Newsagent, 28 October 2016] 19 20 3. Focusing on lower price Introducing premium features “Living in a post-EUTPD II world… [a retailer reported] “Customers have become more price-sensitive since 21 segments into cheaper price segments legislation banned the sale of 10- packs and they are more concerned about how much they can get for 22 their money these days”…To help retailers tap into the trend for budget tobacco, JTI has relaunched 23 Scottish brand Kensitas Club King Size and dropped its RRP “ Yau A. The latest developments from the 24 biggest tobacco brands. [Retail Newsagent, 5 April 2018] 25 4. Promote products by 4.1 Bevelled edges and “In order to re-engage disengaged cash-strapped smokers migrating to lower-priced brands and categories, 26 innovating exemptions to resealable packs manufacturers have been “adding value” to their brands through innovati on October 4, 2021 by guest. Protected copyright. on, both on the pack and via the 27 the legislation product itself… PMI concentrated on areas such as pack size (extra-large pack sizes), pack type (resealable), 28 cigarette length (compact), microslims, filter type (with a focus on recessed filters) and flavour capsules 29 (including the world’s first recessed filter capsule and the world’s first double capsule – menthol and 30 peppermint). Pack innovation: Tactile finishes, including raised surfaces such as embossing and bevelled 31 edges… (39)1 [Euromonitor, July 2016] 32 4.2 Menthol “JPS Green Edge will replace it and feature a menthol inner liner within the packaging, which the company 33 claims will be “more effective at transferring flavour to the cigarettes than traditional menthol tips””. 34 Imperial Tobacco [Talking Retail, 24 November 2017] 35 36 1 37 This Euromonitor report was published two months into the sell-off period. We did find evidence of embossing and raised surfaces on packets prior to the full 38 implementation of the legislation but these changes were lost when standardised packaging came into effect. During the sell-off, filter innovations, capsule innovations, 39 bevelled edges and a pack resealing mechanism on one brand were observed – these changes were able to carry through when packs became standardised. In this study 40 we did not observe extra length cigarettes, a greater volume of cigarettes or microslims. 41 42 3

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“’The margins we make on miniature cigars are 30% when sold at http://bmjopen.bmj.com/ RRP’ [Retailer]” [Retail Newsagent, 5 April 18 2018] 19

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38 Feb-17 55% 11% 490464 218940 http://bmjopen.bmj.com/ 39 Mar-17 75% 20% 539695 132601 40 Apr-17 91% 16% 534343 45509 41 May-17 97% 5% 557734 19294 42 Jun-17 98% 2% 539118 9037 43 44 Jul-17 99% 1% 559731 5908 45 Aug-17 99% 0% 560994 4609

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BMJ Open: first published as 10.1136/bmjopen-2018-028506 on 24 September 2019. Downloaded from 4 Table S4 Menthol and capsule innovation 5 6 7 Present at start New Variant Total 8 N % N % N % 9 Menthol* 10 FM premium 9 28% 2 20% 11 26.2 11 12 FM midprice 8 25% 0 0% 8 19.0 13 FM value 8 25% 4 40% 12 28.6 14 FM subvalue 3 9% 3 30% 6 14.3 15 16 no price segment 4 13% 1 10% 5 11.9 17 32 76.2% 10 23.8% 42 100.0 18 For peer review only 19 20 Capsule** 21 FM premium 2 15% 0 0% 2 10.5 22 FM midprice 2 15% 0 0% 2 10.5 23 24 FM value 9 69% 3 50% 12 63.2 25 FM subvalue 0 0% 3 50% 3 15.8 26 Total 13 68.4% 6 31.6% 19 100.0 27 *Menthol: variant name includes ‘menthol’ or ‘green’ 28 **Capsule: variant name includes ‘capsule’, ‘crushball’, ‘dual’, ‘duo’, ‘demand’, ‘click on’ or ‘burst’ 29 30 31 32 Table S5 Euromonitor estimates of the growth of cigars and cigariillos 33 34 value constant £ mln value current £ mln volume million units 35 2015 291.8 289.9 390.4 36 37 2016 282.5 282.5 382.8

38 2017 324.5 332.6 451.6 estimate http://bmjopen.bmj.com/ 39 2018 347.8 366.3 493.8 estimate 40 Source: © Euromonitor International 41 42 43 44 45

46 on October 4, 2021 by guest. Protected copyright. 47 48 49 50 51 52 53 54 55 56 57 58 59 60

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