Cigarette Packaging in the Philippines: a Comparison by Flavor and Flavor Capsule Presence

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Cigarette packaging in the Philippines: A comparison by flavor and flavor capsule presence

Jennifer Brown, MPH Katherine Clegg Smith, PhD Meng Zhu, PhD Meghan Moran, PhD Connie Hoe, PhD Joanna Cohen, PhD

Johns Hopkins Bloomberg School of Public Health Funding source: This work was supported with funding from Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use (Bloomberg.org).

Industry funding: None

Off label medication uses discussed: None

• Philippines has a high menthol market share

Source: World Health Organization

• Menthol cigarettes are associated with smoking initiation and decreased likelihood of quitting and staying quit

• Flavor capsule cigarettes associated with misperceptions of harm and appeal to youth

• No research has examined difference between menthol and non-menthol cigarette packaging

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Objective To compare and describe the similarities and differences in packaging components being used between packs that vary by flavor and flavor capsule presence that were on the market in the Philippines in 2016.

• What structural components (pack type, opening style, shape) are used to package cigarettes?

• What graphic components (color, imagery, descriptors) are used on cigarette packaging?

• Are there differences and/or similarities between groups of packaging that vary by flavor and capsule presence and the structural and graphic components used?

• Quantitative content analysis

• Compared prevalence of structural elements and graphic components across categories of packs (distinguished by flavor and flavor capsule) using Fisher’s exact test

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Variable Definition No flavor No indication that pack is flavored and no distinguishable flavor/taste/aroma other than tobacco is displayed on cigarette pack or stick “Menthol” or “mint” appears as a descriptor on Menthol or mint cigarette pack or stick Characterizing flavor A characterizing flavor other than “menthol” or other than mint or “mint” is displayed as a descriptor on the cigarette menthol packaging or stick, including, but not limited to caramel/vanilla/chocolate, cinnamon/canella or other spice, clove/kretek, fruit or citrus, coffee, alcoholic beverage, energy drink Non-characterizing Indication that pack is flavored but no flavor distinguishable flavor/taste/aroma other than tobacco is displayed on cigarette pack or stick Flavor capsule pack Pack that indicates in any way that the user is able to change the stick flavor (e.g. convertibles, click and roll, activate)

FLAVOR FLAVOR CAPSULE No flavor Menthol or mint Characterizing Non- flavor – not characterizing menthol or mint flavor

n/a n/a (n=0) (n=0)

Group 1: Non-flavor Group 2: Menthol non- non-capsule (n=36) capsule (n=23) Yes

n/a (n=0)

Group 3: Menthol Group 4: Non-characterizing or other flavor capsule (n=10) capsule (n=6)

Group 1: Group 2: Group 3: Group 4: 1 1 1 2 2 3 Non- Menthol Menthol Non- vs vs vs vs vs vs flavored non-capsule capsule (n=10) characterizing 2 3 4 3 4 4 non- (n=23) or other flavor capsule capsule (n=6) (n=36) n(%) n(%) n(%) n(%) Pack type* ** Hard 27 (75.0) 11 (47.8) 10 (100) 6 (100) Soft 9 (25.0) 12 (52.2) 0 (0) 0 (0) Traditional 36 (100) 23 (100) 10 (100) 6 (100) shape Slim pack* 2 (5.6) 1 (4.3) 0 (0) 2 (33.3)

*p<0.05; values are from Fisher’s exact test **p<0.008, adjusted for multiple comparisons; values are from Fisher’s exact tests

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Group 1: Non- Group 2: Group 3: Group 4: flavored non- Menthol non- Menthol capsule Non-characterizing capsule (n=36) capsule (n=23) (n=10) or other flavor capsule (n=6)

n(%) n(%) n(%) n(%) Pack type* Hard 27 (75.0) 11 (47.8) 10 (100) 6 (100) Soft 9 (25.0) 12 (52.2) 0 (0) 0 (0)

Examples of menthol non-capsule soft packs (group 2) Examples of menthol capsule hard packs (group 3)

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Results – Graphic components Group 1: Group 2: Group 3: Group 4: 1 1 1 2 2 3 Non-flavored Menthol Menthol Non- vs vs vs vs vs vs non-capsule non- capsule (n=10) characterizing 2 3 4 3 4 4 (n=36) capsule or other flavor (n=23) capsule(n=6) n(%) n(%) n(%) n(%) Green* 1 (2.8) 21 (91.3) 6 (60) 2 (33.3) ** **

Blue 9 (25.0) 2 (8.7) 5 (50) 2 (33.3)

Purple* 0 (0) 0 (0) 2 (20) 0 (0)

Masculine 1 (2.8) 0 (0) 0 (0) 1 (16.7) appeal Less harm 1 (2.8) 1 (4.3) 0 (0) 0 (0) “Taste” 3 (8.3) 1 (4.3) 2 (20) 2 (33.3) “Fresh”* 0 (0) 0 (0) 1 (10) 3 (50) ** ** “Cool/ice”* 0 (0) 1 (4.3) 3 (30) 1 (16.7) “Sensation” 0 (0) 1 (4.3) 2 (20) 0 (0) Technology* 3 (8.3) 1 (4.3) 10 (100) 6 (100) ** ** ** ** *p<0.05; values are from Fisher’s exact test **p<0.008, adjusted for multiple comparisons; values are from Fisher’s exact tests

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Group 1: Non- Group 2: Group 3: Group 4: flavored non- Menthol non- Menthol capsule Non-characterizing or capsule (n=36) capsule (n=23) (n=10) other flavor capsule(n=6) n(%) n(%) n(%) n(%) Green* 1 (2.8) 21 (91.3) 6 (60) 2 (33.3)

Example of green menthol non-capsule pack Example of green menthol capsule pack

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Group 1: Non- Group 2: Group 3: Group 4: flavored non- Menthol non- Menthol capsule Non-characterizing or capsule (n=36) capsule (n=23) (n=10) other flavor capsule(n=6) n(%) n(%) n(%) n(%) “Fresh”* 0 (0) 0 (0) 1 (10) 3 (50)

Examples of non-characterizing flavor capsule pack displaying “fresh”

©©2019, 2014, Johns Hopkins UniverUniversity.sity. All rights reserved. Group 1: Non- Group 2: Group 3: Group 4: flavored non- Menthol non- Menthol capsule Non-characterizing or capsule (n=36) capsule (n=23) (n=10) other flavor capsule(n=6) n(%) n(%) n(%) n(%) Technology* 3 (8.3) 1 (4.3) 10 (100) 6 (100)

Examples of menthol capsule packs using technology imagery

2 other flavor capsule packs: Coffee flavor with ice coffee flavor and coffee flavor with orange coffee flavor

4 non- characterizing flavor capsule packs: “Fresh” and green color could potentially indicate menthol flavoring

+ First study to describe differences in packaging between menthol and non-menthol packs

+ Data collected in geographically and culturally diverse areas in the Philippines

- Sample was collected in 2016; likely changes to market

- Not able to confirm meaning of structural elements and graphic components to consumers

• Different materials, color (green), descriptors (“fresh”, technology terms) and imagery (technology) are used on cigarette packaging to distinguish between cigarette types in the Philippines

• Findings highlight the need for a greater awareness of the potential for different packaging components to convey product characteristics to consumers, some that may be misleading or that are attractive to a new generation of smokers

• Can inform future tobacco control policy as the Philippines and other countries consider bans on flavored tobacco and displays at point-of-sale and adoption of plain tobacco packaging

• Future research will explore consumer perceptions of menthol and flavor capsule cigarette packaging and assess whether distinguishing marketing features are associated with:  Attractiveness  Less harm  Intention to try