BackgroundThe Philippines has a high smoking prevalence and one of the largest tobacco menthol market shares in the world. Flavour capsule cigarettes were introduced to the Philippines in 2013, most of which are menthol flavoured, and their market share is increasing. We explored perceptions of flavoured cigarette packaging among young adult Filipinos.MethodsWe conducted eight focus groups with 63 young adults ages 18–24 years in Manila in 2019, stratified by gender and smoking status. We conducted a thematic analysis of the transcripts.ResultsMost participants assessed relative harm of cigarettes based on strength, mainly determined by colour of the packaging. Menthol cigarettes with primarily blue packaging were considered less harmful than menthol cigarettes with primarily green packaging. Many participants considered flavour capsule packs most attractive, compared with non-flavoured and traditional menthol cigarettes, due to the colouring of the packs and expectations regarding taste. Some participants likened the capsules and the taste of flavour capsule cigarettes to candy, and many participants thought flavour capsule cigarettes would most likely be smoked by teenagers or young adults.ConclusionsYoung adult Filipinos believe that some menthol-flavoured cigarettes are less harmful than other flavoured cigarettes and non-flavoured cigarettes and find flavour capsule cigarettes attractive. A tobacco flavour ban and implementation of plain packaging might help reduce misperceptions of risk and make cigarettes less appealing.

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BackgroundTobacco remains the world’s leading preventable cause of death, with the majority of tobacco-caused deaths occurring in low- and middle-income countries. The first global health treaty, the Framework Convention on Tobacco Control (FCTC), outlines a set of policy initiatives that have been demonstrated as effective in reducing tobacco use. Article 11 of the FCTC focuses on using the tobacco package to communicate tobacco-caused harms; it also seeks to restrict the delivery of misleading information about the product on the pack.ObjectiveThe objective of this study was to establish a surveillance system for tobacco packs in the 14 low- and middle-income countries with the greatest number of smokers. The Tobacco Pack Surveillance System (TPackSS) monitors whether required health warnings on tobacco packages are being implemented as intended, and identifies pack designs and appeals that might violate or detract from the communication of harm-related information and undermine the impact of a country’s tobacco packaging laws. The protocol outlined is intended to be applicable or adaptable for surveillance efforts in other countries.MethodsTobacco packs were collected in 14 countries during 2013. The intention was, to the extent possible, to construct a census of “unique” pack presentations available for purchase in each country. The TPackSS team partnered with in-country field staff to implement a standardized protocol for acquiring packs from 36 diverse neighborhoods across three cities in each country. At the time of purchase, data on price and place of acquisition of each pack was recorded. The field staff, according to a standardized protocol, then photographed packs before they were shipped to the United States for coding and archiving.ResultsEach pack was coded for compliance with the country-specific health warning label laws, as well as for key design features of the pack and appeals of the branding elements. The coding protocols were developed based upon prior research, expert opinion, and communication theories. Each pack was coded by two independent coders, with consistency of personnel across the project. We routinely measured intercoder reliability, and only retained variables for which a good level of reliability was achieved. Variables where reliability was too low were not included in final analyses, and any inconsistencies in coding were resolved on a daily basis.ConclusionsAcross the 14 countries, the TPackSS team collected 3307 tobacco packs. We have established a publicly accessible, Internet archive of these packs that is intended for use by the tobacco control policy advocacy and research community.

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