Price differences between capsule, menthol non-capsule and unflavoured cigarettes in 65 countries in 2018

Do-It-Yourself Flavored Capsule Cigarettes: Exploiting Potential Regulatory Loopholes?

INTRODUCTION

Capsule cigarettes allow users to crush liquid-filled capsules to release flavors into cigarettes' filters. New devices are emerging across the globe that allow people who smoke to circumvent tobacco flavor restrictions via injectable capsules. This study examined TikTok videos marketing flavored capsule injector devices.

METHODS

TikTok videos (n = 832) posted worldwide between July 6, 2021, and December 28, 2023, that used hashtags #injectorflavor, #flavourclickball, #flavorball, and #injectorballcigarette were collected using a TikTok application programing interface. A codebook was developed using a systematic iterative approach, identifying six codes: flavor capsules, promotes flavors (i.e., fruit, mint or menthol flavors, nonalcoholic drinks, alcoholic drinks), demonstrates how to use or refill large injector devices, demonstrates how to use small convenient devices, includes music (any or English language). Two independent coders annotated all videos.

RESULTS

Overall, 88.3% (n = 735) of the videos displayed flavor capsules and had been viewed more than 72 million times. Half (51.6%) of the videos demonstrated how to use large box-shaped devices to inject capsules into the filter of a cigarette, and 15.0% of the videos showed how to do this with smaller, more convenient devices. Flavors including fruit (35.5%), menthol/mint (27.8%), nonalcoholic drinks (21.9%), and alcoholic drinks (11.6%) were used to promote these capsules. Most videos (85.6%) were uploaded by sellers on "TikTok shop."

DISCUSSION

TikTok accounts are promoting injectable capsule devices that circumvent flavored tobacco sales restrictions. Policy makers, tobacco control advocates, and public health practitioners should be aware of such marketing to inform regulation and develop prevention strategies.

IMPLICATIONS

Our findings identified an emerging product that can encourage circumvention of flavor restriction policies. Regulators, policy makers, public health practitioners, researchers, and advocates should be aware of such products to inform regulation and develop prevention strategies. Given the potential for these products to reduce the intended effects of flavored tobacco sales restrictions, policy makers must be poised to address materials that consumers use to create their own flavored tobacco products, including flavor capsules designed to be inserted into cigarettes.

Use of flavor capsule cigarettes and their preliminary impact on smoking cessation in Mexico: an exploratory study

BACKGROUND

No study has assessed the impact of flavor capsule cigarettes (FCCs) on smoking cessation. Thus, the purpose of this exploratory study was to assess (1) the sociodemographic and smoking-related characteristics associated with using FCCs, and (2) the preliminary impact of FCCs on smoking cessation.

METHODS

This study is a secondary data analysis of a single-arm study with 100 individuals living in Mexico who smoked and received a smoking cessation mHealth intervention and pharmacotherapy support. The primary outcomes were self-reported and biochemically verified 7-day smoking abstinence at Month 3.

RESULTS

Just over one-third of participants (36%) used FCCs, with a preference for one capsule and menthol/mint flavor. Compared to participants who smoked non-FCCs, participants who smoked FCCs were (1) younger, (2) more likely to be women, and (3) more likely to smoke less than 10 cigarettes per day (CPD; all p's < 0.05). After controlling for all significant associations, age younger than 50 years old (AOR = 3.26, 95% CI 1.25-8.51) and being a woman (AOR = 3.62, 95% CI 1.41-9.35) were positively and independently associated with smoking FCCs. Treating those lost to follow-up as participants who continued smoking, 41.7% (15/36) of participants who smoked FCCs self-reported smoking abstinence at month 3 compared to 42.2% (27/64) of participants who smoked non-FCCs (p = 0.96). Furthermore, 33.3% (12/36) of participants who smoked FCCs were biochemically verified abstinent at Month 3 compared to 18.8% (12/64) of participants who smoked non-FCCs (p = 0.10).

CONCLUSIONS

Younger age and being a woman were associated with using FCCs. Self-reported smoking abstinence at Month 3 was comparable between participants who smoke FCCs and non-FCCs. However, biochemically verified abstinent at Month 3 was higher among participants who smoke FCCs compared to participants who smoke non-FCCs, although the difference was not statistically significant. Prospective and adequately powered comparisons must be made between individuals who smoke FCCs and non-FCCs to effectively assess differences in smoking abstinence, and the reasons for these differences.

Prevalence and perceptions of flavour capsule cigarettes among adults who smoke in Brazil, Japan, Republic of Korea, Malaysia and Mexico: findings from the ITC surveys

INTRODUCTION

The global market of flavour capsule cigarettes (FCCs) has grown significantly over the past decade; however, prevalence data exist for only a few countries. This study examined prevalence and perceptions of FCCs among adults who smoke across five countries.

METHODS

Cross-sectional data among adults who smoked cigarettes came from the International Tobacco Control Policy Evaluation Project Surveys-Brazil (2016/2017), Japan (2021), Republic of Korea (2021), Malaysia (2020) and Mexico (2021). FCCs use was measured based on reporting one's usual/current brand or favourite variety has flavour capsule(s). Perceptions of the harmfulness of one's usual brand versus other brands were compared between those who used capsules versus no capsules. Adjusted logistic regression models examined correlates of FCC use.

RESULTS

There were substantial differences in the prevalence of FCC use among adults who smoke across the five countries: Mexico (50.3% in 2021), Republic of Korea (31.8% in 2021), Malaysia (26.5% in 2020), Japan (21.6% in 2021) and Brazil (6.7% in 2016/2017). Correlates of FCC use varied across countries. Capsule use was positively associated with being female in Japan and Mexico, younger age in Japan, Republic of Korea and Malaysia, high education in Brazil, Japan and Mexico, non-daily smoking in Republic of Korea, and having plans to quit in Japan and Republic of Korea. There was no consistent pattern of consumer perceptions of brand harmfulness.

CONCLUSION

Our study documented the high prevalence of FCCs in some countries, pointing to the need to develop and implement regulatory strategies to control these attractive products.