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IntroductionPackaging is a key marketing tool for tobacco companies and an important means of communicating product-related risks to governments. While research has explored promotional characteristics of cigarette packs and compliance with warnings on cigarette packs, studies on roll-your-own (RYO) tobacco packaging are limited.MethodsWe purchased a convenience sample of unique RYO packs (n=116) between November 2022 and May 2024 in five cities in Argentina, where RYO tobacco has increased in popularity. We developed a checklist to examine the presence of pack design features and compliance with on-pack warnings and conducted a descriptive analysis.ResultsThe sample included 50 brands. Most packs were pouches (94.0%) and contained 30 g of tobacco (74.1%). About half (51.7%) were flavoured, most commonly fruit (43.3%), vanilla (21.7%) and chocolate (15.0%). Unflavoured packs frequently featured ‘natural’ or ‘additive-free’ descriptors (51.8%) and light colours (48.2%), while flavoured packs predominantly used flavour descriptors (88.3%) and bright colours (86.7%). Nearly half the packs (46.6%) were locally produced, with 48.1% highlighting their Argentinian origin. In terms of warning compliance, 47.4% of packs failed to display a warning image covering 50% of the front of the pack. The warning image (90.5%) and message (81.9%) were frequently obscured by a tax stamp.ConclusionsThe findings help understand how tobacco companies promote RYO via the packaging. Additionally, this exploratory study could serve as a template for other studies on RYO tobacco.

IntroductionAlthough many countries have introduced pictorial warning labels (PWLs), few use efficacy labels or inserts offering supportive cessation advice or outlining benefits of quitting. Theory and evidence suggest efficacy labels foster positive responses to the threats presented rather than elicit maladaptive responses that manage the fear aroused. We explored how people who smoke roll-your-own (RYO) tobacco responded to potential on-pack efficacy labels that could complement PWLs by promoting self-efficacy and response-efficacy.MethodsWe undertook 27 in-depth interviews with people aged 18 and over (16 female, 8 Māori, 13 aged ≤35) who smoked RYO cigarettes and lived in Aotearoa New Zealand. We probed participants’ responses to efficacy labels and provided them with stimuli they could use to construct their own inspiring label. We used the Extended Parallel Process Model and hope theory to interpret the data, which we analysed using a reflexive thematic analysis approach.ResultsParticipants strongly endorsed efficacy labels; unlike current warning labels, which they saw as didactic and judgemental, efficacy labels offered hope and agency, and helped them envisage the benefits of becoming smokefree. Creating hope valued and empowered participants, while practical advice offered helped them anticipate how they could overcome addiction and become smokefree.ConclusionsOn-pack efficacy labels could complement PWLs and support people to address the threat these warnings describe. Policymakers should explore and implement interventions such as efficacy stimuli, given these appear to resonate with priority population groups and could help reduce health inequities.

IntroductionThis study assessed the substitutability of plausible combustible menthol cigarette alternatives (MCAs) for usual brand menthol cigarettes (UBMCs) in adults who smoke menthol cigarettes.MethodsFollowing three in-lab sampling sessions, 80 adults aged 21–50 who smoke menthol cigarettes chose their preferred MCA: (1) a menthol roll-your-own cigarette (mRYO), (2) a menthol filtered little cigar (mFLC) or (3) a non-menthol cigarette (NMC). Participants were instructed to completely substitute their preferred MCA for their UBMC for 1 week and complete daily diaries documenting adherence and subjective effects. At the final lab visit, participants completed concurrent choice and cross-price elasticity tasks with their substitute product and UBMC as the comparator.ResultsMost (65%) participants chose mRYO as their preferred product, followed by NMC and mFLC. Adherence to MCA was high for all products across the week (range: 63%–88%). Positive subjective effects for mRYO decreased over time but remained numerically higher than the other MCA products; craving reduction also decreased for NMC across phases. In the progressive ratio task, participants chose their UBMC in 61.7% of choices; this did not differ by preferred MCA, although the median breakpoint was highest for mRYO and similar for mFLC and NMC. Cross-price elasticity comparing UBMC and the preferred product indicated high substitutability of each MCA at phase 3 (I values −0.70 to −0.82).Conclusions and relevancemRYOs were the most preferred MCA among the study products, but all MCAs were acceptable substitutes for UBMC using behavioural and economic measures in a short-term trial period. Trial registration number NCT04844762.

ObjectiveWe examined the relationship in Australia from 2007 to 2020 between tobacco tax increases and use of cost-minimising behaviours (CMBs) when purchasing tobacco and: (1) tobacco expenditure and (2) smoking cessation attempts and quit success.MethodsWe used data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007–2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (Nsample=4975, Nobservations=10 474). CMBs included buying RYO tobacco, cartons, large-sized packs, economy packs, or tax avoidance/evasion, smoking reduction and e-cigarette use. Logistic regression, fit using generalised estimating equations, estimated the CMB-outcome association for quit attempts and quit success at the next wave follow-up (Nsubsample=2984, Nobservations=6843).ResultsOver half of respondents used a CMB for tobacco purchase (P-CMB) at baseline (57.1% in 2007–2008), increasing to 76.8% (2018) post-tax increases. Participating in any P-CMB was associated with having higher weekly tobacco expenditure. Engaging in any P-CMB was negatively associated with attempting to quit (aOR=0.82, 95% CI 0.69–0.98). Purchasing RYO tobacco or cartons was associated with making no quit attempts (aOR=0.66, 95% CI 0.52–0.83; aOR=0.72, 95% CI 0.59–0.89, respectively). Among respondents smoking cigarettes who made quit attempts, there were no significant associations between all P-CMBs and quit success. Neither smoking reduction nor vaping were significantly associated with quit attempts.ConclusionP-CMBs are associated with reduced smoking cessation. Reducing opportunities for industry to promote purchasing-related CMB options, such as by standardising pack sizes and reducing the price differential between RYO and manufactured cigarettes could increase the effectiveness of tax increases.

ObjectivesSensory methods use human senses to evaluate product attributes. This review provides an overview of the types of sensory methods used to evaluate the perception of flavour in tobacco and other nicotine-containing (ToNic) products and to discuss how sensory data could inform flavoured ToNic product policy.Data sourcesPubMed, Embase and Web of Science.Study selectionAll peer-reviewed studies evaluating ToNic products using a sensory method published before 23 May 2020.Data extractionTwo independent coders completed title/abstract and full-text screening to choose articles for inclusion (Cohen’s kappa=0.85, strong agreement). Each coder completed data extraction on half the articles, recording relevant information (eg, sensory methods used, results). The coders categorised sensory methods and generated overarching themes.Data synthesisOf 110 articles identified, we included 29 articles containing 35 studies that used sensory methods to investigate ToNic products. The sensory methods included analytic methods such as discrimination and descriptive tests and hedonic methods such as liking tests. Six themes emerged regarding how sensory methods can be used to understand consumer perception and liking of ToNic products and to inform ToNic product policy.ConclusionsThe identified studies highlight that sensory data can inform ToNic product policy. Analytic and sensory hedonic ratings can be used to assess a ToNic product’s ability to promote addiction in the user (ie, abuse liability). Lastly, hedonic ratings can provide information to assess potential use behaviours.

ObjectiveTo systematically review the price elasticity of demand of non-cigarette tobacco products.Data sourcesMedline, Embase, EconLit and the Web of Science without language or time restrictions.Study selectionTwo reviewers screened title and abstracts, then full texts, independently and in duplicate. We based eligibility criteria on study design (interventional or observational), population (individuals or communities without geographic restrictions), intervention (price change) and outcome (change in demand).Data extractionWe abstracted data on study features, outcome measures, statistical approach, and single best own- and cross-price elasticity estimates with respect to cigarettes. We conducted a random effects meta-analysis for estimates of similar product, outcome and country income level. For other studies we reported median elasticities by product and country income level.Data synthesisWe analysed 36 studies from 15 countries yielding 125 elasticity estimates. A 10% price increase would reduce demand by: 8.3% for cigars (95% CI 2.9 to 13.8), 6.4% for roll your owns (95% CI 4.3 to 8.4), 5.7% for bidis (95% CI 4.3 to 7.1) and 2.1% for smokeless tobacco (95% CI −0.6 to 4.8). Median price elasticities for all ten products were also negative. Results from few studies that examined cross-price elasticity suggested a positive substitution effect between cigarette and non-cigarette tobacco products.ConclusionsThere is sufficient evidence in support of the effectiveness of price increases to reduce consumption of non-cigarette tobacco products as it is for cigarettes. Positive substitutability between cigarette and non-cigarette tobacco products suggest that tax and price increases need to be simultaneous and comparable across all tobacco products.

IntroductionThe Food and Drug Administration (FDA) has issued proposed product standards banning menthol as a characterising flavour in cigarettes and cigars. The public health benefits of these product standards may be attenuated by the role of plausible substitutes in the marketplace. Therefore, the present study examined the addiction potential of plausible combustible menthol alternatives compared with usual brand menthol cigarettes (UBMC).MethodsNinety-eight adult menthol cigarette smokers completed four visits, smoking their UBMC at the first session and three menthol cigarette alternatives in random order at the subsequent visits: (1) a preassembled menthol roll-your-own (mRYO) cigarette using menthol pipe tobacco and mentholated cigarette tube, (2) a menthol filtered little cigar (mFLC) and (3) a non-menthol cigarette (NMC). Measures of smoking topography, exhaled carbon monoxide (CO), craving and withdrawal, subjective effects and behavioural economic demand indices were assessed.ResultsCompared with UBMC, menthol cigarette alternatives resulted in different puffing topography and CO exposure (except mRYO), and lower levels of positive subjective experience and behavioural economic demand indices. Among the alternative products, participants reported the highest level of positive subjective experience and higher demand for mRYO, compared with mFLC and NMC. Similarly, participants were significantly more likely to want to try again, purchase and use the mRYO product regularly compared with mFLC and NMC.Conclusions and relevancemRYO cigarettes were the most highly rated cigarette alternative among study products, suggesting their potential appeal as a menthol cigarette substitute and needed inclusion of menthol pipe tobacco and cigarette tubes in FDA’s proposed ban.

ObjectiveWe examined Australian tobacco purchasing trends, the average self-reported price paid within each purchase type and the association between type of tobacco product purchased and participant characteristics, including quit intentions, between 2007 and 2020.MethodsWe analysed data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007–2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (nsample=5452, nobservations=11 534). The main outcome measures were type of tobacco products purchased: RYO, carton, pack or pouch size and brand segment. Logistic regression, fit using generalised estimating equations, was estimated the association between the outcome and participant characteristics.ResultsThe reported price-minimising purchasing patterns increased from 2007 to 2020: any RYO (23.8–43.9%), large-sized pack (2007: 24.0% to 2016: 34.3%); shifting from large-sized to small-sized packs (2020: 37.7%), and economy brand (2007: 37.2% to 2020: 59.3%); shifting from large (2007: 55.8%) to small economy packs (2014: 15.3% to 2020: 48.1%). Individuals with a lower income, a higher nicotine dependence level and no quit intention were more likely to purchase RYO and large-sized packs.ConclusionRYO, large-sized packs and products with a low upfront cost (eg, small RYO pouches and small-sized economy brand packs) may appeal to people on low incomes. Australia’s diverse tobacco pack and pouch sizes allow the tobacco industry to influence tobacco purchases. Standardising pack and pouch sizes may reduce some price-related marketing and especially benefit people who have a low income, are highly addicted and have no quit intention.

BackgroundIn the UK in May 2016, standardised packaging of tobacco products was implemented, including minimum pack sizes of 20 sticks or 30 g loose tobacco. The change was intended to reduce uptake by increasing upfront costs to young people, but there was concern it may unintentionally increase consumption among people smoking. This study aimed to assess whether the introduction of the policy was associated with changes in (1) mean daily factory-made (FM)/roll-your-own (RYO) cigarettes consumption among people smoking predominantly (a) FM and (b) RYO cigarettes; and (2) current smoking prevalence among 16–24-year-olds.MethodsData (N=257 929) were from a representative monthly cross-sectional survey of adults (≥16 years) in England, collected between November 2007 and January 2020. Outcome measures were mean daily (FM/RYO) cigarette consumption among those smoking FM/RYO cigarettes, and prevalence of current smoking among 16–24-year-olds. Time-series analyses were conducted using Autoregressive Integrated Moving Average with Exogenous variables (ARIMAX) regression models including a gradual level change starting in June 2017 and ending in May 2018 for cigarette consumption and a step change in June 2016 for prevalence of current smoking.ResultsThe ARIMAX model was not able to detect a change in mean daily cigarette consumption—for FM (Badj=−0.543, 95% CI −1.381 to 0.296) or RYO (Badj=0.002, 95% CI −0.518 to 0.522) following the implementation of standardised packaging. The unadjusted analysis suggested the implementation of standardised packaging was associated with a small (3%) decrease in smoking prevalence among 16–24-year-olds (Bunadj=−0.031, 95% CI −0.062 to 0.000), but this association was attenuated after adjustment for covariates (Badj=−0.010, 95% CI −0.039 to 0.019).ConclusionsThe implementation of standardised packaging of tobacco products was not associated with a meaningful change in the mean number of FM or RYO cigarettes consumed by people smoking in England, suggesting the larger pack size has not had an unintended consequence of substantially increasing cigarette consumption. However, there was also little evidence that the policy substantially reduced smoking among 16–24-year-olds.