• Menthol and flavoured cigarettes are widely available in low and middle-income countries (LMICs) many of which have high smoking rates
• LMICs have young populations – flavours appeal to young people, who may not understand the harms of flavoured tobacco
• Recently high-income countries have put bans in place; at the same time there has been marked growth of menthol market share in some LMICs
• There is a lack of regulation to reduce the appeal of flavours e.g. plain packs and advertising bans at point-of-sale or near schools
• Targets for new and improved bans include flavour capsules, and flavour references on packaging and cigarette sticks
• A ban on all flavourings may be easier and more effective in preventing product substitution
• A lack of data, especially in low-income countries, hinders the development of good regulation
• Multinational tobacco companies can threaten income from tobacco exports if governments attempt to put tobacco controls in place

This page covers flavoured tobacco, including menthol cigarettes, in low and middle-income countries (LMICs).¹²

Background

Flavoured tobacco products are available in various forms around the world, including products previously only used in particular regions or countries. For example in Indonesia, the vast majority of smokers use kretek, clove-flavoured cigarettes,³⁴ and they are now available in other countries.⁵⁶

Flavoured tobacco is used in waterpipe, a device which originated in middle-eastern countries and is increasingly popular elsewhere, including among young people.⁷

Here we focus on what are often called ‘conventional’ products, like cigarettes and cigarillos, which are sold by large transnational tobacco companies (TTCs): Philip Morris International (PMI), British American Tobacco (BAT), Imperial Brands (IMB, previously Imperial Tobacco) and Japan Tobacco International (JTI) (JTI also owns Nakhla in Egypt, which produces flavoured waterpipe) We summarise findings from Tobacco Control Research Group (TCRG) research on the extent of flavoured and menthol cigarette use in LMICs and the development of the market for ‘capsule’ products (cigarettes with flavour capsules in the filter).

We describe specific challenges for LMICs, including flavour regulation and evidence gathering. We then summarise flavour market evidence and research, first relating to LMICs in general and then by World Health Organization (WHO) region and individual countries (where available).

• For general background and evidence, including information on the global market, and details of specific bans and associated industry interference, see Flavoured and Menthol Tobacco.

For details of product regulation at country level, see the searchable database on the Tobacco Control Laws website, published by the Campaign for Tobacco Free Kids (CTFK). For countries that are parties to the WHO Framework Convention on Tobacco Control (FCTC) progress towards implementation of relevant articles, including newer products, is detailed in the FCTC implementation database

Specific challenges for LMICs

LMICs with no ban often have other major tobacco control policy gaps that are not necessarily menthol/flavour related but worsen the negative impact of menthol/flavours.⁸ One such policy is plain, or standardised, packaging,  which can include restrictions on flavour descriptors as well as colours on packaging which are known to signify flavour (e.g. green for menthol).⁹ However, plain packaging policies have yet to be implemented in many countries, including some high-income countries, so this would be a significant challenge in LMICs. Another relevant policy is the prohibition of marketing, especially near schools.¹⁰

Governments have more conflicts of interest in tobacco growing areas as they receive much needed foreign currency for tobacco exports,  and multinational companies can threaten this income stream if governments attempt to put tobacco controls in place.⁸¹¹  However, apart from rare exceptions the tobacco industry contributes little overall to the balance of payments.¹²¹³

Regulatory challenges

The WHO published brief guidance on the regulation of menthol and flavoured tobacco which summarised some regulatory options including restrictions on: the sale of menthol branded products,  the use of menthol at noticeable levels (giving a ‘characterising flavour’),  or banning any menthol ingredients.¹⁴  The report points to likely opposition from the tobacco industry in countries or regions with an established menthol market.¹⁴ This was the case with the European Union (EU) menthol ban which only came into full force in 2020, after the tobacco industry had successfully lobbied for a delay. Testing for characterising flavour is more difficult and expensive than a ban on ingredients; this makes banning menthol as an ingredient particularly efficient for LMICs.

The WHO noted that:

“A ban on all flavour agents that increase tobacco product attractiveness, rather than focusing on menthol exclusively, can provide an alternate route to restricting menthol, and may prevent the unwanted introduction of menthol substitutes.”¹⁴

Research and data

As of 2021, when TCRG researchers conducted a review of evidence on menthol/flavour in LMICs,¹⁵ there were very few research papers from countries in Eastern Europe, the Eastern Mediterranean region, and Africa.

Lack of data means that it is hard to monitor markets and company shares in specific countries.  Market research service Euromonitor (which receives project funding from Philip Morris International) includes no low-income countries and is proprietary, making it expensive and hard to access even for the middle-income countries which are included.

More research is needed on menthol and flavour in LMICs to help governments monitor the tobacco industry and its products, as recommended by the WHO: “An evidence base using data collected from the region of interest can provide more direct support for regulation.”¹⁴

Market in LMICs

Evidence suggests menthol and flavoured tobacco products are widely used in LMICs.  Data from the International Tobacco Control (ITC) Policy Evaluation Project suggests that menthol is smoked by more than 20% of smokers in several middle-income countries. Although the dates vary (see the note above on data challenges) this research gives an indication of the scale of the problem. The highest rates were found in Zambia (42% in 2014) and Thailand (35% in 2012). Kenya and India also had over 20% menthol smokers, with China just under just under that level.¹⁶

A study from Johns Hopkins University, between 2015 and 2017, found a range of flavoured and capsule cigarettes on the market in those LMICs with the highest number of smokers: Bangladesh, Brazil, China, India, Indonesia, Philippines, Russia, Thailand, and Vietnam.¹⁷

The main TTCs operating in these countries (PMI, JTI, and BAT) mostly sold menthol or mint flavours. China National Tobacco Corporation (CNTC) sold  a mix of flavours.¹⁷

There is also evidence from a number of studies that menthol and flavour tobacco use is rising, either as a proportion of the market or substantively.  Evidence from TCRG research shows that after the implementation of the European Union (EU) menthol ban in 2020, there was a marked increase in the share of menthol/flavoured products in some LMICs.¹⁵ A study of cigarette packs in Brazil, Indonesia, the Philippines, Russia, Thailand, and Vietnam, between 2013 and 2016, found that the number of flavour capsule variants on the market was growing.¹⁸ Most were mint and menthol flavour but with others the flavour was unclear from the product name.¹⁸

A number of studies have identified related marketing activities.  Marketing strategies for flavour capsules are likely driving their global growth particularly among young people in LMICs.¹⁹

TCRG’s review  of tobacco industry strategies underpinning the growth of menthol/flavoured tobacco use in LMICs  highlighted widespread marketing in stores (including retailers near schools), on billboards, on TV, online and via brand ambassadors. The packaging of flavoured and menthol products, legally displayed in stores, was  found to be colourful with non-conventional, appealing names for flavours.¹⁵

Tobacco companies also use symbols on cigarette sticks to indicate that they contain capsules.²⁰ Researchers studying this form of marketing in LMICs have described the space on a cigarette as “valuable communicative real estate” for tobacco companies, which could be better used to display public health messages.²⁰

Research and data from specific regions and countries is summarised below. We refer in many places to TCRG research based on 2019 cigarette market data from Euromonitor. In this data ‘high market share’ means 20% or more of the total cigarette market in that country in 2019. ‘High market share growth’ means that the share doubled between 2005-19 and was growing from 2017.¹⁵ We link to regional and country profile pages on TobaccoTactics, where available.

Africa

Nigeria has high menthol/flavour market share and high market share growth.¹⁵

Cameroon has high market share, the only other country in the region for which this data was available. (For Egypt see Eastern Mediterranean region below.)¹⁵

Tanzania

JTI sells a menthol cigarette called Sweet Menthol through its subsidiary in Tanzania. It describes this product as “the leading local mainstream menthol brand”.²¹

Zambia

JTI owned brand Sweet Menthol is the third most popular cigarette in Zambia.  It is cheap and is usually sold as single sticks.²²  On its webpage for Zambia, JTI describes itself  as a leaf farming company, and does not mention that it sells cigarettes in the country. A locally owned company, Roland Imperial,  also sells menthol cigarette brands.²³

ITC survey data showed a high prevalence of menthol smokers in Zambia, with 43% of smokers choosing the product.²⁴ Menthol was most commonly used among younger smokers, those with a middle income, and those that don’t smoke every day. Over a third of smokers indicated that they thought menthol cigarettes were less harmful than non-menthol.²⁴

Kenya

ITC survey data from Kenya also suggests a high prevalence of menthol smokers.²⁴²⁵ In 2018, 21% of smokers with a regular cigarette brand smoked menthol or sweet menthol (although Euromonitor estimates that only 7% of cigarette sales are menthol).¹⁵  More women smoke menthol than men in Kenya, and two thirds of smokers believed that menthol is less harmful than other cigarettes.²⁴²⁵

Ethiopia

In 2015, Ethiopia enacted a total flavour ban on all forms of tobacco.

• For details see Flavoured and Menthol Tobacco

This was a pre-emptive ban as flavour sales were low. However there has been a lack of enforcement at the retail level.⁸ Flavoured products are not made in Ethiopia and more collaboration with customs is needed to prevent illicit importation.⁸ There is also a lack of awareness that the ban includes waterpipe products.¹⁴

Since 2017, two years after the ban was enacted, JTI has owned 70%  the state owned tobacco company, NTE.²⁶

Latin America

Menthol cigarettes are popular in Latin America, and increasingly so in some countries.¹⁵ Guatemala and Peru have high market share and high market share growth. There is high market share in Columbia and the Dominican Republic, and high market share growth in Argentina, Bolivia and Costa Rica.¹⁵

Use of flavour capsule cigarettes is particularly high in Chile and Mexico.²⁷  According to BAT’s annual report in 2014,  sales of  flavour capsule cigarettes had increased in the region despite price rises, while overall cigarette sales were down.²⁸

A study of over 1,000 retailers located close to schools in Latin American cities (Argentina, Bolivia, Brazil, Chile and Peru) found that the majority (85%) sold flavoured cigarettes, and most (71%) sold capsule versions.¹⁰ (Similar findings were reported in Uruguay, a high income country, immediately before the implementation of plain pack regulations in 2020.)²⁹

These products were frequently displayed near the point of sale, or confectionary. Some stores also had advertisements and price promotions.¹⁰ Unconventional flavour descriptors such as “fusion blast” and “ruby ice” were very common.³⁰

Brazil

Survey data from 2016-2017 among adult smokers in Brazil found that over 50% supported a ban on menthol and over 60% supported a ban on all additives.³¹ Support did not vary across sociodemographic groups. When menthol smokers were asked what they would do if menthol cigarettes were banned, a third reported they would quit, around 20% would reduce the amount they smoked and a similar number would switch to non-menthol cigarettes. Slightly fewer said they would still find a way to get menthol cigarettes.³¹

ITC survey data from the same period suggested that 8% of smokers with a regular cigarette brand smoked menthol.³² 13% believed that menthol cigarettes were less harmful than non-menthol cigarettes, and over a third reported that they were smoother on the throat and chest.  Nearly two thirds  of surveyed smokers supported a complete ban on all cigarette additives, including flavourings.³²

An online sample of women aged 16- 26 (smokers and non-smokers) preferred packs with flavour descriptors.³³

• The tobacco industry has used a range to tactics to undermine and delay Brazil’s menthol ban. For details see Flavoured and Menthol Tobacco

Chile

In 2013, Chile sought to implement a law banning substances that cause higher levels of addiction, harm or risk, leading to tobacco industry resistance and interference.¹⁴

• For details see Flavoured and Menthol Tobacco

Mexico

Studies of retailers in Mexican cities, found that the majority sold menthol and flavoured products, and more than half of stores situated near schools sold flavour capsule cigarettes.³⁴³⁵ Many flavoured cigarettes have descriptors which suggest there is a flavour, but the type of flavour is unclear: chemical analysis of dual flavoured cigarettes suggested flavours were menthol and another flavour, for example fruit.³⁶

A study in Mexico City found that colour and flavour descriptors on cigarette packs made the products more appealing, and some smokers believed they would taste better.³⁷

Guatemala

A study of convenience store retailers in Guatemala found that all sold flavoured tobacco products.³⁸

The majority (88%) of indoor tobacco advertisements in Guatemala were found to be for capsule cigarettes.³⁸

South East Asia & Western Pacific

There is high market share of menthol/flavour in India, Malaysia, Philippines and Thailand, and high market share growth in Vietnam.¹⁵  A 2010 study noted that governments in the region had no legislation banning exotic flavours of cigarettes and cigarettes with new flavours had appeared in Cambodia, Indonesia, Malaysia and the Philippines.³⁹

Philippines

Menthol has been advertised to appeal to young women in the Philippines since the 1970s with menthol brands common for many decades.⁴⁰ PMI, JTI, BAT and Korea Tobacco & Ginseng (KT&G) all sell flavoured capsule cigarettes in the Philippines.⁴¹

Menthol packs studied in the Philippines were harder than non-menthol (for capsule protection) giving a quality feel. Flavoured capsule brands had a greater technological appeal,⁴¹ and packs were rated as more attractive by young adults.⁴²

Blue and white packs were perceived to be less harmful than other colours, as were the descriptors ‘light’ and ‘cool’, whereas the term ‘strong’ was perceived as more harmful.⁴²  Researchers called for greater action and support for banning flavour additives.

Malaysia

In Malaysia, menthol cigarette marketing has been aimed at young people and women.  In the 1980s Brown and Williamson’s Newport menthol cigarettes were marketed in Malaysia with youthful American images and were sold at a cheap price point.⁴³ An internal document from 1993 reveals how the company was developing sweet and fruit flavours for the Malaysian market. ⁴³⁴⁴ A 2003 study noted that the menthol variant of Cartier Vendome (a BAT brand at the time) was described as ‘pearl tipped’ so likely to appeal to women.⁴⁵

In 2013, vanilla, mint and fruit flavoured cigarettes were on sale, and strawberry cigarette packs with pink packaging were documented.⁴⁶

China

In China ‘flavour capsule’ was found to be one of the most common cigarette terms used in online tobacco marketing.  One website explicitly linked flavour capsules with female smokers.⁴⁷

Indonesia

In Indonesia the dominant cigarettes are kreteks which are flavoured with cloves.  Industry attempts to introduce their own cloved flavoured products had failed at least to 2004.⁴⁸  In 2009 PMI and BAT acquired two domestic manufacturers which allowed them access to the kretek market.⁴⁹ In 2009 PMI launched the first super slims kretek for women and Marlboro black menthol for young men.  By 2012 BAT had launched several kretek brands. Both companies were aware that kreteks  are particularly carcinogenic due to the presence of toxic chemical compounds: Anethole, Coumarin and Eugenol.⁴⁹

In Indonesia the flip lid of the cigarette packet was used by Esse (owned by Korean Tobacco & Ginseng, KT&G) to promote the brand with phrases evoking flavour, like “sweet surprise” and “its honey”.  Research found seven cigarette brands with capsules.  Flavours included mint, menthol, berry and honey.⁵⁰

Eastern Mediterranean

There is high market share growth in in Pakistan and Egypt .¹⁵

• See also Waterpipe for information on the role of flavours in promoting these products.

Eastern Europe

Data shows that in Russia menthol/flavour has both a high market share and high market share growth.¹⁵

Other LMICs in the region with high market share growth are Ukraine, Bosnia Herzegovina, Belarus, Azerbaijan, Kazakhstan and Uzbekistan.¹⁵

Relevant Links

WHO Advisory note: banning menthol in tobacco products (2016)

WHO Case studies for regulatory approaches to tobacco products: menthol in tobacco products (2018)

WHO FCTC decision on banning waterpipe flavour (2016)

A global map of menthol bans is available on Tobacco Atlas: Product Sales

TobaccoTactics Resources

• Flavoured and Menthol Tobacco
• Menthol Cigarettes: Industry Interference in the EU and UK

TCRG Research

A growing menace: menthol and flavoured tobacco products in LMIC, M. Zatonski, K. Silver, S. Plummer, R. Hiscock, Tobacco Induced Diseases, 2022;20(April):39, doi:10.18332/tid/146366
STOP research summary (May 2022)

Marketing of flavour capsule cigarettes: a systematic review, C. Kyriakos, M. Zatonski, F. Filippidis, Tobacco Control, Published Online First: 18 January 2022, doi: 10.1136/tobaccocontrol-2021-057082[/ref]

Flavour capsule cigarette use and perceptions: a systematic review, C.N. Kyriakos, M.Z. Zatoński, F.T. Filippidis, Tobacco Control, Published Online First: 04 October 2021, doi: 10.1136/tobaccocontrol-2021-056837

For a comprehensive list of all TCRG publications, including research that evaluates the impact of public health policy, go to TCRG publications.

References

The post Flavoured and Menthol Tobacco in LMICs appeared first on TobaccoTactics.

• Menthol cigarettes make up 10% of the global cigarette market.
• Using flavouring agents as additives is thought to establish and sustain tobacco use, particularly among young people.
• Cigarettes with flavour capsules in the filter create novelty and interactivity and are more popular among young people. Sales of capsule cigarettes are high in some countries, including South Korea and Chile.
• The tobacco industry is able to use its vast resources to extensively develop, market and promote flavoured products.
• Regulation of flavour is recommended by the WHO.
• Flavour bans have been found to reduce cigarette sales and smoking, and so are subject to industry interference. Tobacco companies advocate for bans on ‘characterizing flavours’ (rather than bans on additives) and can exploit them.
• There is little evidence that menthol bans lead to an increase in the illicit tobacco trade.

Menthol cigarettes are key products in tobacco company portfolios, representing an estimated 10% of the global cigarette market according to the World Health Organization (WHO).¹⁴ Using flavouring agents as additives is thought to promote and sustain tobacco use, and therefore WHO recommends banning menthol and other flavours in cigarettes.⁵¹

Note that this page focuses on cigarettes. There are many other kinds of flavoured tobacco products, including waterpipe, smokeless tobacco, including snus.

Flavours are also used in newer nicotine and tobacco products, such as e-cigarettes (also known as electronic nicotine delivery systems, or ENDS), heated tobacco products (HTPs) and nicotine pouches.

Figure 1: Retail publication sponsored by JTI (Source: Scottish Local Retailer/Japan Tobacco International, “Making a Mint”, 2020, PDF supplied by Action on Smoking and Health)

Background

Cigarettes are produced and sold with a variety of flavours, including menthol, fruit, spice, herb, alcohol, sweet and floral.⁵²⁵³ Menthol, a type of alcohol that can be obtained from mint plants or manufactured, is the most widely used cigarette flavour.⁵⁴⁵⁵⁵⁶ Besides adding a flavour, menthol desensitises receptors that lead to irritant sensations from nicotine, making the experience of smoking less harsh.⁵⁴⁵⁷ In the United States non-menthol cigarette consumption declined by 33%  from 2009-2018 but menthol cigarette consumption only declined by 8%.⁵⁸

Smoking menthol may help establish smoking among young people,^565960616263 and reduce the likelihood of quitting.⁵⁹⁶⁰⁶⁴ Banning menthol should discourage sustained tobacco use.⁵⁹⁶⁵

Menthol cigarettes could contribute to health inequalities: in the USA they have been found to be disproportionately smoked by those with lower incomes,⁵⁷⁶⁶⁶⁷ those with a lower level of education,⁵⁷ women,⁶⁸ African Americans,⁶⁹⁷⁰ the LGBTQ+ community,⁷¹⁷² and young people.⁷³

Menthol cigarettes are more commonly used by less-established or ‘novice’ smokers, and those who are experimenting with smoking.⁶⁷⁷³ Research shows that the tobacco industry has manipulated the menthol content of cigarettes to promote smoking initiation and sustain tobacco use.⁷⁴⁷⁵ Menthol was found to be key to industry strategy in Singapore, to both recruit and retain young smokers.⁷⁶

Mass distribution and marketing of menthol did not start until the 1960s although a US patent for menthol flavouring was granted in the 1920s.⁵⁵⁵⁶⁷⁷ In 2007 a new innovation for adding flavour appeared on the Japanese market which has since become common elsewhere, often marketed as a ‘crushball’, in which flavour is added via crushing a small plastic capsule in the filter.⁷⁸⁷⁹ Tobacco companies have been developing flavour capsules since the 1960s and multiple innovations have been patented, but not yet marketed.⁸⁰ Cigarettes with flavour capsules are popular with young people due to the interactivity, and the novelty of smoking a cigarette with two flavours.⁷⁸⁷⁹⁸¹ Flavour capsule use is high in Chile, Mexico and South Korea.⁸² In some countries use is high among women.⁸² Some markets, such as the UK, only had menthol flavoured capsule cigarettes available, and not other flavours.⁸³

Menthol can be present in tobacco products not labelled as menthol.⁸⁴⁸⁵ The tobacco industry has stated that this might occur as a by-product of processing, but that it is also added deliberately to improve the flavour.⁵⁷⁸⁶

Regulation and Industry Interference

Regulation of flavours that make smoking more palatable is recommended by the WHO Framework Convention of Tobacco Control (FCTC).¹⁴⁵¹ According to a review conducted by researchers at Johns Hopkins University, as of 2021, about 40 countries have active or pending policies on flavour.⁸⁷ These policies differ according to whether the following are banned:

• all tobacco products
• products with flavour additives
• products with a noticeable or ‘characterising’ flavour
• flavour descriptors and images on packaging

Tobacco industry documents show that the industry favours characterising flavour bans.⁸⁸

Turkey was the first country to successfully introduce a ban on flavoured cigarettes, including menthol, in 2015, to be fully implemented in 2020.⁸⁹⁹⁰

Also in 2015, Ethiopia banned menthol flavouring for all forms of tobacco to prevent appeal to children and adolescents, a pre-emptive move as Ethiopia had no significant existing use of menthol.¹⁴⁹¹ The ban was comprehensive, covering manufacture, import, distribution, and  sale. It bans aroma as well as taste, effectively banning additions to packaging.⁸

While most flavour policies mention reducing youth use, only some restrict flavour descriptors on tobacco packaging.⁸⁷

For up-to-date information on regulation of tobacco products around the world see the Tobacco Control Laws website, produced by the Campaign For Tobacco Free Kids (CTFK).

For countries that are parties to the FCTC, progress towards implementation of relevant articles (9 and 10) is detailed in the FCTC implementation database.

Brazil

In 2012, in order to prohibit the addition of substances that enhance the attractiveness of tobacco products through flavour and taste, Brazil became the first country in the world to pass a law banning menthol tobacco products. However it was unable to enact the law due to industry interference and a lengthy court battle.⁹²⁹³

A review of academic, government and commercial documents found the tobacco industry used a range of strategies to interfere with the legislation, including instigating demonstrations by tobacco farming front groups, media articles, litigation, lobbying, and industry-commissioned studies questioning the rationales for legislation.⁹² Arguments used by the tobacco industry included that: a ban would threaten employment, increase illicit trade, or prevent successful growing of burley tobacco; there is a lack of evidence that a ban would reduce smoking; and that a ban would be illegal.⁹²

Philip Morris Brasil (PMB) had challenged the ban through its membership of The National Industry Confederation (Confederação Nacional da Indústria, CNI), arguing that the ban was unconstitutional.⁹⁴⁹⁵ According to PMI’s 2018 annual report, “The tobacco union requested a stay of the enforcement of the ingredient ban while the appeal is pending”.⁹⁵

The Brazilian government finally won the court case in February 2018, although the ban was not fully enacted due to ongoing interference.^87939296 Researchers noted that these strategies had also been used elsewhere, and that the legislation was delayed for many years despite a lack of evidence to support industry arguments.⁹²

Chile

The Ministry of Health in Chile, a country with high use of menthol cigarettes, particularly among women, tried to introduce a menthol ban under an existing law in 2013.¹⁴⁹⁷ After lobbying from the tobacco industry, the ban was rejected. The industry argued that menthol products were no different to other tobacco products, and that there was a lack of evidence of increased addiction or harm.¹⁴⁹⁸ A new bill was introduced in 2015, supported by data showing very high use of menthol-flavoured cigarettes by young people (66% for smokers under 18).

In response to the new bill, British American Tobacco (BAT) threatened to withdraw its operations from Chile.⁹⁹¹⁰⁰ Despite passing the law in the Senate, as of February 2020 the law had yet to be implemented.¹⁰¹ Although the bill stalled, BAT went ahead with the closure of some of its factories. According to the Campaign for Tobacco Free Kids, this “can be interpreted as a decision to consolidate based on cost efficiency and not on local tobacco-control laws”.¹⁰⁰ BAT continues to manufacture and market menthol cigarettes in Chile, with sales of capsule cigarettes increasing (see below).

Canada

Menthol cigarettes were initially exempted from a flavour ban in Canada in 2010. Evidence showed that menthol cigarettes were used by nearly a third of high school aged smokers.¹⁰² The tobacco industry lobbied against extending the ban to non-cigarette products (cigarillos and smokeless tobacco).¹⁰³ After implementation tobacco companies developed new variations on existing products, including small menthol cigars, to get around the ban.^1487104

A series of menthol bans were implemented in Canadian provinces, starting with Nova Scotia in May 2015, and by October 2017 menthol cigarettes had been banned across Canada.^14105106107 First Nations reserves were included, removing a potential legal route for purchasing menthol after the ban, although products may still be available.¹⁰⁵¹⁰⁸

Canadian legislation bans menthol’s use as an ingredient because menthol’s presence at subliminal levels reduces the negative sensations of smoking.^109110111

United States

In 2019, 18.5 million people in the US were current smokers of menthol cigarettes.¹¹² On 28 April 2022 the US Food and Drug Administration (FDA) announced proposed standards for banning menthol as a characterising flavour in cigarettes and cigars.¹⁰⁸¹¹³ In 2009 the US had previously banned characterising flavours in cigarettes (see below) except menthol.

Characterising Flavour

Factors relevant for determining whether a product has a characterising flavour as stated by the FDA include, but are not limited to, presence and amount of flavour ingredients or additives, multisensory experience, implicit or explicit flavour representations (including descriptors) on the packaging.  Industry has commented that characterising flavour requires a clear and scientifically based definition for compliance.¹¹²

However, there is also evidence that tobacco companies have have undermined ‘characterising flavour’ bans implemented in other countries, notably the EU and UK.

The rules were to come into effect one year after the final publication of the regulations (not yet provided).¹¹²¹¹⁴  The ban would also cover tribal lands.¹⁰⁸

As the tobacco companies make ‘massive profits’ from menthol, legal challenges and protests from the tobacco industry and third party allies are likely.¹¹⁵¹¹⁶ 30% of British American Tobacco’s operating profit is reported to come from the sale of menthol cigarettes in the US alone.¹¹⁷

• For more information see Flavoured and Menthol Tobacco in the US

Moldova

Moldova, a non-EU country in the lower middle-income category with a high smoking rate, was due to ban menthol cigarettes in May 2020 at the same time as the EU.⁸⁹¹¹⁸ In 2019, PMI increased its lobbying efforts in Moldova, to try to gain influence over tobacco control policy in the country. For more information see Swiss Diplomats Lobbying for PMI.

European Union and UK

An EU-wide ban on the sale of flavoured cigarettes was introduced in May 2016, including menthol, under the 2014 revised European Tobacco Products Directive (TPD).¹¹⁹ After protests against the TPD from the tobacco industry, implementation of the ban on menthol cigarettes was postponed to 2020.¹²⁰¹²¹

Many of the brands assessed by the EU Commission advisory panel on characterising flavour have been found to have a chemical profile suggestive of having a characterising flavour, and noticeable odours.¹²²

• For details of the EU regulation, and the range of tactics used by tobacco companies to exploit loopholes in the legislation (figure 1) and circumvent the menthol ban, and a 2023 ban on flavoured HTPs, see Menthol Cigarettes: Industry Interference in the EU and UK

Do Bans Work?

Evidence from the US

The US flavour cigarette ban (with the exception of menthol) came into effect in September 2009. Survey data for the period up to 2017 suggested the ban reduced cigarette smoking long term among young adults (27%) and youth smokers (43%) but not older adults. Immediately post ban significant numbers of young adult and youth smokers of other flavours switched to menthol and non-flavoured cigarettes.¹²³ However, by 2015 cigar sales had also increased, particularly flavoured cigars. Internet vendors, especially those based outside the US were found to be selling flavoured products in 2011, two years after the flavour ban.¹²⁴

The 2009 ban only applied to cigarettes. In 2014, 61% of middle and high school smokers had recently used flavoured hookah and 64% had used flavoured cigars.¹²⁵

In June 2017, the city of San Francisco, USA, banned the sale of all flavoured tobacco products including menthol. Retailers were given training, and shops were inspected. By December 2019, the comprehensive ban had reduced sales of flavoured products by 96%. Total tobacco sales declined significantly further than in neighbouring cities without bans.¹²⁶

Evidence from Canada

The country wide Canadian ban was in place in October 2017, but several states implemented bans beforehand from 2015 onwards. In Ontario, a menthol cigarette ban was enacted in January 2017. Having a ban in place was associated with a reduction in menthol and total cigarette sales.¹²⁴

Across Canada, state menthol bans significantly increased quit success among menthol smokers compared with non-menthol smokers.¹²⁷  The ban also prevented relapse among smokers who had quit pre-ban. ¹²⁸ In 2015, even though some states had already passed legislation, 15% of 15 to 19 year olds reported smoking menthol cigarettes.¹²⁹ Between 2018 and August 2020, 2-3% of  16-19 year olds were estimated to be smoking menthol or capsule cigarettes.¹³⁰ Most menthol smokers switched to non-menthol cigarettes, and menthol accessories (which could provide a menthol flavour) remained on sale in Canada.¹²⁸

In 2009, Canada had banned on all non-menthol flavour additives small cigars as well as cigarette. Despite an increase in non-flavoured cigars, there was a net reduction in cigar sales by 2015.¹²⁴

Evidence from the EU and UK

The European Union flavour ban (with the exception of menthol) came into force in May 2017. Survey data from eight EU countries suggested that between 2016 and 2018 only 11% of smokers of the banned flavours continued to smoke them, 62% moved to unflavoured cigarettes and 5% moved to menthol cigarettes. Only 9% quit completely.¹³¹

The EU menthol ban came into force on 20 May 2020. An International Tobacco Control (ITC) study in 2020-2021 surveyed the same sample of adult smokers in the Netherlands before and after the EU menthol ban.¹³² This study found that menthol use significantly decreased from 8% to 4% post-ban. Compared to non-menthol smokers, menthol smokers had higher quit attempt rates (67% vs 50%). 40% of those who smoked menthol pre-ban switched to non-menthol cigarettes while just over a third continued to smoke menthol cigarettes after the ban.¹³² Over 40% of menthol smokers  reported using flavour accessories post-ban, including filters, flavour cards, marker pens, and drops, which were not banned.¹³³ 4% of all smokers used these accessories post-ban.¹³³

The menthol ban was adopted into UK legislation before the UK left the EU. Results from evaluations have been mixed.  A study using the ITC Youth Tobacco and Vaping Survey found that in England, the percentage of youth smokers (age 16-19) whose usual cigarette brand was menthol declined from 12% in Feb 2020 to 3% in August 2020. This fall was not replicated in countries which did not have a menthol ban enacted during the study period. However, reported menthol smoking in the previous 30 days was still high post-ban at over 40%.¹³⁰  Between July 2020 and June 2021, Smoking Toolkit Study data suggested 16% smokers in England reported smoking menthol cigarettes; women and younger smokers were more likely to report menthol smoking. There appeared to be a decline in reported menthol smoking in mid-2021.¹³⁴ Some remaining reports of menthol smoking could be at least partly because menthol accessories and cigarillos were still available.¹³⁵

The tobacco industry attempted to boost menthol sales after the ban was announced.¹³⁶ Between September 2019 and February 2020, before the ban, sales of menthol cigarettes fell by 57% in UK convenience stores (as reported by the Retail Data Partnership). However, under 2% of stores had stopped selling them.¹³⁷ The analysts did not identify any significant rise in sales of RYO tobacco, cigarillos or e-cigarettes. Therefore, it was unclear whether customers were switching to products bought elsewhere (e.g. online), or were in fact quitting.¹³⁷

• For more on product innovation see Menthol Cigarettes: Industry Interference in the EU and UK

Flavour Bans and Illicit Tobacco

Where neighbouring countries do not implement a ban, it has been suggested that there is a risk that smuggling will increase.¹³⁸ Tobacco companies have used this argument when lobbying against regulation, including the TPD.

However, the risk associated with the movement of illicit tobacco is often exaggerated by the tobacco industry. An evaluation of the 2015 menthol ban in the Canadian Province of Nova Scotia found no change in seizures of menthol or nonmenthol cigarettes after 3 years.¹²⁴ In Romania there was no increase in tobacco confiscations after the EU ban.¹³⁹ Both before and after the ban, about 2% purchases in the Netherlands were illicit.¹³³ Despite English smokers continuing to smoke menthol cigarettes after the menthol ban, there was no reported rise in purchasing of cigarettes from illicit sources.¹³⁴

The Global Market for Menthol Cigarettes

Euromonitor International produces data on cigarette market share by volume of capsule cigarettes (i.e. of any flavour, including menthol) and menthol flavoured cigarettes (i.e. without capsules) for up to 78 countries. Note that Euromonitor receives project funding from Philip Morris International.¹⁴⁰

From 2010 to 2020, capsule cigarettes experienced significant market growth, with an average increase of 0.7 percentage points per year.¹⁴¹   Growth occurred across all WHO regions, with the exception of Europe. Here there was an increase until 2019, then a decrease of 0.6 percentage points to 2020, likely due to the EU characterising flavour ban. Capsule cigarette market growth was most substantial for upper-middle income countries (with an average market share of 1.0% to 11.4) and the WHO region of the Americas (1.5% to 16.2%).¹⁴¹ The five countries with the highest average annual growth rates of capsule cigarettes  were: India (154%), Uzbekistan (122%), Uruguay (115%), Russia (84%), and Ukraine (84%). Four of these are middle-income countries.¹⁴¹ By 2019, capsule cigarettes made up a larger proportion of the global cigarette market than menthol flavoured cigarettes.  The overall market share of menthol cigarettes decreased by an average of 0.2 percentage points per year.¹⁴¹

According to Euromonitor, in 2020, capsules accounted for 3.3% of the market worldwide (by volume) and menthol flavoured cigarettes 2.4%. ¹⁴² However, regional distribution varies. Four of the five countries with the highest capsule market shares in 2020 were in Latin American: Chile (48%), Peru (35%), Guatemala (33%), Mexico (27%), and South Korea (25%).¹⁴¹

The market share of menthol flavoured cigarettes remained high in many countries, the highest being in the WHO Western Pacific region (15% in 2020) and Africa region (13%). The five countries with the largest menthol market shares in 2020 were: Singapore (47%), Dominican Republic (33%), Cameroon (30%), USA (29%) and Japan (28%).¹⁴¹ In contrast, in Europe the average market share for menthol flavoured cigarettes was only 1.5% across the region.

Both types of flavoured cigarette are equally popular in Nigeria and have over 40% of the tobacco market. Only two of the countries included in Euromonitor’s dataset, North Macedonia and Canada, had no measurable market for either.¹⁴²

• For more information on the market and industry tactics in low and middle-income countries, see Flavoured and Menthol Tobacco in LMICs

Company Market Shares

Tobacco companies do not share their sales figures for menthol tobacco products, so market share needs to be calculated from different data sources.

• For details of tobacco company shares in the UK see Menthol Cigarettes: Industry Interference in the EU and UK

TobaccoTactics Resources

• Menthol Cigarettes: Industry Interference in the EU and UK
• Promotion of Newer Products Around The UK Menthol Ban
• Flavoured and Menthol Tobacco in LMICs
• Flavoured and Menthol Tobacco in the US
• Smokeless Tobacco
• Waterpipe

Relevant Links

Flavors (Including Menthol) in Tobacco Products, STOP resource (May 2022)

Case studies for regulatory approaches to tobacco products: menthol in tobacco products, World Health Organization advisory note (2018)

Partial guidelines for implementation of articles 9 and 10 of the WHO Framework Convention on Tobacco Control: regulation of the contents of tobacco products and of tobacco product disclosures, World Health Organization, WHO website (2012)

A global map of menthol bans is available on Tobacco Atlas: Product Sales

Public Health Law Center: Menthol and Other Flavoured Products, PHLC website (United States)

US Food and Drug Administration, Tobacco Product Standard for Menthol in Cigarettes (5 April 2022)

Centers for Disease Control and Prevention, Office on Smoking and Health Summary of Scientific Evidence: Flavored Tobacco Products, Including Menthol (United States, February 2021)

TCRG Research

• Flavour capsule cigarette use and perceptions: a systematic review, C.N. Kyriakos, M.Z. Zatoński, F.T. Filippidis, Tobacco Control, Published Online First: 04 October 2021, doi: 10.1136/tobaccocontrol-2021-056837
• Tobacco industry tactics to circumvent and undermine the menthol cigarette ban in the UK, R. Hiscock, K. Silver, M. Zatonski, A. Gilmore, Tobacco Control, 18 May 2020, doi:10.1136/tobaccocontrol-2020-055769
• A growing menace: menthol and flavoured tobacco products in LMIC, M. Zatonski, K. Silver, S. Plummer, R. Hiscock, Tobacco Induced Diseases, 2022;20(April):39, doi:10.18332/tid/146366
  STOP research summary (May 2022)

For a comprehensive list of all TCRG publications, including research that evaluates the impact of public health policy, go to the Bath TCRG’s list of publications. 

References

The post Flavoured and Menthol Tobacco appeared first on TobaccoTactics.

Background

Aznar began his career in the People’s Party of Spain in 1989 and had a long career in politics.¹⁴³

• President of Spain (2004-2016)
• Prime Minister of Spain (1996-2004)
• President of the People’s Party, the main conservative party of Spain (1990-2004)

Several other posts including:

• Member of the Board of Directors of News Corp, media conglomerate owned by Rupert Murdoch (2013-on going)¹⁴⁷
• Member of International Advisory Board Barrick Gold (2011- on going)¹⁴⁸
• Founder of Friends of Israel Initiative (2010-on going)¹⁴⁹
• President of the think-tank Fundación para el Análisis y los Estudios Sociales (FAES) – The Foundation for Social Studies and Analysis (1989-on going)¹⁵⁰

Relationship with the Tobacco Industry

Spain

During his terms in office and thereafter, Aznar has been criticised for having an open-door policy with the tobacco industry.¹⁵² The major Spanish newspaper El Pais published articles about the ties between Aznar and El Club del Fumador,¹⁵³ a non-profit organisation funded by Philip Morris International which promotes the right to smoke and use tobacco products. This organisation is part of a network that includes the tobacco industry funded groups Forest and the World Smokers Resistance, among others. According to El Pais, Aznar met with members of this organisation when in office, at el Palacio de la Moncloa, the official residence of the Prime Minister of Spain.¹⁵³

In 1998, Aznar led the privatisation of Tabacalera, the tobacco company owned by the Spanish Government since the 17th century.¹⁵⁴ He appointed one of his close friends to handle the privatization process, the former president of Telefonica, Cesar Alierta.¹⁵⁵

Imperial Tobacco bought the company. Later on, a corruption scandal was uncovered regarding the sale of Tabacalera. Alierta and his family allegedly used confidential information to purchase a large number of Tabacalera’s shares for personal profit.¹⁵⁴ The corruption case reached Spain’s Supreme Court in 2007. The Court was criticized for acquitting Alierta and his family, on the grounds that the statute of limitations had run out.¹⁵⁶

Chile

According to public records from the Government of Chile, Aznar met with the Chilean Minister of Finance, Felipe Larrain Bascuñan and the Chief of Staff of the Ministry of Finance, Francisco Matte Risopatrón, on 8 May 2018.(Image 1)¹⁵¹ The meeting lasted 30 minutes, and in the meeting minutes Aznar and the rest of his colleagues are portrayed as ‘interest lobbyists’. The records describe that the purpose of the meeting was to discuss:

“the electronic cigarette market and tax implications. Preparation, dictation, modification, denial or rejection of administrative acts, bills and laws and also decisions taken by taxpayers”¹⁵¹

Chile, following its commitment to the Framework Convention on Tobacco Control (FCTC), has adopted regulations that prohibit tobacco product advertising, including smoke-less products, as well as strict rules that government officials must not meet with the tobacco industry or its representatives. The next day, on 9 May 2018, according to public records, Chilean Minister Felipe Larrain Bascuñan met for an hour with a number of lobbyists from different multinational corporations, including two lobbyists for PMI.(Image 2)¹⁵⁷ Aznar was not present at this meeting.¹⁵⁷

Peru

In January 2019, the Congress of the Republic of Peru, began discussions on stricter tobacco product regulations, including a ban on tobacco advertising.¹⁵⁸ At the same time, a group of congress representatives from Fuerza Popular, one of the main right-wing parties of Peru, submitted the 3833 bill¹⁵⁹ to replace the current tobacco control law 27805 with less restrictive regulations. These proposed amendments would allow the introduction of e-cigarettes in Peru.¹⁶⁰

Several newspapers and media outlets reported that Aznar travelled to Peru, in February 2019 on a similar mission to the one in Chile, lobbying for the tobacco industry.^{161 162} Allegedly, Aznar made an appointment to meet with the Minister of Health but did not attend this meeting. ¹⁶²

Other TobaccoTactics Resources

• Philip Morris International
• Revolving Door
• Lobbying Decision Makers

References

The post José María Aznar appeared first on TobaccoTactics.

The Republic of Chile is a high-income country, according to the World Bank classifications¹⁶³, situated along the western seaboard of South America which shares borders with Argentina, Bolivia and Peru. Chile is a representative democratic republic, which major political parties include the political coalition ‘Chile Vamos’ composed by four centre-right parties and the Partido Socialista de Chile.¹⁶⁴

Tobacco Control Legislation

Chile became a Party to the WHO Framework Convention on Tobacco Control (FCTC) on September 11, 2005.¹⁶⁵ To comply with the FCTC, Chile’s tobacco control law underwent different amendments with the latest version agreed in 2018.¹⁶⁶ The amendments were aimed at strengthening the tobacco law by incorporating the ban on the use of additives, plain packaging, the ban on the display of tobacco products at points of sale and the strengthening of the health authority.¹⁶⁷¹⁶⁸ Despite approval by the Health Commissions of the Senate and the Chamber of Representatives, the amendments have faced delays while with the Agriculture Commission of the Chamber of Representatives.
Meanwhile President Sebastian Piñera began his second term in office in March 2018.¹⁶⁹Dr. Jaime Mañalich returned as Chile’s Minister of Health in June 2019. He set tobacco control as one of the priorities in the Chilean public health agenda as well as addressing the aggressive tobacco industry interference taking place in the country.¹⁷⁰¹⁷¹
Piñera’s second term in government has seen a complicated political situation with often low levels of public approval and an increase in social protests. In October 2019, the Chilean Government’s repression of social protest reached global media outlets and leaving the political scenario unstable.¹⁷²

Smoking in Chile

Chile’s has implemented several tobacco control policies with a reduction in the prevalence of tobacco use seen in both the general population and young people. Between 2010 and 2016 there was a decrease of 6.5% in the consumption of tobacco overall.¹⁷³ Even so, Chile continues to have one of the highest prevalence rates of smoking in the Americas region.¹⁷⁴ with one in three people over 15 years old currently smoking.¹⁷⁵ Furthermore, one in five children aged 13-15 years old smokes and the average age they start is 13.7 years.¹⁷³ There has been a strong market penetration of menthol cigarettes, those flavoured with capsules (40% of the market) and extensive marketing of electronic cigarettes.¹⁷⁶ In Chile, two out of every three children under the age of 18 smoke menthol cigarettes and 44% start smoking with this type of tobacco. Half of menthol cigarette smokers belong to the lowest socioeconomic levels¹⁷⁷ Every year more than 16,000 people die in Chile due to pathologies caused by or associated with tobacco consumption.¹⁷³
According to the Institute of Clinical and Health Effectiveness, smoking costs the Chilean government more than 1 billion Chilean pesos a year in direct costs alone (treatments, hospitalizations, surgeries, medicines).¹⁷⁸. This is equivalent to 0.8% of the annual GDP and 30% more expenditure than that collected from tobacco taxes each year.

Roadmap to Tobacco control

Chile ratified the Framework Convention on Tobacco Control in June 2005. To comply with the FCTC, the Chilean government has adopted several tobacco control policies. A study conducted in 2015 by the School of Public Health of the University of Chile and the Pan-American Health Organization, demonstrated the positive effect of plain packaging to discourage tobacco use in adolescents. Regulations in Chile establish up to 50% of the packaging has to be covered by health warnings, with rotating images and messages and avoiding misleading language such as “low tar”. This is a measure that has been proven highly effective and that does not affect local trademark rights or infringe the Chilean Constitution¹⁷⁹.

Tobacco Tax

In early 2019, the Chilean parliament began discussions on a new tax reform with senators of the health commission (Girardi and Goic) as well as civil society (Foro Nacional de Cáncer, Mesa Ciudadana Tabaco or Salud) pushing for an increase in taxes on tobacco and alcohol.¹⁸⁰ It has been proposed that the increase would be a source of funding for the National Cancer Law enabling prevention policies and treatments, which has been sanctioned but has no allocated budget. Senator Goic, one of those pushing for this tax increase, has been one of the strongest promoters of the National Cancer Law.¹⁸¹
A study conducted in Chile in June 2019, concluded that

“higher prices and the tobacco control policies enacted in 2006 were associated with lower hazards of starting smoking. Our results add to the increasing evidence that higher cigarette prices are associated with reduced hazard of starting smoking in LMICs”¹⁸²

E-cigarettes and HTP in Chile

Electronic cigarette consumption has grown from 3.6% in 2014 to 6.5% in 2016 amongst those aged 12-65 years.¹⁸³ The highest prevalence of electronic cigarette consumption has been consistently observed in younger age groups (15-24 years)¹⁷³ particularly in the Metropolitan Region (Greater Santiago) where the consumption of electronic cigarettes among those aged 13-15 years was 12.1% in 2016¹⁸⁴
The marketing on electronic cigarettes has resulted in a significant increase in awareness, from 46.9% in 2014 to 66.5% in 2016.¹⁸⁵
A Decree of the Institute of Public Health (ISP) regulates e-cigarettes as a pharmacological product. The National Agency of Medicines, ANAMED, as the governing body of the certification of medicines in Chile, authorized some of these products to be marketed as pharmaceutical products, when it could have been regulated by existing regulations on tobacco.¹⁸⁶
In September 2019, a new bill was sent to Parliament proposing to regulate e-cigarettes and heated tobacco products as tobacco products. Under this proposed bill, these next generation products would be regulated by the tobacco law enacted in 2013, resulting in a ban on advertising and promotion, on the sale to minors, on smoking or vaping in enclosed spaces and they would need to include health warnings as traditional cigarettes.¹⁸⁷ The health minister, Dr. Mañalich, told the media that “the industry has shifted and it is offering the same toxic product, the same poison, in different ways and with an extraordinarily aggressive form of marketing”¹⁸⁷ The industry has been making public statements about their disagreement with the new regulation bill, arguing that these regulations would not make a difference. British American Tobacco’s main arguments are based on the need to differentiate e-cigarettes from traditional cigarettes, grounded on their scientific evidence on harm reduction.¹⁸⁸

Tobacco Industry Interference

The tobacco industry has played a strong role in undermining the public health efforts on tobacco control in Chile for many years. The information gathered through the Global Tobacco Industry Interference Index 2020 showed that governments describe the tobacco industry interference as the main challenge towards the implementation of FCTC. ¹⁸⁹ Senators, members of the Ministry of Health and the Minister of Health himself have publicly exposed the aggressive lobbying that the tobacco industry has been carrying out.¹⁹⁰¹⁹¹

A range of tobacco industry tactics have been used, including:

• To delay and postpone the debating of the tobacco law that is currently sitting at the agriculture commission.¹⁹¹
• Philip Morris International has engaged in high-level hearings with Ministers and senior officials of Finance, Economy, Health, Parliamentarians and Consumer Public Service (SERNAC) and Taxation (SII) in a number of opportunities.¹⁹²
• Inviting journalists to travel to Europe to promote their new products, which subsequently resulted into articles and reports in the media promoting their products as ‘low-risk alternatives’. Articles including bronchopulmonary physicians in the media endorsing these products as smoking cessation therapies.¹⁹³¹⁹⁴
• Organising meetings and events addressed to doctors and funded by PMI to promote their new products.¹⁹⁵

  

  Invite to PMI funded event in Chile May 2019

• sponsorship of a pre-meeting event in the framework of the Asia Pacific Economic Cooperation Forum (APEC) leaders meeting in Chile, called “APEC 2019 CEO Summit” that will be held from November 14 to 16 2019 in Chile. The Heads of State meeting (presidents of the participating countries) will be held on November 16 and 17. Philip Morris International will be a platinum sponsor of the event.¹⁹⁶
• spreading misinformation, including over-estimating the numbers on illicit trade in the country, arguing a 386% increase in the last five years¹⁹⁷¹⁹⁸ while the government official numbers show a trend of less 10% in the last 14 years.¹⁹⁹
• The creation of the Observatory of Illicit Trade, a public-private partnership created by the National Chamber of Commerce in 2016, with the objective of generating relevant information on illicit trade.²⁰⁰ The Observatory is composed of 13 public institutions, including the Ministry of Finance, the Chilean law enforcement agency, and the national customs and border control department, and by several private actors including British American Tobacco.²⁰⁰ Since 2016, all the reports on tobacco illicit trade produced by the Observatory have lacked independence and transparency given the direct involvement of the tobacco industry. The reports have either been conducted or commissioned by British American Tobacco.²⁰¹ The Observatory promotes unnecessary interaction between the government and the tobacco industry, going against the guidelines of article 5.3 of the FCTC.

TobaccoTactics Resources

• WHO Definitions of Tobacco Industry Tactics
• Latin America and the Caribbean region

Relevant Link

• WHO Framework Convention on Tobacco Control, World Health Organization, 2003

Acknowledgement

With thanks to Sonia Covarrubias, Nancy Ortiz, Pamela Morales and Maria Teresa Valenzuela Schmidt from Chile libre de Tabaco and Lidia Amarales from RespiraLibre who contributed to this page.
Final editorial decisions were made by the Tobacco Control Research Group.

References

The post Chile-Country Profile appeared first on TobaccoTactics.