5.13.1 Confectionery cigarettes
Chocolate, sugar and bubblegum sticks made to look like cigarettes and cigars have been sold for many decades, often in packaging closely resembling that of real tobacco products.1 Probably the most widely recognised Australian confectionery cigarettes were ‘Fags’: white sugar sticks with one tip dyed red to simulate a lit cigarette.
Having young children accustomed to playing with the cigarette-like lollies in facsimile brand packaging provides obvious benefits for tobacco manufacturers.1 Although the tobacco companies publicly distanced themselves from confectionery cigarettes from the 1960s, they failed to pursue trademark infringements by confectionery companies.1
Research from the US in the 1990s found that children who bought confectionery cigarettes were almost four times more likely to have tried real cigarettes. This effect remained significant after parental smoking status was taken into consideration. Children liked confectionery cigarettes and tended to see them as illicit or mature pleasures, and to use them as props to imitate smoking behaviour.2 Research from the US has shown that adults who used confectionery cigarettes in childhood were about twice as likely to take up smoking, than adults who did not consume the lollies.3 Greater use of confectionery cigarettes was associated with a higher likelihood of becoming a smoker, irrespective of potential socio-demographic confounding factors.3
Confectionery cigarettes remain available in some parts of the world4 but are no longer legally sold in most states and territories in Australia. Interestingly however, the cigarette-shaped lollies sold as Fags in Australia continue to be sold but with a rebranding of the name from ‘Fags’ to ‘Fads’.
5.13.2 Flavoured cigarettes
Proliferation of flavoured brands has been attributed to the tobacco industry’s need to attract and retain young smokers in an increasingly challenging regulatory environment.5,6 Fruit and confectionary flavoured tobacco products that may appeal to children were effectively banned from sale in Australia in the late 2000s and the role of added cigarette flavourings in fostering smoking initiation was highlighted in partial guidelines adopted by the WHO Framework Convention on Tobacco Control (WHO FCTC) Conference of the Parties in November 2010.7 See Section 19.4.3 for the latest information. However, flavoured capsule cigarettes, flavoured roll-your-own (RYO) and pipe tobacco products continue to be available on the Australian market along with flavoured cigarettes papers for use with RYO tobacco—see Chapter 12, Section 12.8 for greater detail.
Analysis of tobacco industry documents suggests that companies have used flavourings to mask the harshness of tobacco smoke and improve palatability of tobacco products. This is particularly important for new tobacco users.7 Studies on the popularity of mainstream flavoured brands in the US (such as those produced by the major tobacco companies RJ Reynolds and Brown & Williamson) have shown that flavoured cigarettes are primarily used by younger people,5 and that college-age non-smokers, experimenters and smokers are more likely to have positive expectancies of flavoured variants of cigarettes compared with regular cigarettes.8 This confirms what the tobacco industry has long understood: that younger novice smokers are much more likely to be attracted to novelty flavoured tobacco products than older or established smokers.6
Flavoured tobacco products, including menthol and flavour capsule cigarettes, are discussed in greater detail in Chapter 10, Section 10.8.4
Menthol
Menthol flavoured tobacco products are popular among young people. In 2014, 51.7% of Australian past-month smokers aged 12 to 17 years old had smoked a menthol hybrid/dual flavoured cigarette.9 A 2019 garbology study of environmental contamination from tobacco product waste conducted across 12 public high schools in California found 620 combustible cigarette butts, of which, 42% were menthol.10 Examination of tobacco industry documents reveals that menthol has been, and continues to be, essential to the tobacco industry’s strategy for recruiting and retaining young smokers.11 Moreover, these documents show how tobacco companies have analysed the concomitant effect of controlling menthol levels and increasing brand sales among specific groups.12 While adult menthol users prefer stronger levels of menthol sensation, brands with milder levels of menthol are also available and these appear to be more attractive to adolescent and young adult smokers.12 Investigators conducted independent laboratory tests on menthol brands and analysed data on menthol brand use from a nationally representative US health survey. They found evidence that the industry manipulated cigarette menthol levels and introduced new menthol brands to gain market share, especially among young people.12
Flavour capsules
Flavour capsule cigarettes were reported in 2018 as the fastest growing segment of the combustible cigarette market. 13,14 First introduced in Japan in 2007, flavour capsule cigarettes feature a crushable capsule embedded in or near the filter of a combustible cigarette, which, when squeezed, releases concentrated flavouring.15 Menthol is the most commonly employed flavour for capsule cigarettes, providing a cooling, smoothing and anaesthetic effect on mucus membranes, masking the irritating effects of cigarette smoke. 15 Popular flavours reported globally include fruit, mint variations and beverage/cocktail flavours such as green tea and mojito.13 Researchers suggest flavour capsule cigarettes appeal particularly to young people as they reduce the initial harshness of smoking and may imply reduced risk.16
Speculation that flavour capsule cigarettes have been positioned by the tobacco industry as a starter product, is backed by research showing use of flavour capsule cigarettes to be highest among young adults, and associated with later onset of smoking.15 One study, conducted in New Zealand, concluded that flavour capsule cigarettes appealed more to non-smokers and non-daily smokers, than they did to daily smokers. This finding, in combination with flavour capsule cigarettes’ appeal to young people, means this product is positioned to recruit non-smokers and potentially increase overall smoking prevalence, especially among young people.16
5.13.3 Packaging
The tobacco industry has consistently denied that packaging influences the uptake of smoking among young people, however industry documents clearly show that systematic and extensive research has been carried out by these tobacco companies to ensure that cigarette packaging appeals to selected target groups, including women and young people.17-20 Innovation in package design has been used by the tobacco industry as a way to communicate with consumers during increasing limitations on traditional tobacco advertising and promotion, especially in countries such as Australia.20,21 Elements of pack design engineered by tobacco companies to appeal to consumers include colour, imagery and logos; product descriptors and wording including typeface; pack shape, size and material as well as method of opening and seal.17,22 Evidence from internal tobacco industry documents detailing consumer research and marketing plans show that slim, rounded, oval and booklet shaped packs were found to be particularly appealing to young people. 20 In a 2009 UK study, children as young as 11 years old reported misperceptions of health risk based on pack design and wording. Brands considered to be less dangerous were also perceived as more appealing and chosen as the preferred brand if trying smoking.23 See Section 10.8 Trends in products and packaging for a detailed discussion about innovations in product and packaging design.
There is a growing body of research showing the effectiveness of health warnings for reducing the appeal of tobacco packaging and discouraging the uptake of smoking, especially among young people.24-32 Plain packaging has been shown to have great effect on reducing the appeal of tobacco packaging for young people and discouraging smoking uptake.33-39 For a detailed discussion on both health warnings and plain packaging, see InDepth 12A Health warnings and InDepth 11A Packaging as promotion: Evidence for and effects of plain packaging.
Packaging has also been altered to accommodate different quantities of cigarettes, with smaller packs being of particular appeal to young people. As mentioned in Section 5.12, the tobacco industry has been shown to target starters, new users and younger users through small pack size offerings, in both factory made packs and roll-your-own pouch sizes, based on young and new smokers’ lower consumption rates, their preference for cheaper per-pack prices, as well as smaller packs being easier to conceal.40, 41 In 1985 and early 1986 Philip Morris launched its popular brands Alpine and Peter Jackson in packs of 15. Dubbed ‘kiddie packs’ by health advocates, the cost of small packs was about half the price of other larger pack sizes at the time. South Australian research conducted soon after their introduction showed that the smaller packets were especially popular among young teenage smokers.42 While smaller packs of cigarettes were subsequently banned, ‘splittable’ packs, whereby a packet of 20 cigarettes could be separated along a perforated line to make two smaller packs, similar in dimensions to an ‘iPod’, were launched by British American Tobacco Australia in 2006.43 Since then, legislation has been introduced in Australia specifying minimum numbers of cigarettes per package and elements of pack design, which is intended to counter packaging that appeals to young users (see Section 5.23). See also, Section 10.8.1.1 Conveying value for money through the pack.
5.13.4 Other products
Alternative tobacco product use, such as waterpipe, otherwise known as hookah or shisha, is popular among adolescents in Western countries.44 Waterpipe smoking is particularly appealing to young people as they are used in social gatherings, come in various flavours, and can be used to perform smoke tricks.45 Use of waterpipe has been shown to be a novel risk factor for never smokers to initiate combustible cigarette smoking as well as a predictor of subsequent initiation of other tobacco products and e-cigarettes among young people.46,47 Research has found adolescents and young adults underestimate and discount the long-term risks associated with waterpipe.45 For information about the health effects of waterpipe smoking see Chapter 3, Section 3.27.5.
While some researchers argue that electronic cigarettes have the potential to be a useful cessation aid for smokers, there has been a dramatic increase in young non-smokers using these devices, particularly in the US 48,49, see 18B.6.1 Uptake among non-smokers and 18B.3 Extent of use. Since 2014, e-cigarettes have been the most popular tobacco product among young people in the US, having been used by 27.5% of high school students and 10.5% of middle school students in 2019. Among high school students who reported using e-cigarettes, more than one-third (34.2%) had used them on at least 20 of the past 30 days. Among students who reported ever having tried e-cigarettes, the three most common reasons for use were ‘I was curious about them’ (55.3%), ‘friend or family member used them’ (30.8%) and ‘they are available in flavors, such as mint, candy, fruit, or chocolate’ (22.4%). Among all students included in the survey, 28.2% perceived there to be no or little harm from intermittent e-cigarettes use, and 9.5% perceived there to be no or little harm from intermittent cigarette use.50
Furthermore, research has also shown that use of e-cigarettes by young non-smokers may act as a ‘gateway’ to tobacco smoking.51-53 Curiosity, willingness and intentions to smoke tobacco cigarettes were higher among users of e-cigarettes according to an Australian study examining e-cigarette use among young never (tobacco cigarette) smokers and its association with susceptibility for future tobacco cigarette use. This relationship remained significant even after controlling for numerous covariates, leading the researchers to conclude that even one or two puffs of an e-cigarette has the potential to increase susceptibility to combustible tobacco smoking among Australian young people. 54 See 18B.6.2 A ‘gateway effect’ to tobacco smoking.
Researchers have demonstrated how US electronic cigarette start-up Juul Labs Inc. specifically engineered its products in ways that make them both highly palatable and highly addictive.55 Their research showed Juul e-cigarettes were designed to emit a high-nicotine concentration aerosol in a protonated form—rather than freebase— meaning it is easily inhaled.55 Due to the products exceptionally high nicotine content—5% nicotine, compared to 1%–3% for other e-liquids—the product is extremely addictive.56 Juul also released flavours which were particularly appealing to young people, such as Crème brulee, Fruit medley and Mango.57 In addition, Juul adopted a marketing strategy which appeared to appeal directly to young non-smokers, including use of advertisements featuring attractive young models as well as social media and other media outlets frequented by young people. 57 In July, 2019 there was a two-part hearing in the US—Part I58 & Part II59—building on Congresses Economic and Consumer Policy Subcommittee’s investigation into Juul Labs Inc.’s role in what the FDA described as a youth nicotine addiction epidemic. The Subcommittee on Economic and Consumer Policy determined that Juul Labs Inc. had deliberately targeted children in order to become America’s largest seller of e-cigarettes. Specifically, the Subcommittee found:
•Juul deployed a sophisticated program to enter schools and convey its messaging directly to teenage children
•Juul targeted teenagers and children, as young as eight years old, in summer camps and public out-of-school programs
•Juul recruited thousands of online ‘influencers’ to market to teens.
The Subcommittee’s finding was based on approximately 55,000 non-public documents that the company produced to the Subcommittee and the Massachusetts Attorney General.
For more on electronic cigarettes see In Depth 18B Electronic cigarettes (e-cigarettes).
Relevant news and research
For recent news items and research on this topic, click here. (Last updated March 2020)
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58. No authors listed. Examining JUUL’s Role in the Youth Nicotine Epidemic: Part I. Committee on Oversight and Reform, 2019. Available from: https://oversight.house.gov/legislation/hearings/examining-juul-s-role-in-the-youth-nicotine-epidemic-part-i
59. No authors listed. Examining JUUL’s Role in the Youth Nicotine Epidemic: Part II. Committee on Oversight and Reform, 2019. Available from: https://oversight.house.gov/legislation/hearings/examining-juul-s-role-in-the-youth-nicotine-epidemic-part-ii