Tobacco use is a major contributor to disease, early death, and health inequities. In Latin America, tobacco is responsible for almost one million deaths per year.
Prevalence of tobacco use among adolescents in Latin America was the highest in the world at the start of the century, and while this has declined smoking rates among 13-15 year-olds remain higher than for adults in many Latin American countries.
A significant problem in Latin America is the rapid growth in sales of flavour cigarettes, especially in Argentina, Guatemala, Mexico and Peru, where they now account for between 20% and 55% of the tobacco market (Moodie et al., 2023).
The growth in these countries, and across much of Latin America, is due to tobacco industry marketing innovation, specifically the introduction of cigarettes with frangible flavour-changing capsules in the filter.
There can be up to three capsules in a filter, each of which can be burst by squeezing them to release a liquid or powder that changes the flavour (Moodie et al., 2019).
Despite being one of the most successful recent product innovations in the tobacco field in decades, and having high youth appeal, there are only 20 or so primary studies on capsule cigarettes (Kyriakos et al., 2022).
As the cigarette stick is important for tobacco companies to promote cigarettes, one idea is to make the cigarette less appealing. These are often called ‘dissuasive’ cigarettes, which can be an unappealing colour, display a warning, or both.
Published studies on dissuasive cigarettes collectively provide support for dissuasive cigarettes (Al-Zalabani et al., in press), and Canada is going to require them for all cigarettes from 2024.
However, all research is from high-income countries with strong tobacco control policies, with no research on dissuasive cigarettes in Latin America (Al-Zalabani et al., in press).
The REMAP project is funded by the Medical Research Council (MRC) and is focused on understanding how tobacco companies market flavoured cigarettes in four Latin American countries (Argentina, Guatemala, Mexico, Peru), the impact this has on adolescent smoking attitudes, intentions, and behaviours, and whether ‘dissuasive cigarettes’ may put adolescents off smoking.
There will be three interlinked studies. The first, in 2023, explored how flavour cigarettes are marketed in retail outlets, and via cigarette packs and sticks, using a retail monitor and pack collection from approximately 500 stores in each of our four study countries (Argentina, Guatemala, Mexico, Peru) and also Ecuador, with colleagues in Ecuador joining the REMAP team in 2022. The images of retail marketing, the packs, and cigarette sticks, in these five countries can be seen on the website.
The second study, in 2024, explored how adolescents view flavour cigarettes and marketing, and dissuasive cigarettes, using small discussion groups.
The third study will involve school surveys to assess whether cigarette stick design can be used to reduce the desirability of, and interest in, smoking.
