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Young adult susceptible non-smokers’ and smokers’ responses to capsule cigarettes
  1. Janet Hoek1,2,
  2. Philip Gendall2,
  3. Christine Eckert3,
  4. Jordan Louviere4,
  5. Mei-Ling Blank2,
  6. James F Thrasher5
  1. 1 Department of Public Health, University of Otago, Wellington, New Zealand
  2. 2 Department of Marketing, University of Otago, Dunedin, New Zealand
  3. 3 UTS Business School, Marketing Discipline, University of Technology Sydney, Sydney, New South Wales, Australia
  4. 4 Department of Marketing, University of South Australia, Adelaide, South Australia, Australia
  5. 5 Department of Health Promotion, Education & Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
  1. Correspondence to Professor Janet Hoek, Departments of Public Health and Marketing, University of Otago, Dunedin 9054, New Zealand; janet.hoek{at}otago.ac.nz

Abstract

Background Flavour capsule cigarette variants (FCVs), which allow users to customise their smoking experience and reduce the harshness of smoking, have captured an increasing share of many markets. We examined tobacco companies’ argument that such product innovations aim simply to shift market share, by estimating smokers’ and susceptible non-smokers’ responses to FCVs.

Methods We conducted an online survey of 425 smokers (daily and non-daily), susceptible non-smokers (n=224) and former smokers (n=166) aged between 18 and 25. Restrpondents completed a choice experiment, a behavioural probability measure and a perception task. We analysed the choice data using a conditional logistic regression and a rank-ordered logistic regression, and the probability and perception data using t-tests and descriptive statistics.

Results Non-smokers preferred an FCV relative to an unflavoured cigarette, whereas the opposite was the case for smokers. Susceptible non-smokers and former smokers were more likely to try a fruit flavoured FCV than an unflavoured stick, while daily smokers were more likely than non-daily smokers to do the same. Susceptible non-smokers, former smokers and non-daily smokers also had more positive perceptions of FCVs relative to unflavoured sticks than did daily smokers.

Conclusions FCVs appeal more to non-smokers than to smokers, and more to non-daily smokers than to daily smokers. They thus appear likely to recruit non-smokers and potentially increase overall smoking prevalence. Policy responses include ensuring standardised packaging legislation disallows FCVs by specifically regulating the appearance and design of tobacco products, or introducing bespoke regulation that addresses the threat posed by FCVs.

  • public policy
  • tobacco industry
  • packaging and labelling

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Introduction

Tobacco control policies restricting tobacco advertising, removing retail promotions and using excise taxes to make tobacco less affordable, have required tobacco companies to find new ways of recruiting the ‘replacement’ smokers on whom their business depends.1 2 Several companies have developed new products, such as ‘slim’ cigarettes and ‘lipstick’ packs, which successfully target young women by offering symbolic promises of thinness and sophistication.3–5 Others have fashioned cigarette sticks to communicate brand attributes shown on pack exteriors,6 or used stick designs that appeal to specific groups.7

Policies such as plain or standardised, packaging address these initiatives by specifying standard dimensions for both sticks and packs;8 however, no country has implemented either standardised packaging legislation or bespoke regulation that addresses innovation within the cigarette stick itself. Tobacco companies have exploited this regulatory lacuna in different ways; some have created intriguing and symbolic indentations in filter tips, while others have developed brand variants that include a flavour capsule (or capsules) within cigarette filters.9–11 When crushed, these capsules add a flavour (typically fruit or menthol) to the cigarette smoke inhaled.12

First introduced in 2007, flavour capsules variants (FCVs) have shown such rapid growth that one commentator declared: ‘With an estimated shipment volume of over 30 billion sticks in 2011, vertiginous growth rates and variants in every international brand portfolio, flavour capsule technology is a confirmed recent tobacco industry success story’.13 Market reports estimate the global capsule cigarette market at more than US$5 billion in 2015 and forecast growth of ten percent between 2018 and 2022.14 Analyses of New Zealand (NZ) cigarette release data show rapid growth in capsule variants, which now account for around ten percent of the leading brand’s product portfolio.15

Positioned as both intriguing and ‘fresh’, capsule cigarettes combine a promise of greater pleasure with an implication of reduced harm.5 16 They enable smokers to customise their smoking experience and gain social cachet through using a novel product,17 18 and allow tobacco companies to add value to ‘value’ brands.12 More generally, flavours appeal strongly to young people, many of whom find their early experiences of smoking unpalatable and welcome a more customised hedonic experience.19

Analyses of tobacco industry documents reveal an acute awareness of how flavours could promote smoking experimentation among young adults and suggest that, by the early 1990s, tobacco companies had already begun exploring flavour capsules.20 As technologies have evolved, tobacco companies have developed FCVs to ameliorate initial unpleasant experiences of smoking, thus facilitating more rapid smoking uptake and nicotine dependence.21–24

Studies show FCVs appeal most strongly to young adults and adolescents, including those who have never smoked before.12 21 24 Evidence that some US young people regard FCVs as less harmful than other cigarettes led researchers to label them a ‘starter product’.21 The FDA has ruled that one variety of FCVs failed the test of ‘substantial equivalence’ to products already marketed in the USA because it raised concerns about public health, and required its removal from the US market.25 Nevertheless, other FCVs, including variants within the same brand family, remain available in the USA, and uptake has grown quickly in other countries.10 12 15 26

FCVs’ rapid growth not only questions tobacco companies’ purported commitment to a smoke-free future,27 but threatens the declines in smoking uptake observed in many countries, and potentially undermines other tobacco policy measures.10 24 Immediately before the introduction of plain packaging in Australia, tobacco companies launched FCVs, preference for which grew to approximately 3%–4% in the two years after implementation.12 FCVs remain permitted in countries such as NZ, which began implementing standardised packaging in March 2018, where regulations define the external appearance of sticks, but do not prohibit capsules embedded within sticks.8 Failure to prohibit FCVs effectively allows tobacco companies to build brand equity and position smoking as alluring by using attractive cigarette design features.

To examine whether FCVs threaten declines in smoking uptake and potentially undermine other tobacco control policies, we examined how 18 to 25 year old NZ smokers and susceptible non-smokers responded to FCVs, and estimated the likelihood they would experiment with this new tobacco product. Following tobacco companies’ argument that their marketing aims to change market share rather than attract new smokers,28 we hypothesised that existing smokers would show greatest interest in trialling capsules. Following the same logic, we expected non-smokers to show little interest in experimenting with FCVs. Our study involved three phases: a simple choice experiment comparing FCVs with an unflavoured cigarette, estimation of flavoured cigarettes’ likely effect on trial behaviour, and measurement of how young adults perceived capsule cigarettes.

Methods

Procedure

We conducted an online panel survey of young adults aged between 18 and 25, using two NZ panel providers (Research Now and Survey Sampling International) to boost recruitment of Māori (the indigenous peoples of NZ) and Pacific respondents (the panel owners were able to avoid respondent duplication). Online panels are used increasingly in health research as internet penetration exceeds landline coverage (91.5% cf. 85.5% in NZ).29 Potentially eligible panel members received an email containing a link to the survey and were invited to follow the link, which took them to the survey site. After answering some initial screening questions (age, gender, ethnicity, smoking susceptibility),30 eligible respondents next saw an information sheet outlining the study aims and their rights as respondents. To proceed to the survey itself, potential respondents had to confirm they had read the information sheet and then actively consent to participate. An ethics reviewer with delegated authority from the University of Otago Human Ethics Committee reviewed and approved the project as a low risk study.

Sample

The sample comprised 425 current smokers and 390 susceptible non-smokers, stratified by gender and ethnicity; the survey was fielded between 20 November and 3 December 2017, using the Qualtrics Platform. Figure 1 outlines the sampling process.

Figure 1

Response flow chart.

We defined smokers as respondents who either smoked every day (daily smokers) or at least once a month but not every day (non-daily smokers). We defined susceptible non-smokers as respondents who had never smoked regularly but gave responses other than ‘Definitely would not’ or ‘Definitely will not’ when asked if they would smoke a cigarette offered to them by a friend or if they would smoke a cigarette in the next 12 months.30 In addition, we recruited former smokers, defined as respondents who used to smoke but who did not currently smoke, who we also classified as susceptible non-smokers.

Experimental design

Respondents were told that the survey would explore their views on flavour capsule cigarettes, which we described as a new type of cigarette that has a flavour capsule embedded in the filter. The questionnaire explained: ‘When you crush or squeeze this capsule while smoking the cigarette it releases a flavour, which could be menthol or another flavour.’ Respondents watched a short explanatory video about capsule cigarettes before proceeding with the survey.

The experimental choice designs differed for smokers and non-smokers to recognise the fact that price is relevant to smokers but not to non-smokers (who do not typically buy tobacco). Because including price as a variable for smokers required a more complex experimental design, we reduced the number of flavours tested with smokers, and thus the number of comparisons required and the overall survey burden.

Choice experiments

For smokers, we used an alternative-specific design that included four flavours—Menthol Blast, Rum and Coke, Fruit Burst, and Pineapple and Mango—plus an unflavoured control, and four price levels—$19.80, $22.00, $24.20 and $26.40—representing the current range of cigarette prices in NZ.31 To reduce respondent burden, we presented options in two blocks of eight pairs that each contained a test flavour-price and a control-price combination. Respondents thus viewed eight pairs of images—each with an unflavoured cigarette option and a flavour capsule option—and were asked which pack in each pair they would prefer if the options shown were those from which they had to choose (respondents could choose neither pack).

For susceptible non-smokers, we used a Youden design, which is a balanced incomplete block design in which one row or column has been removed from a Latin square.32 With a Youden square, the columns of the design matrix form a balanced incomplete block design, while the rows contain every treatment. Our experimental design involved seven sets of three options. We tested six flavoured capsule options—Menthol Blast, Rum and Coke, Fruit Burst, Pineapple and Mango , Energy Drink, and Hawaiian Mojito—plus an unflavoured control. Respondents were asked which of the three packs shown a non-smoker like them would be most likely to try, and which they would be least likely to try (technically, this was a case 1 Best Worst (BWS) experiment).32 Online supplementary file 1 contains examples of the packs smokers and susceptible non-smokers evaluated and details of both questionnaires.

All packs displayed the same health warning ‘Smoking causes lung cancer’ and we used the brand name ‘Kool’ or ‘Kool Crush/Crush Duo’ for the capsule packs. (The ‘Kool’ brand is not sold in NZ and was therefore unlikely to be recognised by NZ respondents.) We used standardised packaging to present the options as we wanted the most aversive packaging possible to provide a stringent test of capsule cigarettes’ effects. Standardised packaging has been mandatory in NZ from mid-2018 (though was not in place during the data collection period).

Behavioural likelihood experiment

Following the choice task, we asked respondents: ‘If a friend offered you a cigarette, how likely would you be to try it if it had the following flavours?’ Respondents used a slider scale that emulated the Juster Scale (an 11-point probability scale) to estimate their likelihood of trying each of the test flavours in the choice experiment (four in the case of smokers, six for non-smokers) and an unflavoured control.33

Perception measurement

We then asked respondents to rate a capsule cigarette compared with an unflavoured cigarette on nine characteristics, using a seven-point semantic differential scale. The characteristics tested included perceived harm, taste, satisfaction and pleasure (see online supplementary file 1).

After completing these tasks, smokers were asked about their current smoking behaviour, use of capsule cigarettes and quit intentions. Finally, we collected additional demographic information from all respondents.

Data analyses

For the smoker choice experiment, we used conditional logistic regression to model the appeal of each flavour relative to a defined benchmark, namely the regular flavour. Conditional logit is appropriate when the choice among alternatives is a function of the characteristics of the alternatives (in our study, the flavour and price of the cigarette), in addition to the characteristics of the individual making the choice.34 For our estimated model, Likelihood Ratio (LR) χ2, 26 df=1236.6, prob χ2=0.000. Log likelihood=−3115.9.

The choice experiment for the susceptible non-smokers asked respondents to select their most and least preferred choice from a set of three options. We thus obtained a full ranking of the alternatives in each choice set and analysed the data using rank-ordered logistic regression. This model differs from the usual logit model of qualitative choice, which considers only the most preferred alternative, with the advantage that the additional information can provide more precise estimates of the unknown parameters.35 For our estimated model, LR χ2, 14 df=562.9, prob χ2=0.000. Log likelihood=−4610.1.

To assess differences between different sociodemographic groups and their preference for flavoured versus regular cigarettes, we included the respective interactions in both models, including interactions involving the ‘neither’ choice option for smokers. For both analyses, the variables were dummy coded, and we estimated both models with Stata V.15.

To analyse the behavioural likelihood experiment and respondents’ perceptions of capsule cigarettes we used SPSS V.24 to calculate simple descriptive statistics and conduct t-tests of differences between means.

Results

Sample characteristics

Our sample comprised 815 respondents of whom 425 were smokers and 390 were susceptible non-smokers. Table 1 contains full details of the sample profile.

Table 1

Sample profile

Choice experiments

As figure 2 shows, smokers preferred a cigarette without a flavour over those containing flavours, with significantly lower preferences for all flavours except Fruit Burst (relative to the no flavour option). Figure 2 also shows that non-smokers preferred all flavours, with fruit flavours, particularly Fruit Burst, Pineapple and Mango and Hawaiian Mojito, the most popular. Online supplementary file 2 contains the full data. Predictably, smokers found lower prices significantly more attractive than higher prices, but were willing to pay more for an unflavoured cigarette compared with a flavoured option. This willingness to pay ranged from 13 cents per pack when the alternative was Fruit Burst, to $1.96 for Pineapple and Mango, to $2.84 for Rum and Coke and $2.93 for Menthol Blast.

Figure 2

Smokers’ and non-smokers’ preferences for flavour capsule cigarettes. SNS, susceptible non-smokers.

As noted, our utility function also included an interaction term for (any) flavour and sociodemographics. Among smokers, we found no differences in preference by education or ethnicity, or by heaviness of smoking, or past trial of FCVs. However, female smokers were more likely than male smokers to choose an FCV, as were those with a higher probability of quitting, but daily smokers were significantly less likely than non-daily smokers to select an FCV.

Among non-smokers, analysis of the interaction terms between (any) flavour and sociodemographics revealed that women were significantly more likely than men to prefer a flavour capsule, whereas respondents with high education were significantly less likely than respondents with low education to choose a flavour. None of the other demographic variables examined had a significant relationship with flavour preferences. Table 2 contains these findings.

Table 2

Impact of sociodemographics on preference for capsule cigarettes

Behavioural probability

The behavioural probability experiment, which asked how likely respondents would be to try a flavoured or non-flavoured cigarette offered to them, replicated the patterns shown in figure 2. Table 3 shows smokers were significantly more likely than susceptible non-smokers to accept a cigarette offered to them, regardless of whether it was flavoured or not flavoured. Non-daily smokers were more likely than daily smokers to prefer menthol flavours (and the difference for Fruit Burst flavoured capsules was borderline significant: p<0.10). Daily smokers were significantly more likely than non-daily smokers to accept an unflavoured cigarette. Former smokers and never smokers showed few differences, but never smokers were more likely than former smokers to indicate they would try a fruit flavoured cigarette (significantly so for Pineapple and Mango and Hawaiian Mojito).

Table 3

Behavioural likelihood experiment: smokers and susceptible non-smokers

Product perceptions

We used a seven-point semantic differential scale to measure respondents’ perceptions of capsule cigarettes compared to non-flavoured cigarettes. A score of 4.0 indicates no difference in perception between the two options and, for most of the characteristics tested, smokers’ and non-smokers’ mean scores were close to 4.0 (see table 4). Nevertheless, non-daily smokers, former smokers and never smokers were significantly more likely than daily smokers to perceive capsule cigarettes as having a smoother taste and to be more satisfying, more attractive, and more fun to smoke. While these differences in perception between daily smokers and other groups are relatively small, they show a consistent pattern of capsule cigarettes appealing more to those who are not regular smokers.

Table 4

Smokers’ and non-smokers’ perceptions of capsule cigarettes

Discussion

Tobacco companies have often responded to market threats by introducing product innovations, including filters and misleading descriptors such as ‘light’ and ‘mild’, which created erroneous perceptions of reduced harm, reassured concerned smokers and deterred many from quitting.36–38 However, FCVs address a quite different threat—continuing declines in smoking uptake among young people—by reducing the initial harshness of smoking and creating a more palatable experience. Even when presented in standardised packaging, FCVs effectively repositioned smoking as attractive, appealing and enjoyable, and appear likely to attract new generations of smokers.20 Tobacco companies have even anticipated further restrictions on their marketing by describing FCVs using colours that connote flavours (e.g., ruby red for berry).39

Evidence that FCVs appeal more to non-smokers and non-daily smokers than to daily smokers, adds weight to concerns that FCVs will recruit non-smokers who prefer less harsh and more enjoyable flavours than regular tobacco, and facilitate non-daily smokers’ progression to daily smoking. While smokers found all of the flavour variants tested except Fruit Burst significantly less preferable than an unflavoured option, non-smokers were significantly more likely to prefer each flavour option relative to the unflavoured option. Our results reinforce earlier studies identifying how flavoured products appeal to young adults and function as a gateway to tobacco use.20 40 41 We extend these findings by illustrating how FCVs enhance smoking’s appeal while circumventing flavour restrictions designed to reduce smoking uptake.

While tobacco companies claim cigarettes are a ‘mature’ product and that marketing only shifts market share between brands,27 28 we found smokers strongly preferred unflavoured cigarettes and were even willing to pay more for an unflavoured option. These findings reflect evidence that ‘taste’ is the most important attribute underlying smokers’ brand preferences;42 because FCVs change smoking’s taste, they are logically a less appealing option than the brand smokers normally use. By contrast, susceptible non-smokers do not have a regular brand affiliation but will likely understand that flavours could improve the initial harshness of smoking.18 20 FCVs thus offer susceptible non-smokers (and non-daily smokers) a more palatable and ‘smoother’ experience than unflavoured options would provide.

Irrespective of their preference for unflavoured cigarettes, more than half the smokers surveyed (52%–58%) would accept a flavoured cigarette, if offered to them; three-quarters would accept an unflavoured cigarette. Smokers’ willingness to smoke a cigarette they do not find as appealing as an unflavoured option may reflect two factors. First, the high price of tobacco in NZ (between $NZ1.00 and $NZ1.40/stick) may make offers of cigarettes difficult to reject. Second, smoking is a highly social activity, particularly among young adults, who report higher cigarette consumption when socialising. Norms of social smoking may over-ride taste preferences,43 particularly given smoking an FCV may be a one-off experience, after which smokers would revert to their own unflavoured brand.

Although a lower mean proportion of susceptible non-smokers were likely to try a flavoured cigarette, around one-third (28%–37%) would smoke one of the novel flavoured cigarettes, if offered to them. These estimates exceed the 24% that would smoke a regular cigarette in similar circumstances, and are consistent with evidence from Australia and Latin American countries, where FCVs’ popularity has grown, particularly among younger smokers.12 17 24 26

FCVs' appeal to young people reflects the greater palatability offered and may add a new ritualistic dimension that enhances smoking and becomes a source of pleasure in its own right.23 Finally, FCVs may create a façade of reduced risk likely to appeal to experimenting smokers, and reinforce rationalisations used to diminish the prospect of addiction.44

Our study has some limitations. First, we did not measure actual behaviour, and future research could use naturalistic methods or ecological momentary assessments to explore how FCVs contribute to smoking practices and usage settings. Second, we tested a limited range of perceptions. Further research is required to quantify erroneous reduced-harm perceptions reported in earlier studies;12 17evidence these beliefs are widespread could support policies to ban these products. Finally, we examined a limited demographic; though, as the group at greatest risk of smoking uptake, young adults are a logical group to examine.45 Nonetheless, future research could examine whether FCVs encourage smoking experimentation among younger adolescents, and assess whether they promote relapse among recent quitters.

Our study is strengthened by our use of standardised packaging to present all packs; this highly aversive packaging had not been implemented in NZ at the time of data collection and is likely to have depressed responses to each of the outcome measures. Our findings are thus conservative estimates of the effects FCVs may have on young adults in jurisdictions where standardised packaging has not been introduced. Further, the consistent findings across three different measures indicate our results have good convergent validity.

FCVs’ appeal to susceptible non-smokers raises questions about their possible role as a transition (or destination) product for non-smokers experimenting with electronic nicotine delivery systems (ENDS). Evidence that young people who experiment with ENDS are more likely to smoke combustible tobacco raises the possibility that FCVs could bridge the gap between ENDS use and smoking, potentially undermining the major reductions in youth smoking observed in many countries. The Framework Convention on Tobacco Control (FCTC) recognised this potential and recommended restricting or banning flavours that mask the ‘harshness’ of tobacco smoke on the grounds these promoted and sustained tobacco use, and made tobacco products appear attractive. Future research should examine associations between ENDS use and FCV use, and whether and how transition from ENDS to combustible tobacco occurs.

Conclusions

Tobacco companies’ ambition to realise a smoke-free world is belied by their development of FCVs, which appeal to susceptible non-smokers and non-daily smokers more than they do to daily smokers. Because FCVs appeal disproportionately to young people, policy-makers should disallow this product innovation. Countries introducing standardised packaging could do so by ensuring their policies encompass FCVs, while those not yet at this point could develop bespoke regulations to prevent FCV sales. More generally, measures restricting or banning flavours in both tobacco and inhaled smoke would align with FCTC recommendations and prevent product innovations that serve only to recruit the next generation of smokers.

What this paper adds

  • Among young adults, flavour capsule cigarette variants (FCVs) appeal more to susceptible non-smokers than to smokers, and more to non-daily smokers than to daily smokers; this evidence heightens concerns that FCVs act as a gateway to smoking experimentation and an enabler of regular smoking.

  • Neither current standardised packaging policies nor policies banning tobacco flavours disallow FCVs; this regulatory loophole has enabled tobacco companies to use FCVs to recruit new smokers and foster smoking among non-daily smokers.

  • Our findings challenge claims by tobacco companies that this tobacco product innovation appeals predominantly to smokers, and suggest that countries should ensure their tobacco control regulations prevent FCV sales.

Acknowledgments

We thank Joanna Cohen and Michelle Scollo, who kindly shared images and information that helped us formulate this study.

References

Footnotes

  • Contributors JAH conceptualised the project and obtained research funding. PG and JAH prepared the questionnaire and JL designed the choice experiments. PG oversaw the data collection. PG and CE analysed the data. JAH and PG led the manuscript development. M-LB and JFT provided feedback on the questionnaire and study design, and on the manuscript. JAH, PG and CE responded to the reviewers' comments. All authors have seen and approved the final version. JAH is guarantor of the manuscript. Authors are listed in descending order of contribution.

  • Funding This study was funded by University of Otago.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval An ethics reviewer with delegated authority from the University of Otago Human Ethics Committee reviewed and approved the project as a low-risk study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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