Cultural appropriation on Marlboro packs in Mexico: ofrenda symbolism a cruel irony =================================================================================== * Graziele Grilo * Joanna E Cohen * Luz Myriam Reynales-Shigematsu * Kevin Welding * Maria Guadalupe Flores Escartin * Alena Madar * Katherine Clegg Smith * advertising and promotion * low/middle income country * packaging and labelling * tobacco industry * surveillance and monitoring It has been previously documented that the tobacco industry exploits culturally significant symbols in its marketing practices. A 2009 *Tobacco Control* editorial showed how the tobacco industry, through advertising and corporate social responsibility activities, associates tobacco products with religious figures, health professionals, national landmarks and more, ‘propelling us toward a world where nothing matters more than profit for its own sake’.1 We recently found blatant examples of cultural appropriation on cigarette packs in Mexico (see figures 1 and 2). ![Figure 1](http://tobaccocontrol.bmj.com/https://tobaccocontrol.bmj.com/content/tobaccocontrol/32/6/806/F1.medium.gif) [Figure 1](http://tobaccocontrol.bmj.com/content/32/6/806/F1) Figure 1 Marlboro packs with the Mexican flag colours at the bottom. When opened, packs read ‘Throw the butts in the trash’ (*tira las colillas al bote*). Images are available for public access on the Tobacco Pack Surveillance System (TPackSS) website ([https://globaltobaccocontrol.org/tpackss/](https://globaltobaccocontrol.org/tpackss/)). ![Figure 2](http://tobaccocontrol.bmj.com/https://tobaccocontrol.bmj.com/content/tobaccocontrol/32/6/806/F2.medium.gif) [Figure 2](http://tobaccocontrol.bmj.com/content/32/6/806/F2) Figure 2 Metallic box with a cigarette pack inside. When opened, it is possible to read: ‘Long Live Mexico September 2021’ (*Viva México Septiembre 2021*) and ‘Mexico always clean – You can use this box as an ashtray’ (*México siempre limpio. Puedes usar esta lata como un cenicero*). Images are available for public access on the Tobacco Pack Surveillance System (TPackSS) website ([https://globaltobaccocontrol.org/tpackss/](https://globaltobaccocontrol.org/tpackss/)). Since 2013, the Tobacco Pack Surveillance System has systematically collected tobacco packs in low-income and middle-income countries to monitor health warning label compliance and assess design features and marketing appeals on packs.2 In October–November 2021, we returned to Mexico for a second wave of data collection. During this period, we noticed that several Marlboro packs emphasised Mexican cultural symbolism in their marketing. On 16 September, Mexico celebrates its Independence Day (*fiestas patrias*),3 a festivity filled with traditional food and decorations using the colours of the Mexican flag (green, white and red). Subsequently, on 1 and 2 November, the country celebrates the Day of the Dead (*día de los muertos*),4 in which families honour their deceased relatives by building altars (*ofrendas*) with food, pictures and other offerings. Both holidays are colourful and full of decoration, including cut-out tissue paper (*papel picado),* such as the flags that can be seen on the Marlboro packs, also used to decorate the altars. Of note is the fact that the flags on the packs were blended with the Marlboro chevron, and the colours of the Mexican flag appear at the bottom of the packs. Additionally, it is worthwhile noting that some of these packs were promotional items, being sold as a metallic box that could serve as an ashtray or a collectible item. Also of concern was the fact that the metallic boxes were sold for the same price as the non-promotional Marlboro packs, potentially enticing smokers to buy and collect all the different designs. Despite much progress in tobacco control in Mexico, especially in the years following the implementation of the 2008 General Law on Tobacco Control, which included key tobacco control policies, smoking prevalence has stagnated over the past decade.5 6 Strong tobacco industry interference, weak enforcement and lack of stronger policies in subsequent years are some of the reasons for the lack of reduction in smoking prevalence.5 Moreover, 43% of Mexican smokers use flavour capsule cigarettes7 just like four out of the five packs in the figures. Since the introduction of flavour capsule cigarettes in 2007, this market has rapidly risen globally8 and particularly in Latin America.9 Flavour capsule cigarettes contain a liquid-filled gelatin capsule inside the filter that the user can crush at any time to release a flavour. In Mexico, it is also worthwhile noting that flavour capsule cigarettes are available in the discount market,10 including international brands such as Pall Mall, with most variants being flavour capsule cigarettes,11 which could help explain why smoking prevalence has stagnated. The tobacco industry remains a major obstacle to the implementation of stronger tobacco control policies in Mexico.5 Besides the appropriation of important Mexican culture imagery, the tobacco industry lobbies Congress and other government institutions against strong tobacco control measures. Despite the tobacco industry’s historical efforts of trying to be seen as being part of the solution to the tobacco epidemic, it continues to innovate its products, including packaging design, in order to maintain and grow its consumer base. Moreover, the industry persists in exploiting loopholes in tobacco advertising, promotion and sponsorship (TAPS) regulations by using the pack as a key communication platform with consumers, including at the point of sale. Legislators in Mexico passed a bill on 14 December 2021, establishing 100% smoke-free and emission-free environments and a comprehensive TAPS ban.12 However, tobacco product displays were not included in the ban. Considering the extensive evidence around plain packaging as a way to reduce the appeal of tobacco products,13–15 including among youth,16–19 Mexico should consider plain and standardised packaging to decrease the appeal of cigarette packs such as those documented here. To further curb tobacco industry innovation, Mexico should also consider banning flavours from tobacco products. ## Ethics statements ### Patient consent for publication Not applicable. ### Ethics approval This study does not involve human participants. ## Footnotes * Contributors GG was the primary writer of the manuscript. All authors contributed to revising the manuscript critically for important intellectual content. All authors approved the final version of the manuscript. * Funding This work was supported by funding from Bloomberg Philanthropies' Bloomberg Initiative to Reduce Tobacco Use (bloomberg.org) (47580). * Competing interests None declared. * Provenance and peer review Not commissioned; externally peer reviewed. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: [http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/). ## References 1. Malone RE . On tobacco industry cultural appropriation. Tob Control 2009;18:425–6.[doi:10.1136/tc.2009.034488](http://dx.doi.org/10.1136/tc.2009.034488) pmid:http://www.ncbi.nlm.nih.gov/pubmed/19955535 [FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjE4LzYvNDI1IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 2. Smith K , Washington C , Brown J , et al . The tobacco pack surveillance system: a protocol for assessing health warning compliance, design features, and appeals of tobacco packs sold in low- and middle-income countries. JMIR Public Health Surveill 2015;1:e4616:e8.[doi:10.2196/publichealth.4616](http://dx.doi.org/10.2196/publichealth.4616) pmid:http://www.ncbi.nlm.nih.gov/pubmed/27227142 [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Ftobaccocontrol%2F32%2F6%2F806.atom) 3. Gobierno del Estado de México. Fiestas patrias en México. Available: [https://edomex.gob.mx/septiembre\_2021](https://edomex.gob.mx/septiembre_2021) [Accessed 16 Nov 2021]. 4. History. Day of the dead (día de los muertos), 2018. Available: [https://www.history.com/topics/halloween/day-of-the-dead](https://www.history.com/topics/halloween/day-of-the-dead) [Accessed 16 Nov 2021]. 5. Reynales-Shigematsu LM , Wipfli H , Samet J , et al . Tobacco control in Mexico: a decade of progress and challenges. Salud Publica Mex 2019;61:292–302.[doi:10.21149/9360](http://dx.doi.org/10.21149/9360) pmid:http://www.ncbi.nlm.nih.gov/pubmed/31276348 [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=http://www.n&link_type=MED&atom=%2Ftobaccocontrol%2F32%2F6%2F806.atom) 6. Zavala-Arciniega L , Reynales-Shigematsu LM , Levy DT , et al . Smoking trends in Mexico, 2002-2016: before and after the ratification of the WHO’s framework convention on tobacco control. Tob Control 2020;29:687–91.[doi:10.1136/tobaccocontrol-2019-055153](http://dx.doi.org/10.1136/tobaccocontrol-2019-055153) pmid:http://www.ncbi.nlm.nih.gov/pubmed/32019893 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjI5LzYvNjg3IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 7. Zavala-Arciniega L , Gutiérrez-Torres DS , Reynales-Shigematsu LM . Cigarros con cápsulas de sabor en México: prevalencia, proporción de uso entre fumadores Y predictores de consumo. Ensanut 2018-19. Salud pública Méx 2020;62:820–8. 8. Moodie C , Thrasher JF , Cho YJ , et al . Flavour capsule cigarettes continue to experience strong global growth. Tob Control 2019;28:595–6.[doi:10.1136/tobaccocontrol-2018-054711](http://dx.doi.org/10.1136/tobaccocontrol-2018-054711) pmid:http://www.ncbi.nlm.nih.gov/pubmed/30368482 [FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjI4LzUvNTk1IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 9. Thrasher JF , Islam F , Barnoya J , et al . Market share for flavour capsule cigarettes is quickly growing, especially in Latin America. Tob Control 2017;26:468–70.[doi:10.1136/tobaccocontrol-2016-053030](http://dx.doi.org/10.1136/tobaccocontrol-2016-053030) pmid:http://www.ncbi.nlm.nih.gov/pubmed/27329114 [FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiRlVMTCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjI2LzQvNDY4IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 10. Thrasher JF , Abad-Vivero EN , Moodie C , et al . Cigarette brands with flavour capsules in the filter: trends in use and brand perceptions among smokers in the USA, Mexico and Australia, 2012-2014. Tob Control 2016;25:275–83.[doi:10.1136/tobaccocontrol-2014-052064](http://dx.doi.org/10.1136/tobaccocontrol-2014-052064) pmid:http://www.ncbi.nlm.nih.gov/pubmed/25918129 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjI1LzMvMjc1IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 11. Gutiérrez-Torres DS , Saenz de Miera Juarez B , Reynales-Shigematsu LM , et al . Trends in cigarette brand preference among Mexican smokers: the rise of Pall Mall. Tob Control 2021;30:305–11.[doi:10.1136/tobaccocontrol-2019-055450](http://dx.doi.org/10.1136/tobaccocontrol-2019-055450) pmid:http://www.ncbi.nlm.nih.gov/pubmed/32381679 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjMwLzMvMzA1IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 12. Organizacion Panamericana de la Salud. La reforma a la Ley General de Control de Tabaco en México implementa ambientes 100% libres de humo de tabaco y emisiones, 2021. Available: [https://www.paho.org/es/noticias/17-12-2021-reforma-ley-general-control-tabaco-mexico-implementa-ambientes-100-libres-humo](https://www.paho.org/es/noticias/17-12-2021-reforma-ley-general-control-tabaco-mexico-implementa-ambientes-100-libres-humo) [Accessed 12 Jan 2021]. 13. Wakefield MA , Germain D , Durkin SJ . How does increasingly plainer cigarette packaging influence adult smokers' perceptions about brand image? an experimental study. Tob Control 2008;17:416–21.[doi:10.1136/tc.2008.026732](http://dx.doi.org/10.1136/tc.2008.026732) pmid:http://www.ncbi.nlm.nih.gov/pubmed/18827035 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjE3LzYvNDE2IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 14. Gallopel-Morvan K , Moodie C , Hammond D , et al . Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging. Tob Control 2012;21:502–6.[doi:10.1136/tobaccocontrol-2011-050079](http://dx.doi.org/10.1136/tobaccocontrol-2011-050079) pmid:http://www.ncbi.nlm.nih.gov/pubmed/21998127 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjg6IjIxLzUvNTAyIjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 15. Leas EC , Pierce JP , Dimofte CV , et al . Standardised cigarette packaging may reduce the implied safety of natural American spirit cigarettes. Tob Control 2018;27:e118–23.[doi:10.1136/tobaccocontrol-2017-053940](http://dx.doi.org/10.1136/tobaccocontrol-2017-053940) pmid:http://www.ncbi.nlm.nih.gov/pubmed/29255011 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjEwOiIyNy9lMi9lMTE4IjtzOjQ6ImF0b20iO3M6Mjk6Ii90b2JhY2NvY29udHJvbC8zMi82LzgwNi5hdG9tIjt9czo4OiJmcmFnbWVudCI7czowOiIiO30=) 16. Germain D , Wakefield MA , Durkin SJ . Adolescents' perceptions of cigarette brand image: does plain packaging make a difference? J Adolesc Health 2010;46:385–92.[doi:10.1016/j.jadohealth.2009.08.009](http://dx.doi.org/10.1016/j.jadohealth.2009.08.009) pmid:http://www.ncbi.nlm.nih.gov/pubmed/20307829 [CrossRef](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=10.1016/j.jadohealth.2009.08.009&link_type=DOI) [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=20307829&link_type=MED&atom=%2Ftobaccocontrol%2F32%2F6%2F806.atom) [Web of Science](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=000275784700013&link_type=ISI) 17. Hammond D , Daniel S , White CM . The effect of cigarette branding and plain packaging on female youth in the United Kingdom. J Adolesc Health 2013;52:151–7.[doi:10.1016/j.jadohealth.2012.06.003](http://dx.doi.org/10.1016/j.jadohealth.2012.06.003) pmid:http://www.ncbi.nlm.nih.gov/pubmed/23332478 [CrossRef](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=10.1016/j.jadohealth.2012.06.003&link_type=DOI) [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=23332478&link_type=MED&atom=%2Ftobaccocontrol%2F32%2F6%2F806.atom) [Web of Science](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=000313560100004&link_type=ISI) 18. Hammond D , White C , Anderson W , et al . The perceptions of UK youth of branded and standardized, 'plain' cigarette packaging. Eur J Public Health 2014;24:537–43.[doi:10.1093/eurpub/ckt142](http://dx.doi.org/10.1093/eurpub/ckt142) pmid:http://www.ncbi.nlm.nih.gov/pubmed/24108274 [CrossRef](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=10.1093/eurpub/ckt142&link_type=DOI) [PubMed](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=24108274&link_type=MED&atom=%2Ftobaccocontrol%2F32%2F6%2F806.atom) [Web of Science](http://tobaccocontrol.bmj.com/lookup/external-ref?access_num=000339908200005&link_type=ISI) 19. White V , Williams T , Wakefield M . Has the introduction of plain packaging with larger graphic health warnings changed adolescents' perceptions of cigarette packs and brands? Tob Control 2015;24:ii42–9.[doi:10.1136/tobaccocontrol-2014-052084](http://dx.doi.org/10.1136/tobaccocontrol-2014-052084) pmid:http://www.ncbi.nlm.nih.gov/pubmed/28407611 [Abstract/FREE Full Text](http://tobaccocontrol.bmj.com/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6MTQ6InRvYmFjY29jb250cm9sIjtzOjU6InJlc2lkIjtzOjE1OiIyNC9TdXBwbF8yL2lpNDIiO3M6NDoiYXRvbSI7czoyOToiL3RvYmFjY29jb250cm9sLzMyLzYvODA2LmF0b20iO31zOjg6ImZyYWdtZW50IjtzOjA6IiI7fQ==)