• 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).

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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/).

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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/).

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.