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Tobacco companies’ creation of additional communication space: a content analysis of cigarette pack inserts and onserts
  1. Torra E Spillane1,2,
  2. Alena Madar3,
  3. Joanna E Cohen3,
  4. Kevin Welding3,
  5. Katherine Clegg Smith3
  1. 1Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
  3. 3Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Torra E Spillane, HBS, Johns Hopkins University Bloomberg School of Public Health, Baltimore, 21205, MD, USA; tes2137{at}


Objectives Pack inserts and onserts—removable items placed inside or on the outside of packs—are a communicative strategy used by tobacco companies that provide them with additional marketing space. A content analysis of these items was conducted across several years, countries and brands to assess how these items are used to communicate with consumers.

Methods Between 2013 and 2020, cigarette packs were systematically collected using the Tobacco Pack Surveillance System protocol. Packs with inserts or onserts (n=178) were identified from 11 low and middle-income countries. Packs were coded for tobacco company strategies, physical pack characteristics and imagery and lexical marketing appeals.

Results Of the 5903 packs, 3% (n=178) had an insert or onsert. 171 of these (96%) were inserts. While most (78%) pack exteriors were entirely in English, over half (51%) of the inserts/onserts were entirely in the local (non-English) language from where the pack was collected. The most common appeals on the inserts/onserts were product dependability (64%), luxury/aspirational (55%) and machinery/technology (37%). Product images were prevalent as well as images or words mentioning filters (22%). The most used appeals involved featuring aspects of a product (66%), addressing customers directly (52%) and informing customers about new aspects of a product (31%).

Conclusions Cigarette pack inserts/onserts are unregulated in many countries and provide additional space for tobacco companies to extend and innovate their advertising. Tobacco advertising and packaging policies such as plain and standardised packaging should expand to address inserts/onserts to protect consumers more fully from industry promotion of deadly products.

  • Advertising and Promotion
  • Tobacco industry
  • Packaging and Labelling

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  • Contributors JEC, KW and KCS conceived the study and oversaw coding and analysis. TES and AM coded the inserts and onserts. All authors reviewed the coding progress and discussed discrepancies. TES drafted the manuscript. All authors contributed to revising the report critically for important intellectual content and approved the final version.

  • Funding This work was supported by Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use.

  • Competing interests None declared.

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