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Another day, another tobacco company’s devious behaviour: cutout health warning labels on Indonesian cigarette packs
  1. Beladenta Amalia1,
  2. Natalie Nguyen1,
  3. Kevin Welding1,
  4. Katherine Clegg Smith2,
  5. Joanna E Cohen1
  1. 1Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  2. 2Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Beladenta Amalia, Institute for Global Tobacco Control, Johns Hopkins University, Baltimore, MD 21205, USA; beladenta24{at}

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The tobacco industry has responded to increasingly restrictive marketing environments for their harmful products with a continued focus on appealing packaging. In countries where plain and standardised packaging is not mandated, tobacco packs routinely feature characterising flavours and concept descriptors,1 2 bright colours, misleading descriptors,3–5 and cultural,6 7 feminine,8 sporty,9 and youth10 appeals—each of which might distract or detract from health warning labels (HWLs).

Following the protocol of the Tobacco Pack Surveillance System,11 our recent (September 2022) systematic collection of tobacco packs in Indonesia uncovered a concerning practice of a tobacco company altering the HWLs on cigarette packs to reduce the coverage, increase the branding space and potentially undermine HWL effectiveness. In this collection, we found four unique cigarette packs with a cutout on the front HWL area that appeared decorative (figure 1). These packs also had ‘Espresso’ and ‘Caffe Latte’ flavour descriptors (figure 1A, B, C, and D) and attractive colours, such as gold, yellow (figure 1A, B, C, and D), silver and ‘starry’ blue (figure 1E and F).

Figure 1

Cutout front pictorial health warnings of Indonesian cigarette packs with one (A) resembles a bow tie, and two (B and D) have the brand’s slogans written on the folded flip-top (red circled). Another pack with a slogan is not shown and available upon request. Also present on these packs: ‘Espresso’ and ‘Caffe Latte’ flavour descriptors (A-D) and attractive colours, such as gold, yellow (A-D), silver and ‘starry’ blue (E, F).

Inside three packs featuring Chinese characters, we observed the text ‘Prosperity’, ‘Wisdom’ and ‘Longevity’ under the flip-top and next to the hidden parts of the HWL (figure 1B and D). In one instance, the missing HWL area resembles a bow tie on an image of a man with throat cancer (figure 1A). The observed text resulting from the HWL fold may indicate intentionality in HWL cutouts as they use the space to display the slogans in the interior.

The combination of the colours, flavour descriptors, Chinese characters and decorative cutouts on the packs may appeal to different groups of people. Colours and flavour names on cigarette packaging could increase the appeal and promote smoking among youth and young adults.10 12 In Chinese culture, the three slogans ‘Prosperity’, ‘Wisdom’ and ‘Longevity’ are commonly used to express good wishes, and when used together, they represent the presence of three Gods: Fú (福) for fortune, Lù (禄) for prosperity and Shòu (寿) for longevity.13 Due to the significant influence of Chinese culture and the high presence of the Chinese Indonesian ethnic group in many Indonesian provinces,14 the Chinese characters and slogans on the cigarette packs may appeal to Indonesian consumers, particularly Chinese Indonesians, as symbols of aspiration and wisdom.

Although all the packs had in-rotation HWLs and tax stamps, this practice of cutouts renders the packs not compliant with Indonesia’s HWL regulation that mandates a 40% coverage of the front and back of the pack.15 Our measurement of the altered HWLs of the four cigarette packs showed a sizeable reduction of the HWL coverage resulting from the cutouts, making them fall well below the regulatory requirement. The discovery of this devious practice likely reduces the effectiveness of the HWLs in conveying key health information to consumers.16

These packs are manufactured by PT. Sumatra Tobacco Trading Company (PT. STTC), a national company based in Pematang Siantar, Indonesia, that is known for its non-clove (‘white’) cigarette brands, such as Marcopolo, Union and Kennedy, which we also collected. Although not a key player in Indonesia, where the market is dominated by clove-mixed cigarettes and is highly concentrated in the top three companies (ie, Gudang Garam, Philip Morris International/HM. Sampoerna and Djarum), PT. STTC has exported its products to South-East Asia, China, the USA, Russia, Middle East and South America.17–19 Despite not being an industry-wide phenomenon in Indonesia at this time, this paper is the first to report this type of HWL manipulation. If this is left unenforced, this may set a negative precedent for tobacco companies to disregard the law without penalty.

The tobacco industry undermines tobacco control policy when it is not comprehensive, including tobacco packaging. For example, in response to the newly imposed packaging restrictions, tobacco companies introduced voluntary warnings in a foreign language (English) that deterred the implementation of stronger government-mandated HWLs in local languages, expanded brand variant names (eg, ‘Dunhill Premier Red’ on plain packaging that was once ‘Dunhill Premier’ packaged in red) and introduced a ‘transitional’ packaging, where the original graphical brand elements were printed on cellophane, in a country that bans misleading descriptors.20–22

The inclusion of an explicit prohibition of any kind of manipulation or alteration to the HWL is warranted in future legislation, including in the current proposal to increase Indonesia’s HWL size. It is crucial that these regulatory measures are strongly enforced to send a clear message to tobacco companies that such practices are unacceptable and will not be tolerated.

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  • Twitter @beladenta

  • Contributors KCS and JEC conceived the study. BA and NN conducted the analyses. BA wrote the first draft of the article. All authors contributed to the writing and editing of the manuscript.

  • Competing interests None declared.

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