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Short report
Across the world availability of flavour accessories for tobacco products
  1. Anne Havermans1,
  2. Charlotte G G M Pauwels1,
  3. Ingrid M E Bakker-'t Hart1,
  4. Ranti Fayokun2,
  5. Lotte E van Nierop1,
  6. Ina M Hellmich1,3,
  7. Reinskje Talhout1
  1. 1Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
  2. 2No Tobacco Unit, World Health Organization, Geneva, Switzerland
  3. 3Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
  1. Correspondence to Dr Anne Havermans, Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, Netherlands; anne.havermans{at}rivm.nl

Abstract

Objective This study aimed to provide an inventory of different types of flavour accessories for combustible tobacco products in eight countries varying in their approaches to flavour legislation and cultural aspects, including tobacco use.

Methods A standardised search protocol was developed and shared with local informants to acquire information on the availability and marketing of flavour accessories in web shops accessible from Brazil, India, Italy, Singapore, South Africa, Switzerland, the UK and the USA. Characteristics of the products and web shops were reported, and flavours were categorised in a flavour wheel.

Results Flavour accessories were available in all participating countries. Reported types are flavour capsules, cards, filter tips and tubes for make-your-own cigarettes, drops, sprays, rolling paper, aroma markers, a flavour stone and a flavour powder. In total, 118 unique flavours were reported, which were mostly fruity and sweet. Marketing of these products was often associated with (menthol) flavour bans.

Conclusions The wide availability and variety of flavour accessories raise significant public health concerns, as they have attractive flavours, and thus hinder the regulatory aim of flavour bans. Flavour accessories are not tobacco products and thus not regulated as such. Therefore, it is recommended that policymakers include these products in comprehensive flavour bans, to close this loophole in existing tobacco control measures.

  • Advertising and Promotion
  • Public policy
  • Surveillance and monitoring
  • Tobacco industry

This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (CC BY NC 3.0 IGO), which permits use, distribution,and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article’s original URL.

https://doi.org/10.1136/tc-2023-058255

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    WHAT IS ALREADY KNOWN ON THIS SUBJECT

    • Worldwide, countries have implemented bans on flavours in tobacco products to discourage tobacco use, particularly among youth. However, the effect of flavour bans including menthol is being reduced by recent market developments.

    WHAT IMPORTANT GAPS IN KNOWLEDGE EXIST ON THIS TOPIC

    • This paper is the first to provide an inventory of different types of flavour accessories in countries in different regions of the world. These non-tobacco containing accessories are available in a wide variety of flavours and are often targeted at prior menthol cigarette smokers.

    WHAT THIS STUDY ADDS

    • Overall, the wide availability and variety of flavouring accessories raises public health concerns, since they are likely to undermine the impact of flavour bans. Our data suggest that policymakers should consider a ban on these products to close loopholes in existing regulations or the development of new flavour bans to maximise public health benefits.

    Introduction

    Flavours increase tobacco product appeal and contribute to the initiation of use, particularly among youth.1–5 To discourage tobacco product use, particularly by young people, many governments have restricted or prohibited the use of flavours in tobacco products.6 7 Brazil was the first country to approve a ban on all flavouring additives in tobacco products, in 2012,8 which, due to tobacco industry interference, remains to be implemented.9 10 Since then, the European Union banned characterising flavours other than tobacco in cigarettes, roll-your-own (RYO) tobacco and heated tobacco products (HTPs),11 12 while the USA banned characterising flavours, with the exception of menthol, in cigarettes and RYO tobacco.13 Menthol bans appear to be at least partly effective in reducing smoking prevalence.14 15 Yet, substantial numbers of menthol smokers remain after the implementation of menthol bans.16–18 This may reflect mitigation of restrictions by a variety of licit means, such as purchasing of menthol cigarettes abroad or adding menthol aromas to unflavoured cigarettes.

    Most likely as a response to flavour bans, manufacturers have marketed products that allow consumers to introduce flavours to (unflavoured) tobacco products. These ‘flavour accessories’ provide a means to circumvent the regulatory aim of flavour bans. They are generally not covered by tobacco control laws, as they do not contain nicotine or tobacco. Many types of flavouring accessories exist, including sprays, cards, capsules, filter tips, cigarette (rolling) papers and tubes for make-your-own (MYO) cigarettes.16 19–21 Note that RYO describes ‘cigarettes’ that are hand-rolled from loose tobacco, with cigarette paper (and in some cases a filter tip), while MYO refers to cigarettes made from loose tobacco inserted in a filtered tube. Several studies reported post-menthol ban use of flavour accessories by up to 21% of pre-ban menthol cigarette smokers.15 18 22 23

    This study aimed to increase awareness among governments and researchers of the existence of flavour accessories for tobacco products and their potential use to circumvent legislation and regulation. To that end, we gathered qualitative data on the availability and marketing of these products on eight online markets in various regions across the world, building on previous work on flavour accessories from the Netherlands.23

    Methods

    Search protocol

    A standardised and easy-to-perform search protocol and reporting format were developed to obtain and report information on the occurrence and marketing of flavour accessories on web shops accessible from the included countries (online supplemental file 1 and 2). The search protocol included seven sets of keywords (table 1), describing either the action of adding flavour to a tobacco product or a type of flavour accessory, based on previously identified flavour accessories on the Dutch market.23 Eight countries with different degrees of flavour regulation (table 2) participated in the study. A key criterion for the selection of countries was the availability and willingness of informants to conduct the search within the time frame of the project. Data was collected in April and May 2023.

    Supplemental material

    View this table:
    Table 1

    Seven sets of keywords that were to be entered in Google search by local informants in their own language

    View this table:
    Table 2

    Participating countries and their level of flavour regulation

    Country informants were asked to translate the keywords into their local language(s) and enter each of them in the Google search engine. Subsequently, they were instructed to visit all 10 websites on the first page of the Google search results and provide information (in English) on the web shop and the accessories sold in the reporting template. The template included questions regarding the type, brand and flavour of the accessory and marketing tactics. The authors collected and merged findings from all countries and described the identified products and their characteristics.

    Flavours

    All flavours found were characterised and presented in a flavour wheel. Following the approach previously described for e-liquids,24 25 and waterpipe tobacco products,26 primary and secondary flavour descriptors were distinguished. Primary flavour descriptors are those associated with a particular product as a whole (eg, ‘fruit salad’ or ‘bubble gum’) and were classified into one of the 16 main categories (inner wheel) and in one of the subcategories (outer wheel). Thus, accessories with ‘fruit salad’ as the primary flavour descriptor were classified in the main fruit (other) category and in the mixed fruit subcategory. When the flavour description did not relate to a product as a whole, but contained several separate attributes (eg, strawberry, menthol and kiwi), the first flavour mentioned was considered the primary flavour descriptor (strawberry) and any other attributes were secondary flavour descriptors (menthol and kiwi). Secondary descriptors, if present, were classified into a subcategory only (outer wheel). Flavours were identified based on products’ flavour description (eg, coconut, lime, rum), product name (eg, That Coconut Stuff) and, if needed, images displayed on the retailers’ websites. For 27 products, additional flavour information was searched for online. Three remained unclassified. Other products that could not be classified were ‘mixed flavour’ packages containing a variety of flavoured capsules. Reported flavours in each country were visualised in a table.

    Results

    Reported flavour accessories

    All participating countries reported a range of flavour accessories on their markets, regardless of their different levels of tobacco product flavour regulation (table 2). Reported product types are flavour capsules, cards, filter tips and tubes for MYO cigarettes, drops, sprays, rolling paper, aroma markers, a flavour stone and a flavour powder (figure 1). Flavour capsules followed by cards and filter tips were reported most frequently and in all countries (with the exception of cards in one country). Drops and sprays were reported in five and four out of eight countries, respectively. Rarely reported product types were rolling paper, aroma markers, a flavour stone and flavour powder. The number of unique brands and manufacturers reported per product type decreased in the same order, with most brands and manufacturers reported for flavour capsules and only a single brand reported for aroma markers, the flavour stone and flavour powder. Four out of the 66 reported manufacturers are also manufacturers of tobacco products (ie, Bull Brand, Dark Horse, Gawith Hoggarth and Imperial Tobacco). All reported products, brands and manufacturers are listed in online supplemental file 3.

    Figure 1
    Figure 1

    Different types of flavour accessories identified on the internet. Some are meant to flavour individual products (A, C, E, F, G), whereas others are designed to flavour a product batch (B, D, H, I). (A) Click capsules/beads/balls: Liquid-filled beads, a few millimetres in size, that can be inserted into a cigarette filter or separate filter tip or tube used for roll-your-own (RYO) or make-your-own (MYO) cigarettes. When pressed, the bead ‘pops’ and releases its liquid into the filter40 (B) Card: Flavour infused card, shaped like a credit card, to be inserted into a cigarette pack.41 (C) Filter tip: Flavoured filter tip that can be used with RYO tobacco or in a filter tube used for MYO cigarettes.42 (D) Spray: Liquid applied by spraying onto, for example, loose tobacco.43 (E) Drops: Liquid that can be dripped onto the cigarette filter by means of a dispenser bottle.44 (F) Filter tube/rolling paper: Paper tube used for making an MYO cigarette, or rolling paper used for making an RYO cigarette.45 (G) Marker: Marker which releases a flavoured liquid. Can be applied by drawing a line across the side of a cigarette, or by pressing the tip into the end of the filter.46 (H) Stone/stick: A porous stone-like stick, with dimensions comparable to a cigarette, that can be inserted into a cigarette pack.47 (I) Powder: A flavour powder that can be added to loose tobacco.48

    Available flavours

    Over all countries and products, 118 unique flavours were reported, as shown in the outer ring of the wheel (figure 2). These were mostly sweet flavours, including fruit, alcohol, other beverages, candy, dessert and other sweets. Eight flavours, classified as ‘other flavours’, could not be classified into the other 15 main categories. These contain plant-based flavours such as green bean paste and fennel, as well as fungus flavours such as cordyceps and ganoderma. The range of reported flavours varied between products, with flavour capsules being available in a particularly wide range of sweet and fruity flavours; filter tips, flavour sprays, rolling papers and aroma markers having mostly menthol and a smaller range of fruit flavours; and flavour drops and flavour capsules contained in a cigarette filter mostly having menthol flavours and the powder having a chicory flavour. Menthol/mint and fruit flavours were reported in all countries, while nuts, dessert and tobacco flavours were only identified in a few countries (figure 3).

    Figure 2
    Figure 2

    Flavour wheel showing the 118 unique flavours found in flavour accessories (outer ring) classified into 13 main categories (inner ring).

    Figure 3
    Figure 3

    Overview of flavour accessory flavours in eight countries. Coloured bars represent the number of times flavours in each of the main categories of the flavour wheel were reported, per country. The longer the bar, the more frequently this type of flavour was reported.

    Marketing

    In many cases, target users, mostly smokers and sometimes menthol smokers, were mentioned explicitly on the website promoting the accessory. In two cases, local informants reported that youth were explicitly mentioned as a target group. Websites often contained colourful images of the products and flavours they came in. Some websites had a professional and sleek design or showed positive customer reviews and/or high ratings (eg, five stars). A (menthol) flavour ban was mentioned on the website for many of the products reported in the UK, but not or rarely for products in other countries (with data on this topic lacking for Italy). Websites also often reported (practical) advantages of using these products, such as having the opportunity to choose when to enjoy flavoured smoke, adjustable flavour strength, the variety of flavours available and ease of use. In some cases, special price offers were reported, including two types of gift sets.27 28

    Discussion

    Our study shows the variety of flavour accessory types and flavours available in eight countries from diverse global regions. Moreover, the website mining sheds some light on target groups and marketing tactics. The findings are in line with data previously reported in the Netherlands.23

    Variety of available product types and flavours

    We found that flavour capsules, cards and filter tips together account for the largest share of flavour accessories that are marketed on websites. If demand follows the patterns of supply, it is likely that these products would also be the most used products. However, we did not study the prevalence of use and more research on this topic is needed. Flavour drops and sprays were reported in lower numbers, potentially because the resulting flavour strength and distribution throughout the product when using these is less predictable than when using filter tips, capsules or cards, making the latter products more attractive and more likely to be marketed. Previous studies confirm that flavour capsules are an attractive design feature, especially for adolescents and young adults.29–32 An alternative explanation for the lower numbers of drops and sprays is that these accessories are intended for use with loose tobacco for RYO or MYO which are less prevalent forms of tobacco use.

    Overall, 118 unique flavours were identified and visualised in a flavour wheel, most of which were fruity or sweet. This is similar to previously published flavour wheels of e-liquids,24 25 waterpipe tobacco26 and cigarillos.33 Surprisingly, seven different tobacco flavours were reported, which seems odd for products meant to flavour tobacco products. These included flavour sprays and capsules. One website reports that their spray is intended for homegrown tobacco.34 This product seems similar to tobacco casings, used to balance the flavour of tobacco products. Flavour combinations of menthol and a fruity or sweet flavour (eg, mint and berry) seem to be increasingly popular. Yet, combined flavours are not reflected as a separate category in the flavour wheel. Future studies may consider adapting our approach to better reflect the range and types of flavours offered.

    Menthol was the most reported flavour across product types and countries. This is in line with mentholated cigarettes historically being a popular product category, indicating that many smokers enjoy menthol flavour in their cigarettes. Accessories with menthol or fruit flavours were reported in all countries. Flavours reported more rarely are tobacco (two countries), dessert (one) and nuts (one). The low number of nut flavours is in line with previous findings for e-liquids, waterpipe tobacco and cigarillo’s,24 26 33 indicating that nuts may not be a popular flavour for tobacco and tobacco-related products. The low number of dessert flavours reported is in line with the waterpipe and cigarillo flavour wheels, but different from the e-liquid flavour wheel, where this was a large category.24 They seem to be particularly targeted at the e-cigarette market and may not taste well with tobacco.

    Marketing tactics

    Flavour accessories were mostly marketed to smokers, and in some cases to menthol smokers specifically. Some websites explicitly mentioned a (menthol) flavour ban, which makes it seem that flavour accessories are being promoted as a way to maintain use of mentholated cigarettes after implementation of such a ban. Websites were made to look attractive with colours and sleek designs and often showcased advantages of the promoted flavour accessory. Indeed, colours and flavours are known to appeal to youth and play an important role in the initiation of tobacco and related product use.3 4 32 It should also be noted that social media plays a significant role in marketing of tobacco and nicotine products35 and while it was not the focus of our study, we recommend future studies on marketing of flavour accessories to include this source.

    Strengths and limitations

    Our study is the first across-country inventory of flavour accessory types, elucidating the occurrence of accessories in different types of markets worldwide with respect to tobacco regulation and cultural preferences.

    It is important to note that data were collected online, by one informant per country, at one moment in time, and thus represent a momentary snapshot of the accessible internet markets in that country on that day. The search strategy was executed by eight different local informants. Although they received the same instructions, we cannot be certain that they all proceeded consistently and it is likely that there are differences in interpretation and comprehensiveness. Therefore, the overview likely gives an underestimation of the markets and should be interpreted as products that were minimally on the market in these countries at the time of data collection. Due to the differences in reporting between countries, it is not possible to interpret quantitative differences, such as comparing the size of the different markets. Overall, the collected data suffice to conclude that a large variety of different products, in an abundance of flavours, are available in countries from all global regions.

    Regulatory implications

    This study reported sales of flavour accessories in countries with and without flavour bans. This suggests that these products are not only ways of undermining bans, but are complementary to flavour sales in unregulated markets, potentially in anticipation of future flavour bans. This inventory is a first step, and more rigorous surveillance is needed going forward, including comparisons pre- to post-flavour ban implementation.

    The development and marketing of flavour accessories counteract the intended regulatory impact of flavour bans, which is decreasing tobacco product appeal and initiation of tobacco product use, particularly among youth. Therefore we recommend policymakers to consider banning flavour accessories as part of comprehensive flavour bans on tobacco products, to maximise the effect of such bans. Whether this means implementing new bans or expanding current bans, it is imperative that definitions are broad enough to capture non-tobacco and non-nicotine products such as flavour accessories. Prohibiting products that do not contain nicotine or tobacco is challenging and there is a risk that some flavour accessories will remain on the market, promoted for other intended purposes such as food flavouring. Yet, regulators have the possibility to implement stricter policies to reduce the variety of products and flavours available. For example, they could ban flavoured products designed for use with tobacco products, such as flavour capsules and filters. Moreover, regulating marketing and promotion, both in brick-and-mortar stores and online, may reduce awareness and use of flavour accessories. For example, by prohibiting the marketing of flavour accessories as means to flavour tobacco products, or by banning the display and/or sales of these products in places where tobacco products are sold.

    Finally, as flavours are known to lower harm perception,36–38 (potential) consumers should be made aware that the use of flavour accessories will not reduce the risks of tobacco consumption and may even increase health risks, by exposing users to the toxicological impact of inhaling flavourings.39 Regulators should also be aware that any public communication on new tobacco and related products, may unintentionally accelerate their awareness and use.

    While this study focused on flavour accessories for tobacco products, it is likely that there are similar issues with e-cigarettes and other newer tobacco and nicotine products. Flavour bans for those products should therefore also prohibit after-market flavour accessories.

    Conclusions

    In an online study in eight countries, a wide range of flavour accessories for tobacco products were identified. Overall, 118 unique flavours were reported, which were mostly fruity and sweet. Menthol flavours were most frequently reported across products and countries. Overall, the wide availability and variety of flavour accessories raise significant public health concerns as they increase the attractiveness of tobacco products and hinder the regulatory aim of flavour bans. Therefore, it is recommended that policymakers include these post-market products in new comprehensive flavour bans to close the loophole in existing laws and regulations. Moreover, marketing, promotion, and points of sales of flavour accessories could be restricted to support tobacco control policies.

    Ethics statements

    Patient consent for publication

    Ethics approval

    Not applicable.

    Acknowledgments

    This work has partly been reported in WHO’s report on flavour accessories and WHO’s information sheet on flavour accessories. We would like to thank Dr Yvonne Staal and Dr Peter Keizers for their critical assessment of the draft manuscript. We would like to also express our thanks to the other reviewers, including Professor Stan Glantz, Dr Suchitra Krishnan-Sarin, Dr David Ashley, Mr Thomas Wenzl and Professor Ivan Berlin. We also wish to express our gratitude to all local informants who collected data for this study; Dr Andre Oliveira da Silva, Dr Garima Bhatt, Dr Nuan Ping Cheah, Dr Enrico Davoli, Dr Filippos Filippidis, Ms Christina Kyriakos, Dr Shannon Kozlovich, Ms Zanele Mthembu, Dr Luciano Ruggia and Mr Kris Schürch.

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    Footnotes

    • Contributors The authors confirm contribution to the paper as follows: study conception and design: AH, IBH, RF, RT; data collection: LVN, RF and local informants credited in acknowledgements; analysis and interpretation of results: AH, CGGMP, IMH; draft manuscript preparation: AH, CGGMP, IMH, RT. All authors reviewed the results and approved the final version of the manuscript.

    • Funding Funding for this publication was made possible, in part, by the Food and Drug Administration through grant U18FD006317. Views expressed in written materials or publications do not necessarily reflect the official policies of the Department of Health and Human Services; nor does any mention of trade names, commercial practices or organisation imply endorsement by the US Government, the WHO and the Dutch Ministry of Health Welfare and Sport.

    • Disclaimer The author is a staff member of the World Health Organization. The author alone is responsible for the views expressed in this publication and they do not necessarily represent the views, decisions or policies of the World Health Organization.

    • Competing interests No, there are no competing interests.

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

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.