If the government is serious about particularly curbing teenage smoking and vaping — or the use of electronic cigarettes or electronic nicotine delivery systems (ENDS) — then it should start regulating the efforts of cigarette and vape producers to introduce more flavors and make their products more appealing to the younger market.
It is bad enough that a recent observational study by the Institute for Global Tobacco Control (IGTC) found “that tobacco and nicotine product sale and advertising persist within proximity of schools in the Philippines, despite regulations prohibiting sales, displays, advertisements, and promotions of tobacco products within 100 meters.”
But another study by IGTC published recently also found that countries like the Philippines and Vietnam also lacked laws to regulate the use of different “flavors” in the production and sale of cigarettes and other tobacco products. Of course, the concern is that the use of flavors, perhaps to make nicotine delivery more palatable, is also making tobacco products more youth-friendly.
“Tobacco product flavors can increase product appeal, adolescent initiation and experimentation, and difficulty quitting. Flavored tobacco products are not restricted in Vietnam or the Philippines despite the high smoking prevalence among those 15 years of age and older (24% and 23%, respectively). There are no published reports to our knowledge on the levels of flavor chemicals in the cigarettes sold in these two countries,” noted a journal article published in Nicotine and Tobacco Research.
The article was written by scientific experts from IGTC, which was formed in 1998 as part of the Department of Health, Behavior and Society at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland. IGTC is a partner in the Bloomberg Initiative to Reduce Tobacco Use and a Collaborating Center of the World Health Organization. Its mission is to prevent death and disease from tobacco products by generating evidence to support tobacco interventions.
In December 2022 to January 2023, IGTC monitored the local sale and marketing of cigarettes, e-cigarettes, and heated tobacco products (HTP) at over 6,000 retailers within 200 meters of 353 schools in nine cities and regions. And, it found that “2,070 cigarette, 43 e-cigarette, and 33 HTP retail locations were observed within 100 meters of the majority of schools,” in violation of Philippine law.
In a newer study published in Nicotine and Tobacco Research in August, IGTC experts also noted that “a range of flavored cigarette products are being offered by tobacco companies in Vietnam and the Philippines, presumably to maximize cigarette sales. Regulation of flavor chemicals should [thus] be considered in these two countries.”
They added that “Article 9 of the WHO Framework Convention on Tobacco Control (FCTC), ratified by both Vietnam and the Philippines, states that ‘there is no justification for permitting the use of ingredients, such as flavoring agents, which help make tobacco products attractive’… Analyses found that cigarettes purchased in Vietnam and the Philippines contained menthol and other flavor chemicals. Tobacco companies are offering multiple flavor chemical profiles and nominally nonflavored versions in these countries.”
At this point, the Philippines already finds it difficult to strictly and effectively enforce regulations on advertising, promotion, and sale of cigarettes and tobacco and vaping products. And while it can work to further limit youth access to tobacco products and alternatives, this effort should include regulation on the introduction of flavors. The IGTC study noted that tobacco products sold in the Philippines had three main flavor groupings: menthol, nonflavored, and menthol plus other flavor chemicals (OFCs).
As noted by Lauren Czaplicki, a scientist at IGTC and co-author of the study, “Flavored tobacco products are a culprit in extending the tobacco epidemic, making cigarettes appealing to consumers — including young people… By banning and removing flavored tobacco products from the market, countries can successfully counter the tobacco industry’s sugar-coated, predatory marketing tactics.”
The IGTC study found that many cigarette brands sold in Vietnam and the Philippines contained menthol and OFCs. And this is concerning since “menthol makes cigarettes more palatable and can suppress respiratory symptoms; the tobacco industry intentionally manipulates the level of menthol in cigarettes brand variants to appeal to different consumers; and, individuals who regularly smoke menthol may prefer variants with higher menthol levels. Furthermore, those who smoke menthol have a lower likelihood of quitting despite making more quit attempts.”
Chemical analysis by experts from IGTC also showed the “presence of OFCs in brand variants purchased in both countries, either alone or, more commonly, in combination with menthol. Oftentimes, OFCs and menthol were found in flavor capsules or flavor threads… Flavor capsules and threads are being used to appeal to new consumers.”
“Evidence indicates that flavor chemicals, including fruit flavors, menthol and clove, and flavor capsule cigarettes, are appealing to young people. Filipino young adults even liken flavor capsule cigarettes to candy. The present study indicates that flavor chemicals and flavor delivery technology are readily available for sale in Vietnam and the Philippines, suggesting a comprehensive flavored tobacco ban that includes all flavors present in any component part of a cigarette or tobacco product is required in both countries,” IGTC added.
If not a ban, at least some regulation of flavors should be considered, as the Philippines is falling behind its goal of a 30% reduction in smoking by 2025. IGTC said, adding that “a comprehensive flavor ban that includes all flavors present in all cigarette components, including flavor capsules and threads, is one pathway to reduce cigarette sales and promote smoking cessation in these two countries and the Western Pacific region.”
At this point, the Philippine effort to curb youth smoking is far from comprehensive, despite the increase in excise taxes on cigarettes and tobacco products in recent years. The recent IGTC study talks only about the use of flavors in cigarettes. It will be interesting to wait for a similar study on the use of flavors by vaping products and nicotine delivery systems.
Marvin Tort is a former managing editor of BusinessWorld, and a former chairman of the Philippine Press Council