BACKGROUND: Historically, tobacco companies have used flavored tobacco products to enhance the appeal of tobacco consumption, encourage initiation and experimentation of tobacco use, and contribute to sustained tobacco use. While flavored tobacco products are regulated in several countries, there is no existing regulation on flavored tobacco products in the Philippines, specifically for cigarettes and cigars. This study aims to update evidence on the flavored tobacco product landscape in the Philippines by assessing both the flavor descriptors and flavor imagery featured on cigarette and cigar packaging.
RESULTS: We collected 106 cigarette and cigar products from four major cities in the National Capital Region, Balanced Luzon, Visayas, and Mindanao. Of these 106 cigarette and cigar products, 62 (58.49%) had flavor descriptors. Three crushable capsule products did not feature any flavor descriptor but were included for flavor imagery examination. We identified five categories of flavor descriptors: menthol, concept descriptors, tobacco, beverages, and other flavors. Out of 62 packs, ten featured more than one flavor descriptor on the packaging. Menthol flavor descriptors comprised the majority of flavor descriptors. Imagery and other graphic elements closely resonate with and enhance the flavor descriptors found on these packs.
CONCLUSIONS: This study aimed to update the evidence on the flavored tobacco product landscape in the Philippines and address their absence of regulation. Regulating flavored tobacco products requires a comprehensive policy approach complemented by complete enforcement. Flavor substances, flavor descriptors, and flavor imagery must be regulated altogether; however, it is ideal to enforce a ban on flavored tobacco products in compliance with the WHO FCTC, to which the Philippines is a signatory. Policymakers should consider plain packaging as an intervention to eliminate the appeals associated with flavored tobacco products.

BACKGROUND: Health warnings about alcohol consumption could inform consumers and discourage alcohol consumption, but little is known about what topics these warnings should address. We sought to identify promising topics for alcohol warnings.
METHODS: In January 2024, we recruited a convenience sample of 2,522 US adults ages ≥ 21 years. In an online within-subjects experiment, participants viewed messages about 6 topics (5 warning topics selected from a pool of 16 topics [e.g., liver disease, liver cancer] and 1 control topic [i.e., recycling or reselling products]) shown in random order. For each topic, participants viewed and rated 2 statements about that topic on perceived message effectiveness (primary outcome) and reactance (secondary outcome).
RESULTS: The 16 warning topics elicited higher perceived message effectiveness than the control topic (ps < 0.001). Among the warning topics, liver disease, most cancer types, dementia or mental decline, and hypertension elicited the highest perceived message effectiveness, while breast cancer, sleep, and drinking guidelines elicited the lowest. Fourteen of the 16 warning topics (all except for fetal harms and impaired driving) elicited more reactance than the control topic (ps < 0.001). Warning topics that elicited high perceived message effectiveness generally elicited high reactance, except for messages about liver disease and liver cancer, which elicited high perceived message effectiveness but only moderate reactance.
CONCLUSIONS: Warning messages about a variety of topics hold promise for discouraging alcohol consumption. Messages about liver disease, most cancer types, dementia or mental decline, and hypertension are perceived as especially effective; however, none of these topics are included in the current US alcohol warning.

Manufacturers of medical devices are legally required to carry out post-market surveillance and respond to any on-market complaints they receive about their device. When it comes to addressing use issues experienced on market, manufacturers often focus on revising the instructions for use (IFU) and labeling. One of the challenges with this approach is the potential need to re-validate via a human factors validation study, without knowing whether the changes made will be effective in addressing the identified issues. With populations becoming increasingly technically literate, there is now great potential to rethink the way we can support self-injection through digital and web-based tools. This paper introduces the potential of digital instructions to improve the user experience of self-injection and address known use issues, as well as the challenges of incorporating them in medical device design.

OBJECTIVE: This study explores perspectives of on-pack alcohol warning labels, and how they might influence alcohol purchase and/or consumption behavior to inform culturally appropriate label design for effective behavior change.
METHODS: New Zealand participants ≥18 years, who reported having purchased and consumed alcoholic beverages in the last month were recruited via a market research panel and grouped into 10 focus groups (n = 53) by ethnicity (general population, Māori, and Pacific peoples), age group, and level of alcohol consumption. Participants were shown six potential alcohol health warning labels, with design informed by relevant literature, label framework, and stakeholder feedback. Interviews were transcribed and analyzed via qualitative (directed) content analysis.
RESULTS: Effective alcohol labels should be prominent, featuring large red and/or black text with a red border, combining text with visuals, and words like \"WARNING\" in capitals. Labels should contrast with bottle color, be easily understood, and avoid excessive text and confusing imagery. Participants preferred specific health outcomes, such as heart disease and cancer, increasing message urgency and relevance. Anticipated behavior change included reduced drinking and increased awareness of harms, but some may attempt to mitigate warnings by covering or removing labels. Contextual factors, including consistent design and targeted labels for different beverages and populations, are crucial. There was a strong emphasis on collective health impacts, particularly among Māori and Pacific participants.
CONCLUSIONS: Our findings indicate that implementing alcohol warning labels, combined with comprehensive strategies like retail and social marketing campaigns, could effectively inform and influence the behavior of New Zealand\'s varied drinkers.

CONCLUSIONS: Cigars are sometimes marketed with cannabis references because they are often used for smoking blunts (i.e., cannabis rolled in cigar paper with or without tobacco). However, little research exists on the impact of cannabis co-marketing on cigar perceptions.
METHODS: Participants included 506 US youth (ages 15-20) recruited April-June 2023 through Qualtrics who reported ever using little cigars or cigarillos (LCCs), past 30-day use of LCCs, or susceptibility to using LCCs. We then conducted a between-subjects experiment, randomizing youth to view one of two cigarillo packages: 1) a package with cannabis co-marketing (i.e., the package included a cannabis-related flavor descriptor and the word \"blunt\" appeared in the brand name and product label) or 2) a package with no cannabis co-marketing. We assessed the effects of the packaging on perceptions of product ingredients, addictiveness and harm perceptions, product appeal, susceptibility to using the product shown, and purchase intentions.
RESULTS: Packages with cannabis co-marketing were perceived as more likely to contain cannabis (OR: 5.56, 95 % CI: 3.73, 8.27) and less likely to contain tobacco (OR: 0.42, 95 % CI: 0.25, 0.70) or nicotine (OR: 0.57, 95 % CI: 0.40, 0.82). Cannabis co-marketing also led to higher susceptibility to using the product shown (B: 0.21, p = 0.02). We did not find evidence that cannabis co-marketing changed harm perceptions or purchase intentions.
CONCLUSIONS: Among a sample of US youth, cannabis co-marketing on cigar packages may change perceptions of product ingredients and increase susceptibility to using such products, which could lead to the initiation of cigars and cannabis.

BACKGROUND: One of the commonly abused drug substances in both rural and urban communities of the developing countries is tobacco. The slow poison is still present even though anti-tobacco laws has been implemented to eliminate this threat.
OBJECTIVE: To measure the violation of Cigarettes and Other Tobacco Products Act (COTPA), 2003 under sections 4, 5, 7, 8, 9 & 10 in Puducherry.
METHODS: An observational cross-sectional survey was conducted over three months (June to August 2022) in 194 public places and 126 tobacco points-of-sale at Puducherry district. A multi-stage cluster sampling was employed. An observational checklist was used to record the violation of COTPA sections. The data were analyzed using SPSS-v16.
RESULTS: Section 4 and 5 violations were 67% and 47% respectively, while other sections (7,8,9,10) were compliant with the law in >85% of the parameters observed exception being display of \"Warning\" in specified font and colour (10%). The COTPA compliance rate was quite low in the observed public places. \"No smoking area\" and \"Smoking Here Is an Offense\" signage was seldom displayed in most public places.
CONCLUSIONS: Despite the fact that the law has been carefully drafted, it has been implemented to a limited extent. For guaranteeing adherence and rigorous implementation of the act\'s provisions, the concerned authorities shall perform timely and routine compliance assessments.

Consumers often inadvertently misperceive the health hazards associated with over-the-counter pesticides under the current textual labeling policy, potentially leading to improper use. We conducted an incentivized framed field experiment with eye tracking to evaluate the effectiveness of the current pesticide labels that convey risk using signal words (Caution, Warning, Danger) compared to two visually focused label alternatives: traffic light colors and skull intensity symbols. A total of 166 participants were randomly assigned to one of three label formats and asked to rank toxicity levels and make purchasing decisions within multiple price lists. Results show that signal words fail to adequately communicate toxicity levels. Specifically, participants\' correct assessment of toxicity level dramatically improves from 54% under the existing signal word label to 95% under the traffic light and 83% under the skull intensity symbol labels. We also find that participants are more likely to choose the less toxic alternatives under the new labels, suggesting the current labeling system may affect choice and have unintended adverse effects on human health.

BACKGROUND: Despite progress made by many countries on the adoption of plain tobacco packaging laws over the last years, low- and middle-income countries, with a large supply of loose cigarettes via informal vendors, remain far behind.
OBJECTIVE: To study the potential effectiveness of plain tobacco packaging and dissuasive cigarette sticks, via willingness-to-pay estimates, when illicit cigarette options are available.
METHODS: We conducted a discrete choice experiment (DCE) in which respondents chose licit and illicit products with three attributes: packaging (standard vs. plain packaging), stick design (branded stick vs. stick with warning), and price level. The sample, collected on 12/2021, consisted of 1761 respondents from an internet panel involving smokers and nonsmokers. Conditional logit and latent class models were used to estimate the willingness-to-pay (WTP) to avoid restrictive packaging elements.
RESULTS: Nonsmokers are willing to pay USD $5.63 for a pack of cigarettes to avoid plain packaging, which is higher than the actual commercial price of illicit cigarettes (USD $2.40). The WTP increases to USD $12.14 in the presence of illicit alternatives. Smokers are also willing to pay to avoid illicit options, which they also deem riskier, and the presence of such options increases the WTP to avoid plain packaging. However, nonsmokers do not perceive the illicit option as riskier. The dissuasive stick (stick with warning) does not affect perceptions of risk and plays a small role in terms of choice for both smokers and nonsmokers.
CONCLUSIONS: Even in the presence of illicit tobacco alternatives, plain packaging seems to be as effective in reducing the attractiveness of tobacco products in Colombia as in other countries that have already adopted it. Given conflicting results on the case for dissuasive sticks, there is a need for more research.

Alcohol container labels might reduce population-level alcohol-related harms, but investigations of their effectiveness have varied in approach and quality. A systematic synthesis is needed to adjust for these differences and to yield evidence to inform policy. Our objectives were to establish the effects of alcohol container labels bearing one or more health warnings, standard drink information, or low-risk drinking guidance on alcohol consumption behaviour, knowledge of label message, and support for labels. We completed a systematic review according to Cochrane and synthesis without meta-analysis standards. We included all peer-reviewed studies and grey literature published from Jan 1, 1989, to March 6, 2024, in English, French, German, or Spanish that investigated the effects of alcohol container labels compared with no-label or existing label control groups in any population on alcohol consumption behaviour, knowledge of label message, or support for labels. Data were synthesised narratively as impact statements and assessed for risk of bias and certainty in the evidence. A protocol was preregistered (PROSPERO CRD42020168240). We identified 40 publications that studied 31 labels and generated 17 impact statements. 24 (60%) of 40 publications focused on consumption behaviour and we had low or very low certainty in 13 (59%) of 22 outcomes. Alcohol container labels bearing health warnings might slow the rate of alcohol consumption (low certainty), reduce alcoholic beverage selection (moderate certainty), reduce consumption during pregnancy (low certainty), and reduce consumption before driving (moderate certainty). Interventions with multiple types of rotating alcohol container labels likely substantially decrease alcohol use (moderate certainty) and reduce alcohol sales (high certainty). To the best of our knowledge, this is the first systematic review on multiple types of alcohol container labels assessing their effects for certainty in the evidence. Limitations included heterogeneity in label designs and outcome measurements. Alcohol container labels probably influence some alcohol consumption behaviour, with multiple rotating messages being particularly effective, although effects might vary depending on individual health literacy or drinking behaviour. Alcohol container labels might therefore be effective components of policies designed to address population-level alcohol-related harms.

BACKGROUND: Alcohol health-warning labels are a policy option that can contribute to the reduction of alcohol-related harms, but their effects and public perception depend on their content and format. Our study aimed to investigate the effect of health warnings on knowledge that alcohol causes cancer, the perceptions of three different message topics (responsible drinking, general health harm of alcohol, and alcohol causing cancer), and the role of images included with the cancer message.
METHODS: In this online survey experiment, distributed in 14 European countries and targeting adults of the legal alcohol-purchase age who consumed alcohol, participants were randomly allocated to one of six label conditions using a pseudorandom number generator stratified by survey language before completing a questionnaire with items measuring knowledge and label perceptions. Effect on knowledge was assessed as a primary outcome by comparing participants who had increased knowledge after exposure to labels with the rest of the sample, for the six label conditions. Label perceptions were compared between label conditions as secondary outcomes.
RESULTS: 19 110 participants completed the survey and were eligible for analysis. Our results showed that a third of the participants exposed to the cancer message increased their knowledge of alcohol causing cancer (increase for 1131 [32·5%, 95% CI 29·8 to 35·2] of 3409 participants [weighted percentage] for text-only message; increase for 1096 [33·3%, 30·4 to 36·2] of 3198 [weighted percentage] for message inlcuding pictogram; and increase for 1030 [32·5%, 29·6 to 35·4] of 3242 [weighted percentage] for message including graphic image), compared with an increase for 76 (2·4%, -1·2 to 6·0) of 3018 participants who viewed the control message. Logistic regression showed that cancer messages increased knowledge compared with the control label (odds ratio [OR]text only 20·20, 95% CI 15·88 to 26·12; ORpictogram 21·16, 16·62 to 27·38; ORgraphic-image 20·61, 16·19 to 26·68). Cancer messages had the highest perceived impact and relevance, followed by general health harm and responsibility messages. Text-only and pictogram cancer messages were seen as clear, comprehensive, and acceptable, whereas those including an image of a patient with cancer had lower acceptability and the highest avoidance rating of all the labels. The only identified interaction between perceptions and experimental conditions (with gender) indicated higher comprehensibility and acceptability ratings of cancer labels than responsibility messages and control labels by women, with the results reversed in men.
CONCLUSIONS: Health warnings are an effective policy option to increase knowledge of alcohol causing cancer, with a generalisable effect across several countries. Europeans consider alcohol health-warning labels to be comprehensible and acceptable, with cancer-specific health warnings having the highest perceived impact and relevance.
BACKGROUND: EU4Health.