Cigarette Pack Structure Elements in Low- and Middle-Income Countries

Objectives: The tobacco industry can attract consumers using appealing packaging, including pack structure. We assessed the variety of pack structure elements across select low- and middle-income countries (LMICs). Methods: Between 2013 and 2017, we systematically collected 3542 packs from 14 LMICs. The selected countries represented LMICs with the greatest number of smokers. We assessed packs for 4 packaging structure elements: pack-type (hard, soft, or box), pack-shape, pack-edge, and opening-style. We used descriptive statistics to analyze the packag- ing structure elements by country and tobacco company. Results: All 14 countries assessed had predominantly hard packs (88.3% of the total sample). We identified 5 pack-shape variants; the most common pack-shape in all countries was the rectangular non-slim pack-shape (79.2%). Straight right-angled edge packs were the most common in 11 of the 14 countries assessed, but rounded edge packs were the most common in Turkey (58.5%). We found 9 broad categories of pack-opening styles, with the most common being the flip-top (94.5%). Conclusion: Although we found common packaging structure elements across the 14 LMICs, we also noted diverse packaging structures. Restrictions on pack structure elements are important as these elements can contribute to the attractiveness of tobacco products.