Natural, Organic, Additive-Free And Pure On Cigarette Packs In 14 Countries

Objectives: The tobacco industry uses terms like "light" and "mild" to mislead consumers to believe its product is less harmful. US tobacco brands have marketed products with terms (eg, natural) that inaccurately convey reduced harm. Little is known about how these terms are being used elsewhere. This study aims to describe the frequency of "natural," "organic," "additive-free," and "pure" descriptors on cigarette packs in 14 low-and middle-income countries (LMICs). Methods: Cigarette packs were purchased as part of TPackSS (Tobacco Pack Surveillance System) between 2013 and 2017 from 14 LMICs where the majority of tobacco users live. Packs were coded for "natural," "organic," "additive-free," and "pure" descriptors. Results: Packs containing at least one of the 4 sets of descriptors were found in 12 of 14 countries. "Natural" terms were most commonly identified, present on packs from 10 countries. "Organic" terms were least common, only found in 2 countries. Overall, 2.8% of the 5576 country-year-unique packs contained at least one of the studied descriptors. Conclusions: The tobacco industry is using potentially misleading terms on packs in LMICs. These problematic associations can be resolved by following labeling guidelines to prevent misleading or deceptive terms.