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INTRODUCTION: Previous studies have identified pricing strategies that the tobacco industry employs to try to minimise the impact of tobacco taxation, but these studies are mostly about high-income countries. This research examines industry price responses to a recent cigarette tax increase in Mexico, including in the capsule cigarette segment that has expanded rapidly in Latin America. METHODS: Data of cigarette prices and sales in Mexico between October 2018 and September 2021 licensed from NielsenIQ were used following a quasi-experimental design to analyse price changes after excise tax increases with fixed effect models by product. To explore heterogeneous responses, estimates were disaggregated by cigarette attributes such as presence of capsules and market segment. Differential shifting was also assessed. RESULTS: Increasing the tobacco tax from 2011MX$0.35(≈US$0.02) to 2020 MX$0.4944(≈US$0.0283) in January 2020 was associated with an overall 8% cigarette price increase in real terms. However, some cigarette types, including premium to discount segments, exhibited price increases larger than the tax increase, which reduced the relative price of ultra-low-priced cigarettes. Instead of a single hike, prices were gradually raised throughout the first months of 2020 for all cigarette types. A combination of both pricing strategies was employed for capsule cigarettes. The 2021 smaller tax adjustment for annual inflation was fully passed onto consumer, maintaining real prices constant. CONCLUSIONS: The industry's ability to raise prices more than the tax increase and manage these price increases smoothly suggests that there was room for larger tobacco tax increases in Mexico. Future developments on tobacco taxes could consider a fully specific tax structure or minimum taxes to mitigate the adverse effects of market segmentation and differential shifting.

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INTRODUCTION: The global market for capsule cigarettes has grown rapidly, especially in Latin America. This research examined the sales trends and patterns as well as packaging characteristics of capsule cigarette in Mexico in recent years. METHODS: National data on cigarette sales in Mexico between October 2018 and September 2021 licensed from NielsenIQ were supplemented with cigarette pack pictures and Internet searches to determine whether characterizing flavor, concept flavor, and action descriptors were used. Market share in sales value and volume was calculated by capsule and flavor status, descriptors, price tier, manufacturer, pack size, and cigarette length for the whole time period and for each month. Number of unique brand variants was also examined. RESULTS: Capsule cigarette sales totaled US$4.29 billion or 30.99 billion sticks during the assessed period, comprising 37.7% of the cigarette market share in sales value or 35.5% in sales volume. Over half of capsule cigarettes sold during this time period had concept flavor descriptors, 17.8% contained characterizing flavor descriptors, and 15.1% contained action descriptors that were suggestive of the interactive aspects of capsules. The monthly market share of capsule cigarette sales volume among all cigarette sales in Mexico increased steadily from 33.3% in October 2018 to 37.3% in September 2021. CONCLUSIONS: The expanding capsule cigarette market in Mexico is concerning, given the product's associated misconceptions of reduced harm and greater appeal among youth. Findings underline the need for enhanced regulations to address the public health threat posed by capsule cigarettes. IMPLICATIONS: Capsule cigarettes have a substantial market share in Mexico, with increasing popularity. Descriptors and other product characteristics such as cigarette length might be used to increase the appeal and target particular populations. Policy makers should consider banning capsules and flavors in cigarettes including descriptors or other indication in product presentation that could be perceived as denoting a taste, aroma, or sensation, and making the appearance and design of tobacco products more commensurate with the harm they cause by adopting plain and standardized packaging.

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INTRODUCTION: Tobacco industry documents reveal companies' knowledge of a similar young adult market across countries in terms of attitudes and lifestyle aspirations. Some tobacco companies, therefore, use similar marketing approaches across different jurisdictions. We examined young adults' perceptions of flavored cigarette packs, including those containing flavor capsules, in Mexico and the Philippines. METHODS: We conducted a secondary analysis of five focus groups held in Mexico and four in the Philippines with young adults who smoke (aged 18-24 years), separated by gender, in which participants interacted with cigarette packs purchased locally. Transcribed and translated data were thematically analyzed and compared between countries. RESULTS: Three major themes were identified: 1) Flavor capsules cigarettes are recognizable via pack design through imagery on the pack that is understood to signify capsules; 2) Colors signal flavor and make the pack attractive; and 3) Young adults who smoke identify the target audience for these products as young people and those who are beginning to smoke. CONCLUSIONS: Young adults who smoke in Mexico and the Philippines interpreted flavored cigarette pack design similarly and thought that young people are the main audience for these products. This suggests a successful marketing approach creating shared perceptions of flavored cigarette packs in different world regions. It is likely that similar tactics are used in other countries around the world. Therefore, jurisdictions might use evidence from other jurisdictions to support the implementation of evidence-based tobacco control policies. These findings also support the implementation of plain and standardized packaging and flavor bans that would also limit product innovation such as capsules.

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Exposure to tobacco marketing is positively associated with smoking initiation and behaviours. There is limited literature examining disparities among reported exposure in low- and middle-income countries. This study sought to fill this gap with a survey among 1427 adolescents and 889 adult smokers in Mexico City in 2020. Data were analysed using chi-square and hierarchical regression models. Two-thirds of adolescents noticed cigarette pack displays in stores. Participants from low- and mid-socioeconomic status (SES) neighbourhoods were more exposed to tobacco marketing than their counterparts through several channels. After addressing the shared variance among participants from the same household nested in neighbourhood SES level and controlling for gender, adolescent non-smokers and adult smokers who noticed pack displays were more likely to be susceptible to smoking (OR = 1.8, 95% CI 1.4-2.4) and to smoke more (OR = 1.7, 95% CI 1.21-2.47); adult smokers who noticed tobacco marketing at more places were less likely to be certain about smoking risks (OR = 0.9, 95% CI 0.8-0.9). The results suggest that the tobacco industry targets youth and individuals from low-SES neighbourhoods through several channels. Greater exposure to tobacco marketing was associated with increased susceptibility to smoking and decreased risk perception. These findings support a comprehensive ban on tobacco marketing in Mexico.

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BACKGROUND: Flavoured cigarettes are popular in Mexico. We examined how cigarette packaging design features used to communicate flavour influence perceptions of appeal, harm, perceived interest and pack preference among Mexico City residents. METHODS: We conducted an experimental survey. Participants aged 13-34 years were randomly assigned to one of three conditions, viewed packs with systematically manipulated design features (colour, capsule image and flavour name) and answered questions on appeal, perceived harm, perceived interest and pack preference. Data were analysed using mixed effects and conditional logistic regression. RESULTS: 1500 adolescents and 950 adults participated. Regardless of flavour, cigarette packs with a background colour and capsule image were more appealing to adolescents (OR=13.19, 95% CI 11.53 to 15.10; OR=1.68, 95% CI 1.45 to 1.88) and adults (OR=4.18, 95% CI 3.73 to 4.69; OR=1.66, 95% CI 1.49 to 1.85) than packs without. Among adolescents, 'Tropical Burst' named packs were more appealing (OR=1.43, 95% CI 1.20 to 1.72) than packs without a flavour name and among adults, 'Arctic Air' named packs were more appealing (OR=1.20, 95% CI 1.02 to 1.14). Adolescents and adults reported a preference for trying packs that displayed a flavour name, background colour or capsule image (b=0.104, b=0.702, b=1.316, p<0.001 and b=0.126, b=0.619, b=0.775, p<0.001). CONCLUSIONS: Colours and flavour capsule images appeal to adolescents and adults in Mexico. Mexico should consider adopting plain packaging to reduce appeal and interest.

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BACKGROUND: Straw cigarettes are hand-rolled tobacco in a corn straw, common in Brazil and believed to be less harmful by consumers. Traditionally consumed in rural areas and by men, a recent increase in use among young people in urban areas was observed. This study assessed marketing appeals of straw cigarette packaging in Brazil. METHODS: Following a systematic protocol, unique straw cigarette packs were purchased in 2013, 2016 and 2019 from three cities: Manaus, Salvador and São Paulo. Packs were double-coded for the absence/presence of marketing appeals (ie, luxury/quality, masculinity, classic/timeless, flavours and less harm). RESULTS: The number of unique straw cigarette packs purchased as part of the overall sample increased in the most recent collection: 2.3% (n=3), 1.3% (n=2) and 15.5% (n=27) in 2013, 2016 and 2019, respectively. Across the years, all packs presented luxury/quality elements (eg, images of crests); 93.8% (n=30) included the word 'artisanal'. Masculine appeal (eg, images of men) was present on 56.3% (n=18) of packs. Almost half had classic/timeless elements, including the words 'tradition'/'original'. In 2019, 59.3% (n=16) of the packs were flavoured compared with none in previous years. Over a quarter of all packs presented a less harm appeal (eg, 'smooth'). CONCLUSION: We identified an increase in availability of unique straw cigarette packs, strong branding and use of misleading descriptors on the packs. The adoption of plain packaging and the implementation of Brazil's additive ban could help to reduce the appeal of straw cigarettes and curb the current increase in use among youth.

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[ABSTRACT]. Objectives. To provide detailed information about how countries in the Region of the Americas are fulfilling the requirements set out in the guidelines for the implementation of Article 11 of the WHO Framework Convention on Tobacco Control in relation to the rotation of health warning labels and to identify possible challenges in the implementation of the laws or regulations governing the rotation. Methods. We first searched for and identified all the relevant laws or regulations pertaining to health warning labels on cigarette packs in 24 countries and territories in the Region of the Americas. We then analyzed these documents to see whether the requirements in the guidelines of the WHO Convention were being met, identi- fying similarities and differences across countries. Results. We found that the majority of countries (18/24) rotate the warning labels within the 12–36 month period recommended by the WHO Convention, and about half (13/24) have sets of 8 to 12 warning labels, thus complying with the additional regional guidance, which adds other stipulations. Across the Region, there is variability regarding transition periods between sets, which range from 1 to 6 months. In the majority of coun- tries, the leading authority in charge of warnings is the Ministry of Health. Conclusions. Our analysis shows that even when countries’ laws meet the requirements of the WHO Con- vention, there are still challenges. Most countries’ laws require future legislation or regulations to be adopted before new iterations of warnings can come into effect. If legal instruments are not adopted in a timely fashion – which is occurring in many countries – new warning labels are not implemented on time, and message fatigue becomes a risk.

[RESUMEN]. Objetivos. Proporcionar información detallada sobre cómo los países de la Región de las Américas están cumpliendo con los requisitos establecidos en las directrices para la aplicación del artículo 11 del Convenio Marco de la OMS para el Control del Tabaco en lo relativo a la rotación de las etiquetas con advertencias sanitarias, e determinar cuáles son los posibles retos en la aplicación de las leyes o regulaciones que rigen esta rotación. Métodos. En primer lugar, se buscaron las leyes o regulaciones pertinentes relacionadas con las etiquetas de advertencia sanitaria en los paquetes de cigarrillos en 24 países y territorios de la Región de las Américas y se indicó cuáles eran. A continuación, se analizaron estos documentos para comprobar si se cumplían los requisitos de las directrices del Convenio Marco de la OMS, y se señalaron las similitudes y las diferencias entre los países. Resultados. Se determinó que la mayoría de los países (18/24) rotan las etiquetas de advertencia en el período de 12 a 36 meses que se recomienda en el Convenio Marco de la OMS, y aproximadamente la mitad (13/24) disponen de conjuntos de 8 a 12 etiquetas de advertencia, de modo que también cumplen con la orientación regional, que añade otras estipulaciones. En los distintos países de la Región existe variabilidad con respecto al período de transición entre los conjuntos de etiquetas, y este oscila entre 1 y 6 meses. En la mayoría de los países, la principal autoridad encargada de las advertencias es el Ministerio de Salud. Conclusiones. Este análisis muestra que incluso cuando las leyes de los países cumplen con los requisitos del Convenio Marco de la OMS, persisten los retos. Las leyes de la mayoría de los países requieren que en el futuro se adopten leyes o regulaciones antes de que puedan entrar en vigor nuevas iteraciones de adver- tencias. Si no se adoptan de manera oportuna los instrumentos jurídicos, como está ocurriendo en muchos países, las nuevas etiquetas de advertencia no se aplican a tiempo y se corre el riesgo de que el mensaje cause una sensación de hartazgo.

[RESUMO]. Objetivos. Fornecer informações detalhadas sobre o cumprimento, pelos países da Região das Américas, dos requisitos estabelecidos nas diretrizes para a implementação do Artigo 11 da Convenção-Quadro da OMS para o Controle do Tabaco em relação à rotatividade das advertências sanitárias, bem como identificar possíveis desafios na implementação das leis ou regulamentações que regem a rotatividade. Métodos. Inicialmente, pesquisamos e identificamos todas as leis ou regulamentações relativas a advertên- cias sanitárias em embalagens de cigarro em 24 países e territórios da Região das Américas. Em seguida, analisamos esses documentos para verificar se os requisitos das diretrizes da Convenção-Quadro da OMS estavam sendo cumpridos, identificando semelhanças e diferenças entre os países. Resultados. Constatamos que a maioria dos países (18/24) aplica a rotatividade das advertências no período de 12 a 36 meses, conforme recomendado pela Convenção-Quadro da OMS, e cerca de metade (13/24) dispõe de conjuntos de 8 a 12 advertências, cumprindo assim a orientação regional complementar, que acrescenta outras estipulações. Na Região, o período de transição entre os conjuntos varia de 1 a 6 meses. Na maioria dos países, a principal autoridade responsável pelas advertências é o Ministério da Saúde. Conclusões. Nossa análise mostra que, mesmo quando as leis nacionais satisfazem os requisitos da Con- venção-Quadro da OMS, ainda há desafios. A legislação da maioria dos países exige que as novas leis ou regulamentações entrem em vigor antes do início de novos ciclos de advertências. Caso os instrumentos legais não sejam adotados em tempo hábil — o que vem ocorrendo em muitos países — as novas etiquetas de advertência não são implementadas a tempo, com o consequente risco de fadiga da mensagem.

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BACKGROUND: Tobacco companies are offering cigarettes with 'concept' descriptor names that suggest sensation and/or flavour properties (eg, Marlboro 'Velvet Fusion'). Little has been known about the identities and levels of flavour chemicals in such cigarettes. METHODS: Thirty-three filter cigarette variants from 27 packs (including two sampler packs with four variations each) from Canada and Mexico were analysed (rod + filter) for 177 flavour chemicals plus triacetin, a filter plasticiser and possible flavourant. Five brands of US mentholated filter cigarettes were also analysed. RESULTS: Twenty-seven of the 33 cigarettes (all were Mexican variants) were categorised as 'menthol-plus': significant menthol (3.0-11.9 mg/cigarette), plus varying amounts (0.32-3.4 mg/cigarette) of total other flavour chemicals (TOFCs) (excludes triacetin). For 10 of the 27, TOFCs >1.0 mg/cigarette. For 7 of the 27, the TOFCs profile was categorised as containing total fruit flavour compounds (TFFCs) >1.0 mg/cigarette. One Mexican variant was categorised as 'menthol-only' (TOFCs ≤0.15 mg/cigarette). All menthol-plus and menthol-only cigarettes contained one or two optional-crush capsules in their filters (crushed prior to analysis). All five Canadian brand variants were 'non-flavoured'. All five US brand variants were 'menthol-only'. CONCLUSIONS: All but one of the 'concept' descriptor cigarettes from Mexico were 'menthol-plus'. While the Canadian cigarettes complied with Canada's flavour chemical ban, concept descriptors on the packs may increase appeal. Given the scale of the problem posed by menthol alone, health officials seeking to decrease the appeal of smoked tobacco should examine the extent to which 'concept descriptor' cigarettes using 'menthol-plus' flavour profiling together with artful descriptors are furthering the problem of smoked tobacco.

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ABSTRACT Objectives. To provide detailed information about how countries in the Region of the Americas are fulfilling the requirements set out in the guidelines for the implementation of Article 11 of the WHO Framework Convention on Tobacco Control in relation to the rotation of health warning labels and to identify possible challenges in the implementation of the laws or regulations governing the rotation. Methods. We first searched for and identified all the relevant laws or regulations pertaining to health warning labels on cigarette packs in 24 countries and territories in the Region of the Americas. We then analyzed these documents to see whether the requirements in the guidelines of the WHO Convention were being met, identifying similarities and differences across countries. Results. We found that the majority of countries (18/24) rotate the warning labels within the 12-36 month period recommended by the WHO Convention, and about half (13/24) have sets of 8 to 12 warning labels, thus complying with the additional regional guidance, which adds other stipulations. Across the Region, there is variability regarding transition periods between sets, which range from 1 to 6 months. In the majority of countries, the leading authority in charge of warnings is the Ministry of Health. Conclusions. Our analysis shows that even when countries' laws meet the requirements of the WHO Convention, there are still challenges. Most countries' laws require future legislation or regulations to be adopted before new iterations of warnings can come into effect. If legal instruments are not adopted in a timely fashion - which is occurring in many countries - new warning labels are not implemented on time, and message fatigue becomes a risk.

RESUMEN Objetivos. Proporcionar información detallada sobre cómo los países de la Región de las Américas están cumpliendo con los requisitos establecidos en las directrices para la aplicación del artículo 11 del Convenio Marco de la OMS para el Control del Tabaco en lo relativo a la rotación de las etiquetas con advertencias sanitarias, e determinar cuáles son los posibles retos en la aplicación de las leyes o regulaciones que rigen esta rotación. Métodos. En primer lugar, se buscaron las leyes o regulaciones pertinentes relacionadas con las etiquetas de advertencia sanitaria en los paquetes de cigarrillos en 24 países y territorios de la Región de las Américas y se indicó cuáles eran. A continuación, se analizaron estos documentos para comprobar si se cumplían los requisitos de las directrices del Convenio Marco de la OMS, y se señalaron las similitudes y las diferencias entre los países. Resultados. Se determinó que la mayoría de los países (18/24) rotan las etiquetas de advertencia en el período de 12 a 36 meses que se recomienda en el Convenio Marco de la OMS, y aproximadamente la mitad (13/24) disponen de conjuntos de 8 a 12 etiquetas de advertencia, de modo que también cumplen con la orientación regional, que añade otras estipulaciones. En los distintos países de la Región existe variabilidad con respecto al período de transición entre los conjuntos de etiquetas, y este oscila entre 1 y 6 meses. En la mayoría de los países, la principal autoridad encargada de las advertencias es el Ministerio de Salud. Conclusiones. Este análisis muestra que incluso cuando las leyes de los países cumplen con los requisitos del Convenio Marco de la OMS, persisten los retos. Las leyes de la mayoría de los países requieren que en el futuro se adopten leyes o regulaciones antes de que puedan entrar en vigor nuevas iteraciones de advertencias. Si no se adoptan de manera oportuna los instrumentos jurídicos, como está ocurriendo en muchos países, las nuevas etiquetas de advertencia no se aplican a tiempo y se corre el riesgo de que el mensaje cause una sensación de hartazgo.

RESUMO Objetivos. Fornecer informações detalhadas sobre o cumprimento, pelos países da Região das Américas, dos requisitos estabelecidos nas diretrizes para a implementação do Artigo 11 da Convenção-Quadro da OMS para o Controle do Tabaco em relação à rotatividade das advertências sanitárias, bem como identificar possíveis desafios na implementação das leis ou regulamentações que regem a rotatividade. Métodos. Inicialmente, pesquisamos e identificamos todas as leis ou regulamentações relativas a advertências sanitárias em embalagens de cigarro em 24 países e territórios da Região das Américas. Em seguida, analisamos esses documentos para verificar se os requisitos das diretrizes da Convenção-Quadro da OMS estavam sendo cumpridos, identificando semelhanças e diferenças entre os países. Resultados. Constatamos que a maioria dos países (18/24) aplica a rotatividade das advertências no período de 12 a 36 meses, conforme recomendado pela Convenção-Quadro da OMS, e cerca de metade (13/24) dispõe de conjuntos de 8 a 12 advertências, cumprindo assim a orientação regional complementar, que acrescenta outras estipulações. Na Região, o período de transição entre os conjuntos varia de 1 a 6 meses. Na maioria dos países, a principal autoridade responsável pelas advertências é o Ministério da Saúde. Conclusões. Nossa análise mostra que, mesmo quando as leis nacionais satisfazem os requisitos da Convenção-Quadro da OMS, ainda há desafios. A legislação da maioria dos países exige que as novas leis ou regulamentações entrem em vigor antes do início de novos ciclos de advertências. Caso os instrumentos legais não sejam adotados em tempo hábil — o que vem ocorrendo em muitos países — as novas etiquetas de advertência não são implementadas a tempo, com o consequente risco de fadiga da mensagem.

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Objectives: Cigarette packs are relevant to branding strategies, designed to appeal to specific groups. There is little research on how pack features increase product appeal among key constituents such as youth in low- and middle-income countries. Methods: We conducted 10 focus group discussions (FGDs) with adolescents and 5 FGDs with young adult smokers in Mexico City, separated by age, gender, smoking, and socioeconomic status. Participants separated 23 cigarette packs into "appealing" and "unappealing" groups, and were asked to explain their decisions, describing the features that supported their views. FGDs were video-recorded, transcribed in Spanish, translated into English, and subjected to thematic analysis. Results: Pack groupings did not differ greatly across FGDs; bold, contrasting colors and elements communicating flavor and promotion increased cigarette pack appeal and desire to try. Participants perceived packs with these features to be used by and designed for youth, like themselves. Conclusion: Our findings reinforce the importance of packaging design in attracting new consumers and maintaining current ones. Mexico should consider stronger tobacco advertising policies that include packaging color and depiction of flavor to reduce product appeal.

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OBJECTIVE: Capsule cigarettes, electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) are now readily available in Guatemala. As in most countries, the point-of-sale (POS) remains an important marketing channel for the tobacco industry. Therefore, we sought to characterise the POS marketing of these products in the two largest cities in Guatemala. METHODS: Convenience stores were randomly surveyed in mid and high socioeconomic status (SES) neighbourhoods in Guatemala City (n=60) and Quetzaltenango (n=15) in 2019. We adapted a previously implemented checklist to assess the availability of interior advertising of capsule cigarettes, e-cigarettes and HTP. Data entry was done in Kobo toolbox and analysis in STATA. RESULTS: All stores sold conventional and flavoured capsule cigarettes, 78% e-cigarettes and 68% HTP. Most cigarette advertising was for capsule cigarettes. E-cigarettes were more likely to be sold in Guatemala City (96%) than in Quetzaltenango (13%). HTPs were only found in Guatemala City (85%), with no difference between high and medium SES neighbourhoods. Median number of ads for cigarettes and capsule cigarettes was higher in the high SES neighbourhood. Most e-cigarettes (83%) and HTP (74%) were found <50 cm from candy. E-cigarettes and HTP were available in a wide range of flavours. All stores that sold HTP had flavoured HEETS (amber, bronze, turquoise, yellow, blue and purple). CONCLUSION: We found a high prevalence of advertising for capsule cigarettes, e-cigarettes and HTP at the POS. The POS, a crucial advertising channel for the tobacco industry, is now being used for new products and therefore needs to be urgently regulated.

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INTRODUCTION: Tobacco companies vary pack colours, designs, descriptors, flavours and brand names on cigarette packs to target a multitude of consumers. These different brand variants can falsely imply that some brand variants are less harmful than others. Uruguay is the only country that requires cigarette companies to adhere to a single presentation (one brand variant) per brand family. METHODS: An existing, systematic pack purchasing protocol was adapted for data collection. Neighbourhoods in Montevideo were categorised into five strata by percentage of poor households. Five neighbourhoods within each stratum were selected based on geographical variation. In each neighbourhood, a 'starting hub' was identified and a systematic walking protocol was implemented to purchase unique packs at four key vendor types. RESULTS: Unique packs were purchased in 9 out of 25 neighbourhoods. Fifty-six unique packs were purchased, representing 30 brands. Of these, 51 packs were legal, representing 26 brands. The majority of the legal brands (n=16; 62%) were compliant with the requirement. The remaining packs were non-compliant due to differences in colour, design element, brand name, crest and descriptors. Although not prohibited by the single presentation requirement, 16 legal brands had more than one stick count (10, 11, 14 or 20 sticks), and packs from four brands had more than one packaging type (hard, soft or tin). CONCLUSION: Overall, compliance with Uruguay's single presentation requirement was good. In addition to the current restrictions, future single presentation requirements could expand to include packs in more than one stick count and packaging type.

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BACKGROUND/AIMS: To estimate and compare price differences between legal and illicit cigarettes in 14 low- and middle-income countries (LMIC). DESIGN: A cross-sectional census of all packs available on the market was purchased. SETTING: Cigarette packs were purchased in formal retail settings in three major cities in each of 14 LMIC: Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Pakistan, the Philippines, Russia, Thailand, Turkey, Ukraine and Vietnam. PARTICIPANTS: A total of 3240 packs were purchased (range = 58 packs in Egypt to 505 in Russia). Packs were categorized as 'legal' or 'illicit' based on the presence of a health warning label from the country of purchase and existence of a tax stamp; 2468 legal and 772 illicit packs were in the analysis. MEASUREMENTS: Descriptive statistics stratified by country, city and neighborhood socio-economic status were used to explore the association between price and legal status of cigarettes. FINDINGS: The number of illicit cigarettes in the sample setting was small (n < 5) in five countries (Brazil, Egypt, Indonesia, Mexico, Russia) and excluded from analysis. In the remaining nine countries, the median purchase price of legal cigarettes ranged from US$0.32 in Pakistan (n = 72) to US$3.24 in Turkey (n = 242); median purchase price of illicit cigarettes ranged from US$0.80 in Ukraine (n = 14) to US$3.08 in India (n = 41). The difference in median price between legal and illicit packs as a percentage of the price of legal packs ranged from 32% in Philippines to 455% in Bangladesh. Median purchase price of illicit cigarette packs was higher than that of legal cigarette packs in six countries (Bangladesh, India, Pakistan, Philippines, Thailand, Vietnam). Median purchase price of illicit packs was lower than that of legal packs in Turkey, Ukraine and China. CONCLUSIONS: The median purchase price of illicit cigarettes is higher than that of legal cigarette packs in Bangladesh, India, Pakistan, Philippines, Thailand, and Vietnam, Brazil, Egypt, Indonesia, Mexico, Russia appear to have few or no illicit cigarettes for purchase from formal, urban retailers.

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OBJECTIVE: Celebrity cancer diagnoses generate considerable media coverage of and increase interest in cancer screening, but do they also promote primary cancer prevention? METHODS: Daily trends for smoking cessation-related media (information-availability) and Google queries (information-seeking) around Brazilian President and smoker Lula da Silva's laryngeal cancer diagnosis announcements were compared to a typical period and several cessation awareness events. RESULTS: Cessation media coverage was 163% (95% confidence interval, 54-328) higher than expected the week after the announcement but returned to typical levels the second week. Cessation queries were 67% (95% confidence interval, 40-96) greater the week after Lula's announcement, remaining 153% (95% confidence interval, 121-188), 130% (95% confidence interval, 101-163) and 71% (95% confidence interval, 43-100) greater during the second, third, and fourth week after the announcement. There were 1.1 million excess cessation queries the month after Lula's announcement, eclipsing query volumes for the week around New Years Day, World No Tobacco Day, and Brazilian National No Smoking Day. CONCLUSION: Just as celebrity diagnoses promote cancer screening, they may also promote primary prevention. Discovery of this dynamic suggests the public should be further encouraged to consider primary (in addition to the usual secondary) cancer prevention around celebrity diagnoses, though more cases, cancers, and prevention behaviors must be explored.

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