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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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BACKGROUND: The aim of this study was to document how Mexico adopted a WHO Framework Convention on Tobacco Control (FCTC)-based national tobacco control law. METHODS: We analyzed publicly available documents and interviewed 14 key stakeholders. We applied the Multiple Streams Framework (MSF) to analyze these findings. RESULTS: Previous attempts to approve comprehensive FCTC-based initiatives failed due to a lack of political will, the tobacco industry's close connections to policymakers, and a lack of health advocacy coordination. Applying the MSF reveals increased attention towards collecting and sharing data to frame the severity of the problem (problem stream). The expansion of a coordinated health advocacy coalition and activities led to increased support for desired FCTC policy solutions (policy stream). The election of President López Obrador and legislative changes led to a deep renewed focus on tobacco control (politics stream). These three streams converged to create a policy window to secure a strong FCTC-based initiative on the political agenda that was ultimately passed. CONCLUSIONS: The Mexican experience illustrates the importance of continued health advocacy and political will in adopting FCTC-based policies. Other countries should follow Mexico's lead by collecting and sharing data through coordinating efforts in order to be prepared to seize political opportunity windows when strong political will is present.

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OBJECTIVE: Although Brazil became the first country worldwide to ban the sale of all tobacco products with any additive that could alter their flavours and tastes in 2012, its implementation was effectively halted by tobacco industry lawsuits, including a constitutional challenge filed in the Federal Supreme Court in 2013. This study aimed at examining, for the first time in the country, the evolution over time of the new registrations of tobacco products with additives that would have been banned if not for the tobacco industry's interference ('counterfactual scenario'). METHODS: We used the newly available public database on the registration of tobacco products developed by the Health Regulatory Agency (from 2008 onwards). All types of tobacco products intended for the domestic market that contained 'banned additives in a counterfactual scenario' and were registered between January 1 and December 31 of each year were selected. RESULTS: Between 2012 and 2023, a total of 1112 new registrations of tobacco products with 'banned additives' were recorded. The spread of hookah tobacco registrations started in 2014, and by 2023, the cumulative incidence of registrations containing 'banned additives' was 641. Both manufactured cigarettes and hookah products reached their peaks in new registrations in 2020. CONCLUSIONS: After 12 years since the resolution intended to ban all additives that change the aroma and taste of tobacco products in Brazil, primarily to prevent smoking initiation, the tobacco industry's interference continues to successfully block its implementation. Countries facing similar challenges in tobacco control could consider generating comparable national data that might help expose the adverse impacts of tobacco industry interference on public health.

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OBJECTIVE: To determine whether the association between tobacco advertising (TA) exposure and poor self-rated oral health (SROH) is mediated through secondhand smoke (SHS) exposure in Brazilian adults who have never smoked. METHODS: Secondary cross-sectional analysis of The Brazilian National Health Survey 2019 data. The daily, weekly, or monthly exposure to SHS at home or at work was set as the mediator. Mediation analysis within a counterfactual approach used adjusted binary logistic regressions for both poor SROH and SHS exposure, to estimate the natural direct effect (NDE), natural indirect effect (NIE) through SHS exposure, and marginal total effect (MTE) of TA exposure on poor SROH. To assess the robustness of the results, we calculated the E-value for the MTE. RESULTS: The sample comprised 53,295 never smoker adults. The MTE of TA exposure on poor SROH was 1.09 (1.03, 1.16), with the indirect effect through SHS exposure responsible for only 16.6% of the total (NIE: 1.01 [1.01, 1.02] and NDE: 1.08 [1.02, 1.14]). An effect of 1.42 would be required for an unmeasured confounder to explain away the association between TA and SROH. CONCLUSION: More individuals exposed to TA have poor SROH than those unexposed, with secondhand smoke exposure explaining only a small portion of this effect. Upstream tobacco policies should consider oral health outcomes.

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INTRODUCTION: Monitoring tobacco industry marketing strategies in countries that have introduced plain packaging helps with documenting variations in the market during the transition period. Uruguay implemented plain packaging in February 2020. We describe changes in the characteristics of tobacco packaging, content and sticks before and after plain packaging implementation. METHODS: Data were collected across 15 neighbourhoods in different socioeconomic areas in Montevideo, Uruguay, before and after implementation (2019 and 2021). A high school or college was selected in each neighbourhood as the walking protocol starting point. Two stores were visited per neighbourhood. Cigarettes and roll-your-own tobacco (RYO) were purchased and coded for the presence of taste or sensation lexical and imagery features. RESULTS: The number of unique products increased between 2019 (n=23) and 2021 (n=40). Prior to implementation, all packs presented design features. After its implementation, 95.7% of cigarette packs complied with regulations. Overall, 34.7% of cigarettes and RYO were flavoured in 2019 versus 50.0% in 2021 (p=0.01). In 2019, all flavoured cigarette packs conveyed taste through language and/or imagery, while cigarettes had designs on the filter suggesting the potential for altering the flavour. In 2021, 44.0% of cigarette packs indicated flavour through lexicon; and 81.0% of cigarette sticks still included a flavour capsule. CONCLUSIONS: After implementation, we noticed an increase in the availability of unique flavoured cigarettes and RYO among surveyed retailers. However, this increase was less pronounced compared with what is reported in the Latin American region. Non-compliance was identified. Greater efforts should be made enforcing current policy.

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ABSTRACT Objective. To document tobacco industry strategies to influence regulation of new and emerging tobacco and nicotine products (NETNPs) in Latin America and the Caribbean. Methods. We analyzed industry websites, advocacy reports, news media and government documents related to NETNPs, focusing on electronic cigarettes and heated tobacco products. We also conducted a survey of leading health advocates. We applied the policy dystopia model to analyze industry action and argument-based strategies on NETNP regulations. Results. Industry actors engaged in four instrumental strategies to influence NETNP regulation - coalition management, information management, direct involvement in and access to the policy process, and litigation. Their actions included: lobbying key policy-makers, academics and vaping associations; providing grants to media groups to disseminate favorable NETNP information; participating in public consultations; presenting at public hearings; inserting industry-inspired language into draft NETNP legislation; and filing lawsuits to challenge NETNP bans. The industry disseminated its so-called harm reduction argument through large/influential countries (e.g., Argentina, Brazil, and Mexico). Industry discursive strategies claimed NETNPs were less harmful, provided safer alternatives, and should be regulated as so-called harm reduction products or have fewer restrictions on their sale and use than those currently in place. Conclusion. Our analysis provides a better understanding of industry strategies to undermine tobacco and nicotine control. To help counter industry efforts, health advocates should proactively strengthen government capacities and alert policy-makers to industry attempts to create new regulatory categories (so-called reduced-risk products), provide misleading information of government authorizations of NETNPs, and co-opt so-called harm-reduction messages that serve the industry's agenda.

RESUMEN Objetivo. Documentar las estrategias de la industria tabacalera para influir en la regulación de los productos de tabaco y nicotina novedosos y emergentes (PTNNE) en América Latina y el Caribe. Métodos. Se analizaron los sitios web de la industria, los informes de defensa de la salud, los medios de información y los documentos gubernamentales relacionados con los PTNNE, prestando especial atención a los cigarrillos electrónicos y los productos de tabaco calentado. También se realizó una encuesta a líderes de la promoción de la salud. Aplicamos el modelo de distopía política para analizar las estrategias de acción y argumentación de la industria en relación con la regulación de los PTNNE. Resultados. Las partes interesadas de la industria recurrieron a cuatro estrategias instrumentales para influir en la regulación de los PTNNE: gestión de coaliciones, gestión de la información, participación directa y acceso al proceso de formulación de políticas, y litigios. Sus acciones incluyeron: trabajar con los principales responsables de la formulación de políticas, académicos y asociaciones de vapeo; conceder subvenciones a grupos de medios de comunicación para que difundan información favorable a los PTNNE; participar en consultas públicas; realizar presentaciones en audiencias públicas; introducir un lenguaje inspirado por la industria en la legislación sobre los PTNNE; y presentar demandas judiciales para dificultar las prohibiciones de los PTNNE. La industria difundió su argumentación, denominada de reducción de daños, en países grandes e influyentes como, por ejemplo, Argentina, Brasil y México. Las estrategias discursivas de la industria afirmaban que los PTNNE eran menos nocivos, proporcionaban alternativas más seguras y debían regularse del mismo modo que los denominados productos de reducción de daños o tener menos restricciones que las vigentes en la actualidad para su venta y consumo. Conclusión. Este análisis permite comprender mejor las estrategias de la industria para socavar el control del tabaco y la nicotina. Para contribuir a contrarrestar los esfuerzos de la industria, los defensores de la salud deberían fortalecer activamente las capacidades gubernamentales y alertar a los responsables políticos de los intentos de la industria de crear nuevas categorías reglamentarias (los denominados productos de riesgo reducido), proporcionar información engañosa sobre las autorizaciones gubernamentales de los PTNNE y apropiarse de los denominados mensajes de reducción de daños que responden a la agenda de la industria.

RESUMO Objetivo. Documentar as estratégias usadas pela indústria do tabaco para influenciar a regulamentação de produtos novos e emergentes de tabaco e nicotina (NETNPs, sigla em inglês) na América Latina e no Caribe. Métodos. Foram analisados sites do setor, relatórios de ativistas, notícias em meios de comunicação e documentos governamentais relacionados aos NETNPs, com foco em cigarros eletrônicos e produtos de tabaco aquecido. Também foi realizada uma pesquisa com ativistas importantes na área da saúde. O modelo de distopia política foi utilizado para analisar as ações e as estratégias baseadas em argumentos do setor para a regulamentação de NETNPs. Resultados. Os agentes do setor utilizaram quatro estratégias instrumentais para influenciar a regulamentação de NETNPs: gestão de coalizões; gestão de informações; envolvimento direto e acesso ao processo de formulação de políticas; e ações legais. As ações dos agentes incluíram: trabalhar com os principais formuladores de políticas, acadêmicos e associações de cigarros eletrônicos; conceder subsídios a grupos de comunicação para disseminar informações favoráveis aos NETNPs; participar de consultas públicas; fazer apresentações em audiências públicas; inserir linguagem gerada pela indústria na legislação de NETNPs; e entrar com ações judiciais para contestar proibições de NETNPs. O setor disseminou seu argumento de "redução de danos" em países grandes e influentes (por exemplo, Argentina, Brasil e México). As estratégias discursivas do setor afirmavam que os NETNPs eram menos prejudiciais, ofereciam alternativas mais seguras e deveriam ser regulamentados como "produtos de redução de danos" ou ter menos restrições à venda e ao uso do que as atualmente em vigor. Conclusão. Nossa análise oferece uma melhor compreensão das estratégias usadas pelo setor para enfraquecer o controle do tabaco e da nicotina. Para ajudar a combater os esforços do setor, os ativistas em saúde devem fortalecer de forma proativa a capacidade dos governos e alertar os formuladores de políticas sobre as tentativas da indústria de criar novas categorias regulatórias (os chamados "produtos de risco reduzido"), fornecer informações enganosas sobre as autorizações governamentais de comercialização dos NETNPs e cooptar mensagens de "redução de danos" para atender aos interesses do setor.

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BACKGROUND: An important element to consider in tobacco tax policy is the illicit market of cigarette sales. The objective of this paper is to provide estimates of both conditional and unconditional price elasticities of cigarette consumption in the licit and illicit markets in Brazil. METHODOLOGY: Microdata from the National Health Survey in 2013 and 2019 are used to estimate conditional and unconditional price elasticities of cigarette consumption in the licit and illicit cigarette markets by income quartiles and age cohorts. The identification is based on brand information and the official minimum cigarette price defined by the government, as sales below this price are prohibited and illegal. FINDINGS: The results, robust to potential endogeneity, indicate that there is joint statistical difference in price elasticities across age cohorts and income groups by market type. However, individuals smoking illicit cigarettes, regardless of age cohort and income quartiles, are less sensitive to price changes than those consuming licit brands. CONCLUSIONS: The illicit cigarette market prevents the government from collecting tobacco tax revenues and weakens the social reach of price-oriented antismoking public policies. Fighting the illicit trade should be a major concern of public policies aiming at reducing cigarette consumption.

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INTRODUCTION: Tobacco is one of the world's largest preventable causes of premature death, accounting for more than 8 million deaths and costing the global economy US$1.4 trillion each year. Smoking is a global problem with 1.3 billion people using tobacco worldwide, who will face harmful effects on health and on people's current and future financial situations and quality of life.This article aims to be the first study to generate evidence on the effects of smoking on household expenditure and the number of people living under the poverty threshold by studying the crowding out and impoverishing effect in Mexico. METHODS: Through econometric methods and maximising a household utility function we estimate the crowding out and impoverishing effect of tobacco consumption in México based on household's income and spending survey from 2020. RESULTS: Spending on tobacco crowds out household spending on other goods and services. In Mexico, spending on tobacco results in decreased spending on essential goods and services, like education and healthcare, and increased spending on harmful goods such as alcoholic beverages. These effects are common across all income levels but are more pronounced in low-income households. When spending on tobacco increases, for example, following regular price increases made by the tobacco industry, the crowding out effect is exacerbated.In addition, smoking has an impoverishing effect on the population. This is because some families find that their remaining income level falls below the poverty line after deducting money spent on tobacco (a concept known as secondary poverty). In Mexico, 909 132 people are left with a disposable income level below the extreme poverty line because of expenditure on tobacco and smoking-related diseases. CONCLUSIONS: Smoking affects individual health and the finances of households in Mexico, particularly those of low-income people. By increasing tobacco taxes, those who quit smoking increase their quality of life and well-being. However, those who continue to smoke and increase their tobacco spending are affected by a shift in their spending on other goods and services.The increase in tobacco taxes must be accompanied by public policies that help reduce tobacco consumption and compensate the crowding out on goods and services relevant to the development of households.

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El consumo de cigarrillos y tabacos crea una externalidad que tiene mayor relevancia en el detrimento de la calidad de vida y de la expectativa de vida que experimenta el individuo fumador con relación a los que no consumen cigarrillos o tabacos. el costo psicosocial no cuantificado de forma financiera supera con creces cualquier expectativa de beneficio económico. El presente artículo versa en torno al impacto socioeconómico del tabaquismo en Cuba. La distribución económica inducida por el tabaquismo conlleva a la persistencia de una inequidad socioeconómica tal, que se agudiza con el número de fumadores y la intensidad del consumo de cigarrillos y tabáquico. Este fenómeno contradice el principio socialista de distribución con arreglo al trabajo, donde los no fumadores no deberían cargar con las consecuencias del tabaquismo y los propios fumadores no deberían ser inducidos a persistir en el consumo tabáquico. La sutileza de los costos sociales atribuibles al tabaquismo y el impacto de los beneficios del comercio interior y exterior, no permiten valorar en su completa dimensión los principales efectos del tabaquismo desde el aspecto socioeconómico.

The cigarettes and tobacco consumption creates an externality that is more relevant in the detriment of the life quality and life expectancy experienced by the individual smoker, in relation to those who do not consume cigarettes or tobacco. The psychosocial cost not financially quantified far exceeds any expectation of economic benefit. This article deals with the socioeconomic impact of smoking in Cuba. The economic distribution induced by smoking leads to the persistence of such socioeconomic inequity, which worsens with the number of smokers and the intensity of cigarette and tobacco consumption. This phenomenon contradicts the socialist principle of distribution according to work, where non-smokers should not bear the consequences of smoking and smokers themselves should not be induced to persist in smoking. The subtlety of the social costs attributable to smoking and the impact of the benefits of domestic and foreign trade do not allow a full assessment of the main effects of smoking from the socioeconomic aspect.

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OBJECTIVES: We analyse the employment effects of increasing tobacco taxation in Argentina by building a computable general equilibrium (CGE) model. METHODS: In line with recent changes in tobacco taxation in the country, the CGE model simulates an increase in excise tax on cigarettes. RESULTS: The results show that even a substantial increase in tobacco taxation induces a zero-net change in overall employment in the economy when the newly raised tax revenues are spent by the government on education, health or public infrastructure. Increased tobacco taxes may shift jobs from tobacco-related sectors to other sectors of the economy, but the overall impact on the total number of jobs is negligible. CONCLUSIONS: The widely documented positive effects of higher tobacco taxes (including a healthier population, more productive workers, savings from avoided costs of medical treatment for tobacco-related diseases, reductions in the number of new young smokers, among others) would far outweigh the nearly null effect of higher taxes on total net employment.

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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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OBJECTIVES: To identify proponents and opponents of the commercialisation and marketing of e-cigarettes and heated tobacco products (HTPs), identify the arguments used on both sides and compare how the arguments have changed over time, we analysed three policy discussions occurring in 2009, 2018 and 2019. METHODS: We conducted a content analysis of one document and six videos from these discussions, provided on the Brazilian Health Regulatory Agency website, or upon request. RESULTS: The arguments most used by tobacco companies were related to claims that the use of e-cigarettes and HTPs is less harmful than conventional tobacco. Unions that support its commercialisation also argued that lifting the ban would prevent smuggling and guarantee their quality. On the other side, universities, medical and anti-tobacco institutions argued that such devices may have health risks, including the risk of inducing cigarette smoking. In 2009, most arguments belonged to the 'health' theme, while in 2018 and 2019 economic arguments and those related to morals and ethics were frequently used. CONCLUSIONS: Those that supported the commercialisation and marketing of e-cigarettes and HTPs first focused on arguments of harm reduction, while 10 years later the right to access and potential economic consequences also became common. Public health agents and academics must gather evidence to effectively respond to these arguments and discuss these policies, and must prepare themselves to use and respond to arguments related to moral and economic themes.

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Abstract Brazil has advanced in tobacco control actions, with a significant decline in the prevalence of tobacco use. However, it is essential to identify more vulnerable populations, such as LGBT persons. This study aimed to analyze the discursive production sustaining the search for support and penetration of the tobacco industry among the LGBT population, taking the sponsorship of Philip Morris Brasil to the LGBT parade in São Paulo in 2019. We employed the critical discourse analysis of a report published on a blog. The analysis of the piece points to the use of vocabularies such as diversity, inclusion, modernity, and innovation, which concern the LGBT cause and the launch of its new product. The text conveys a high commitment and a courteous tone, using discursive resources that associate the company with technical and behavioral innovation ideas. It communicates intertextually with regulatory bodies about introducing its new product in the Brazilian market (prohibited in Brazil). It uses different ideological operators, such as the euphemism of the smokeless or smoke-free future. The work shows a tobacco industry strategy to promote its heated product while supporting LGBT cause and promoting a positive corporate image.

Resumo O Brasil tem avançado em ações de controle do tabaco, resultando em grande declínio da prevalência de tabagismo. Entretanto, é fundamental identificar populações mais vulneráveis, como as pessoas LGBT. Este estudo teve como objetivo analisar a produção discursiva que sustenta a busca de apoio e penetração da indústria tabageira junto à população LGBT, tomando o caso do patrocínio da Philip Morris Brasil à parada LGBT em São Paulo em 2019. A metodologia utilizada foi análise de discurso Crítica de notícia publicada em um blog. A análise da peça aponta para utilização de vocabulários como diversidade, inclusão, modernidade e inovação, que dizem respeito à causa LGBT e ao lançamento de novo produto. O texto traz alto grau de comprometimento e tom cortês, fazendo uso de recursos discursivos que associam a empresa às ideias de inovação técnica e comportamental. Comunica intertextualmente com órgãos regulatórios acerca da entrada no mercado brasileiro de seu novo produto (proibido no Brasil). Faz uso de diferentes operadores ideológicos, como o eufemismo do futuro sem fumaça ou futuro livre de fumaça. O trabalho apresenta uma estratégia da indústria do tabaco para promover seu produto de tabaco aquecido enquanto apoia a causa LGBT e promove imagem corporativa positiva.

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Objective: To assess progress in and barriers to implementing bans on tobacco advertising, promotion and sponsorship (TAPS) in Uruguay, which has a complete ban, and Argentina, with a partial ban. Methods: Legislation on TAPS bans in Uruguay and Argentina was reviewed and relevant published literature, news stories, civil society reports and tobacco industry reports retrieved to analyze progress in implementing TAPS bans. Results: In Uruguay, the complete TAPS ban, which includes standardized tobacco packaging, maintains high compliance and severely limits exposure of TAPS, despite a few problems with corporate social responsibility, social media, and transnational advertising. In Argentina, the partial TAPS ban has more problems with compliance and exposure to TAPS. The most important barriers to implementing TAPS bans in both countries are the tobacco companies. In Uruguay, tobacco companies do not comply in a few areas but the complete ban greatly minimizes this. In Argentina, however, tobacco companies can more easily exploit gaps in the partial TAPS ban, such as advertising at the points of sale, promoting contests, and using influencers on social media. Conclusions: The partial TAPS ban in Argentina illustrates the problems with enforcement and the tobacco industry's ability to exploit loopholes and continue to market their products, especially to young people. A complete TAPS ban, including standardized tobacco packaging, as in Uruguay, is easier to implement and enforce and is effective in reducing exposure to tobacco advertising. Nevertheless, governments should prioritize implementing TAPS bans on social media, which remains a difficult sphere to monitor and allows tobacco companies to continue recruiting and targeting young people.

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BACKGROUND: Paraguay is a major supplier of illicit cigarettes for the Latin American region and beyond. In July 2022, Paraguay ratified the FCTC Protocol. This is an opportunity and a challenge for neighboring countries to implement coordinated actions. This is the first analysis of the foreign trade data for cigarettes and their inputs using Paraguayan data to contextualise the illicit trade problem in Latin America and globally. METHODS: Combining publicly available Paraguayan databases, this research constructs a database to analyse imported cigarette inputs, particularly by identifying the companies and their national origins. RESULTS: A complex multinational supply chain perpetuates a flow of inputs into Paraguay that contributes to the production and export of illicit tobacco products. Brazil is a relevant legal supplier of intermediate goods for the Paraguayan tobacco industry yet is not a significant destination of the legal exports of cigarettes produced in Paraguay. Yet, Paraguayan cigarettes are widely available in the Brazilian market, almost all of them illicit. Trade data also show the role of other countries in the region as major cigarette input exporters to Paraguay. Evidence also supports that high volumes of legal exports from Paraguay to third countries (including Bolivia, Suriname, Aruba and Curacao) may be fuelling illicit trade through triangulation to other countries. CONCLUSIONS: The oversupply-that is, more supply than necessary for domestic consumption and legal exports-of cigarette inputs likely divert illegally back to the countries exporting these inputs and others. Thus, the responsibility for illicit trade in cigarettes falls not only on Paraguayan companies but also on companies exporting inputs to Paraguay to producing these illicit goods. Furthermore, Paraguay is not only exporting illicitly directly to Brazil and Argentina, but also appears to oversupply other countries in South America and the Caribbean that cannot legally absorb this trade through domestic consumption and/or legal re-export.

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Objective: To explore the association between reporting conflict of interest (COI) and having a positive outcome toward vaping in scientific articles. Methods: A cross-sectional study that analyzed a sample of 697 articles published between 2017 and 2020 regarding vaping. Information on the reporting of COI, type of COI (no conflict, conflict with the tobacco industry, pharmaceutical industry, or other), and country of publication were collected. To explore the association between reporting COI and having a positive result for vaping, two logistic regression models were fitted, both adjusted by country of publication. Results: From 88 articles that reported COI, 23 reported COI with the tobacco industry, 44 with the pharmaceutical industry, and 21 reported another type of conflict. We found that reporting any type of COI increased by 4.7 times the odds (OR 4.70; 95% CI [2.89, 7.65]) of having a positive result for vaping. Additionally, compared to other countries, manuscripts published in England had 2 times higher odds (OR 2.40; 95% CI [1.16, 4.98]) of reporting a positive result for vaping. Reporting COI with the tobacco and pharmaceutical industries increased the odds of favorable results by 29 times (OR 29.95; 95% CI [9.84, 90.98]) and 2 times (OR 2.87; 95% CI [1.45, 5.69]), respectively. Conclusions: In scientific articles, reporting COI and having positive results for vaping are highly associated. COI should be considered and caution should be exercised when using data for policy-making.