Adapting the Tobacco Pack Surveillance System Protocol to Assess Electronic Cigarette Packaging: Protocol for a...

In 2021, a total of 82 million people used electronic cigarettes (e-cigarettes) globally. E-cigarette regulations around the globe vary widely from the product being banned in some jurisdictions to being completely unregulated in others. The Tobacco Pack Surveillance System (TPackSS) was initiated in 2012 to monitor tobacco packs available in 14 low- and middle-income countries with the greatest number of people who smoke. The aim of TPackSS is to assess compliance with country-specific tobacco packaging and labeling requirements and identify marketing features and appeals used on tobacco packaging.

The objective of this study was to adapt and expand the previous TPackSS protocol to also include disposable e-cigarette devices and their accompanying products: e-cigarette liquids and pods or cartridges.

E-cigarettes were added to TPackSS data collection in Indonesia in 2022 and in China in 2023. Collection took place in Jakarta, Medan, and Surabaya in Indonesia and Shanghai, Beijing, Chongqing, Guangzhou, Kunming, and Shenzhen in China. A total of 15 neighborhoods per city in Indonesia and 12 per city in China were visited. The TPackSS protocol developed for tobacco products in 2012 to 2013 was used as the foundation for the adapted protocol for e-cigarettes. The adaptation of the original TPackSS protocol followed an iterative process involving extensive discussions among the TPackSS study team, comprising researchers with expertise in tobacco control and 13 years of experience in tobacco product packaging surveillance. The study adapted the sampling frame and sampling strategy, pack collection procedures, photography guide, shipment and translation procedures, and codebook to account for the unique country contexts for e-cigarettes (eg, regulations, market for e-cigarettes, and retailer landscape) and the heterogeneity of e-cigarette packaging observed. These adaptations were based on the review of peer-reviewed literature, white papers, Euromonitor data, and consultation with researchers with expertise in e-cigarette marketing and with in-country public health professionals. Using Indonesia as a pilot country, the protocol was evaluated and further refined post implementation for use in China.

The TPackSS study began in 2012 and was funded by Bloomberg Philanthropies. Data collection took place from September to October 2022 in Indonesia and April to May 2023 in China. Across Indonesia and China, 968 unique e-cigarette products were collected. TPackSS data collection, coding procedures, and study findings are publicly available for use on the TPackSS website.

The protocols presented here, which were used in 2 countries with contrasting e-cigarette markets and regulatory requirements, can be adapted for use in other countries. Findings from use of this adapted protocol can inform policy by providing insights into the design features and marketing appeals of e-cigarette products available on the market, as well as compliance with health warning label requirements where applicable.