How e-cigarettes’ marketing targets the youth

The tobacco industry’s focus on low- and middle-income countries has always been a health equity issue. With cigarette use being discouraged in developed nations, tobacco companies have increasingly turned to developing nations to renew demand for their harmful and lethal products. Grappling with social and economic challenges, these nations, have a tough time pushing back against the industry’s well-oiled machinery that lobbies for relaxed restrictions and preferential regulatory treatment.

The Philippines is no stranger to this. At one point, it harbored the most powerful tobacco lobby in Asia, which neutralized the “Yosi Kadiri” campaign during the “golden era of health promotion.”

Despite this, policy milestones have been achieved in regulating the packaging, marketing, and use of tobacco products. Regulations have eventually caught up with the tobacco industry such that the percentage of adults who smoke cigarettes in the Philippines has declined from 29.7 percent in 2009 to 19.5 percent in 2021. This steady decline was achieved through (1) the Philippines’ ratification of the WHO Framework Convention on Tobacco Control (FCTC) in 2005, (2) the Tobacco Regulation Act of 2003, (3) the Graphic Health Warnings Law, and (4) the series of advocacy-led sin tax reforms that have raised the price of cigarettes since 2012. Many of these reforms have been institutionalized to protect the youth from the allure of cigarettes, given that around 90 percent of smokers get hooked on nicotine from a very young age.However, these victories have been complicated by the introduction of e-cigarettes and heated tobacco products. While the tobacco industry “officially” positions these electronic smoking devices (ESDs) as alternatives to help smokers quit cigarettes, these products uniquely appeal to nonsmokers as their marketing is clearly oriented toward the youth. Amidst the backdrop of immature regulatory frameworks in the mid-2010s, e-cigarettes were introduced with aggressive cross-border advertising, including product placement in loosely regulated video streaming services. ESDs, marketed as “modern” and “sophisticated” accessories, are strategically crafted to entice young persons; as such, they are picked up by social media influencers, some paid by the industry, and kept relevant in online platforms frequented by the youth.

Aside from their widespread availability, the attraction of electronic smoking devices is heightened by the variety of their flavor options. Mimicking the flavors found in a candy store, e-cigarettes come in such flavors as mango, mint, and bubblegum, which mask their dangerous chemical content and lead the young into thinking that these products are harmless. This tactic echoes historical strategies where flavored cigarettes were used to attract new users, particularly the younger generation and people of color.

Affordability further strengthens the appeal of ESDs. Compared with the short-lived pack of 20 regular cigarettes, the 10,000 puffs offered by high-nicotine single-use e-cigarettes, taxed at a much lower rate than conventional cigarettes, are an attainable luxury for the young.

Even in physical spaces, ESDs are being heavily promoted at points of sale to Filipino youth. According to Johns Hopkins University, ESDs are more likely to be placed with products usually meant for the youth, and are more likely to appear at children’s eye level in stores that are within the vicinity of schools and centers of youth activity. With strong public health evidence showing that e-cigarette use leads to future consumption of combustible cigarettes, these industry practices have justifiably raised concerns about public health.

To make matters worse, while tobacco companies have been buying up e-cigarette companies en masse, they have also been fighting every guardrail put in place to limit the appeal and availability of ESDs among the youth. Initially intended to be exclusive for those over 21 years old, newer and more relaxed regulations now allow anyone, 18 years and older in the Philippines, to buy nicotine starter packs that would keep them addicted for life.

What happened in the Philippines is a cautionary tale on the consequences of allowing tobacco companies a seat at the table when negotiating public health policy. Using the promise of risk mitigation for recalcitrant smokers through ESDs, tobacco companies have successfully distracted us from the industry’s inherent and irreconcilable conflict of interest whenever they try to insert themselves into discourses on public health. With their constant lobbying for “balanced regulation” of industry interests and public health, tobacco companies have abandoned the welfare of the youth for the sake of their bottom line and the long-term viability of their profit model.

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Anton Javier, M.D., is program officer of Southeast Asia Tobacco Control Alliance’s FCTC. He was also a primary care physician for persons with HIV. Following his studies on international health, he proceeded to work on sin taxes with the Department of Health, and on tobacco product regulation with the Food and Drug Administration.