Systematic Assessment of Flavor Cues and Additives in Cigarettes and Heated Tobacco Products in Korea: Cross-Sectional Surveillance Study.

Abstract

In South Korea, where plain packaging has not been adopted, tobacco packaging continues to function as a key marketing tool for the tobacco industry, using texts, colors, and imagery to attract consumers. Among these, flavor cues are especially important as they enhance product appeal. Cigarette sticks also serve marketing functions through design features such as colors and capsule indicators. This study aimed to examine flavor-related cues on cigarettes and heated tobacco products (HTPs) packaging and stick design and to assess the presence of flavor additives in these products. This surveillance study was conducted in November 2024. Tobacco products were purchased from convenience stores located in Seoul, supplemented by cross-referencing with national market monitoring data. Of 353 identified products, 214 products (150 cigarettes and 64 HTPs) were collected. Flavor cues were categorized by pack and stick design features, and additives were identified through sensory analysis of product components. Among the collected products, 63.1% (54% for cigarettes and 84.4% for HTPs) had both flavor cues and flavor additives, while 20.6% (27.3% for cigarettes and 4.7% for HTPs) had neither. Flavor cues were found in 67.3% of cigarettes and 95.3% of HTPs (P<.001), and flavor additives in 59.3% of cigarettes and 84.4% of HTPs (P<.001). Pack color was the most common cue, and additives were most often delivered through crushable capsules. HTPs used a wider range of flavoring methods, including flavoring in tobacco leaves and inner wrappers. Tobacco packaging and stick design in South Korea remain important marketing tools for the tobacco industry. Flavor cues and additives are widely used in tobacco products, particularly in HTPs. These findings highlight the need for plain packaging policies and bans on flavor additives in tobacco products.