Background:
Tobacco companies use descriptors on cigarette packs to convey less harm. The WHO FCTC Article 11 calls for the elimination of misleading packaging. This study compares the use of misleading descriptors on packs before (2013) and after (2015/2016) regulations on misleading descriptors were implemented in three lower middle income Asian countries.

Methods:
A census of cigarette packs on the market were purchased in 2013 and 2015/2016 in Indonesia, the Philippines, and Vietnam using a systematic protocol. Packs displaying the country's health warning labels in rotation at time of purchase were double coded for select misleading descriptors in 2013 and for banned descriptors in 2015/2016.

Results:
In 2013, 33%, 28%, and 11% of packs, in Indonesia (n=215), the Philippines (n=98), and Vietnam (n=83), respectively, displayed "light(s)", "mild", or "low". In 2015/2016, 76 packs (36%) from Indonesia (n=209) displayed one or more of the following banned descriptors: "light", "mild", "low tar", "slim", "special", "full flavor", and "premium", 36 with those in the brand name. No packs from the Philippines (n=83) displayed explicitly banned descriptors. Three packs from Vietnam (n=88) displayed "mild" but no other banned descriptors. In the Philippines and Vietnam, alternative descriptors such as "smooth" and colors (e.g. "wind blue") have replaced "light(s)".

Conclusions:
While compliance with new regulations in the Philippines and Vietnam is high, as they do in other countries, tobacco companies are using alternative descriptors to convey cigarette strength. By retaining a similar overall design, many brands previously labeled "light(s)" may still be recognizable to consumers. In Indonesia, tobacco companies are taking advantage of a loophole in regulations that allows for misleading descriptors to remain in previously used brands or trademarks. These findings reinforce that tobacco companies continue to use the same tactics to circumvent regulations on misleading descriptors and the need for plain packaging that includes restrictions on brand names.