Background:
Even in the context of ever more restrictive packaging requirements, tobacco companies are able to communicate about capsule technology on cigarette packs.

Methods:
From 2013-2017 we purchased unique cigarette pack presentations using a systematic protocol in 14 low- and middle-income countries. Two independent coders examined the packaging and the stick from 4,510 cigarette packs for imagery and words marketing capsule activation. Additional content analysis was conducted to better describe how capsules are presented on packs.

Results:
142 cigarette packs were coded as having a capsule. We identified three features consistently used to communicate that the product offered a capsule: a ball and/or power button symbol (92%); blue or green color for the capsule imagery (90%); and suggestive capsule terms (e.g. “activate”, “pop it”, “switch”) (96%). All capsule packs used at least two of these features and 78% used all three. We also identified that tobacco companies educated consumers and reinforced the capsule appeal through repeated exposure to a capsule image: tobacco companies used the pack panels, under the lid, foil, flip-top, cellophane, and the stick to market capsules. Most packs (88%) displayed a capsule image on the front panel, and had a capsule image in two or more places on the packaging (85%). All capsule packs used a capsule image on the stick itself. Companies frequently gave instruction on how to use the capsule: 61% of the packs had an image and/or statement related to activation.

Conclusions:
Our analysis shows that strategic and consistent methods are used to communicate capsules to consumers. Industry reports have indicated that the market share for flavor capsule cigarettes is growing. It is important for public health regulators to recognize these marketing patterns; plain packaging would help to reduce the attractiveness of new cigarette features such as capsules.