TY - JOUR T1 - Innovations that harm: tobacco product and packaging in low-income and middle-income countries JF - BMJ Innovations JO - BMJ Innov DO - 10.1136/bmjinnov-2021-000865 SP - bmjinnov-2021-000865 AU - Jennifer L Brown AU - Katherine Clegg Smith AU - Kevin Welding AU - Joaquin Barnoya AU - Joanna E Cohen Y1 - 2022/04/25 UR - http://innovations.bmj.com/content/early/2022/05/02/bmjinnov-2021-000865.abstract N2 - Innovation is generally regarded as positive, however, what is good for business can prove bad for public health. Innovation is recognised by the tobacco industry as a key strategy for growth and maintaining positive consumer perceptions of brands.1 There can be product innovation related to new cigarette brands and variants, and packaging innovation which refers to changes made to the pack design and marketing elements.2 Innovation in this context can also refer to ways the tobacco industry responds to new tobacco packaging and labelling policies to reduce their effectiveness.The vast majority (80%) of the world’s 1.3 billion smokers live in low- and middle-income countries (LMICs), as classified by the World Bank according to gross national income.3 In line with the WHO Framework Convention on Tobacco Control (WHO FCTC), many countries have made great progress in implementing tobacco control policies, particularly LMICs in banning tobacco advertising, promotion and sponsorship (TAPS). Seventy-five per cent of the countries with comprehensive TAPS bans are LMICs.3 These restrictions to tobacco advertising for television, magazines, billboards and points of sale have made the tobacco pack an increasingly important way for the tobacco industry to communicate with current and prospective smokers. Cigarette packs act as miniature billboards for the product and are used by the tobacco industry to increase appeal and minimise fears of the deleterious health effects of their products. Four major themes focusing on new tobacco industry strategies to reduce effectiveness of tobacco packaging and labelling policies, and innovations in tobacco product and packaging in LMICs, are discussed here: (1) manipulation of health warning labels (HWLs), (2) changes to pack structure and maximal use of surface area for advertising, (3) proliferation of and emergence of flavour capsules and concept flavour descriptors and (4) pack design features that communicate ‘less harm’.Policies … ER -