Anti-smoking Global Index

The methodology used in any index may always contain subjective aspects due to the nature of the subject matter, which implies standardizing reality data in a comparative indicator that is easy to read for very different scenarios. To preserve practicality, it has been decided to standardize the scores in each evaluated category and then introduce the subjectivity quota in the weighting assigned to each within the final score.

The methodology evaluates 11 categories in total.

Two of them are considered the most relevant because they are considered the starting point or basis for the rest of the categories. These are Prohibition and (regulatory) Framework. The remaining categories are fundamental in their contribution to the transition from combustible tobacco to Non-Combustible Nicotine Products (NCNPs). Each is described below:

Categories

PACKAGING

assesses the regulations regarding the packaging of products. In particular, whether or not health warnings are required and, in extreme cases, generic packaging. For health warnings, the mere existence of such warnings is not penalized, but they are compared with those for combustion products, where a more significant restriction on the latter is penalized. The logic behind this category is that the generic warnings commonly implemented tend to discourage the use of the product exaggeratedly. Packaging allows the identification and differentiation of products, which is essential to facilitate user consumption.

EXCISE

evaluates the tax burden on products concerning combustion products. The logic implemented is that taxes impact the price of a product, and the higher the price, the lower the consumers willingness to purchase them. Therefore, a lower tax burden on combustion products would encourage using NCNPs.

DISPLAY

evaluates the regulations regarding display in the retail trade in general. Here, it is interpreted that the possibility of comparison, visualization, and knowledge of products by customers is strongly linked to the possibility of access to products in commercial environments.

CLAIMS

assesses whether there is an endorsement by the authorities of the relatively lower-risk claims of the products.

SWITCHING

evaluates the existence of actions by the authorities that proactively encourage the use of these products or recognize their lower relative risk concerning combustion products (even without encouraging their use). This category is considered vital because it makes it possible to differentiate the normative policy of the legal, regulatory framework from the general health policy implemented by governments, which in many cases plays an informative and scientific reference role on the part of the health authority.

LEGAL

assesses the existence of any regulation that allows or disallows the commercial sale of the Non-Combustible Nicotine Product in question. In turn, for vape products and nicotine patches, it is evaluated whether there is any limit on the nicotine content in case the commercial sale is allowed. This is relevant given that countries have been detected where the product in question is permitted but with significant limitations on the amount of nicotine, transforming it into an ineffective product for the abandonment of combustible products. These limits, below which it is considered restrictive, were established based on the EU Tobacco Products Directive (TPD) for vaping liquids and on the Bundesinstitut für Risikobewertung’s study “Health risk assessment of nicotine pouches.”

FRAMEWORK

assesses the existence of a specific regulatory framework for the product. What is meant by framework, and what is not? A (regulatory) framework exists when local authorities have amended or introduced legislation specifically to regulate or prohibit an NCNP. Therefore, this is the case even if the local authorities have merely introduced a new definition in the existing legislation on combustible products to extend it to a new non-combustible product. In that sense, we can say that there is no regulatory framework when the restrictions are inferred from pre-existing legislation on combustible products and/or the "market freedoms" are unintentional and merely due to the lack of legislation.

FLAVOURS

evaluates restrictions on the use of flavorings in products. Here, it weighs the attractiveness of a greater offer of flavorings in products, increasing the likelihood of replacement of combustible products. The evidence shows a positive relationship between the use of flavors and the transition of smokers toward quitting cigarettes.

SALES

evaluates the marketing channels for the products permitted by the regulations. In particular, the channels allowed to obtain the products have been classified into three types: general retail (regardless of whether a marketing license is required), specialized stores, and pharmacies. Here, it is interpreted that the availability in broader commercial channels would allow a greater reach of these harm reduction tools while circumscribing the products to specialized trade areas reduces the availability and the promotion of consumption.

ONLINE

evaluates the possibility of marketing products through digital channels. As in Sales, the greater accessibility to products is rewarded, understanding that this positively impacts the replacement of combusted products.

COMMS

evaluates the regulations regarding whether it is allowed to advertise products and in what form it can be done. In this case, it is understood that advertising is a good mechanism for consumers to access information on the availability of alternatives, and, therefore, prohibitions disable consumers' knowledge. Cases where the regulation provided a health warning according to the risk of the product, have been contemplated and not penalized because of the advertising of these products (which, in general, have a very low but existing degree of toxicity and contain nicotine, which is addictive) can reach minors and new users on a massive scale. It has been penalized when restrictions mirror those of combustion products.

PACKAGING

EXCISE

DISPLAY

CLAIMS

assesses whether there is an endorsement by the authorities of the relatively lower-risk claims of the products.

SWITCHING

LEGAL

FRAMEWORK

FLAVOURS

SALES

ONLINE

COMMS

PACKAGING

EXCISE

DISPLAY

CLAIMS

assesses whether there is an endorsement by the authorities of the relatively lower-risk claims of the products.

SWITCHING

As can be seen, evaluating the last nine categories depends on the absence of prohibition in the first two categories. In cases where the product is prohibited, the latter is not assessed and takes the minimum value of zero. The values of the options within the categories have been standardized. These can take a maximum value of 100 and a minimum value of 0, with intermediate values in specific categories. Then, the categories are weighted according to their importance in replacing combustion products to obtain the final score per product.

Thus, the following methodology is configured, where all the categories, the options within them, the scores for each option, and the weighting that each category has in the final score per product are shown:

Category	Option		Points	Weighter
Legal	Vaping	The product is legal, and the nicotine limit (if existent) is equal to or above 20mg/ml	100	30,0%
		The product is legal but the nicotine limit is below 20mg/ml	50
		The product is not legal	0
	THP	The product is legal	100
		The product is not legal	0
	Snus	The product is legal	100
		The product is not legal	0
	NP	The product is legal and the nicotine limit (if existent) is equal to or above 16.6mg/pouch	100
		The product is legal but the nicotine limit is below 16.6mg/pouch	50
		The product is not legal	0
Framework		There is a specific regulatory framework for the product	100	25,0%
		There is a specific regulatory framework for the product, but it is non-differentiated from cigarettes	50
		There is no specific regulatory framework for the product	0
		The product is not legal	0
Flavors		All flavors are allowed	100	7,5%
		Tobacco, mint, menthol, and other (e.g., fruit) flavors are allowed	75
		Tobacco, mint, and menthol flavors are allowed	50
		Only tobacco flavors or NO flavors are allowed	0
		This product category is banned	0
Sale		Can be purchased in general retail (regardless of licensing schemes)	100	7,5%
		Can be purchased in specialized retail only	50
		Can be purchased only in pharmacies	0
		This product category is banned	0
Online		Online sales are allowed	100	7,5%
		Online sales are not allowed	0
		This product category is banned	0
Comms		At least adult-targeting, age-gated communications are allowed (e.g., social media)	100	5,0%
		Restrictions are equivalent to the ones applicable to cigarette communications	50
		Communications are banned	0
		This product category is banned	0
Packaging		Text Health Warnings are required but differentiated from cigarettes, or none is required	100	5,0%
		Text Health Warnings are required but not differentiated from cigarettes	50
		Graphic Health Warnings or Plain Packaging are required	0
		This product category is banned	0
Excise		No excise taxes are levied on the product	100	5,0%
		Excise taxes levied on the product are up to 10% of those levied on cigarettes	90
		Excise taxes are levied on the product at between 10% and 50% of those levied on cigarettes	50
		Excise taxes levied on the product are greater than 50%, or equivalent, of those levied on cigarettes	0
		This product category is banned	0
Display		Retail display is allowed	100	2,5%
		Retail display is not allowed	0
		This product category is banned	0
Claims		Authorities back relative risk claims for the product	100	2,5%
		Authorities do not back relative risk claims for the product	0
		This product category is banned	0
Switching		Authorities proactively encourage switching to this product category	100	2,5%
		Authorities accept the relative risk of this product but do not proactively encourage switching to it.	50
		Authorities do not accept the relative risk of this product but do not proactively discourage switching to it.	25
		Authorities actively discourage switching to this product.	0
		This product category is banned	0

To obtain the final score per country, the weighted average of the score of each product has been taken. For this purpose, it has been defined that Vape Products will have a relative weight of 73 percent of the final score, Heating Tobacco Products 18 percent, and Snus and Nicotine Pouches 4.5 percent each.

These figures coincide with the distribution of consumers worldwide. However, it is important to clarify that there may be a bias against heated tobacco products and smokeless oral products because they currently have less time of exposure to the markets, regulatory consideration, industrial development, and diffusion, a momentary particularity that we estimate to be temporary and that will not represent the state of the market in the coming years, once it has normalized.

For the measurement of the index in the United States, it has been decided to measure the product indexes and the general index on a state basis and then weigh these state indexes to arrive at a national index. In turn, the individual state indices have been weighted based on the population in each state to arrive at the national indices. This decision is because the regulations that impact some categories are state-based and, therefore, may vary from state to state.

Finally, in the 2024 Effective Anti-Smoking Policies Global Index, the regional grouping of countries is aligned with the criteria established by both the United Nations (UN) and the World Bank. The regions delineated in the Index are

ASIA -
OCEANIA

ASIA -
AFRICA

AMERICAS

EUROPE

By adhering to the regional groupings as defined by the UN and World Bank, the Index provides a structured and universally accepted approach to understanding the diverse landscape of global anti-smoking policies. This methodology not only facilitates a more organized analysis but also enhances the comparability and relevance of the findings across different parts of the world, ensuring that the insights drawn are both accurate and applicable on a global scale.

Description of the

METHODOLOGY

Used in the Preparation

of the Index

Categories

PACKAGING

EXCISE

DISPLAY

CLAIMS

SWITCHING

LEGAL

FRAMEWORK

FLAVOURS

SALES

ONLINE

COMMS

PACKAGING

EXCISE

DISPLAY

CLAIMS

SWITCHING

LEGAL

FRAMEWORK

FLAVOURS

SALES

ONLINE

COMMS

PACKAGING

EXCISE

DISPLAY

CLAIMS

SWITCHING