Abstract
Introduction
Capsule cigarettes allow users to crush liquid-filled capsules to release flavors into cigarettes’ filters. New devices are emerging across the globe that allow people who smoke to circumvent tobacco flavor restrictions via injectable capsules. This study examined TikTok videos marketing flavored capsule injector devices.
Methods
TikTok videos (n = 832) posted worldwide between July 6, 2021, and December 28, 2023, that used hashtags #injectorflavor, #flavourclickball, #flavorball, and #injectorballcigarette were collected using a TikTok application programing interface. A codebook was developed using a systematic iterative approach, identifying six codes: flavor capsules, promotes flavors (i.e., fruit, mint or menthol flavors, nonalcoholic drinks, alcoholic drinks), demonstrates how to use or refill large injector devices, demonstrates how to use small convenient devices, includes music (any or English language). Two independent coders annotated all videos.
Results
Overall, 88.3% (n = 735) of the videos displayed flavor capsules and had been viewed more than 72 million times. Half (51.6%) of the videos demonstrated how to use large box-shaped devices to inject capsules into the filter of a cigarette, and 15.0% of the videos showed how to do this with smaller, more convenient devices. Flavors including fruit (35.5%), menthol/mint (27.8%), nonalcoholic drinks (21.9%), and alcoholic drinks (11.6%) were used to promote these capsules. Most videos (85.6%) were uploaded by sellers on “TikTok shop.”
Discussion
TikTok accounts are promoting injectable capsule devices that circumvent flavored tobacco sales restrictions. Policy makers, tobacco control advocates, and public health practitioners should be aware of such marketing to inform regulation and develop prevention strategies.
Implications
Our findings identified an emerging product that can encourage circumvention of flavor restriction policies. Regulators, policy makers, public health practitioners, researchers, and advocates should be aware of such products to inform regulation and develop prevention strategies. Given the potential for these products to reduce the intended effects of flavored tobacco sales restrictions, policy makers must be poised to address materials that consumers use to create their own flavored tobacco products, including flavor capsules designed to be inserted into cigarettes.
Introduction
Marketing, sales, and consumption of flavor capsule cigarettes, such as Camel Crush (R.J. Reynolds), are a global concern.1–4 These products have been marketed toward millennials, often promoting the experience of crushing the liquid-filled capsule, which releases flavor into the cigarette’s filter.3 Capsule cigarettes convert tobacco-flavored cigarettes to menthol or other-flavored cigarettes and are popular among youth and young adults, with rates of past 30-day use between 2017 and 2019 ranging from 52% to 60% among those under 30 years in Mexico and Chili, respectively.2,3,5 Global marketing has promoted this product as being smoother and more fun and attractive than noncapsule cigarettes.6
Policies intended to reduce tobacco use by restricting flavored tobacco products have been implemented in several countries.7 Although the United States (US) is one of the few countries that exempts menthol cigarettes from flavor restrictions,7 the US Food and Drug Administration (FDA) issued proposed rules in 2022 to prohibit cigarettes with menthol as a characterizing flavor and cigars with characterizing flavors. Evidence from Canada and the US demonstrates flavor restriction laws reduce availability, marketing and advertisements, and the use of flavored tobacco products, with US data showing moderate associations with the decrease of tobacco use among youth.8,9 However, tobacco companies have used strategies to circumvent regulation. For example, following Ontario, Canada’s menthol sales restriction law in 2017, cigarettes with menthol-suggestive marketing (e.g., green packaging) increased by 11%.10 In US states that have recently prohibited the sale of flavored tobacco products (California and Massachusetts), the tobacco industry has marketed new cigarette varieties labeled “non-menthol” that contain a synthetic cooling agent, WS-3.11 Thus, public health organizations and decisionmakers should be aware of potential loopholes or enforcement challenges when developing policies and enforcement measures.
The sale of flavor additives is a method of circumventing flavored tobacco product prohibitions, such as the menthol restriction laws in the European Union (EU) and Canada.12,13 These products (including menthol flavor cards, filter sprays, drops, loose filter tips, and injectable flavored capsules) allow consumers to create the types of products they can no longer buy legally in finished form.12 Although initial research has identified these products12 and the marketing and illegal sales of tobacco products on social media,14,15 no research to our knowledge has examined the promotion of tobacco flavor additives on social media. Thus, this study’s purpose was to identify marketing and promotion of injectable flavored capsules for cigarettes on TikTok.
Methods
Data Collection
TikTok videos (n = 832) and metadata were collected on January 25, 2024, using a TikTok application programing interface (API; https://console.apify.com/). TikTok was selected due to the platforms’ popularity among young audiences,16 and recent literature indicated that it has been used to circumvent other tobacco control laws (e.g., flavor restriction laws and minimum legal sales age).15,17 Consistent with exploratory research regarding e-cigarette exposure on Tiktok,15 popular hashtags were used to identify tobacco related discussions (e.g., #menthol), and hashtags were tailored to unique language specific to liquid-filled capsules based on reach of the videos and specificity to the topic (i.e., #injectorflavor [52.6 million views], #flavourclickball [45.9 million views], #flavorball [4.5 million views], and #injectorballcigarette [50.4 million views]). Videos, posted between July 1, 2021 (approximately one year after the EU’s flavor restriction law went into effect), and December 31, 2023,7 were deemed eligible if they included depictions of an injection device for cigarettes or flavored capsules intended for the insertion into cigarette filters. Although prior studies restricted searches to English language videos,15 we also coded the visual depiction of foreign-language videos. Thus, all posts were included regardless of language, capturing international marketing content. All procedures were exempt from review by the University of Arkansas Institutional Review Board (Protocol # 2110361112).
Codebook Development
The study codebook was developed using a grounded theory approach.18 To do this, the authors (PDD, ES, MT, NB) viewed 25 of the most viewed videos (140 800 to 23 000 000 views). Using an inductive coding procedure, emergent themes were identified, and used to develop defined codes; visual examples of videos were included in the codebook. Two coders (MT, NB) were trained using 25 additional TikTok videos, where codes were added to include novel topics related to devices that inject flavored capsules into cigarettes. Emergent codes included: presence of flavor capsules; flavor promotions (fruit, menthol/mint, nonalcoholic drinks, alcoholic drink flavors); demonstrations inserting capsules into cigarettes using box-shaped refillable injection devices; demonstrations of refilling these devices with capsules; and demonstrations of using smaller, more convenient devices (i.e., holds capsules and functions as an injector via a stick connected to the back or via a protrusion on the front of the device). We also identified whether the video included music and if the song used English language. The final codebook included six unique codes, see Table 1 for operational definitions.
Table 1.
Codebook With Operational Definitions
| Code | Operational definitions | N (%) |
|---|---|---|
| Flavor capsules | Video includes images that display flavor gel capsules. These can include flavor capsules inside the device. | 729 (99.1) |
| Promotes flavors | ||
| Fruit | Video displays, mentions, or use of emojis to promote fruits flavored capsules. | 261 (35.5) |
| Mint or menthol | Video displays, mentions, or use of emojis to promote menthol or mint flavored capsules. | 204 (27.8) |
| Drink flavors | Video shows capsules that promote drink flavors that are not alcohol (e.g., coca cola) or milk drinks. | 161 (21.9) |
| Alcohol flavors | Video shows capsules that are alcohol flavored (e.g., champaign, mojito). | 85 (11.6) |
| Demonstrate how to use an injector device | Video demonstrates how to poke a hole in the cigarette and put the gel capsule inside with the injector device using box-shaped device. | 379 (51.6) |
| Demonstration of how to refill an injector device | Video demonstrates how to refill the injector device. | 61 (8.3) |
| Demonstration convenient device | Video demonstrates how to use small convenient device. Will include how to puncture cigarette and insert capsule inside cigarette filter. | 110 (15.0) |
| Music | ||
| Any language | Music included with video. | 710 (96.6) |
| English language | Music uses English language. | 114 (15.5) |
Coding and Analysis
Following training, two coders annotated a subsample of videos and met weekly to determine interrater reliability (using Cohen’s kappa) and discuss discrepancies. After four weeks of coding, the coders met acceptable reliability (Κ > .70) on all but two codes, ranging from Κ = 0.44 to 0.89. Codes with kappa values less than .70 included English language music and demonstration of convenience device. After coders resolved discrepancies and updated operational definitions for these codes, they annotated all videos, and the first author adjudicated all discrepancies when they occurred. Videos determined to be irrelevant (n = 97, 11.7%; e.g., displayed food flavor injectors or content not relevant to tobacco products) were removed before analysis. Metadata analyzed included: posting authors’ number of followers, likes, and videos posted); count of times the video had been viewed; and engagement (i.e., number of likes, comments, and shares). The reach and engagement of the 735 relevant videos was reported using median, range, and inter-quartile range (IQR) of the total number of views, likes, shares, comments, collections (number of times the TikTok user saved the video to their “collection”), and number of followers, likes, and videos posted by the author.
Results
There were 72 599 568 views across the 735 videos of flavored capsules being used as cigarette flavor additives (9 [1.2%] with 0 views, median = 282, range = 0–23 000 000, and IQR = 153–2153). There were 1 067 438 “likes” of the 726 videos that were viewed (174 [24.0%] with 0 “likes,” median = 3, range = 0–212 100, and IQR = 1–14. Viewed videos were shared 12 298 times (514 [70.8%] where shared 0 times, median = 0, range = 0–3077, and IQR = 0–1). Viewed videos generated 5901 comments (535 [73.7%] had 0 comments, median = 0, range = 0–987, IQR = 0–1). Viewed videos were saved into viewers’ collections 73 594 times (419 [57.7%] were “collected” 0 times, median = 0, range = 0–14 700, IQR = 0–2). There were 1 791 731 TikTok accounts that followed the authors who posted the videos (15 [2.0%] had 0 followers, median = 93, range = 0–76 400, IQR = 76–458). Authors received 34 717 488 “likes” (25 [3.4%] received 0 “likes,” median = 976, range = 0–19 000 000, IQR = 721–8907). Authors who posted a video about injection devices had posted a total of 218 121 videos (4 [0.5%] had posted no other videos besides the one collected in this sample, median = 132 videos, range = 1–38 200; IQR = 17–138). Overall, 85.6% (n = 629) of video authors identified as sellers, meaning they sold products on TikTok Shop. Although price and shipping fees were not displayed in videos, video authors often requested customers to send direct messages to purchase. An online search indicated large box-shaped flavor injectors were sold at external websites for prices ranging from $24.99 (mywolfshack.com) to $43.99 (bigamart.com). Smaller devices were advertised on eBay (not through TikTok Videos) for $4–$8 USD. Each of these websites indicated products could be shipped internationally.
All but six videos displayed capsules; few displayed the injection devices without capsules inside. Half (51.6%, n = 379) demonstrated how to use the box-shaped injection devices, and 8.3%, (n = 61) demonstrated how to refill these. Additionally, 15.0% (n = 110) of the videos portrayed people using smaller, convenient devices, in which the disposable container that stored the flavor capsules also injected the capsules into cigarette filters or included an insertion stick. Although all videos appeared to originate from Indonesia, all included at least one English language hashtag. Nearly all videos featured music (96.6%, n = 710) and English language music was used in 15.5% (n = 114) of the videos.
Many videos promoted flavored capsules, often with multiple flavors displayed in a single video. One third (35.5%, n = 261) of the videos promoted fruit flavors such as grape, watermelon, banana, and strawberry. Menthol, mint, or frozen mint flavors were included in 27.8% of the videos (n = 204). Nonalcoholic drink flavors (e.g., milk, coffee, tea, and Coca Cola) were included in 21.9% (n = 161) of the videos. Lastly, alcohol flavors, including champagne, mojito, and wine, were included in 11.6% (n = 85) of the videos.
Discussion
This study sought to characterize the promotion of devices that injected flavored capsules into cigarettes displayed on TikTok. Our findings confirm TikTok accounts promote injectable capsule devices that likely circumvent flavored tobacco sales restrictions. Alternatively, selling these products may be legal in jurisdictions that (1) do not restrict flavored tobacco sales over the internet or (2) do not restrict products like these, intended to alter a tobacco product’s characteristics, in their tobacco product definitions. Flavored capsule injection devices range from large box-shaped devices that can hold hundreds of liquid capsules to small, convenient devices that could be hidden in a person’s pocket. The 735 videos analyzed in this study demonstrated how laws that do not extend flavor restrictions to include all materials used in the consumption of tobacco products could be thwarted by loopholes that allow consumers to create flavored cigarettes in jurisdictions where sales of pre-filled flavored capsule cigarettes are restricted.
Our findings suggest that these injection devices are intended to be flavor additives for cigarettes and should be prohibited under most flavored policies. However, tobacco marketing restrictions and the definition of tobacco products differ by platform,19 and unless platforms use this comprehensive definition of tobacco, these videos may not violate their site content restriction. Further, entities that are considering laws that prohibit the sale of flavored tobacco products should ensure that they employ a broad definition of tobacco products that would also prohibit the sale of materials consumers use to create their own flavored products, including online, and work to protect young people from marketing of flavored tobacco products on social media. Laws that prohibit the sale of flavored tobacco products reduce use and laws that prohibit the sale of menthol cigarettes, in particular, have been shown to increase cessation.8,9 Post policy surveillance should assess for shifts in product sales and use that could indicate products, like injectable capsules found on social media and online sales sites, are being used to undermine policy effectiveness.
This research may have implications for jurisdictions’ current and future flavored tobacco policies. Evidence has demonstrated that price for capsule cigarettes varies by country, with five countries (Argentina, Chile, Pakistan, Peru, and Thailand) found to have significantly higher prices for capsule cigarettes than unflavored cigarettes, ranging from 11.1% and 24.1%, p < .05.20 Price is an important predictor of tobacco use,21 particularly among young people,22 and given the lower prices of the smaller convenience devices, these products provide a cheaper option in areas where capsule cigarettes are more expensive than noncapsule cigarettes.20 Further, increases in tobacco prices have also been found to increase quit attempts and successful abstinence among people who smoke.23 Given the low price, flavor capsule injector use could increase across the globe, potentially increasing combustible cigarette use among populations who would otherwise not smoke.
This study was subject to limitations. Videos using related hashtags or videos/images on other social media sites, such as Instagram or Facebook may exist and were not examined. Given the qualitative nature of the study, other codes may be identified by other researchers. Exploration of external websites did not use a systematic approach to determine the full breath of prices for these products. Future researchers could attempt to purchase these products to discover shipping fees and methods used avoid detection in areas with flavor restriction laws.
Content analyses of social media allow for timely surveillance of novel products and strategies used to circumvent tobacco control policies.15 Our findings identified an emerging product that can encourage circumvention of flavor restriction policies. Regulators, policy makers, tobacco control advocates, and public health practitioners should be aware of such products to inform regulation and develop prevention strategies. Given the potential for these products to reduce the intended effects of flavored tobacco sales restrictions, policy makers must be poised to address materials that consumers use to create their own flavored tobacco products.
Contributor Information
Page D Dobbs, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA; Department of Health, Human Performance and Recreation, Center for Public Health and Technology, University of Arkansas, Fayetteville, AR, USA.
Eric K Soule, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA.
Margaret Mahoney, Public Health Policy Consultant, Minneapolis, MN, USA.
Mufazzela Tabassum, Department of Health, Human Performance and Recreation, University of Arkansas, Fayetteville, AR, USA.
Nia Burgess, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA.
Lisa Henriksen, Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA, USA.
Author Contributions
Page Dobbs (Conceptualization [equal], Investigation [equal], Methodology [equal], Writing—original draft [lead]), Eric Soule, Jr. (Methodology [equal], Validation [equal], Writing—review & editing [equal]), Margaret Mahoney (Validation [equal], Writing—review & editing [equal]), Mufazzela Tabassum (Data curation [equal], Writing—review & editing [equal]), Nia Burgess (Data curation [equal], Writing—review & editing [equal]), and Lisa Henriksen (Supervision [equal], Validation [equal], Writing—review & editing [equal])
Declaration of Interests
None declared.
Funding
PDD was supported by the National Cancer Institute and the Center for Tobacco Products (CTP) of the US Food and Drug Administration (FDA; K01CA267967). LH and MM are supported by the National Cancer Institute (P01 CA225597). EKS’s effort is also supported by grant number U54DA036105 from the National Institute on Drug Abuse of the National Institutes of Health and the CTP of the US FDA and grant number P50MD017319 from the National Center on Minority Health and Health Disparities of the National Institutes of Health. The information, views, and opinions contained herein are those of the authors and do not necessarily reflect the views and opinions of the funding organizations.
Data Availability
Data will be made available upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data will be made available upon reasonable request.