Tobacco and nicotine product packaging serves as communication real estate for both tobacco company marketing and health communication through required government warnings [7,8]. E-cigarette packages can be designed to resemble other objects (eg, Tic Tac container and technology devices such as mobile phones) [9-11]. They also feature a wide variety of marketing appeals such as themes of fantasy or violence, graphic elements such as cartoon characters, and heavily stylized brand names [10]. Among youth, there is an increased interest in trying fully branded e-cigarette packaging when compared to e-cigarette products with plain packaging [12-14]. E-cigarette package attractiveness is also enhanced by a variety of flavors, vibrant colors, and other branding that targets specific subgroups [12,15].

In addition to company branding (names, colors, textual elements, imagery, shapes, and sizes), e-cigarette packaging can also include HWLs, nicotine concentration, and ingredient lists. HWLs on e-cigarette packaging are associated with reduced e-cigarette use initiation and higher intentions to quit vaping among adults and youth [15-19].

The Tobacco Pack Surveillance System (TPackSS) study was initiated in 2012 with the goal to collect and analyze tobacco products (cigarettes, kreteks, bidis, and straw cigarettes) and their packaging in low- and middle-income countries with the greatest number of people who smoke. Data collection started in 2013 [20]. Roll your own and smokeless tobacco were added to tobacco product collection in 2015 and 2016, respectively, and heated tobacco products and nicotine pouches were added to the types of products to be collected in 2021 and 2022, respectively. The data collection protocol aims to collect 1 of every unique package available for sale in each country. The data generated from TPackSS data collection can inform policies that reduce appeal and attractiveness of tobacco product packaging and more effective HWL implementation and enforcement.

Beginning in 2022, e-cigarettes were added to the TPackSS data collection protocol. In the context of this paper, the term “e-cigarettes” refers to disposable e-cigarette devices and/or their accompanying products: e-cigarette liquids and pods or cartridges. It also can be used to refer to the packaging of these products when discussing them together as a whole. It does not include reusable e-cigarette devices such as tank systems or e-cigarette accessories and parts. In the work described here, e-cigarettes are not included in our definition of tobacco products.

E-cigarettes were an important product type to add to surveillance as the market has grown significantly since their debut in 2007 [21]. As of 2025, a total of 12 million youth aged 13 to 15 years across 110 countries reported current use of e-cigarettes [22]. Surveillance is critical in a market where regulations vary across the globe, including many jurisdictions with no or partial regulations [22]. The TPackSS protocol needed to be adapted for e-cigarette products because the retailer landscape often differs between e-cigarette and tobacco vendors (eg, e-cigarettes are commonly sold at vape shops). In addition, they are often shaped differently than tobacco products, can be more heterogeneous, and consist of different components (eg, liquids compared to sticks). Indonesia was the first country in which e-cigarettes were collected as part of the TPackSS study in 2022. Since then, e-cigarettes were also collected in China in 2023, with other country collections planned.

This paper presents an adaptation of the existing TPackSS protocol [20], originally developed for tobacco products, to optimize it for collection of e-cigarettes in parallel with tobacco products and the process for adaptation, including implementation evaluation and protocol refinements. We describe the specific protocol changes made based on product and market differences unique to e-cigarettes and reflect on our experience implementing and refining the adapted protocol in Indonesia and China. Through these case studies, we highlight key methodological considerations for conducting similar research in jurisdictions with varied e-cigarette landscapes and illustrate how these considerations may be incorporated into the protocol.

The original TPackSS protocol was adapted for e-cigarettes using an iterative process to enhance validity and to ensure revisions aligned with the study objectives while maintaining methodological rigor. Initial adaptations were made based on our knowledge of the e-cigarette landscape, country-specific regulations, and e-cigarette products and marketing, informed by the peer-reviewed literature, white papers, Euromonitor data, and consultation with experts in e-cigarette marketing research and in-country public health professionals. All adaptations to the protocol were extensively discussed and agreed upon by the TPackSS study team, comprising researchers with expertise in tobacco advertising, tobacco package HWLs, and packaging design, who have conducted research on tobacco packaging for 13 years. Using Indonesia as a pilot country, implementation of each phase of the adapted protocol was monitored, and the research team held regular debriefings to identify challenges, assess adherence to the protocol, and address any needed clarifications. Reflections made during implementation of the protocol in Indonesia also informed further adaptations to the China protocol. This iterative process of revisions, observation, group discussion and reflection, and refinement enhanced feasibility and data quality while preserving the study’s core objectives.

The original TPackSS protocol included a comprehensive overview of each phase of the research from data collection to dissemination of findings [20]. Here, we present how each step was adapted for e-cigarettes and the factors considered when making adaptations. Descriptions of how the protocol differed in Indonesia and China provide examples of how the protocol can be customized to reflect jurisdiction-specific factors while still adhering to the key steps of the protocol. Table 1 provides a summary of the key differences in the original TPackSS protocol and the protocol developed for e-cigarettes.

The training for data collectors was adapted to contain e-cigarette–specific content and procedures. The specific procedures followed by data collectors to identify unique e-cigarette packages, label e-cigarette packages with unique IDs, create an e-cigarette image archive, document the details of each e-cigarette purchase at the neighborhood level, and create an inventory of e-cigarette packages purchased mirrored the procedures used for tobacco products, as described in the original protocol [20].

The photography guide for e-cigarettes followed the original guide [20], with instructions added to capture additional e-cigarette pack images as needed to account for multiple layers of packaging not commonly found for tobacco products and the greater variety of e-cigarette packaging shapes relative to tobacco products. All layers of e-cigarette packaging were captured, and for e-cigarette packages with unique shapes, all sides that contained descriptors, imagery, or HWLs were captured.

We received updated approval from the US Food and Drug Administration and the US Federal Trade Commission to import and store empty e-cigarette packages for research purposes. E-cigarette products were disposed of prior to shipping; only empty packaging was imported due to safety concerns with shipping batteries and liquid, an issue not encountered with tobacco products. As with tobacco products, packages are stored in our office space in labeled and cataloged boxes. Unlike the intake procedures described previously for tobacco products, intake for e-cigarettes was completed at the same time as coding [20].

Since publication of the original protocol, professional translation services were substituted with Google Translate to translate all non-English text on packaging, including tobacco and e-cigarette packaging, into English. Research assistants now use the image translation feature available via the Google Translate smartphone app to record English translations in Microsoft Excel spreadsheets for reference during coding [24]. For the coding of Chinese e-cigarette packages, all team members were able to read Chinese; therefore, translation was not required.

The e-cigarette codebook was developed through an iterative process involving incorporation of existing measures, consultation with subject matter experts, in-person review of e-cigarettes collected in Indonesia, and pilot testing followed by refinement. First, we combined our previously separate tobacco product codebooks on intake, warning labels, design features, and marketing appeals into a single codebook to be adapted for e-cigarettes. We then added questions on external packaging, nicotine type and presentation, and cessation claims and expanded flavor and youth appeal response options based on the literature on e-cigarettes and personal observation of e-cigarette packaging. Next, we conducted a literature review to identify existing content analyses of e-cigarette advertising and packaging, identifying 15 relevant peer-reviewed publications [9,25-38]. We conducted informational meetings with research teams that authored 5 of these publications, which used data from Greece, England, and the United States. Prior to the meetings, research teams received a list of proposed codebook constructs (ie, product information, nicotine content, flavors, packaging features, warning labels and messages, marketing messages and images, and advertising tactics). During the meetings, researchers provided feedback on these constructs and responded to targeted questions about their experiences in codebook development, features they would have liked to have coded, coding challenges, and unexpected findings. Detailed notes were taken to document lessons learned, suggestions for improvement, and recommendations for additional codebook constructs. Insights gathered were incorporated into the first full draft of the codebook to enhance its practicality and relevance.

To aid codebook development, we also viewed the physical e-cigarette packages collected in Indonesia in person. We found that compared to cigarettes, e-cigarettes from Indonesia came in a greater variety of shapes and displayed unique and varied design elements. The design also seemed more tailored to a younger audience, consistent with the literature on cigarette pack design elements that make cigarettes more attractive to youth and young adults (Figure 2) [39,40]. On the basis of these observations, we added questions and response options to the codebook to capture specific packaging elements likely to appeal to youth (eg, cartoons and fun fonts).

Next, we pilot-tested the codebook with coders and further revised the codebook and accompanying coding guide. A random subsample of 125 packages from Indonesia were used to pilot the first full version of the e-cigarette codebook. Revisions were made for clarity to address package characteristics not previously addressed and to eliminate items that had low interrater reliability. For example, we found the units used to communicate nicotine concentration varied (eg, percentage, “mg,” and “mg/mL”) and added response options accordingly. We also found that “masculine” and “feminine” appeals and brand names could not be determined reliably; these codebook questions were eliminated or edited.

A high level of intercoder agreement was reached for most variables (80%); however, for marketing appeals, there was a trade-off between simplifying the codebook to achieve higher agreement and including appeals that could provide greater context to the marketing being used on the packaging, resulting in lower levels of initial agreement (50%-70%) on some variables.

The codebooks for Indonesia and China e-cigarettes also varied due to different packaging and labeling regulations. At the time of data collection, e-cigarettes were unregulated in Indonesia; therefore, no questions applicable to compliance with existing policies were included in the Indonesia e-cigarette codebook, and only the external packaging layer visible to the consumer at point of sale was coded. Given the existing e-cigarette packaging and labeling policies in China at the time of data collection, the China e-cigarette codebook included related items, and coders were instructed to observe all layers of the packaging and the product. Further revisions were made to the China codebook based on packaging elements specific to Chinese e-cigarettes, additional pilot testing of 10 e-cigarette packages from China, and decisions to simplify the codebook after determining that certain items were not of high priority.

The base codebook structure used in both countries contained 4 sections: product information, nicotine, warning labels, and marketing appeals (Table 2), with some codes only included in the Indonesia or China codebook based on lessons learned and country-specific regulations and context.

Coding of e-cigarette packages followed the same procedures as previously described for tobacco products [20]. Packages were double-coded independently, and discrepancies were resolved by a third reviewer. Since 2021, we have transitioned to coding all products online using pack images generated using the photography guide rather than in person using the physical packages.

Coders used an extensive coding guide with questions, variable definitions, and package examples as a reference during coding. During a virtual training, coders were introduced to the codebook, coding guide, and coding platform Research Electronic Data Capture (REDCap; Vanderbilt University) and practiced coding packages as a group [41]. As with tobacco products, weekly coding review meetings were held to discuss any unusual packages encountered during coding and resolve coding discrepancies.

For Indonesia, separate qualitative coding of cultural appeals was conducted because the original coders were not all native to Indonesia or closely familiar with its cultural context and, therefore, were not able to adequately assess the meaning of some package elements. Two native Bahasa Indonesian speakers who were raised in Indonesia examined all packages and made an initial assessment of whether text or imagery referred to anything related specifically to Indonesia (eg, a popular character in pop culture, food, or a slang phrase); discrepancies were discussed and resolved by a third party when needed. Next, one of these initial coders reviewed the images of the e-cigarette packages again and wrote a short qualitative description (2-4 sentences) of the cultural appeal. A third study member, who was born in Indonesia, conducted a thematic analysis of the cultural appeals across packages and summarized the results. A fourth study member, who was born in Indonesia, reviewed all packages to determine if cultural appeal overlapped with youth appeal and, when appropriate, categorized and described the culturally specific youth appeal. Two additional Indonesians reviewed these youth appeal categories and descriptions and provided additional insight on whether the appeals were mostly known and liked by younger consumers or if they also appealed to a wider audience. For China, cultural appeals were coded quantitatively as part of the standard codebook because all members of the study team were native to or closely familiar with the Chinese cultural context [24].

The TPackSS study began in 2012 with funding from Bloomberg Philanthropies’ Bloomberg Initiative to Reduce Tobacco Use. Between September and October 2022, we collected 825 unique packages in Indonesia, comprising 782 e-cigarette liquid bottles, 26 disposable e-cigarette devices, and 17 disposable pods or cartridges. Of the 825 unique packages collected in Indonesia, 483 were collected in Jakarta, 203 in Surabaya, and 139 in Medan. Between April and May 2023, we collected 143 unique packages in China, comprising 5 disposable e-cigarette devices and 138 disposable pods or cartridges. No e-cigarette liquid bottles were collected in China. This is likely because the law prohibits the sale of e-cigarette products that allow people to add their own e-liquid to a device [42]. Of the 143 unique packages collected in China, 41 were collected in Shanghai, 31 in Beijing, 6 in Chongqing, 25 in Guangzhou, 15 in Kunming, and 25 in Shenzhen. Data analyses for Indonesia are completed, and secondary analyses are being completed for China. Detailed findings from these collections are being disseminated through separate publications scheduled for 2026 [43].

As with our tobacco product collections, we upload images of the e-cigarette packages to the TPackSS searchable online database [20]. Similar to tobacco products, information about a specific pack is provided along with its photos. Individual e-cigarette packages have the same description categories as tobacco products: brand family, product type, country, city, collection date, and price. Additionally, similar to tobacco products, these packages can be filtered and searched by product type, country, brand family, collection year, and specific features. Some of the current features available for tobacco products (ie, HWL noncompliance and flavor appeal) are applicable to e-cigarettes.

The TPackSS website also features a “Share A Pack” section where users can upload and share photos of tobacco packs from their country. These user submissions contain similar description categories and searchable features to the official uploaded TPackSS collections. This user submission feature has been expanded to encourage uploads of e-cigarette products.

As with previous tobacco product collections, in addition to uploading photos of the packages collected to the project website, we are continuing to create and disseminate country-specific fact sheets. These fact sheets are available for download from the website [24]. The field procedures and codebooks used for these collections and our publications on TPackSS findings are also available via the website.