Tobacco companies use flavours in cigarettes to make them taste better. These flavours may encourage young people to try smoking, start to smoke or continue to smoke. Flavoured cigarettes are sold across most of the world, but are very popular in Latin America. The popularity of flavoured cigarettes in many Latin American countries is due to a tobacco industry innovation. Tobacco companies introduced cigarettes that have capsules in the filter that can be burst, by squeezing the filter, to release a liquid that changes the flavour. Some cigarette sticks have as many as three different flavoured capsules in the filter, allowing several flavour options in a single cigarette. There has been little research on flavour 'capsule' cigarettes, even though they appear to appeal to young people and so are a potential route into starting smoking or continuing to smoke. They are a serious threat to adolescent health. The cigarette stick is an increasingly important way for tobacco companies to promote their products, including flavoured cigarettes. Therefore, researchers have recently started to explore ways of making the cigarette stick less appealing, for example by including health messaging on the stick, making it an unappealing colour, or a combination of both. These are called 'dissuasive' cigarettes. Our project has two objectives. The first is to understand how tobacco companies market flavoured cigarettes in Latin America and the impact that flavoured cigarettes have on the smoking attitudes, intentions and behaviours of adolescents. The second is to understand whether dissuasive cigarettes may deter adolescents from smoking. We will conduct three studies in four countries in Latin America where flavoured cigarettes are extremely popular (Argentina, Guatemala, Mexico and Peru). Each study will be carried out in four different towns and cities in each country. For the first study we will visit retailers who sell tobacco to record if, and how, flavoured cigarettes are being promoted in retail outlets and via the cigarette pack and cigarette stick, and whether single cigarettes are sold. The second study will involve discussions with small groups of adolescent smokers and non-smokers to ask what they think about flavoured cigarettes and dissuasive cigarettes. We will show participants examples of the retail marketing and cigarette packs and sticks collected in the first study to help with the discussion. The third study will also explore how adolescents view flavoured cigarettes and dissuasive cigarettes, this time using questionnaires in schools that pupils will be asked to complete during class time. This study will be informed by what adolescents say about flavoured and dissuasive cigarettes in the second study, and also with input from adolescents to develop questions so that they are easy to understand and meaningful. The research team has significant expertise on tobacco marketing and tobacco control policy, and considerable experience of working with policy makers. We will invite our project partners, including the Ministries of Health in each country and regional networks, to help us interpret the results, refine a communication plan and advise on how to make the results widely available. The findings will be communicated through research publications, presentations at conferences and to policy makers, and briefings for policy and advocacy organisations. We will hold stakeholder meetings in each country, and webinars, to present the findings to policy makers and the public. We will also have a website that focuses only on the project. In terms of potential benefits of the research, the findings will allow policy makers and other stakeholders in each country, across Latin America, and globally, to understand how flavoured cigarettes are influencing adolescent smoking, and therefore the potential benefits of banning these, and whether dissuasive cigarettes could help put young people off smoking.

Alcohol consumption ('drinking') is a major cause of disease globally, and is the leading cause of preventable deaths in people aged 15-49 years old. It impacts negatively on the economy as well as drinkers and those around them, through lost days of work, violence, relationship breakdown and road traffic accidents, as well as placing a major burden on health services. Drinking is increasing in low and middle income countries (LMICs) causing harms there to rise. Drinking is not simply a matter of individual choice, as people's choices are shaped by how available, affordable and attractive alcohol is in each community and country. Alcohol companies can increase drinking by making alcohol widely available to buy, opposing government taxation to keep prices low, and designing and promoting brands that are attractive to current and future drinkers. Research has shown that enforcing controls on where, when and by whom alcohol can be bought, increasing alcohol taxes and controlling alcohol advertising are measures likely to work to reduce harms. These measures are supported by the World Health Organization (WHO) although studies are lacking in LMICs, and they need government action and political support to be implemented. They are typically opposed by large alcohol companies. In Brazil and Peru, there are few controls on alcohol, those that do exist are not well-enforced, and there are high levels of alcohol-related harms. Charities, health organizations and others sometimes successfully work together in 'advocacy coalitions' to strengthen controls on alcohol, but have not yet done so in Brazil and Peru. In both countries, new policymakers have recently said that they are concerned about alcohol related harms and interested in introducing greater controls. This creates an opportunity to strengthen alcohol policies to reduce harms and our study will build on this opportunity. Our aim is (1) to understand how policymakers and charities/health organizations in Peru and Brazil view alcohol consumption, harms and possible regulations, what concerns them, what action they would support, and how interested they are in working with others to improve alcohol control policies. We will do this through analysing 60 interviews, split between countries and different 'stakeholder' types i.e. policymakers and charities/health representatives. We also wish find out (2) what alcohol statistics and other data are available in each country to help policymaker decisions, how those data could be improved, and whether they could be used to find out the impact of any policy changes. We will do this by checking national statistics providers, speaking with stakeholders in both countries and international researchers. Our team consists of six experienced researchers who have an excellent range of knowledge relevant to this bid from different academic areas (policy studies, public health, psychology, epidemiology, sociology, health economics), two of whom are based in Peru/Brazil and will lead the research there. We will be supported by a study advisory panel made up of academics, a senior WHO advisor, other health organizations and policymakers from Latin America, and researchers from the USA and South Africa, with expertise in alcohol policy as well as the study of policy changes and health systems more generally. We will recruit fulltime researchers for the study in both Peru and Brazil and offer them multiple opportunities to learn about alcohol policy research, how to use research to influence policy, and working with the media. We will work closely with stakeholders from the start of the study and throughout to give them an opportunity to be involved in shaping (1) our interview questions and (2) our data assessment, so that they are helpful to local policy and advocacy; (3) to share our findings and find out what they think of them, and (4) to plan next steps for policy development, advocacy, and research in each country and regionally.