Smoke and scan: A content analysis of QR code-directed websites found on cigarette packs in China

Introduction: Quick Response codes, or “QR” codes, are used widely in China—for mobile payment, marketing, public transportation, and various other applications. In this study, we examined the content of websites linked from QR codes on cigarette packs collected in China. Aims and Methods: In February 2017, 738 unique cigarette packs were collected from five Chinese cities (Beijing, Guangzhou, Shanghai, Kunming, and Chengdu) using a systematic protocol. Cigarette packs were coded for presence of QR codes on packaging. Packs containing QR codes were then scanned using theWeChat app.Websites sourced from QR codes were coded for required verification, website type, age- and health-related statements, engagement strategies, and marketing appeals. Results: From the sample of 738 unique packs, 109 packs (14.8%) had a QR code on the packaging. The QR codes were linked to 24 unique websites of which 23 could be analyzed. All 23 unique websites were either brand-specific or social media websites; none focused on health or quit information. Of the 23 websites, only three (13.0%) websites had age-restricted site access and just six (26.1%) had any mention of health-related risks associated with product usage. Engagement strategies and/or marketing appeals were found on 20 (87.0%) websites. Conclusions: The Chinese tobacco industry uses QR codes on cigarette packaging to link to web-based marketing content including social media recruitment, contests and giveaways, and product advertisement. It is important to understand where packs send consumers online and what messages they receive, and to consider QR codes on packaging when drafting policy. Implications: Scanning QR codes in China is a commonplace activity.The authors are aware of no published studies on the role QR codes play on the marketing of cigarette packs, in China or elsewhere. This study demonstrates QR codes on cigarette packs can expose users and nonusers to cigarette marketing on interactive websites and protobacco social media pages, mostly without restrictive access or health warnings.This is an area that health authorities can consider regulating, given that this is a channel through which the tobacco industry can communicate with current and potential consumers.