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Reboussin BA, Lazard AJ, Ross JC, Sutfin EL, Romero-Sandoval EA, Suerken CK, Lake S, Horton OE, Zizzi AR, Wagoner E, Janicek A, Boucher M, Wagoner KG. A content analysis of cannabis edibles package marketing in the United States. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 130:104526. [PMID: 39032269 DOI: 10.1016/j.drugpo.2024.104526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 06/28/2024] [Accepted: 07/05/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND With states legalizing cannabis at a rapid pace, and the increasing popularity of edibles, it is important to document marketing practices to better understand how they might be appealing and misleading to consumers to guide state policymakers. METHODS A descriptive content analysis of 1229 cannabis edible packages advertised on a publicly available website between June and November 2022 and available for sale in licensed dispensaries was performed. RESULTS Healthy ingredient descriptors were the most common type of descriptor with 31 % of packages including words like "vegan", "gluten free" and "natural". Quality descriptors like "handcrafted" were on 28 % of packages. Other descriptors were focused on the consumer experience including expected effects (e.g., "relax") (27 %), taste or flavor (e.g., "sour") (21 %) and pharmacokinetics (e.g., "fast-acting") (19 %). Images of non-cannabis plants and outdoor nature settings were on half of packages. Images of the cannabis plant were on 33 % of packages. Flavor imagery including images of food were common (43 %). Other marketing appeals included images of people (15 %), animals (12 %) and space (10 %). CONCLUSIONS Package marketing used by other commercial industries was common on cannabis edible packages. Edibles marketing is distinct from other cannabis products in its ability to focus on the food ingredients which could mislead consumers into thinking the cannabis, rather than the food, is healthy or less harmful. Research examining the impact of cannabis edibles marketing strategies on appeal and harm perceptions is critically needed to guide policymakers as they establish packaging regulations to optimize public health and safety.
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Affiliation(s)
- Beth A Reboussin
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States.
| | - Allison J Lazard
- University of North Carolina at Chapel Hill Hussman School of Journalism and Media, 384 Carroll Hall, Chapel Hill, NC 27599, United States
| | | | - Erin L Sutfin
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - E Alfonso Romero-Sandoval
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Cynthia K Suerken
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Shelby Lake
- University of North Carolina at Chapel Hill Hussman School of Journalism and Media, 384 Carroll Hall, Chapel Hill, NC 27599, United States
| | - Olivia E Horton
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Alexandra R Zizzi
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
| | - Emily Wagoner
- North Carolina State University Poole College of Management, 2801 Founders Dr., Raleigh, NC 27695, United States
| | - Alondra Janicek
- Wake Forest University College of Arts and Sciences, 104 Reynolda Hall, PO Box 7225, Winston-Salem, NC 27109, United States
| | - Madeleine Boucher
- Wake Forest University College of Arts and Sciences, 104 Reynolda Hall, PO Box 7225, Winston-Salem, NC 27109, United States
| | - Kimberly G Wagoner
- Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, United States
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Pei D, Popova L, Chowdhury P, Shi J, Njie G. Exposure to anti- and pro-smoking messages among adults in China: Results from the Global Adult Tobacco Survey, 2018. PLoS One 2024; 19:e0304028. [PMID: 38870150 PMCID: PMC11175413 DOI: 10.1371/journal.pone.0304028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 05/05/2024] [Indexed: 06/15/2024] Open
Abstract
SIGNIFICANCE For decades, tobacco advertisements and promotions have been common in mass media and public places in China. In 2015, China amended the Advertising Law to prohibit the distribution of tobacco advertising, while also initiating waves of tobacco control media campaigns. This study investigates the associations between exposure to anti- and pro-smoking messages, smoking status, and people's smoking-related beliefs and willingness to support tobacco control policies. METHODS A secondary data analysis was performed with the 2018 Global Adult Tobacco Survey of 19,376 adults aged ≥15 years in China. Anti- and pro-smoking message exposures were measured as the sum of sources (media or places) where respondents have seen the messages. Multivariable logistic regression analyses were conducted to examine the relationships among smoking status, message exposure, and the outcome variables (health harm beliefs, support for increasing tax on cigarettes, support for using part of the increased tax on tobacco control) controlling for smoking status and demographic differences. RESULTS Overall, 63.3% of the respondents reported being exposed to anti-smoking messages from at least 1 source, while 18.1% were exposed to pro-smoking messages from at least 1 source. Adults who currently, formerly, and never smoked differed in their beliefs about smoking and willingness to support tobacco control policies. Greater reported exposure to anti-smoking messages was positively associated with belief that smoking is harmful, support for increased cigarette tax, and support for using increased tax revenue for tobacco control measures. Meanwhile, greater reported exposure to pro-smoking messages was negatively related to willingness to support cigarette tax increases. CONCLUSIONS While national and local tobacco control campaigns in China have reached a large proportion of the adult population, there is still room for improvement. China might consider expanding anti-tobacco campaigns, as reported exposure to these messages is associated with increased public awareness of the health hazards of smoking and support for increasing cigarette taxes.
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Affiliation(s)
- Di Pei
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, United States of America
| | - Pranesh Chowdhury
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
| | - Jing Shi
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
- Noninfectious Disease Programs, CDC Foundation, Atlanta, Georgia, United States of America
| | - Gibril Njie
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, United States of America
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Zulkiewicz BA, Winickoff JP, Gottlieb MA, Emmons KM, Tan AS. "Tobacco-free nicotine" electronic cigarette perceptions and use among adolescents and adults in five New England states. Addict Behav Rep 2024; 19:100524. [PMID: 38226008 PMCID: PMC10788778 DOI: 10.1016/j.abrep.2024.100524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/08/2023] [Accepted: 01/02/2024] [Indexed: 01/17/2024] Open
Abstract
Introduction More brands are using tobacco-free nicotine (TFN) in electronic cigarettes (e-cigarettes) and these products are becoming increasingly popular. The term TFN and claims about its properties can mislead consumers about the harms and addictiveness of TFN e-cigarettes, which may increase initiation of these products among non-smokers or influence current smokers' decisions to adopt TFN e-cigarettes as a harm reduction measure. Methods We conducted an observational, cross-sectional survey of 777 adolesc aged 13-17 and 655 current adult cigarette smokers residing in Massachusetts, Connecticut, New Hampshire, Rhode Island, or Vermont about their TFN e-cigarette awareness, use, perceptions, and susceptibility. We examined the association between prior awareness of TFN and use, perceptions, and susceptibility. Results One-third of adolescents and adults reported being aware of TFN. TFN e-cigarette use was less common than tobacco-derived nicotine (TDN) e-cigarette use among adolescents (8.9 % vs. 30.5 %) and adults (21.1 % vs. 79.4 %). Compared to unaware adolescents, adolescents who were aware of TFN more frequently reported being more likely to use TFN compared to TDN e-cigarettes and that TFN e-cigarettes are more addictive than those containing TDN. Aware adult smokers more frequently reported that TFN e-cigarettes are more addictive than TDN e-cigarettes, TFN e-cigarettes cause some harm, TDN e-cigarettes cause little harm, and that TFN and TDN e-cigarettes are equally harmful than those who were unaware previously. Conclusion Public health education campaigns are needed to educate consumers about the harms and addictiveness of TFN e-cigarettes.
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Affiliation(s)
- Brittany A. Zulkiewicz
- University of Pennsylvania Annenberg School for Communication, 3620 Walnut St, Philadelphia, PA 19104, United States
| | - Jonathan P. Winickoff
- Massachusetts General Hospital, Division of General Academic Pediatrics, Harvard Medical School, 55 Fruit St, Boston, MA 02114, United States
| | - Mark A. Gottlieb
- Northeastern University School of Law, Public Health Advocacy Institute, 360 Huntington Ave, Suit 1170CU, Boston, MA 02115, United States
| | - Karen M. Emmons
- Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, United States
| | - Andy S.L. Tan
- University of Pennsylvania Annenberg School for Communication, 3620 Walnut St, Philadelphia, PA 19104, United States
- University of Pennsylvania Leonard Davis Institute of Health Economics, 3641 Locust Walk #210, Philadelphia, PA 19104, United States
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Kong AY, Westneat SC, Anesetti-Rothermel A, van de Venne JG, Debnam C, Ribisl KM, Cohn AM, Rose SW. Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019. Nicotine Tob Res 2024; 26:S73-S81. [PMID: 38817025 PMCID: PMC11140226 DOI: 10.1093/ntr/ntad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 06/01/2024]
Abstract
BACKGROUND The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. METHODS Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. RESULTS Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. CONCLUSIONS In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. IMPLICATIONS We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.
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Affiliation(s)
- Amanda Y Kong
- Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan C Westneat
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Andrew Anesetti-Rothermel
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Judy G van de Venne
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | | | - Kurt M Ribisl
- Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shyanika W Rose
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
- Markey Cancer Center, Lexington, KY, USA
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Seidenberg A, Kaufman A. 'Tobacco-free' claims in tobacco product marketing in the United States. Tob Control 2024; 33:404-405. [PMID: 36424138 DOI: 10.1136/tc-2022-057700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Andrew Seidenberg
- Behavioral Research Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA
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Mercincavage M, Waugh LK, Gratale S, Wackowski O, Pearson JL, House K, O'Connor R, Strasser AA. Acute effects of charcoal filters and package color on cigarette perceptions and use behaviors: Results from a randomized pilot study examining Natural American Spirit "Sky". Drug Alcohol Depend 2024; 255:111080. [PMID: 38198898 PMCID: PMC10843540 DOI: 10.1016/j.drugalcdep.2024.111080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/01/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Charcoal-filtered cigarettes have been available for decades but have never held a major share of the U.S. cigarette market. This pilot study gathered initial behavioral data characterizing how "Sky"-a recently introduced charcoal-filtered cigarette variety that uses potentially misleading marketing features-is used and what impact its packaging color has on consumer perceptions. METHODS Forty adult daily non-menthol cigarettes users (52.5% male, 75.0% White, mean age = 46.1, 14.3 mean cigarettes/day) completed a single-session deception study utilizing a 2 ×2 mixed factorial design to manipulate cigarette filter condition (charcoal vs. non-charcoal) and pack color (light vs. dark). Participants smoked two cigarettes identical in appearance and packaging but differing in filter type (blinded and order counterbalanced) and completed pre- and post-cigarette CO samples and post-cigarette questionnaires. RESULTS Participants endorsed more favorable subjective ratings, puffed less of, held more correct beliefs about risks, and expressed greater intentions to use the charcoal (vs. non-charcoal)-filtered cigarette (p's <0.05). Pack color had few effects on outcomes; however, cigarettes in light vs. dark colored packs were rated as cleaner tasting (p <0.01). Neither filter condition nor pack color affected CO boost. There were no interaction effects on any outcomes. CONCLUSIONS Under blinded conditions, Sky charcoal-filtered cigarettes are initially appealing independent of their packaging color. Findings warrant further study of these effects on perceptions, behavior, and harm exposure after longer, open-label use periods. Findings may inform regulatory decisions regarding cigarette packaging and filter composition.
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Affiliation(s)
- Melissa Mercincavage
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States.
| | - Lizza K Waugh
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Stefanie Gratale
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Olivia Wackowski
- Rutgers Institute for Nicotine and Tobacco Studies, New Brunswick, NJ, United States; University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States
| | - Jennifer L Pearson
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Nevada-Reno, Reno, NV, United States
| | - Kendra House
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
| | - Richard O'Connor
- Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
| | - Andrew A Strasser
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, United States; University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, United States
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7
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Giovenco DP, Ganz O, Spillane TE, Easter AG, Wackowski OA, Villanti AC, Strasser AA, Delnevo CD. Changes in Pack Features Among Top-Selling Cigarettes in the U.S., 2018 and 2021. Am J Prev Med 2023; 65:1124-1128. [PMID: 37295659 PMCID: PMC10700656 DOI: 10.1016/j.amepre.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Cigarette packaging is designed to increase consumer appeal and remains a primary promotional tool in many countries, including the U.S. This study documented changes in the prevalence of pack characteristics among the top-selling cigarette products in the U.S. in 2018 and 2021. METHODS The 50 cigarette packs with the highest national unit sales in U.S. convenience stores in 2018 and 2021 were identified using Nielsen's Scantrack data and subsequently purchased. Packs were coded for features such as dominant color(s), descriptive text, and promotional language. Descriptive analyses conducted in 2022 weighted by total annual unit sales compared the prevalence of pack characteristics between years. RESULTS Three brands-Marlboro, Newport, and Camel-constituted over 80% of pack sales among the top-selling products. Packs with red as a dominant color grew less popular between years (33.3% vs 29.5%), whereas those with green became more prevalent (25.2% vs 28.9%), consistent with a rise in the proportion of menthol sales. The prevalence of descriptors such as flavor and fresh decreased from 46.0% to 39.4% and 9.7% to 5.2%, respectively. Meanwhile, the prevalence of promotional language (e.g., rewards programs) increased from 60.9% to 69.0%. CONCLUSIONS The use of visual and named colors remains common, which can implicitly communicate sensory or health-related attributes. Moreover, promotions may help recruit and retain consumers in the context of more restrictive tobacco control policies and price increases. Given the strong influence that cigarette packaging exerts on consumers, packaging-focused policies, such as plain packaging laws, may reduce appeal and accelerate declines in cigarette use.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York.
| | - Ollie Ganz
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Torra E Spillane
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Alexa G Easter
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Olivia A Wackowski
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrea C Villanti
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
| | - Andrew A Strasser
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Cristine D Delnevo
- Rutgers Biomedical and Health Sciences, Rutgers Center for Tobacco Studies, New Brunswick, New Jersey; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey
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Berg CJ, Schauer GL, Cavazos-Rehg P, Romm KF, Wang Y, Wysota CN, Duan Z, Henriksen L. Cannabidiol Marketing Strategies in the United States: An Analysis of Three Prominent Companies. Cannabis Cannabinoid Res 2023; 8:1150-1160. [PMID: 36169594 PMCID: PMC10714115 DOI: 10.1089/can.2022.0080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction: The popularity and market for cannabidiol (CBD) products have expanded. Materials and Methods: Using Numerator advertising data from 2017 to 2021 regarding three popular CBD companies in the United States (Charlotte's Web, Green Roads, Medterra), we examined (1) general advertising characteristics (e.g., media channel, year); (2) ad content (i.e., themes of headlines and imagery); (3) themes of prominent sources (i.e., specific websites, magazines, etc.); and (4) ad expenditures. Results: Across companies during the study timeframe, there were 475 unique ads (i.e., unique content), 4767 ad occurrences, and $1,471,944 total expenditures. Charlotte's Web accounted for the greatest proportion of unique ads, ad occurrences, and expenditures (53.3%, 62.8%, and 70.3%, respectively), followed by Medterra (40.4%, 33.9%, and 28.5%) and Green Roads (6.3%, 3.3%, and 1.2%). The largest proportion of occurrences and expenditures were via online display (83.5%, 54.8%), followed by mobile (15.9%, 24.8%) and print (0.4%, 20.1%). Per ad occurrences and expenditures, ads prominently featured headline themes focused on brand/trust/quality (27.5%, 18.3%, respectively), wellness (17.5%, 17.7%), pain/sport (9.9%, 20.0%), and promotions (13.2%, 11.6%), in addition to visual themes of the product itself (74.3%, 78.5%) or with women (5.3%, 10.0%). The most prominent source themes were focused on health/wellness (21.0% of ad occurrences, 18.1% of expenditures), followed by other websites and search engines (18.3%, 11.2%), news/weather (12.9%, 21.3%), and entertainment/lifestyle/culture (12.6%, 28.0%). Despite some distinctions between companies, ad and source themes were similar. Conclusions: Regulatory efforts must be informed by ongoing surveillance of CBD marketing and how specific consumer subgroups are impacted by marketing exposure.
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Affiliation(s)
- Carla J Berg
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Gillian L Schauer
- Addictions, Drug & Alcohol Institute, School of Medicine, University of Washington, Seattle, Washington, USA
| | - Patricia Cavazos-Rehg
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Katelyn F Romm
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Yan Wang
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, Milken Institute School of Public Health, Washington, District of Columbia, USA
- George Washington Cancer Center, George Washington University, Washington, District of Columbia, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Bayerman SF, Li M, Syed A, Scherer LD. Development of a Naturalness Preference Scale. Med Decis Making 2023; 43:821-834. [PMID: 37522395 DOI: 10.1177/0272989x231189494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE Naturalness preference can influence important health decisions. However, the literature lacks a reliable way to measure individual differences in naturalness preferences. We fill this gap by designing and validating a scale to measure individual differences in naturalness preference. METHODS We conducted 3 studies among Amazon Mechanical Turk participants. In study 1 (N = 451), we created scale items through an iterative process that measured naturalness preference in hypothesized domains. We conducted exploratory factor analysis (EFA) to identify items that assess the naturalness preference construct. In study 2 (N = 448), we conducted confirmatory factor analysis (CFA) and tests of criterion, discriminant, convergent, and incremental validity. In study 3 (N = 607), we confirmed test-retest reliability of the scale and performed additional validity tests. RESULTS EFA revealed 3 correlated factors consistent with naturalness preference in medicine, food, and household products. The CFA confirmed the 3-factor structure and led to the decision to drop reverse-coded items. The finalized Naturalness Preference Scale (NPS) consists of 20 items and 3 subscales: NPS-medicine, NPS-food, and NPS-household products. The NPS demonstrated good test-retest reliability, and subscales had good validity in their respective domains. The NPS-medicine subscale was predictive of the uptake of a hypothetical COVID-19 vaccine (r = -0.45) and belief in unproven natural COVID remedies and treatments (r = 0.29). CONCLUSIONS The NPS will allow researchers to better assess individual differences in naturalness preference and how they influence decision making and health behaviors. HIGHLIGHTS This research created and validated a scale to measure individual differences in naturalness preference in 3 domains: medicine, food, and household products.This study confirms that the strength of the naturalness preference differs in different domains.An important and timely finding is that higher scores in the naturalness preference medical subscale are associated with belief in COVID-19 misinformation and reluctance toward COVID-19 vaccination.
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Affiliation(s)
- Shawna F Bayerman
- Department of Health and Behavioral Sciences, University of Colorado, Denver CO, USA
| | - Meng Li
- Department of Health and Behavioral Sciences, University of Colorado, Denver CO, USA
| | - Adnan Syed
- University of Colorado School of Medicine/VA Eastern Colorado COIN, Denver, CO, USA
| | - Laura D Scherer
- University of Colorado School of Medicine/VA Eastern Colorado COIN, Denver, CO, USA
- VA Eastern Colorado COIN, Denver, CO, USA
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10
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Pearson J, Ganz O, Ohman-Strickland P, Wackowski OA. Shifts in preference for Natural American Spirit and associated belief that one's own cigarette brand might be less harmful than other brands: results from Waves 1-4 of the Population Assessment of Tobacco and Health (PATH) Study (2013-2018). Tob Control 2023; 32:567-574. [PMID: 34952863 PMCID: PMC9290335 DOI: 10.1136/tobaccocontrol-2021-056985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/30/2021] [Indexed: 11/03/2022]
Abstract
INTRODUCTION People believe that cigarettes using 'organic,' 'additive-free' or similar descriptors are less harmful than other cigarettes. Natural American Spirit (NAS) is the most popular US cigarette brand using these descriptors. This cohort study describes changes in US smokers' odds of preferring NAS and changes in NAS smokers' odds of believing their brand might be less harmful than other brands. METHODS Data come from four waves (2013-2018) of the Population Assessment of Tobacco and Health (PATH) Study. Generalised estimating equations produced population-averaged estimates of relationships between (1) NAS brand preference and wave and (2) belief that one's own brand might be less harmful than other brands, wave and NAS brand preference. Models tested interactions by age group and sexual minority status. RESULTS The odds that smokers preferred NAS increased by 60% in W4 relative to W1. Disproportionate preference by younger adult and sexual minority smokers was observed. The odds that NAS smokers believed their own brand might be less harmful decreased by 50% between W1 and W4, but this perception was still 16 times higher for NAS compared with non-NAS smokers. Given the increasing preference for NAS, there was no significant change in the absolute number of NAS smokers who believed their own brand might be less harmful (W1: 562 122 (95% CI 435 190 to 689 055) vs W4: 580 378 (95% CI 441 069 to 719 689)). CONCLUSIONS Both brand popularity and concentration of brand-related harm perceptions are important for understanding population impact of changes in cigarette marketing.
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Affiliation(s)
- Jennifer Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
- Department of Health Behavior, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Pamela Ohman-Strickland
- Department of Epidemiology and Statistics, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
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11
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Sterling KL, Franco N, Lee E, Tang C, Geller A, Mead A, Anderson M, Kong G. The Portrayal of Premium Cigar Selling Propositions in Lifestyle Magazines: A Content Analysis. Nicotine Tob Res 2023; 25:S69-S75. [PMID: 37506232 PMCID: PMC10380182 DOI: 10.1093/ntr/ntad005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 12/05/2022] [Accepted: 02/02/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Although lifestyle magazines are an important marketing tool for premium cigars, little is known about their recent portrayal of the products. We expand on research conducted for the National Academies of Sciences, Engineering, and Medicine's Committee on Patterns of Use and Health Effects of "Premium Cigars" and Priority Research. AIMS AND METHODS A content analysis of magazine covers, articles, and advertisements published in 2021 from Cigar Aficionado and Cigar Snob (five issues each) and Cigar Journal (three issues) assessed magazine themes and mentions of lower harm. Magazine covers (n = 14), advertisements (n = 105), and every fifth article (n = 45) were coded. RESULTS In total, 92% of the magazine covers, 72.4% of advertisements, and 62.2% of articles had premium cigar content. Celebrities (e.g. musicians and actors) appeared on 92.9% of covers. The most common themes in the advertisements and articles were "high quality." Regarding article content, 80% portrayed the premium cigars' quality (e.g. superior materials), and the taste of featured products (e.g. "tones," "aromas," and "notes") was portrayed in 42.4%. While no articles described their health risks, 6.7% described the positive health effects of premium cigar use (e.g. stress relief and clear cognition). Additionally, a digital search of Cigar Snob and Cigar Aficionado for terms related to lower harm (e.g. "organic," "healthy," "clean," "pure," and "natural") found 7.7 mentions of lower-harm words per issue. CONCLUSIONS Our findings indicate that lifestyle magazines are an important marketing strategy that promotes and normalizes premium cigar use as a high-quality product that can have positive health effects for users. IMPLICATIONS Our manuscript characterized the premium cigar companies' use of selling propositions, including promoting the products' features, safety, taste, and flavors, as a part of their advertising promotion practices. Premium cigar companies used digital and print lifestyle magazines as marketing tools to promote and normalize the use of their products by emphasizing their high quality and positive health benefits (e.g. reducing stress). Premium cigars were promoted as a symbol of power and success, featured in advertisements of upscale social events (e.g. exclusive trade shows, social clubs, and lounges), and often juxtaposed with expensive alcohol, food, and other luxurious goods. Future research should assess if exposure to premium cigar content increases consumer appeal and detracts from the products' potential adverse health outcomes.
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Affiliation(s)
- Kymberle Landrum Sterling
- Health Promotion and Behavioral Sciences, School of Public-Dallas Campus, University of Texas Health Sciences Center, Dallas, TX, USA
| | - Nicholas Franco
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Eugenia Lee
- Health Promotion and Behavioral Sciences, School of Public-Dallas Campus, University of Texas Health Sciences Center, Dallas, TX, USA
| | - Charis Tang
- Martel College, Rice University, Houston, TX, USA
| | - Amy Geller
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Aimee Mead
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Maggie Anderson
- National Academies of Sciences, Engineering, and Medicine, Washington, DC, USA
| | - Grace Kong
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
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12
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Pearson J, Giovenco DP, Lewis MJ, Moran M, Ganz O. Natural American Spirit launches 'Sky', the brand's first commercial organic cigarette with a charcoal filter. Tob Control 2023; 32:397-399. [PMID: 34593613 PMCID: PMC8964832 DOI: 10.1136/tobaccocontrol-2021-056731] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jennifer Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, University of Nevada Reno, Reno, Nevada, USA
| | - Daniel P Giovenco
- Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, USA
| | - M Jane Lewis
- Rutgers Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Meghan Moran
- Health, Behavior & Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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13
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Raskind IG, Prochaska JJ, Epperson AE, Henriksen L. Plant-based menthol cigarettes? Food industry trends and farm-to-pack cigarette advertising. Tob Control 2023; 32:e132-e133. [PMID: 34400569 PMCID: PMC8847494 DOI: 10.1136/tobaccocontrol-2021-056534] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ilana G Raskind
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
| | - Anna E Epperson
- Department of Psychological Sciences, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, California, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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14
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Dewhirst T. Interplay of food and tobacco product descriptors and health claims. Tob Control 2023; 32:e130-e131. [PMID: 34511406 DOI: 10.1136/tobaccocontrol-2021-056831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Timothy Dewhirst
- Department of Marketing and Consumer Studies, Gordon S. Lang School of Business and Economics, University of Guelph, Guelph, Ontario, Canada
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15
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Cao S, Tang C, Carboon I, Hayward C, Capes H, Chen YJM, Brennan E, Dixon H, Wakefield M, Haynes A. The health halo effect of 'low sugar' and related claims on alcoholic drinks: an online experiment with young women. Alcohol Alcohol 2023; 58:93-99. [PMID: 36274258 DOI: 10.1093/alcalc/agac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/26/2022] [Accepted: 09/26/2022] [Indexed: 11/05/2022] Open
Abstract
AIMS To investigate whether 'low sugar' and related claims influence consumers' perceptions of the healthiness or other attributes of alcoholic drinks, promote greater consumption or impact diet and activity behaviour intentions. METHOD N = 501 Australian women aged 18-35 viewed and rated six images of alcoholic drinks in a randomized online experiment with a 2 (claim: low sugar claim, no claim control) × 2 (drink type: cider, ready-to-drink spirits) between-subjects design. RESULTS Participants who viewed drinks with low sugar claims rated them as healthier, less harmful to health, lower in sugar and kilojoules, and more suitable for weight management and a healthy diet than participants who viewed identical drinks with no claim (P < 0.001-P = 0.002). Drinks with low sugar claims were also perceived as being lower in alcohol (P < 0.001) despite being of equivalent alcohol content. There were no significant differences in anticipated social approval associated with consumption or in hypothetical intended consumption of the drinks, but participants who viewed drinks with low sugar claims were less likely to indicate they would compensate for consumption of the drink by modifying food intake or physical activity (P = 0.01). CONCLUSIONS Low sugar and related claims on alcoholic drinks can generate a health halo: consumers generalise from a specific favourable attribute (low sugar) to misperceive other favourable health- and nutrition-related attributes, including lower alcohol content. Findings support calls to reconsider the permissibility of low sugar claims on alcoholic drinks as they may mislead consumers.
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Affiliation(s)
- Shuyan Cao
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia
| | - Changyuan Tang
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia
| | - Isla Carboon
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia
| | - Cassie Hayward
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia.,Empirica Research, 162 Collins Street, Melbourne, 3000, VIC, Australia
| | - Hannah Capes
- Empirica Research, 162 Collins Street, Melbourne, 3000, VIC, Australia
| | - Yan Jun Michelle Chen
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Emily Brennan
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia.,Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Helen Dixon
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia.,Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Melanie Wakefield
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia.,Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, VIC, Australia
| | - Ashleigh Haynes
- Melbourne School of Psychological Sciences, University of Melbourne, Grattan Street, Parkville, 3010, VIC, Australia.,Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Road, Melbourne, 3004, VIC, Australia
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16
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Mercincavage M, Pacek LR, Thrasher J, Cappella JN, Delnevo C, Donny EC, Strasser AA. Effects of advertising features on smokers' and non-smokers' perceptions of a reduced nicotine cigarette modified risk tobacco product. Tob Control 2023; 32:6-12. [PMID: 33858965 PMCID: PMC8517036 DOI: 10.1136/tobaccocontrol-2020-056441] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Research is needed to determine the impact of marketing on perceptions and use of reduced nicotine content (RNC) cigarettes, particularly as US regulators have permitted the sale of an RNC cigarette modified risk tobacco product (MRTP) that seeks further authorisation to advertise using modified risk claims. This study examined the effects of two advertising elements (product name and disclaimer content) on perceptions of an RNC cigarette MRTP. METHODS Adult participants (n=807, 28.7% smokers, 58.2% male, 74.2% non-Latinx white) completed an online MTurk survey. Participants were randomised to view one of six RNC cigarette advertisements, using a 2×3 between-subject factorial design to manipulate product name ('Moonlight' vs 'Moonrise') and disclaimer content (industry-proposed: 'Nicotine is addictive. Less nicotine does NOT mean a safer cigarette' vs focused: 'Less nicotine does NOT mean a safer cigarette' vs no content), then completed recall and product perception questionnaires. RESULTS All participants who viewed the industry-proposed disclaimer (vs no content) perceived greater addiction risk (p's<0.05). Non-smokers who viewed this disclaimer also perceived greater health risks and held fewer false beliefs (p's<0.05). Smokers who viewed Moonlight (vs Moonrise) ads perceived lower health risks (p<0.05). CONCLUSIONS Disclaimer content may effectively inform consumers about addiction risk of a new RNC cigarette MRTP, and further inform non-smokers about health risks. This element, however, had little effect on perceived health risks among smokers, among whom the Moonlight product name was associated with health risk misperceptions similar to the banned 'light' descriptor.
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Affiliation(s)
- Melissa Mercincavage
- Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
| | - Lauren R Pacek
- Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - James Thrasher
- Health Promotion, Education, and Behavior, School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Joseph N Cappella
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Cristine Delnevo
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Eric C Donny
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Baptist Comprehensive Cancer Center and Department of Physiology and Pharmacology, Wake Forest University, Winston-Salem, North Carolina, USA
| | - Andrew A Strasser
- Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, PA, USA
- Annenberg School of Communication, University of Pennsylvania, Philadelphia, PA, USA
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17
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Fitzpatrick I, Dance S, Silver K, Violini M, Hird TR. Tobacco industry messaging around harm: Narrative framing in PMI and BAT press releases and annual reports 2011 to 2021. Front Public Health 2022; 10:958354. [PMID: 36330126 PMCID: PMC9623273 DOI: 10.3389/fpubh.2022.958354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 08/31/2022] [Indexed: 01/24/2023] Open
Abstract
Influencing public perception is a key way in which all transnational corporations (TNCs) maintain market dominance and political power. Transnational tobacco companies (TTCs) have a long history of leveraging narratives to serve commercial ambitions. The global reach of these companies' narratives has been highlighted as a challenge in combatting public health problems caused by tobacco. The corporate power of TTCs is carefully curated, and their narratives play an important role in the setting of governance dynamics at local, national and transnational levels. This qualitative work explores and compares the language used by British American Tobacco (BAT) and Philip Morris International (PMI) around harm, harm reduction and terms used to refer to newer nicotine and tobacco products, including electronic cigarettes and heated tobacco products. We systematically examine framings used by these two TTCs through company reports published between 2011 and 2021. Qualitative coding was carried out by four coders, according to a protocol developed specifically for this work. We firstly identified the presence of pre-selected keywords and then assigned chunks of text containing those key words to one or more associated frames drawn from Boydstun's policy frames codebook (2013). Qualitative coding identified the most common frames from Boydstun's codebook and thematic analysis highlighted three overarching themes. The most common frames assigned were "capacity and resources", "health and safety" and "economic" frames. The overarching themes were individualization, normalization, and regulation. These themes capture how both BAT and PMI use particular framings to downplay the role of TTCs in the perpetuation of population- and individual-level harms related to tobacco use. They seek to normalize their role in public discussions of health policy, to cast themselves as instrumental in the redress of tobacco-related inequalities and shift responsibility for the continuation of tobacco-product use onto individual consumers. These tactics are problematic for the effective and impartial development and implementation of local, national and international tobacco control agendas.
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18
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Byron MJ, Lazard AJ, Brewer NT. Is a cigarette brand with fewer chemicals safer? Public perceptions in two national US experiments. J Behav Med 2022; 45:812-817. [PMID: 35688959 PMCID: PMC10990283 DOI: 10.1007/s10865-022-00329-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 05/02/2022] [Indexed: 11/29/2022]
Abstract
By law, the US government must publicly display the quantities of harmful chemicals in cigarettes by brand, but doing so could mislead people to incorrectly think that some cigarettes are safer than others. We evaluated formats for presenting chemical quantities side-by-side to see if any were misleading. We recruited US convenience (n = 604) and probability (n = 1440) samples. We randomized participants to 1 of 5 formats: checklist, point estimates, ranges, a visual risk indicator, or no-quantity control. Participants were far more likely to incorrectly endorse one cigarette brand as riskier than the other in the checklist (65% made error), point estimate (67-70%), range (64-67%), or risk indicator (68-75%) conditions as compared to the no-quantity control (1%, all p < .001). Among smokers, erroneous risk perceptions mediated the impact of quantity format on interest in switching brands. People viewing chemical quantities for cigarette brands side-by-side misperceived differences in risk, suggesting limited public health value of this information.
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Affiliation(s)
- M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina, 590 Manning Dr, CB 7595, Chapel Hill, NC, 27599, USA.
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA.
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, 27599, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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19
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Czaplicki L, Patel M, Rahman B, Yoon S, Schillo B, Rose SW. Oral nicotine marketing claims in direct-mail advertising. Tob Control 2022; 31:663-666. [PMID: 33958422 PMCID: PMC9411885 DOI: 10.1136/tobaccocontrol-2020-056446] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known regarding how oral nicotine products (eg, nicotine pouches, lozenges) are marketed to consumers, including whether potential implicit reduced harm claims are used. In the current study, we explored the marketing claims present in a sample of direct-mail oral nicotine advertisements sent to US consumers (March 2018-August 2020). METHODS Direct-mail ads (n=50) were acquired from Mintel and dual-coded for the following claims: alternative to other tobacco products, ability to use anywhere, spit-free, smoke-free and product does not contain tobacco leaf. We merged the coded data with Mintel's volume estimate (number of mail pieces sent to consumers) and calculated the proportion of oral nicotine advertisements containing claims by category. RESULTS Of the 38 million pieces of oral nicotine direct-mail sent to US consumers, most featured claims that the product could be used anywhere (84%, 31.8 million pieces); was an alternative to other tobacco products (69%, 26.1 million pieces); and did not contain tobacco leaf (eg, 'tobacco leaf-free', 'simple' approach of extracting nicotine from tobacco; 55%, 20.7 million pieces). A slightly smaller proportion contained claims that oral nicotine was 'spit-free' (52%, 19.8 million pieces) or 'smoke-free' (31%, 11.7 million pieces). CONCLUSION Our results provide an early indication of marketing claims used to promote oral nicotine. The strategies documented, particularly the use of language to highlight oral nicotine is tobacco-free, may covey these products as lower-risk to consumers despite the lack of evidence or proper federal authorisation that oral nicotine products are a modified-risk tobacco product. Future research is needed to examine consumer perceptions of such claims.
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Affiliation(s)
- Lauren Czaplicki
- Health, Behavior & Society, Johns Hopkins University, Baltimore, MD, USA
| | - Minal Patel
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Basmah Rahman
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Stephanie Yoon
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Shyanika W Rose
- Behavioral Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
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20
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Young WJ, Ganz O, Jeong M, Wackowski OA, Delnevo CD. Perceptions of Game cigarillo packaging among young adult tobacco users: The effect of package color and the "natural leaf" descriptor. Addict Behav 2022; 132:107334. [PMID: 35617767 PMCID: PMC9190173 DOI: 10.1016/j.addbeh.2022.107334] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 04/08/2022] [Accepted: 04/09/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Tobacco packaging elements have been shown to influence product perceptions and use intentions. Garcia y Vega's Game cigarillos are distinct from other brands in their use of "natural leaf" on packaging. The term "natural" has been linked to misperceptions about lower risk in the context of cigarettes. This study examines the impact of the "natural leaf" descriptor and pack color on young adults' cigarillo perceptions and intentions. METHODS In April-June 2020, we conducted an online experiment with 1,063 young adults (ages 18-34) that were past year users of cigars, vaping products, or marijuana. Subjects were randomly assigned to view one of eight images of Game cigarillo packs that varied in color and presence of the "natural leaf" descriptor. RESULTS Purple packaging increased perceptions that the product tasted good, smelled nice, was flavored, and that a typical user was young. "Natural leaf" increased beliefs that the product contained high quality tobacco and that a typical user was trendy. When on grey packs, it increased favorable perceptions compared to when on brightly colored packs, including perceptions that the product tasted good, was fresh, that a typical user was trendy, and that the product was flavored. CONCLUSIONS This study is the first to present quantitative evidence on the impact of the "natural leaf" descriptor on cigarillo perceptions and intentions, extending work that has been done in the context of cigarettes. Utilizing highly realistic stimuli, findings demonstrate that both the term "natural leaf" and packaging color can increase favorable perceptions of cigarillos.
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Affiliation(s)
- William J Young
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, USA.
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, USA; Rutgers Cancer Institute of New Jersey, USA.
| | - Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, USA; Rutgers Cancer Institute of New Jersey, USA.
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, USA; Rutgers Cancer Institute of New Jersey, USA.
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, USA; Rutgers Cancer Institute of New Jersey, USA.
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21
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Cao Y, Li H. Harmony Between Humanity and Nature: Natural Vs. Synthetic Drug Preference in Chinese Atheists and Taoists. JOURNAL OF RELIGION AND HEALTH 2022; 61:2743-2752. [PMID: 34146204 PMCID: PMC8214046 DOI: 10.1007/s10943-021-01314-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/08/2021] [Indexed: 05/20/2023]
Abstract
A commonplace observation across many cultures is that humans show a strong preference for natural items on drug choice in the medical domain. Despite an emerging line of psychological research on individual differences in the naturalness-is-better bias, few studies have focused on the role of religious beliefs. According to the core idea of Taoism, people should free themselves from selfishness and desire and behave in concert with the alternating cycles of Nature. Based on the findings regarding the positive relationship between connectedness to nature and naturalness preference, we predict that Taoists, who emphasize harmony between humanity and nature, should show a stronger naturalness-is-better bias than atheists on drug choice due to their higher level of natural connectedness. The results showed that both Chinese atheists and Taoists selected a natural over synthetic drug even though the safety and efficacy of the medicines were described as identical. More importantly, the naturalness-is-better bias is more pronounced in Taoists than atheists. These data suggest that religious beliefs related to individuals' connectedness to nature may moderate the naturalness-is-better bias in health decisions.
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Affiliation(s)
- Yu Cao
- School of Foreign Languages, Zhongnan University of Economics and Law, Wuhan, China
| | - Heng Li
- College of International Studies, Southwest University, Tianshengqiao Road, Beibei, Chongqing, China.
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22
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Moodie C, O'Donnell R. 'I'm killing myself, but I'm saving the planet': rolling tobacco smokers' perceptions of rolling papers. Tob Control 2022; 31:479-482. [PMID: 33229464 DOI: 10.1136/tobaccocontrol-2020-056103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite the global growth of rolling tobacco, we are unaware of any research that has explored smokers' perceptions of the types of rolling papers available, or plain rolling papers, which are now required in Canada and Israel. METHODS Eight focus groups were conducted with rolling tobacco smokers (n=50) in Greater Glasgow (Scotland) between February and March 2020. Participants were shown a number of packs of promotional rolling papers (natural, transparent, prerolled cones, flavoured) and plain rolling papers. RESULTS Rolling papers were often viewed as functional, a necessity for making roll-ups. The appeal of papers was based on the packaging, with a booklet-style pack of natural papers viewed very positively, as well as novelty, usability and taste/smell. Participants often associated papers with particular users, with prerolled cones and some flavoured papers thought to be used by cannabis smokers or younger people and those just starting to smoke. In terms of harm perceptions, natural papers were viewed as a healthier choice than standard papers and more environmentally friendly, whereas transparent papers raised concerns about safety to both the user and the environment. Participants were generally ambivalent towards plain papers, which they did not feel would alter their purchasing or smoking behaviour, although some felt they may be less appealing to youth as the branding would be diminished. CONCLUSIONS The panoply of rolling papers available offers consumers considerable choice. As some promotional papers can increase appeal or create misperceptions of harm then standardising papers would help to counter this.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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23
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Richter APC, Duffy EW, Smith Taillie L, Harris JL, Pomeranz JL, Hall MG. The Impact of Toddler Milk Claims on Beliefs and Misperceptions: A Randomized Experiment with Parents of Young Children. J Acad Nutr Diet 2022; 122:533-540.e3. [PMID: 34391941 PMCID: PMC8840993 DOI: 10.1016/j.jand.2021.08.101] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 08/05/2021] [Accepted: 08/10/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Toddler milk (ie, a nutrient-fortified milk-based drink marketed for children aged 12 to 36 months) has been marketed increasingly in the United States with structure/function claims on product packaging that are potentially misleading. OBJECTIVE This study examined how structure/function claims impact parents' beliefs and perceptions about a toddler milk product. DESIGN This was a 3-arm between-subjects randomized experiment. PARTICIPANTS A diverse sample of 2,190 US parents of children aged 1 to 5 years were chosen to take an online survey. INTERVENTION Participants were randomly assigned to view a toddler milk package with either an unrelated claim ("new and improved," ie, control condition), a "brain development" claim (ie, "brain" claim), or an "immunity-related" claim (ie, "immunity" claim). MAIN OUTCOME MEASURES Outcomes included perceptions, intentions, and beliefs about the toddler milk product. STATISTICAL ANALYSES PERFORMED Linear regression for continuous outcomes and logistic regression for dichotomous outcomes. RESULTS Parents who were exposed to the "brain" claim or the "immunity" claim were more likely to incorrectly believe that the toddler milk was as healthy or healthier than cow's milk compared with those who saw the control claim (89% for brain claim, 87% for immunity claim, and 79% for control; P < .001 for both comparisons). Parents exposed to either the brain or immunity claim had higher intentions to give the toddler milk to their child, higher perceived product healthfulness, and stronger beliefs that pediatricians would recommend the product compared with parents exposed to the control (all, P < .001). CONCLUSIONS These findings suggest that structure/function claims on toddler milk packaging may mislead parents and increase the appeal of toddler milk. Our findings support calls for public health policies to regulate marketing on toddler milk packaging.
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Baig SA. Bayesian inference: Parameter estimation for inference in small samples. Nicotine Tob Res 2021; 24:937-941. [PMID: 34679175 DOI: 10.1093/ntr/ntab221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 10/19/2021] [Indexed: 11/14/2022]
Affiliation(s)
- Sabeeh A Baig
- Center for Tobacco Products, Food and Drug Administration, Document Control Center, Silver Spring, MD
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Pearson JL, Watanabe M, Sanchez J, Mann S, Drake C, Mercincavage M. The "organic" descriptor and its association with commercial cigarette health risk expectancies, subjective effects, and smoking topography: a pilot human laboratory study. Nicotine Tob Res 2021; 24:69-76. [PMID: 34286827 DOI: 10.1093/ntr/ntab151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 07/20/2021] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The purpose of this mixed method pilot study was to (1) examine whether the "organic" descriptor affects smokers' health risk expectancies, subjective ratings of smoking, and topography, and (2) describe how smokers interpret the "organic" descriptor and relate it to their subjective smoking experience. METHODS Twenty-two daily smokers (45.5% men, 81.8% non-Hispanic White, M (SD) age = 47.3 [12.7], M (SD) cigarettes/day = 14.5 [5.1]) completed a within-person laboratory study. Following a baseline session, smokers attended 2 experimental sessions where they smoked a study-provided cigarette (identical across conditions) paired with either an "organic" or conventional (e.g., no "organic") descriptor condition and completed subjective and behavioral measures. Participants completed a semi-structured interview at the last visit. RESULTS Relative to the conventional cigarette, more participants rated the "organic" cigarette as healthier, having fewer chemicals, and having a more favorable burn rate (p's<0.05). There were no differences in total puff volume by condition (p=0.42). Stratifying by gender, men inhaled 225 ml (SE = 82.7) more in the conventional condition (p=0.02); women inhaled 408 ml (SE = 233.3) more in the organic condition (p=0.11). A common understanding of "organic" was that the product was "…less processed... like less chemicals and it's more natural." Some believed that "organic" cigarettes contained fewer chemicals, which in turn produced a "much cleaner and healthier smoking cigarette" and that they could "taste the difference." CONCLUSIONS Findings support that smokers associate the "organic" descriptor with health and reduced harm. This descriptor may differentially impact puffing behavior by gender. IMPLICATIONS This study provides qualitative and quantitative data regarding how the "organic" descriptor influences adult daily smokers' perceptions and use of cigarettes. After smoking two identical cigarettes described as "organic" and conventional (e.g., no "organic"), smokers expressed more problematic health expectancies about the "organic" cigarette condition, providing further empirical support that the "organic" descriptor is associated with expectancies of reduced harm. The source of reduced harm was understood to be fewer chemicals in the organic cigarette. Though preliminary, findings suggest that "organic" may differentially affect puffing behavior by gender.
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Affiliation(s)
- Jennifer L Pearson
- Division of Social and Behavioral Science/Health Administration and Policy, School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Mika Watanabe
- Division of Social and Behavioral Science/Health Administration and Policy, School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Jennifer Sanchez
- Division of Social and Behavioral Science/Health Administration and Policy, School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Suman Mann
- Department of Psychology, School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Cara Drake
- Division of Social and Behavioral Science/Health Administration and Policy, School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Melissa Mercincavage
- Center for Interdisciplinary Research on Nicotine Addiction, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia,PA
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Sutfin EL, Lazard AJ, Soule EK, Kimes CM, King J, Jenson D, Ross JC. Health Claims, Marketing Appeals, and Warnings on Popular Brands of Waterpipe Tobacco Packaging Sold in the United States. Nicotine Tob Res 2021; 23:1183-1190. [PMID: 33406241 DOI: 10.1093/ntr/ntab002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/05/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Waterpipe tobacco (WT) smoking is associated with misperceptions of harm, especially among users. WT packaging contains imagery, flavor descriptors, and text claims that may contribute to misperceptions. The study goal was to characterize visual and text elements of WT packaging. AIMS AND METHODS Using data from the U.S. Population Assessment on Tobacco and Health Study Wave 2 (October 2014-October 2015), we identified the 10 most popular WT brands. For each brand, we identified available flavors, including flavor collections with unique packaging elements. We randomly selected 10 flavors per brand for purchase (March-April 2018). We conducted descriptive content analysis to code all textual and visual design elements of each package. RESULTS Over half (54%) of WT packages had modified risk tobacco product (MRTP) claims prohibited by federal law, including substance-free MRTP claims (43%) and the descriptor "natural" (11%). No MRTP reduced exposure or reduced risk claims were found. Over a quarter (26%) of packaging including one or more of terms that may imply reduced harm including "fresh," "premium," "quality," and "pure." All packages included a text-only warning, yet none appeared on the primary display panel. Almost all packaging (99%) included imagery, with 72% including flavor imagery. The majority of packages (72%) included a smoking cue. The most popular marketing appeals were "well-made" (57%), "enjoyable" (55%), and "patriotic" (47%). CONCLUSIONS Prohibited MRTP claims, other descriptors, and flavor imagery are common on WT packaging, despite federal law. Future research is needed to evaluate if this marketing contributes to misperceptions of reduced harm. IMPLICATIONS Tobacco packaging is used to convey health-related messages, both explicitly and implicitly; however, information about WT packaging is virtually nonexistent. We conducted a content analysis of WT packaging from the 10 most popular US brands. Over half (54%) of packages had prohibited MRTP claims and over a quarter (26%) included one or more descriptors that may be perceived as implying reduced harm. Use of imagery, including smoking cues, was common. The widespread use of prohibited MRTP claims, other descriptors, and imagery on WT packaging may contribute to misperceptions of reduced harm.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Allison J Lazard
- Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric K Soule
- Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Caroline M Kimes
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jessica King
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Desmond Jenson
- Mitchell Hamline School of Law, Public Health Law Center, Saint Paul, MN, USA
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Dewhirst T. Natural American Spirit cigarettes are marketed as 'made different': the role of brand positioning and differentiation. Tob Control 2021; 31:679-682. [PMID: 33727254 DOI: 10.1136/tobaccocontrol-2020-056442] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Timothy Dewhirst
- Department of Marketing and Consumer Studies, Gordon S. Lang School of Business and Economics, Guelph, Ontario, Canada
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Epperson AE, Wong S, Lambin EF, Henriksen L, Baiocchi M, Flora JA, Prochaska JJ. Adolescents' Health Perceptions of Natural American Spirit's On-the-Pack Eco-Friendly Campaign. J Adolesc Health 2021; 68:604-611. [PMID: 32713741 PMCID: PMC7855194 DOI: 10.1016/j.jadohealth.2020.06.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/20/2022]
Abstract
PURPOSE Natural American Spirit (NAS) cigarettes, which have recently grown in popularity, are marketed as eco-friendly and natural. The present study examined whether NAS's on-the-pack messaging influences adolescents' health perceptions of the brand. METHODS In a mixed-factor design, adolescent participants (N = 1,003, ages 13-17, 75% female) were randomized to one of the six exposure conditions. All viewed images of an NAS and a Pall Mall (comparison brand) cigarette pack, but differed in pack color (blue, green, or gold/orange) and brand viewed first. Perceptions of pack logos, addictiveness, harms to the smoker, others, and the environment were assessed directly after viewing pack images for each brand. RESULTS Adolescents who perceived NAS as more pro-environment tended to perceive NAS cigarettes to be less addictive, r = -.19, p < .01. NAS cigarettes also were perceived as less addictive and better for the environment than Pall Mall. Most (90%) participants provided nature-friendly words (e.g., environment, recycle) when asked to describe logos on the NAS packs. In adjusted models, relative to Pall Mall, NAS was perceived as healthier for smokers, healthier for smokers' family and friends, and safer for the environment. Findings did not differ by pack color and ever tobacco use. CONCLUSIONS Adolescents perceived a health advantage for NAS cigarettes with its on-the-pack, eco-friendly and pro-health marketing. The findings are consistent with prior research with adults. Given the accumulating evidence of consumer misperceptions, eco-friendly messaging on cigarettes is a public health concern that warrants further consideration for regulatory intervention.
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Affiliation(s)
- Anna E Epperson
- Division of Adolescent Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Samantha Wong
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Eric F Lambin
- School of Earth, Energy & Environmental Sciences, and Woods Institute for the Environment, Stanford University, Stanford, California; Georges Lemaître Earth and Climate Research Centre, Earth and Life Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Michael Baiocchi
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - June A Flora
- Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, California
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California.
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Vogel EA, Henriksen L, Johnson TO, Schleicher NC, Prochaska JJ. Popularity of natural American Spirit cigarettes is greater in U.S. cities with lower smoking prevalence. Addict Behav 2020; 111:106558. [PMID: 32745944 PMCID: PMC7484141 DOI: 10.1016/j.addbeh.2020.106558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 06/23/2020] [Accepted: 07/12/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Often perceived as a safer smoke, Natural American Spirit (NAS) may find particular appeal in communities with strong non-smoking norms. We hypothesized NAS would be more popular in cities with lower smoking prevalence, with the pattern unique to NAS. We tested household income, cigarette taxes, and young adult population as alternative correlates and examined brand specificity, relative to Marlboro and Pall Mall. METHODS Using proprietary, city-specific sales estimates obtained from Nielsen for 30 U.S. cities over one year (9/7/18-9/9/19), we computed cigarette sales volume as standard pack units per 10,000 adult smokers for NAS and Marlboro and Pall Mall. Linear regression models examined associations between city-level sales volume and adult smoking prevalence, median household income, the sum of state/local cigarette excise taxes, and young adult population. RESULTS NAS sales volume averaged 44,785 packs per 10,000 adult smokers (SD = 47,676). Across 30 cities, adult smoking prevalence averaged 18.0% (SD = 4.5%), median household income averaged $53,677 (SD = $14,825), cigarette excise tax averaged $2.55 (SD = $1.63), and young adult population averaged 10.6% (SD = 2.2%). NAS sales volume was greater in cities with lower adult smoking prevalence (β = -0.39, 95% CI[-0.74, -0.03], p = 0.034), a pattern that was not observed for Marlboro or Pall Mall (ps > 0.356). Marlboro (β = -0.40, 95% CI[-0.76, -0.05], p = 0.027) and Pall Mall (β = -0.48, 95% CI[-0.82, -0.14], p = 0.008) sales volumes were higher in cities where cigarette excise taxes were lower, a pattern not observed for NAS (p = 0.224). CONCLUSION NAS appears to be more popular in cities with lower smoking prevalence and may deter efforts to further decrease prevalence.
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Affiliation(s)
- Erin A Vogel
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Trent O Johnson
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Nina C Schleicher
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University, Stanford, CA, USA.
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Seidenberg AB, Popova L, Ashley DL, Wackowski OA. Inferences beyond a claim: a typology of potential halo effects related to modified risk tobacco product claims. Tob Control 2020; 30:tobaccocontrol-2019-055560. [PMID: 33046582 PMCID: PMC8039054 DOI: 10.1136/tobaccocontrol-2019-055560] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 11/03/2022]
Abstract
When tobacco products are marketed with modified risk tobacco product (MRTP) claims, consumers may infer additional health benefits not directly stated in the claims. We propose a typology of seven potential 'halo effects' (ie, an unintended generalisation) that may occur with MRTP marketing. Evidence currently exists that some of these types of halo effects occur after exposure to MRTP claims. These generalisations are likely unavoidable in certain situations and may sometimes produce accurate inferences. However, some halo effects may be problematic if they mislead consumers into false inferences and result in unintended consequences that have a negative public health impact (eg, reinitiation, dual tobacco product use). To help mitigate unintended consequences and guide regulatory decisions about MRTP claims, we encourage researchers studying MRTP claims to test for halo effects. Regulatory agencies should include potential unintended consequences associated with halo effects when assessing individual-level and population-level health impacts of MRTP claims. Moreover, tobacco manufacturers should be required to report both premarket and postmarket surveillance of halo effects to relevant regulatory agencies. If MRTP claims are to play a role in tobacco harm reduction, it is imperative that they be communicated and interpreted in ways that minimise harms and maximise public health benefits.
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Affiliation(s)
- Andrew B Seidenberg
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
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Baig SA. Bayesian Inference: An Introduction to Hypothesis Testing Using Bayes Factors. Nicotine Tob Res 2020; 22:1244-1246. [PMID: 31693135 DOI: 10.1093/ntr/ntz207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 11/04/2019] [Indexed: 11/13/2022]
Affiliation(s)
- Sabeeh A Baig
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY
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Orlan EN, Queen TL, Ribisl KM, Sutfin EL. One-item susceptibility measure predicts waterpipe and little cigar/cigarillo uptake in a national sample of adolescents and young adults in the United States. Tob Prev Cessat 2020; 5:17. [PMID: 32411881 PMCID: PMC7205113 DOI: 10.18332/tpc/108554] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/02/2019] [Accepted: 04/15/2019] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Adolescents and young adults in the United States (US) are increasingly using non-cigarette tobacco products such as waterpipe (WP) and little cigars/cigarillos (LCC). One way to predict which non-user adolescents and young adults are most likely to use these products is through measuring their susceptibility or openness to using the products. METHODS We conducted a national phone survey (baseline) and an internet survey (follow-up) of adolescents and young adults (ages 13–25 years), who, at baseline, had never used WP (N=1002) or LCC (N=990). At baseline, we measured susceptibility using a single item, asking participants whether they would try WP or LCC if their best friend offered it to them, and subsequently measured uptake at follow-up. We conducted multivariate regression analyses to determine whether product-specific susceptibility was a significant predictor of uptake at follow-up. RESULTS Participants who were susceptible and participants who had ever used another tobacco product had higher odds of using WP (AOR=3.5, AOR=4.2) and LCC (AOR=3.2, AOR=5.3) at follow-up than those who were not susceptible to those products, and had not ever used tobacco products respectively, controlling for sociodemographic factors. The one-item measure had adequate sensitivity (WP=51.4%, LCC=40.2%) and specificity (WP=84.9%, LCC=87.9%). CONCLUSIONS Our national study of US adolescents and young adults shows that a one-item susceptibility measure at baseline was a significant predictor of WP and LCC uptake at follow-up, even after controlling for other predictors. Future research should assess the predictive validity of the one-item compared to the multi-item scale.
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Affiliation(s)
- Elizabeth N Orlan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States
| | - Tara L Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, United States
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, United States
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King JL, Lazard A, Reboussin BA, Ranney L, Cornacchione Ross J, Wagoner KG, Sutfin EL. Optimizing Warnings on E-Cigarette Advertisements. Nicotine Tob Res 2020; 22:630-637. [PMID: 31132095 DOI: 10.1093/ntr/ntz091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 05/25/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION We examined the effect of visual optimizations on warning text recall. METHODS We used Amazon's Mechanical Turk to recruit 1854 young adult (18-34 years) electronic cigarette (e-cigarette) users or susceptible nonusers. We conducted a between-subjects 3 × 2 × 2 experiment to examine the influence of color (black text on white background [BW] vs. black on yellow [BY] vs. yellow on black [YB]), shape (rectangle vs. novel), and signal word (presence vs. absence of the word "warning"). We randomized participants to view one of 12 warnings on a fictional e-cigarette advertisement. We coded open-ended recall responses into three categories: (1) recalled nothing, (2) recalled something, (3) recalled the concept. We examined main effects on warning text recall using multinomial regression. We examined differences in attention, perceived message effectiveness, and appeal. RESULTS Those exposed to BW or BY warnings were more likely than those exposed to YB to recall something (AOR = 1.6, AOR = 1.5, respectively) or the concept (OR = 1.4, BW). Those exposed to novel shape (44.7% novel vs. 37.9% rectangle; p = .003) or color (44.5% BY vs. 41.9% YB vs. 37.5% BW; p = .04) warnings were more likely to report attention to the warning. In aided recall, those exposed to the signal word were more likely than those not exposed to select the correct response (64.0% vs. 31.3%; p < .0001). We did not find differences for message effectiveness or appeal. CONCLUSIONS Visual optimizations such as color may influence warning text recall and should be considered for new warnings. Research should continue exploring variations for advertisement warnings to maximize attention to warning text. IMPLICATIONS This study examines the impact of visual optimizations on recall of the US Food and Drug Administration-mandated e-cigarette advertisement warning text. We found that color might influence warning text recall, but we did not find effects for shape or signal word. It is possible the newly mandated e-cigarette advertisement warnings, which are required to occupy at least 20% of the advertisement, are currently novel enough to attract attention. Future research should examine optimizations following implementation of the new advertisement warnings.
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Affiliation(s)
- Jessica L King
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Allison Lazard
- School of Media and Journalism, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Leah Ranney
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Pearson JL, Moran M, Delnevo CD, Villanti AC, Lewis MJ. Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey. Nicotine Tob Res 2020; 21:970-973. [PMID: 30722066 DOI: 10.1093/ntr/ntz015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/29/2019] [Indexed: 11/14/2022]
Abstract
SIGNIFICANCE US smokers of Natural American Spirit, a brand marketed as "organic" and "additive-free," are more likely than other cigarette smokers to believe that their brand might be less harmful than other brands. This article (1) describes the prevalence of belief that "organic" and "additive-free" tobacco is less harmful than regular tobacco products in the US population and (2) describes the sociodemographic characteristics of adults who believe tobacco products with these descriptors are less harmful. METHODS Data were drawn from the 2017 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults. Logistic regression models were used to examine correlates of the belief that "organic" or "additive-free" tobacco products are less harmful than regular tobacco products. RESULTS Overall, 26.7% of US adults and 45.3% of adult smokers believe that "organic" tobacco products are less harmful than regular tobacco products. Similarly, 35.2% of US adults and 47.1% of smokers believe that "additive-free" tobacco products are less harmful. When examining gender, age, education, race/ethnicity, sexual orientation, and smoking status, only age (adjusted odds ratio [aOR] ~0.98, 95% confidence interval [CI]: 0.97, 0.99 for both outcomes) and smoking status (current vs. never smokers, aOR ~1.78, 95% CI 1.03, 3.07 for both outcomes) were correlates of believing that "organic" or "additive-free" tobacco is less harmful than regular tobacco products. CONCLUSIONS Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread. Younger adults and current smokers are most likely to be misinformed by "organic" or "additive-free" tobacco product descriptors. IMPLICATIONS Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread among US adults and most prevalent among smokers. Removal of terms that incorrectly imply reduced harm may correct current and future consumers' misperceptions about the brand.
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Affiliation(s)
- Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, NV.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meghan Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Andrea C Villanti
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Psychiatry, University of Vermont, Burlington, VT
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
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Hall MG, Lazard AJ, Grummon AH, Mendel JR, Taillie LS. The impact of front-of-package claims, fruit images, and health warnings on consumers' perceptions of sugar-sweetened fruit drinks: Three randomized experiments. Prev Med 2020; 132:105998. [PMID: 31982477 PMCID: PMC7085890 DOI: 10.1016/j.ypmed.2020.105998] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 12/20/2019] [Accepted: 01/21/2020] [Indexed: 10/25/2022]
Abstract
We aimed to examine the impact of claims, fruit images, and health warnings on consumers' perceptions of fruit-flavored drinks with added sugar (i.e., "fruit drinks"). We conducted three 2x2x2 randomized experiments with online convenience samples of U.S. adults (Study 1 n = 2139 in 2018, current e-cigarette users and smokers; Study 2 n = 670 in 2018, current e-cigarette users; Study 3 n = 1006 in 2019, general sample). Participants viewed a fruit drink that differed in the presence of a "100% Vitamin C" claim, a fruit image, or a health warning. On average across the three studies, consumers who saw a claim on a fruit drink believed that the drink was more healthful than those who did not see the claim (mean average differential effect (ADE) = 0.66, p < .001); they were also more interested in consuming the drink (mean ADE = 0.38, p = .001). The health warning decreased perceived product healthfulness (mean ADE = -0.65, p < .001) and consumption interest (mean ADE = -0.49, p < .001). The fruit image had no effect on perceived product healthfulness (mean ADE = 0.03, p = .81) or purchase intentions (mean ADE = -0.04, p = .77). In Study 1 and Study 2, there were no interactions between claims, images, or warnings (all p > .05). In Study 3, the "100% Vitamin C" nutrition claim only increased perceived product healthfulness when the drink did not also have a health warning (interaction p < .05). These findings suggest that 100% Vitamin C claims increase the appeal of fruit drinks, whereas health warnings decrease the appeal. Together, these studies support policies to restrict marketing and require health warnings on sugar-sweetened beverage packaging.
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Affiliation(s)
- Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America.
| | - Allison J Lazard
- Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America; Hussman School of Media and Journalism, University of North Carolina, United States of America
| | - Anna H Grummon
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, United States of America; Carolina Population Center, University of North Carolina, United States of America
| | - Jennifer R Mendel
- Lineberger Comprehensive Cancer Center, University of North Carolina, United States of America
| | - Lindsey Smith Taillie
- Carolina Population Center, University of North Carolina, United States of America; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, United States of America
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Byron MJ, Hall MG, King JL, Ribisl KM, Brewer NT. Reducing Nicotine Without Misleading the Public: Descriptions of Cigarette Nicotine Level and Accuracy of Perceptions About Nicotine Content, Addictiveness, and Risk. Nicotine Tob Res 2019; 21:S101-S107. [PMID: 31867657 PMCID: PMC6939779 DOI: 10.1093/ntr/ntz161] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 09/05/2019] [Indexed: 01/14/2023]
Abstract
SIGNIFICANCE The public incorrectly believes very low nicotine content (VLNC) cigarettes are less carcinogenic than current cigarettes, a belief associated with lower motivation to quit under a VLNC standard. We examined how different descriptions of the nicotine level in VLNC cigarettes affect the accuracy of the public's perceptions about nicotine content, addictiveness, and cancer risk. METHODS Participants were a national convenience sample of 1353 US adults (22% smokers). In an online experiment, we randomized participants to a VLNC description using (1) concise language; (2) a percentage; (3) an interpretation; (4) a percentage and interpretation; (5) a percentage and a pictograph; or (6) a percentage, interpretation, and pictograph; or to a control description using (7) FDA's "minimally or nonaddictive" phrasing. We assessed accuracy of perceived nicotine content, addictiveness, and cancer risk compared to current cigarettes. RESULTS Compared to control, the percentage description resulted in more accurate perceptions about nicotine content (76% vs. 49% accuracy) and addictiveness (44% vs. 34%), but less accurate perceptions about cancer risk (56% vs. 68%; all ps < .05). Adding interpretation or pictographs to the percentage description did not increase accuracy. The concise language description reduced accuracy of perceived nicotine content and addictiveness but increased accuracy of cancer risk (all ps < .05). CONCLUSIONS Stating that 95% of nicotine would be removed more accurately conveyed the nicotine content and addictiveness of VLNC cigarettes. However, descriptions that better conveyed nicotine content and addictiveness misled people about cancer risk. IMPLICATIONS Implementation of a VLNC standard should include plans for a communication campaign that conveys that VLNC cigarettes will be less addictive but equally toxic to smoke. Stating the percent reduction in nicotine is likely to more clearly communicate reduced addictiveness but may also exacerbate risk misperceptions. VLNC communication requires further study to ensure the public accurately understands a VLNC standard.
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Affiliation(s)
- M Justin Byron
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Marissa G Hall
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jessica L King
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
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Lewis MJ, Jeong M, Ackerman C. Naturally similar: Natural American Spirit and Nat Sherman's new cigarette. Tob Control 2019; 29:e161-e162. [PMID: 31471452 DOI: 10.1136/tobaccocontrol-2019-055247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- M Jane Lewis
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Michelle Jeong
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
| | - Christopher Ackerman
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, New Jersey, USA
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Lazard AJ, Byron MJ, Peters E, Brewer NT. Communicating about chemicals in cigarette smoke: impact on knowledge and misunderstanding. Tob Control 2019; 29:556-563. [PMID: 31462579 DOI: 10.1136/tobaccocontrol-2018-054863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 05/16/2019] [Accepted: 06/05/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND The USA must publicly share information about harmful and potentially harmful constituents (chemicals) in tobacco products. We sought to understand whether webpages with chemical information are "understandable and not misleading to a lay person." METHODS Participants were a national probability sample of US adults and adolescents (n=1441, 18% smokers). In an online experiment, we randomly assigned participants to view one of the developed webpages (chemical names only, names with quantity ranges, names with visual risk indicators) or no webpage in phase one (between subjects). Participants completed a survey assessing knowledge, misunderstanding, perceived likelihood, perceived severity of health effects from smoking and quit intentions (smokers only). In phase two (within subjects), participants viewed all three webpage formats and reported webpage perceptions (clarity, usability, usefulness) and perceived impact (affect, elaboration, perceived effectiveness). RESULTS In phase one, viewing any webpage led to more knowledge of chemicals (48%-54% vs 28% no webpage, ps<0.001) and health harms (77% vs 67% no webpage, ps<0.001). When exposed to any webpage, 5%-23% endorsed misunderstandings that some cigarettes are safer than others. Webpage format did not affect knowledge or reduce misunderstandings. Viewing any webpage led to higher perceived likelihood of experiencing health effects from smoking (p<0.001) and, among smokers, greater intentions to quit smoking (p=0.04). In phase two, where participants viewed all formats, a visual risk indicator led to the highest perceived impact. CONCLUSIONS Knowledge of chemicals and health effects can increase after viewing a website. Yet, websites may not correct the misunderstanding that some cigarettes are safer.
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Affiliation(s)
- Allison J Lazard
- School of Media and Journalism, University of North Carolina, Chapel Hill, North Carolina, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - M Justin Byron
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA.,Department of Health Behavior, Gillings School of Global Public, University of North Carolina, Chapel Hill, North Carolina, USA.,Family Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Ellen Peters
- Psychology, Ohio State University, Columbus, Ohio, USA
| | - Noel T Brewer
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA .,Department of Health Behavior, Gillings School of Global Public, University of North Carolina, Chapel Hill, North Carolina, USA
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Meier BP, Dillard AJ, Lappas CM. Naturally better? A review of the natural‐is‐better bias. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2019. [DOI: 10.1111/spc3.12494] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Jain V, Alcheva A, Huang D, Caruso R, Jain A, Lay M, O'Connor R, Stepanov I. Comprehensive Chemical Characterization of Natural American Spirit Cigarettes. TOB REGUL SCI 2019; 5:381-399. [PMID: 33907702 PMCID: PMC8075288 DOI: 10.18001/trs.5.4.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Marketing of the Natural American Spirit (NAS) cigarettes implies reduced risk of toxic exposures. We aimed to provide a comprehensive chemical characterization of these cigarettes. METHODS We analyzed 13 varieties of NAS for a range of tobacco- and combustion-derived constituents. Cigarettes were smoked by 2 standard regimens and analyzed using our routine analytical procedures. We also analyzed tobacco filler and physical cigarette characteristics. RESULTS Under intense smoking conditions, nicotine in smoke of NAS cigarettes averaged 3.3(±0.7) mg/cigarette, compared to 2.4(±0.4) in other brands. The levels of carcinogenic nitrosamines NNN and NNK varied extensively across NAS varieties, their sum ranging from 71 to 443 ng/cigarette. Levels of volatile toxicants were generally similar to, or higher than those found in other commercial US cigarettes. CONCLUSIONS High nicotine content suggests that NAS cigarettes may be more addictive than many other brands. Similarly low TSNA levels were measured in some NAS varieties, independent of whether or not they were labeled as organic. Levels of other toxicants were similar to other brands. Consumer education and additional regulatory measures are needed to address the misperceptions that NAS cigarettes are safer than other commercial cigarette brands.
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Affiliation(s)
- Vipin Jain
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Aleksandra Alcheva
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Darlene Huang
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Rosalie Caruso
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Anshu Jain
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Mula Lay
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Richard O'Connor
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
| | - Irina Stepanov
- Vipin Jain, Research Associate, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Aleksandra Alcheva, Graduate Student, Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, MN. Darlene Huang, Senior Associate, O'Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC. Rosalie Caruso, Senior Research Associate, Tobacco Research Laboratory, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Anshu Jain, Research Scientist, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Mula Lay, Student Intern, Masonic Cancer Center, University of Minnesota, Minneapolis, MN. Richard O'Connor, Professor, Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY. Irina Stepanov, Associate Professor, Masonic Cancer Center and Division of Environmental Health Sciences, University of Minnesota, Minneapolis, MN
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Baig SA, Byron MJ, Pepper JK, Brewer NT. Interest in "organic," "natural," and "additive-free" cigarettes after hearing about toxic chemicals in cigarette smoke. PLoS One 2019; 14:e0212480. [PMID: 30840639 PMCID: PMC6402619 DOI: 10.1371/journal.pone.0212480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 02/04/2019] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The US Family Smoking Prevention and Tobacco Control Act requires the government to disseminate information about the toxic chemicals in cigarette smoke. We sought to understand how the descriptors "organic," "natural," or "additive-free" affect smokers' interest in cigarettes in the context of information about chemicals in cigarette smoke. METHODS Participants were a national probability sample of 1,101 US adult (ages ≥18) smokers recruited in 2014-2015. A between-subjects experiment randomized participants in a telephone survey to 1 of 4 cigarette descriptors: "organic," "natural," "additive-free," or "ultra-light" (control). The outcome was expected interest in cigarettes with the experimentally assigned descriptor, after learning that 2 chemicals (hydrogen cyanide and lead) are in cigarette smoke. Experimental data analysis was conducted in 2016-2017. RESULTS Smokers indicated greater expected interest in "organic," "natural," and "additive-free" cigarettes than "ultra-light" cigarettes (all p <.001) after learning that hydrogen cyanide and lead were in cigarette smoke. Smokers who intended to quit in the next 6 months expressed greater expected interest in the 4 types of cigarettes ("organic," "natural," "additive-free," and "ultra-light") compared to smokers not intending to quit (p <.001). CONCLUSIONS Smokers, especially those intending to quit, may be more inclined towards cigarettes described as "organic," "natural," and "additive-free" in the context of chemical information. An accumulating body of evidence shows that the US should fully restrict use of "organic" and "natural" descriptors for tobacco products as it has done for "additive-free" and "light" descriptors.
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Affiliation(s)
- Sabeeh A. Baig
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York, United States of America
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
| | - M. Justin Byron
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
- Department of Family Medicine, UNC School of Medicine, Chapel Hill, North Carolina, United States of America
| | - Jessica K. Pepper
- Center for Health Policy Science & Tobacco Research, RTI International, Research Triangle Park, North Carolina, United States of America
| | - Noel T. Brewer
- Department of Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, North Carolina, United States of America
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Basáñez T, Majmundar A, Cruz TB, Unger JB. Vaping associated with healthy food words: A content analysis of Twitter. Addict Behav Rep 2018; 8:147-153. [PMID: 30320201 PMCID: PMC6180293 DOI: 10.1016/j.abrep.2018.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/21/2018] [Accepted: 09/21/2018] [Indexed: 01/01/2023] Open
Abstract
E-cigarettes were initially introduced as a less harmful alternative to combustible cigarettes, but marketing efforts may now be exceeding these claims by associating e-cigarettes with words related to healthy foods. These associations could mislead people to assume vaping is a healthy practice. Tweets from January to March 2017 were obtained from the Twitter Streaming Application Programming Interface (API) to assess content about vaping linked to healthy food words. Tweets were classified into one of nine categories along with their source (marketer vs. non-marketer). We content analyzed original English language public postings on Twitter that included vaping-related keywords and at least one of eight co-occurring healthy food-related labels (e.g., 'natural,' 'vitamin,' 'vegan,' and 'organic') (N = 1205). Chi-square analyses compared themes by message source. Findings suggest vaping is being marketed in ways that could paradoxically lead consumers to believe that e-cigarettes are health-enhancing. We found more tweets representing vaping as health-enhancing (9%) than referring to it as a smoking-cessation device (1%). The largest category of tweets referred to vaping as harmless (28%) and therefore compatible with a healthy lifestyle. Tweets presenting vaping as harmless or with a sensation theme were more likely to be authored by marketers than by non-marketers. Food and drug regulation needs to be more vigilant to prevent misleading advertising from e-cigarette marketers.
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Affiliation(s)
- Tatiana Basáñez
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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