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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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Pakdaman S, Broun A, Duart DA, Ajith A, Jewett B, Wong N, Mead-Morse EL, Choi K, Chen-Sankey J. Exploring the hypothetical impact of flavored cigar sales restrictions among black young adult cigar smokers: a semi-structured in-depth interview investigation. J Ethn Subst Abuse 2024; 23:501-519. [PMID: 35943488 PMCID: PMC9908770 DOI: 10.1080/15332640.2022.2109089] [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: 10/15/2022]
Abstract
This study assessed the hypothetical impact of flavored cigar sales restrictions on cigar smoking among Black young adult cigar smokers (ages 21-29). Forty in-depth interviews were conducted in 2020. Interviews were independently coded and analyzed using thematic analysis. When asked how they would smoke cigars given a flavor sales restriction, half of participants reported they would smoke in the same way, a third would stop or reduce smoking, and a few were unsure of what they would do. Cigar smoking outcome expectancies, preference for flavors, and perceived addictiveness of cigar products may predict cigar smoking change given flavor sales restrictions.
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Affiliation(s)
- Sheila Pakdaman
- Department of Preventive Medicine, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Aaron Broun
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- George Washington University, Milken Institute School of Public Health, Washington, D.C., USA
| | - Danielle A. Duart
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- National Cancer Institute. Division of Cancer Epidemiology & Genetics, Rockville, MD, USA
| | - Aniruddh Ajith
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
- University of Pittsburgh, School of Medicine
| | - Bambi Jewett
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
| | - Nicholas Wong
- Health, Emotion, and Addiction Laboratory, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, MD USA
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
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Gratale SK, Ganz O, Talbot EM, Pearson JL, Delnevo CD, Wackowski OA. L&M's foray into marketing 'natural' cigarettes. Tob Control 2024; 33:553-555. [PMID: 36697221 PMCID: PMC10366333 DOI: 10.1136/tc-2022-057770] [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: 01/27/2023]
Abstract
This ad watch details new L&M cigarette marketing in the United States that now features the terms “simple” and “tobacco and water”, while continuing to highlight its affordable and premium qualities. This implicitly positions L&M as an affordable natural brand, which is new for the brand. From a public health standpoint, this warrants attention and raises concern because of the commercial success of brands positioned as “natural”, the well-documented misperceptions of “natural” tobacco as presenting fewer health risks, and the potential to attract vulnerable populations who are both cost and health conscious.
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Affiliation(s)
- Stefanie K Gratale
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Ollie Ganz
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Eugene M Talbot
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Jennifer L Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, Nevada, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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4
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Clark SA, Baler G, Jarman KL, Byron MJ, Goldstein AO, Ranney LM. Qualitative perspective on nicotine pouches from adults who smoke cigarettes in North Carolina. Tob Control 2024:tc-2023-058334. [PMID: 38307719 DOI: 10.1136/tc-2023-058334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/02/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND Little is known about how nicotine pouch products are perceived by people who smoke, including if they are perceived as a cessation aid or a substitute for when they cannot smoke. We qualitatively investigated the reactions and perceptions about On!, a leading brand of nicotine pouches. METHODS We conducted online semistructured interviews with 30 adults who smoke cigarettes. Participants viewed an On! brochure and an image of an opened nicotine pouch and were asked about their initial impression, who the intended user is, and how they thought of the product's safety compared with other tobacco and cessation products. Transcripts were independently coded and the data were analysed using thematic content analysis. RESULTS Among the participants, half identified as female and slightly more than half were white (n=16). The mean age was 43 years old. The following are the central themes that emerged: (1) participants perceived the concealability, flavours and packaging of On! as appealing to youth and young adults; (2) participants perceived nicotine pouches as a product that would supplement rather than replace tobacco use; and (3) the product raised health concerns, which decreased interest in trying nicotine pouches. CONCLUSIONS Participants believed that the On! nicotine pouch promotional material may promote youth and young adult nicotine product initiation and dual product use for people who smoke. Most viewed On! as a product to use with cigarettes, rather than a way to quit cigarettes. Increased surveillance of nicotine pouches is warranted to monitor the trajectory of this emerging tobacco product and prevent youth initiation.
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Affiliation(s)
- Sonia A Clark
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Guido Baler
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen L Jarman
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - M Justin Byron
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Adam O Goldstein
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Leah M Ranney
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Gratale SK, Pearson JL, Mercincavage M, Wackowski OA. Organic, Earth-Friendly Tobacco With a Charcoal Filter and Smooth Taste: A Randomized Experiment Testing Effects of Natural American Spirit's "Sky" Cigarette Advertising on Consumer Perceptions. Nicotine Tob Res 2024; 26:161-168. [PMID: 37349148 PMCID: PMC10803116 DOI: 10.1093/ntr/ntad099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 06/24/2023]
Abstract
INTRODUCTION The Natural American Spirit (NAS) brand has a history of marketing tactics that may convey reduced harm. While no longer allowed to use "additive-free" or natural descriptors (except in the brand name), it continues promoting potentially misleading attributes. This study examined perceptions of NAS's newer "Sky" style, promoted as organic tobacco with a charcoal filter. AIMS AND METHODS In an online experiment, we randomized 1927 adult past 30-day tobacco or nicotine product users to one of six conditions showing Sky ads with different descriptors: (1) charcoal filter, (2) charcoal + organic, (3) charcoal + earth-friendly, (4) charcoal + smooth taste, (5) charcoal + all other descriptors, and (6) no-descriptor control (Sky ads without target descriptors). Product perceptions were compared by condition. Participants also reported perceived benefits of charcoal filters. RESULTS Overall, 28% of participants indicated Sky is less harmful and 38% believed it exposes users to fewer chemicals. Participants in the "charcoal + organic," "charcoal + earth-friendly," and the all-descriptor conditions had higher odds of believing Sky reduces chemical exposure (respectively, 43%, 40%, and 42%), relative to the no-descriptor control. Fewer control participants endorsed beliefs that Sky has a "better filter" and is "more environmentally friendly". Many believed cigarettes with charcoal filters could confer benefits relative to other cigarettes, such as reducing chemical exposure, or being cleaner, purer or safer (though research on relative safety of charcoal filters in cigarettes is inconclusive). CONCLUSIONS Sky marketing may promote misperceptions about product safety and composition, and ads using both charcoal and organic text may particularly reinforce them. IMPLICATIONS This study examined the impact of new cigarette advertising promoting the use of charcoal filters and organic tobacco along with other suggestive claims ("environmentally friendly," "smooth taste") on tobacco users' perceptions of the advertised product-NAS Sky cigarettes. Our study provides new data about positive consumer perceptions of charcoal-filtered cigarettes, and results suggest that combinations of these marketing terms evoke perceptions about reduced harm and reduced exposure to harmful chemicals that may be misleading to the public. Our findings underscore a need for additional regulatory action regarding tobacco marketing that makes use of natural-themed marketing.
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Affiliation(s)
- Stefanie K Gratale
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Jennifer L Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada, Reno, NV, USA
| | - Melissa Mercincavage
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USA
| | - Olivia A Wackowski
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ, USA
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Ganz O, Wackowski OA, Strasser AA, Jeong M, Villanti AC, Miller Lo E, Talbot EM, Delnevo CD. Emergence and growth of 'natural' cigars in the USA. Tob Control 2023; 33:137-140. [PMID: 36282630 PMCID: PMC9718888 DOI: 10.1136/tobaccocontrol-2022-057396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 05/24/2022] [Indexed: 11/03/2022]
Affiliation(s)
- Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Michelle Jeong
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Andrea C Villanti
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Erin Miller Lo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Eugene M Talbot
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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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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Gratale SK, Ganz O, Wackowski OA, Lewis MJ. Naturally leading: a content analysis of terms, themes and word associations in Natural American Spirit advertising, 2000-2020. Tob Control 2023; 32:583-588. [PMID: 35022329 PMCID: PMC9273802 DOI: 10.1136/tobaccocontrol-2021-056938] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/22/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Natural American Spirit (NAS) is a cigarette brand distinguished by supposed 'natural', 'additive-free' characteristics, marketing of which is tied to misperceptions of reduced harm. In 2017, NAS's manufacturer agreed (with the Food and Drug Administration) to remove 'natural'/'additive-free' from US marketing. Prior research has explored NAS marketing immediately post-agreement. This study sought to identify prominent post-agreement terms and themes and analyse how they had been used in pre-agreement ads. METHODS We conducted a content analysis of NAS ads from 2000 to 2020 (N=176), documenting prominent pre-agreement and post-agreement terms/themes and examining how they are used in NAS ads. We coded for descriptors, themes, imagery and promotions, and extended prior research by analysing how leading post-agreement terms were used in conjunction and thematically associated with 'additive-free' and 'natural' before the agreement. RESULTS Results indicated 'tobacco and water' and 'Real. Simple. Different.' increased post-agreement, as did environmental imagery. 'Organic' was prominent pre-agreement and post-agreement. The descriptors used most often in post-agreement ads almost always appeared in conjunction with (and were thematically linked to) 'natural' and 'additive-free' in pre-agreement ads. CONCLUSIONS In the years since the agreement, NAS ads have heavily relied on still-allowable descriptors that may invite reduced risk misperceptions. Notably, these descriptors were consistently used alongside the banned terminology before the agreement and presented as if affiliated conceptually, possibly prompting similar connotations. Findings indicate a continuing need for research into NAS advertising effects and a potential role for additional regulatory action.
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Affiliation(s)
- Stefanie K Gratale
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Ollie Ganz
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
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Kramer RD, Park-Lee E, Marynak KL, Jones JT, Sawdey MD, Cullen KA. Nicotine Pouch Awareness and Use Among Youth, National Youth Tobacco Survey, 2021. Nicotine Tob Res 2023; 25:1610-1613. [PMID: 37279928 PMCID: PMC10961705 DOI: 10.1093/ntr/ntad080] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 05/09/2023] [Accepted: 05/17/2023] [Indexed: 06/08/2023]
Abstract
INTRODUCTION This manuscript examines prevalence of awareness and use of nicotine pouches among U.S. middle and high school students by sociodemographic characteristics and other tobacco product use and characterizes nicotine pouch and other tobacco product use behaviors among current nicotine pouch users. AIMS AND METHODS Data are from the 2021 National Tobacco Youth Survey, a cross-sectional, school-based survey of middle and high school students (N = 20 413; overall response rate: 44.6%), which included questions on nicotine pouches in 2021 for the first time. Prevalence estimates, 95% confidence intervals, and estimated population counts were assessed for nicotine pouch awareness, ever use, and current (past 30 days) use, and for use behaviors related to nicotine pouches (frequency of use, flavor(s) used) and other tobacco products (ever, current, frequency of use) among current nicotine pouch users. RESULTS Over one-third of students (35.5%) had ever heard of nicotine pouches. An estimated 1.9% (490 000) reported ever using them, while 0.8% (200 000) reported current use. Among current nicotine pouch users, 61.6% reported flavored nicotine pouch use, 64.2% reported current e-cigarette use, and 52.6% used multiple (≥2) tobacco products. Current use of nicotine pouches was common among current smokeless tobacco users (41.3%). CONCLUSIONS Overall, in 2021, while relatively few students had ever tried nicotine pouches or currently used them, more than one-third had heard of them. Current nicotine pouch users tended to use other tobacco products, particularly e-cigarettes and smokeless tobacco. Given previous rapid increases in youth uptake of e-cigarettes, it is important to continue monitoring nicotine pouch use among young people. IMPLICATIONS This study's findings provide an important baseline for future monitoring of nicotine pouch awareness and use among middle and high school students. Emerging tobacco products, particularly those that are flavored, widely available, discreet, and inexpensive have the potential to attract youth. Given the potential of these products to appeal to young people, ongoing monitoring of nicotine pouch use behaviors is important to inform public health and regulatory efforts.
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Affiliation(s)
- Renee D. Kramer
- Division of Population Health Science, Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Eunice Park-Lee
- Division of Population Health Science, Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Kristy L. Marynak
- Office on Smoking and Health, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jamal T. Jones
- Division of Population Health Science, Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Michael D. Sawdey
- Division of Population Health Science, Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
| | - Karen A. Cullen
- Division of Population Health Science, Office of Science, Center for Tobacco Products, U.S. Food and Drug Administration, Silver Spring, MD, USA
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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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11
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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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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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13
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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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14
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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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15
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Moran MB, Heley K, Czaplicki L, Weiger C, Strong D, Pierce J. Tobacco Advertising Features That May Contribute to Product Appeal Among US Adolescents and Young Adults. Nicotine Tob Res 2021; 23:1373-1381. [PMID: 33377146 PMCID: PMC8360628 DOI: 10.1093/ntr/ntaa275] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 12/23/2020] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Cigarette advertising is a causal agent of smoking uptake among young people. Although prior research links ad receptivity to tobacco product interest and use, little is known regarding the specific advertising tactics associated with increased product appeal among young people. METHODS A national sample of 13-20 year-olds (N = 3688, youth) and 21-24 year-olds (N = 1556, young adults) in the US participated in an online survey in 2017 (mean age 18.1 years). The majority (72.0%) of youth and nearly half (44.8%) of young adults were never smokers. Participants were shown a cigarette ad, randomly assigned from a pool of 50 advertisements, and reported how much they liked the ad, and were curious about and interested in using the advertised product. All 50 advertisements were content analyzed for a variety of features. Data from the survey and content analysis were merged and mixed effects analyses used to identify the features associated with increased liking, curiosity, and interest in using, referred to collectively as product appeal. RESULTS Presence of a sweepstakes offer was associated with increased liking, curiosity and interest among youth and curiosity and interest among young adults. Outdoors settings, flora imagery, natural descriptors, and environmental themes were associated with increased appeal. Price reductions (eg, coupons) were associated with decreased appeal among youth. CONCLUSIONS This study identified several advertising tactics associated with increased appeal among youth and young adults. If additional research confirms these findings, the U.S. Food and Drug Association should consider restricting use of these tactics in tobacco advertising. IMPLICATIONS This study's findings provide insight into features of cigarette ads that appeal to youth and young adults. Overall, the presence of sweepstakes appealed to youth and young adults and outdoors and environmental themes were particularly appealing to young adults. Such tactics could serve to further brand engagement, improve brand image and lead to initiation or escalation of use. If confirmatory studies further demonstrate the effects of the tactics identified in this study on youth product appeal, U.S. Food and Drug Administration should consider using its authority to restrict the use of youth-appealing tactics.
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Affiliation(s)
- Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kathryn Heley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin Weiger
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Strong
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
- Division of Population, Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
| | - John Pierce
- Department of Family Medicine and Public Health, University of California San Diego School of Medicine, La Jolla, CA, USA
- Division of Population, Moores Cancer Center at UC San Diego Health, La Jolla, CA, USA
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16
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Smith TT, Nahhas GJ, Borland R, Cho YJ, Chung-Hall J, Fairman RT, Fong GT, McNeill A, Popova L, Thrasher JF, Cummings KM. Which tobacco control policies do smokers support? Findings from the International Tobacco Control Four Country Smoking and Vaping Survey. Prev Med 2021; 149:106600. [PMID: 33957152 PMCID: PMC8580201 DOI: 10.1016/j.ypmed.2021.106600] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/22/2022]
Abstract
As governments consider policy action to reduce smoking, a key factor in creating political will is the level of public support, particularly among smokers who are most affected by the policies. The goal of this paper is to assess and compare the level of support in Canada, the United States, England, and Australia for five smoking control policies: 1) banning menthol in cigarettes, 2) banning cigarette additives, 3) reducing nicotine in cigarettes to make them less addictive, 4) raising the minimum age to purchase cigarettes to 21 years and older, and 5) requiring pictorial warning labels on cigarette packs (examined in the US only). Data for these analyses come from 8165 daily cigarette smokers who responded to the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. In all countries, the highest level of support was for raising the legal age for purchase to 21 years and older (62-70%) and reducing the nicotine content of cigarettes to make them less addictive (57-70%). Smokers who were less dependent on cigarettes and those expressing interest in quitting were more likely to support all policies. When asked how they would respond to a nicotine reduction policy, the most common response given was to try the non-nicotine cigarettes to see how they liked them (42-48%), with the next most common response being to quit smoking entirely (16-24%). The high level of support for these proposed policies among daily smokers provides important evidence for policymakers to counteract claims that such policies would be unpopular.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States.
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Robert T Fairman
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ann McNeill
- Addictions Department, King's College London, London, United Kingdom
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
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17
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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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18
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Iles IA, Pearson JL, Lindblom E, Moran MB. "Tobacco and Water": Testing the Health Halo Effect of Natural American Spirit Cigarette Ads and Its Relationship with Perceived Absolute Harm and Use Intentions. HEALTH COMMUNICATION 2021; 36:804-815. [PMID: 31922429 PMCID: PMC10317043 DOI: 10.1080/10410236.2020.1712526] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
In 2015, the FDA formally warned Santa Fe Natural Tobacco Company that their "natural" and "additive-free" claims for its Natural American Spirit cigarettes conveyed reduced harm to consumers. In a settlement, Santa Fe was allowed to continue using the word "natural" in the brand name and the phrase "tobacco and water". The company also uses eco-friendly language and plant imagery and these tactics have also been shown to communicate reduced product harm. In this study, we propose the health halo effect as an overarching framework for explaining how these ad tactics mislead consumers in an effort to provide more comprehensive guidance for regulatory action. In a between-subjects experiment, 1,577 US young adults, ages 18-24, were randomly assigned to view one of five Natural American Spirit cigarette ads featuring either: 1) eco-friendly language; 2) plant imagery; 3) the phrase "tobacco and water"; 4) all of these tactics; or 5) a control condition featuring none of these tactics. In line with past research, ads with the phrase "tobacco and water" or with all the tactics together (vs. control) created a health halo effect, increasing perceptions that Natural American Spirit cigarettes were healthier and had less potential to cause disease; these tactics also had an indirect positive effect on smoking intentions through reduced perceptions of the brand's potential to cause disease and perceived absolute harm. Inconsistent with prior work, the eco-friendly language and plant imagery (vs. control) reduced healthfulness perceptions, increased perceptions of absolute harm, and had an indirect negative effect on smoking intentions. We contribute to past research showing that Natural American Spirit cigarette ad tactics mislead consumers. Inconsistent findings are explained in terms of stimuli design and processing of message features, indices of relative message persuasiveness, and multiple versus single-message designs.
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Affiliation(s)
- Irina A Iles
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute
- Johns Hopkins Bloomberg School of Public Health
| | | | - Eric Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center
| | - Meghan Bridgid Moran
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health
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Heley K, Czaplicki L, Kennedy RD, Moran M. 'Help Save The Planet One Bidi Stick At A Time!': greenwashing disposable vapes. Tob Control 2021; 31:675-678. [PMID: 33782198 DOI: 10.1136/tobaccocontrol-2020-056425] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- Kathryn Heley
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Lauren Czaplicki
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ryan David Kennedy
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Meghan Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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20
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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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21
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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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22
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Perry CL, Creamer MR, Chaffee BW, Unger JB, Sutfin EL, Kong G, Shang C, Clendennen SL, Krishnan-Sarin S, Pentz MA. Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science. Nicotine Tob Res 2020; 22:1063-1076. [PMID: 31127298 PMCID: PMC7457341 DOI: 10.1093/ntr/ntz059] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
Abstract
The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. IMPLICATIONS The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.
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Affiliation(s)
- Cheryl L Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | - MeLisa R Creamer
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Jennifer B Unger
- Keck School of Medicine,University of Southern California, Los Angeles, CA
| | | | | | - Ce Shang
- Oklahoma Tobacco Research Center, Stephenson Cancer Center
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephanie L Clendennen
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Mary Ann Pentz
- Keck School of Medicine,University of Southern California, Los Angeles, CA
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Seidenberg AB, Jo CL, Ribisl KM. Knowledge and Awareness of Added Sugar in Cigarettes. Nicotine Tob Res 2019; 21:1689-1694. [PMID: 30329106 DOI: 10.1093/ntr/nty217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/11/2018] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Sugars naturally occur in tobacco leaf but are also commonly added to cigarettes by tobacco companies. Added sugar increases levels of toxic chemicals in cigarette smoke. Little is known about smokers' knowledge of added sugar in cigarettes and awareness of its effects. METHODS Adult cigarette smokers were recruited through Amazon Mechanical Turk to participate in an online experiment on electronic cigarette advertising. After completing the experiment, participants (N = 4351) answered two items assessing knowledge and awareness of added sugar in cigarettes. Participants had the option of providing open-ended comments about the overall study, and two reviewers read and independently coded comments pertaining to the sugar items. RESULTS Only 5.5% of participants responded "yes" to the question: "Is sugar added to cigarettes?", and only 3.8% of participants indicated being aware that added sugar increases toxins in cigarette smoke. Forty-eight participants mentioned the sugar items when asked to comment about the overall questionnaire. Fifty-two percent of these comments expressed an interest in obtaining more information about added sugar, and 23% described the sugar items as interesting or informative. Three participants commented that learning about added sugar motivated them to quit or cut down on smoking. CONCLUSIONS Among a large sample of smokers, few reported knowledge of added sugar in cigarettes and awareness of its effects. Further, several smokers expressed an interest in learning more about added sugar. Messages about added sugar in cigarettes may be a promising new angle for campaigns to discourage smoking. IMPLICATIONS Few American smokers are aware that sugar is added to cigarettes, and some participants expressed a desire to learn more about this additive. Given such low awareness, the interest among smokers, and increased popular concerns about added sugar in foods and beverages, messaging about added sugar in cigarettes should be developed and tested for inclusion in public health media campaigns.
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Affiliation(s)
- Andrew B Seidenberg
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Catherine L Jo
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Pike JR, Tan N, Miller S, Cappelli C, Xie B, Stacy AW. The Effect of E-cigarette Commercials on Youth Smoking: A Prospective Study. Am J Health Behav 2019; 43:1103-1118. [PMID: 31662169 PMCID: PMC6824286 DOI: 10.5993/ajhb.43.6.8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: In this study, we assessed whether commercials for electronic cigarettes (e-cigarettes) influence the use of e-cigarettes, cigarettes, and cigars among high-risk youth in southern California. Methods: We recruited students (N = 1060) from 29 alternative high schools into a prospective cohort study. We used multilevel Poisson regression models to examine whether exposure to e-cigarette commercials and perceptions of their appeal predicted increased use of e-cigarettes, cigarettes, and cigars one year later. We also tested the potential moderating effect of gender and ethnicity. Results: Models with and without covariates suggest that exposure to e-cigarette commercials is a statistically significant predictor of increased use of e-cigarettes. When gender was added to the models as a moderator, the relationships between commercial exposure and future use of e-cigarettes and cigars were found to be stronger among females. Unadjusted and adjusted models also indicated that students with favorable perceptions of e-cigarette commercials reported greater use of e-cigarettes, cigarettes, and cigars one year later. Conclusions: E-cigarette commercials may play an important role in persuading high-risk youth to use nicotine and tobacco products. Extending the Broadcast Advertising Ban of 1971 to include a broader range of products may be critical to preventing future generations from becoming addicted to nicotine.
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Affiliation(s)
- James Russell Pike
- James Russell Pike, School of Community and Global Health, Claremont Graduate University, Claremont, CA;,
| | - Nasya Tan
- Nasya Tan, School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Stephen Miller
- Stephen Miller, School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Christopher Cappelli
- Christopher Cappelli, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Bin Xie
- Bin Xie, School of Community and Global Health, Claremont Graduate University, Claremont, CA
| | - Alan W Stacy
- Alan W Stacy, School of Community and Global Health, Claremont Graduate University, Claremont, CA
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Attitudinal Spillover from Misleading Natural Cigarette Marketing: An Experiment Examining Current and Former Smokers' Support for Tobacco Industry Regulation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193554. [PMID: 31547517 PMCID: PMC6801407 DOI: 10.3390/ijerph16193554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/13/2019] [Accepted: 09/19/2019] [Indexed: 11/17/2022]
Abstract
This research examined the influence of natural cigarette advertising on tobacco control policy support, and the potential for misbeliefs arising from exposure to cigarette marketing to affect such support. Ample research indicates that natural cigarettes such as Natural American Spirit (NAS) are widely and erroneously perceived as safer than their traditional counterparts because of their marketed “natural” composition. Yet regulatory action regarding natural cigarette marketing has been limited in scope, and little research has examined whether misleading product advertising affects support for related policy, an important component of the policy process. Here, we administered a large-scale randomized experiment (n = 1128), assigning current and former smokers in the United States to an NAS advertising condition or a control group and assessing their support for tobacco industry regulation. Results show that exposure to NAS advertising reduces support for policies to ban potentially misleading terminology from cigarette advertising, and these effects are stronger for daily smokers. Further, misinformed beliefs about the healthy composition of NAS partially mediate effects on policy support. Yet interestingly, exposure to NAS marketing does not reduce support for policies to establish standards for when certain terms are permissible in cigarette advertising. The results of this analysis indicate potential spillover effects from exposure to NAS advertising in the realm of support for regulatory action pertaining to tobacco industry marketing.
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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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Carroll DM, Allenzara A, Jensen J, Stepanov I, Hecht S, Murphy S, Luo X, Donny E, Hatsukami DK. Biomarkers of Exposure and Potential Harm among Natural American Spirit Smokers. TOB REGUL SCI 2019; 5:339-351. [PMID: 33457467 PMCID: PMC7810336 DOI: 10.18001/trs.5.4.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES We compared biomarkers of exposure and potential harm in smokers of American Spirit (AS) to smokers of Marlboro, Newport, Camel, and Pall Mall. METHODS We conducted secondary analysis on: (1) data from a randomized clinical trial (RCT); and (2) the Population Assessment of Tobacco Use and Health (PATH) Study. Biomarkers analyzed included: total nicotine equivalents (TNE); 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol and its glucuronides (total NNAL); N'-nitrosonornicotine and its N-glucuronide (total NNN);3-hydroxypropylmercapturic acid(3-HPMA); 2-hydroxypropylmercapturic acid (2-HPMA), 3-hydroxy-1 methylpropylmercapturic acid (HMPMA); S-phenylmercapturic acid(SPMA); 2-cyanoethylmercapturic acid (CEMA); phenanthrene tetraol(PheT);1-hydroxypyrene (1-HOP);8-iso-PGF2α; white blood count(WBC); prostaglandin E metabolite(PGEM); and high sensitivity C-reactive protein(hsCRP). RESULTS AS smokers did not differ in TNE but had higher TNE per cigarette compared to other brands. Total NNAL, total NNN, CEMA, and 3-HPMA were lower in AS smokers. All other biomarkers were no different in AS smokers compared to all or the majority of the other brands. CONCLUSIONS Levels of total NNAL, total NNN, acrylonitrile, and acrolein were reduced in AS smokers; however, it is not known whether reductions in exposure to these toxicants contribute to reduced harm. Higher TNE per cigarette smoked in AS smokers suggests a greater addictive potential compared to other brands. Regulatory action to ensure that consumers are not misled about the risks of the AS brand are recommended.
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Affiliation(s)
- Dana M Carroll
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Astia Allenzara
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Joni Jensen
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Irina Stepanov
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Stephen Hecht
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Sharon Murphy
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN
| | - Eric Donny
- Wake Forest School of Medicine, Winston-Salem, NC
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Abstract
Objectives The tobacco industry has a history of making "natural" claims in advertisements. We report how viewing advertisements with such claims affected what adolescents found memorable. Methods Adolescent boys (N = 1220; 11-16 years old) were randomly assigned to view a Natural American Spirit (NAS) or other brand cigarette advertisement, and were asked what they remembered about the advertisement. Survey-weighted logistic regression models assessed whether memorability of advertisement components differed by NAS advertisement exposure. Results Adolescents viewing a NAS advertisement (vs another brand) had lower odds of finding memorable the advertisement's warning (OR = 0.58; 95% CI: [0.34, 0.98]) or brand (OR = 0.25; 95% CI: [0.11, 0.54]). They had higher odds of mentioning tobacco (OR = 2.33; 95% CI: [1.49, 3.63]) and packaging (OR = 2.57; 95% CI: [1.51, 4.37]). An estimated 6.7% of those viewing an NAS advertisement said the product was not addictive. Conclusions Reduced-harm claims on cigarette advertisements may affect what adolescents find salient about the advertisement. As the FDA's agreement with Santa Fe Natural Tobacco Company to remove these claims is not inclusive of all reduced-harm claims and does not apply to other companies, findings underscore the need for prohibiting all reduced-harm claims from cigarette advertisements.
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Baig SA, Byron MJ, Lazard AJ, Brewer NT. "Organic," "Natural," and "Additive-Free" Cigarettes: Comparing the Effects of Advertising Claims and Disclaimers on Perceptions of Harm. Nicotine Tob Res 2019; 21:933-939. [PMID: 29529277 PMCID: PMC6588395 DOI: 10.1093/ntr/nty036] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 02/25/2018] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The US Tobacco Control Act restricts advertising or labeling that suggests one tobacco product is less harmful than another. We sought to examine how "organic," "natural," and "additive-free" advertising claims and corresponding disclaimers affect perceptions of cigarettes' harm. METHODS Participants were a national probability sample of adults in the United States (n = 1114, including 344 smokers). We conducted a 5 (claim) × 2 (disclaimer) between-subjects factorial experiment. Participants viewed a Natural American Spirit cigarettes ad claiming they were "organic," "natural," "additive-free," "light," or "regular;" and with or without a corresponding disclaimer. The outcome was perceived harm of the advertised cigarettes. Among smokers, we also assessed interest in switching within their current brand to cigarettes with this characteristic (eg, "additive-free"). RESULTS Claims in the ad had a large effect on perceived harm (Cohen's d = 0.87, 95% CI = 0.47 to 1.29). Claims of cigarettes being "organic," "natural," or "additive-free" reduced perceived harm from the advertised cigarettes, as compared with "regular" and "light" claims. Disclaimers had a small effect, increasing perceived harm (d = 0.25, 95% CI = 0.08 to 0.41). The problematic claims also increased smokers' interest in switching. Disclaimers had no effect on smokers' interest in switching. CONCLUSIONS "Organic," "natural," and "additive-free" claims may mislead people into thinking that the advertised cigarettes are less harmful than other cigarettes. Disclaimers did not offset misperceptions of harm created by false claims. The US Food and Drug Administration should restrict the use of these misleading claims in tobacco advertising. IMPLICATIONS "Organic," "natural," and "additive-free" cigarette advertising claims decrease perceptions of harm among the public and increase interest in switching to such cigarettes among smokers. Disclaimers do not counteract the reduced perceptions of harm or increased interest in switching to these cigarettes. The US Food and Drug Administration should restrict the use of "organic," "natural," and "additive-free" claims in tobacco marketing.
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Affiliation(s)
- Sabeeh A Baig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - M Justin Byron
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Allison J Lazard
- School of Media and Journalism, 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
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Sangalang A, Ophir Y, Cappella JN. The Potential for Narrative Correctives to Combat Misinformation †. THE JOURNAL OF COMMUNICATION 2019; 69:298-319. [PMID: 31205334 PMCID: PMC6544903 DOI: 10.1093/joc/jqz014] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 03/05/2019] [Indexed: 05/24/2023]
Abstract
Misinformation can influence personal and societal decisions in detrimental ways. Not only is misinformation challenging to correct, but even when individuals accept corrective information, misinformation can continue to influence attitudes: a phenomenon known as belief echoes, affective perseverance, or the continued influence effect. Two controlled experiments tested the efficacy of narrative-based correctives to reduce this affective residual in the context of misinformation about organic tobacco. Study 1 (N = 385) tested within-narrative corrective endings, embedded in four discrete emotions (happiness, anger, sadness, and fear). Study 2 (N = 586) tested the utility of a narrative with a negative, emotional corrective ending (fear and anger). Results provide some evidence that narrative correctives, with or without emotional endings, can be effective at reducing misinformed beliefs and intentions, but narratives consisting of emotional corrective endings are better at correcting attitudes than a simple corrective. Implications for misinformation scholarship and corrective message design are discussed.
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Affiliation(s)
| | - Yotam Ophir
- Annenberg Public Policy Center at the University of Pennsylvania, Philadelphia, PA, USA
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | - Joseph N Cappella
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Epperson AE, Henriksen L, Prochaska JJ. Natural American Spirit Brand Marketing Casts Health Halo Around Smoking. Am J Public Health 2019; 107:668-670. [PMID: 28398789 DOI: 10.2105/ajph.2017.303719] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Anna E Epperson
- Anna E. Epperson, Lisa Henriksen, and Judith J. Prochaska are with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Lisa Henriksen
- Anna E. Epperson, Lisa Henriksen, and Judith J. Prochaska are with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Judith J Prochaska
- Anna E. Epperson, Lisa Henriksen, and Judith J. Prochaska are with the Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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Soule EK, Sakuma KLK, Palafox S, Pokhrel P, Herzog TA, Thompson N, Fagan P. Content analysis of internet marketing strategies used to promote flavored electronic cigarettes. Addict Behav 2019; 91:128-135. [PMID: 30606627 DOI: 10.1016/j.addbeh.2018.11.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/23/2018] [Accepted: 11/13/2018] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Flavored e-cigarette (ECIG) use and Internet marketing have increased in the U.S. This study examined the content used to promote flavored ECIG liquids on retailer websites. METHODS Four ECIG liquid retailers from four U.S. geographic regions (n = 16) were randomly selected. Menthol, apple, and tobacco flavored liquids were purchased in April of 2016 (n = 144, 48 unique flavors). Staff analyzed the text and image descriptors displayed on liquid bottles and retailer websites and coded content for presence of specific flavor, taste/smell, chemesthesis (i.e., touch), America/patriotic, and product quality/potentially modified risk content. A follow-up of retailer websites was conducted in March 2018. RESULTS Nearly all (97.9%) ECIG liquids included a description that promoted flavor. Most descriptions including images of something other than an ECIG liquid bottle (e.g., 62% of tobacco ECIG liquid images included dried tobacco leaves, 43% of menthol ECIG liquid images included mint leaves or ice, 62% of apple ECIG liquid images included an apple). Images often promoted product sensations (e.g., cool, ice), sweet tastes of other products (e.g., chocolate, apple pie), or other appeals (e.g., America). Menthol and apple descriptions/images were more likely than tobacco descriptions/images to promote appeals related to chemesthesis (e.g., cool, warm, moist; p < .05). Most flavors were still available in 2018 and included the same flavor descriptions from 2016. CONCLUSIONS Flavored ECIG liquid marketing often includes text descriptions and images that appeal to consumer sensations. Studies are needed to examine how access to point-of-sale Internet advertisements influences attitudes, perceptions, and purchasing of ECIG products, especially among at-risk populations such as youth.
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Affiliation(s)
- Eric K Soule
- Department of Psychology, Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA, USA.
| | - Kari-Lyn K Sakuma
- College of Public Health and Human Sciences, School of Social and Behavioral Sciences, Oregon State University, Corvallis, OR, USA
| | - Sherilyn Palafox
- Cancer Prevention and Control Program, University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Pallav Pokhrel
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Thaddeus A Herzog
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Noel Thompson
- Department of Biostatistics, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Pebbles Fagan
- Department Health Behavior and Health Education, Fay W. Boozman College of Public Health, Center for the Study of Tobacco, University of Arkansas for Medical Sciences, Little Rock, AR, USA
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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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Gratale SK, Maloney EK, Cappella JN. Regulating language, not inference: an examination of the potential effectiveness of Natural American Spirit advertising restrictions. Tob Control 2019; 28:e43-e48. [DOI: 10.1136/tobaccocontrol-2018-054707] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 12/03/2018] [Accepted: 12/11/2018] [Indexed: 11/04/2022]
Abstract
ObjectiveIn 2017, the United States Food and Drug Administration (FDA) reached an agreement with Santa Fe Natural Tobacco Company (SFNTC) stipulating that SFNTC will remove ‘natural’ and ‘additive-free’ from Natural American Spirit (NAS) marketing to combat misperceptions that NAS is a healthier cigarette. The purpose of this study was to assess experimentally the potential effectiveness of the agreement in addressing NAS misperceptions.MethodsIn an online experiment, 820 current and former smokers were assigned randomly to advertising conditions with existing claims from NAS advertisements, modified claims or a no-exposure control. Advertising conditions included (1) ‘original’ NAS advertising text before the agreement; (2) ‘2017 agreement’ language permissible under the FDA–SFNTC agreement (removing ‘natural’, ‘additive-free’); (3) more restrictive (‘stricter’) language representing additional regulation (removing ‘natural’ from the brand name and the phrases ‘tobacco+water’, ‘no chemicals’). Participants completed outcome measures assessing misinformed beliefs and intentions towards NAS.ResultsOne-way ANOVA showed that relative to the ‘original’ language, the ‘2017 agreement’ language reduced misconceptions about NAS addictiveness, but not about health or constituent composition. Yet ‘stricter’ language significantly reduced all categories of misinformed beliefs, which in turn mediated effects on (lower) intentions to use NAS.ConclusionThe 2017 agreement helps dispel some misconceptions about NAS addictiveness, but does not sufficiently rectify misinformation about health or composition. Since ‘stricter’ language more effectively corrects misinformed beliefs, our results suggest the need for further regulations in addressing misinformation that drives intentions towards NAS.
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Epperson AE, Averett PE, Blanchflower T, Gregory KR, Lee JGL. "The Packaging Is Very Inviting and Makes Smokers Feel Like They're More Safe": The Meanings of Natural American Spirit Cigarette Pack Design to Adult Smokers. HEALTH EDUCATION & BEHAVIOR 2019; 46:260-266. [PMID: 30606071 DOI: 10.1177/1090198118820099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS The aim of this investigation was to identify which design elements on Natural American Spirit packs are salient to (i.e., noticed by) U.S. adult smokers and what meanings smokers derive from these elements. METHOD We conducted a secondary analysis of qualitative data from a study of cigarette packaging design. U.S. adult smokers ( n = 33) from all nine census regions participated in six telephone-based focus groups in March 2017. We used constant comparison analysis to identify key themes. RESULTS Four themes were identified, two focused on salient design elements and two focused on design element meanings. The themes of "bright and flashy color" and "the American Indian logo" were identified as key design elements, while the themes of "healthy and safer" and "targeting at-risk smokers" were identified as meanings smokers derived from design elements. CONCLUSIONS Pack design elements influence smokers' perceptions about reduced health risk of Natural American Spirit cigarettes and may be especially dangerous to vulnerable populations, including young adults and American Indians. Findings from this study suggest that the banning of text descriptors may not be enough to address misconceptions about "healthier" cigarettes.
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Leas EC, Pierce JP, Dimofte CV, Trinidad DR, Strong DR. Standardised cigarette packaging may reduce the implied safety of Natural American Spirit cigarettes. Tob Control 2018; 27:e118-e123. [PMID: 29255011 PMCID: PMC7392163 DOI: 10.1136/tobaccocontrol-2017-053940] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND Over two-thirds of Natural American Spirit (NAS) smokers believe their cigarettes might be 'less harmful', but toxicological evidence does not support this belief. We assessed whether standardised packaging could reduce the possibility of erroneous inferences of 'safety' drawn from NAS cigarette packaging. METHODS US adult smokers (n=909) were recruited to a between-subject survey experiment (3 brands×3 packaging/labelling styles) through Amazon Mechanical Turk and rated their perception of whether a randomly assigned cigarette package conveyed that the brand was 'safer' on a three-item scale (Cronbach's α=0.92). We assessed whether NAS packs were rated higher on the 'implied safety' scale than two other brands and estimated the effect that plain packaging (ie, all branding replaced with a drab dark brown colour) and Australian-like packaging (ie, all branding replaced with a drab dark brown colour and a graphic image and text on 75% of the pack surface) had on perceptions of the NAS cigarette package. RESULTS Smokers' ratings of the standard NAS pack on the implied safety scale (mean=4.6; SD=2.9) were 1.9 times (P <0.001) higher than smokers' ratings of a Marlboro Red pack (mean=2.4; SD=2.3) and 1.7 times (P <0.001) higher than smokers' ratings of a Newport Menthol pack (mean=2.7; SD=2.4). These perceptions of implied safety were lower when plain packaging was used (Cohen's d=0.66; P <0.001) and much lower when Australian-like packaging was used (Cohen's d=1.56; P <0.001). CONCLUSION The results suggest that NAS cigarette packaging conveys that its cigarettes are 'safer' and that such perceptions are lower with standardised packaging, both with and without warning images.
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Affiliation(s)
- Eric Craig Leas
- Department of Family Medicine and Public Health, University of California: San Diego, La Jolla, California, USA
- UC San Diego Moores Cancer Center, University of California: San Diego, La Jolla, California, USA
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California: San Diego, La Jolla, California, USA
- UC San Diego Moores Cancer Center, University of California: San Diego, La Jolla, California, USA
| | - Claudiu V Dimofte
- Department of Marketing, San Diego State University, San Diego, California, USA
| | - Dennis R Trinidad
- Department of Family Medicine and Public Health, University of California: San Diego, La Jolla, California, USA
- UC San Diego Moores Cancer Center, University of California: San Diego, La Jolla, California, USA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California: San Diego, La Jolla, California, USA
- UC San Diego Moores Cancer Center, University of California: San Diego, La Jolla, California, USA
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Popova L, Lempert LK, Glantz SA. Light and mild redux: heated tobacco products' reduced exposure claims are likely to be misunderstood as reduced risk claims. Tob Control 2018; 27:s87-s95. [PMID: 30209208 PMCID: PMC6202239 DOI: 10.1136/tobaccocontrol-2018-054324] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 06/11/2018] [Accepted: 06/16/2018] [Indexed: 11/29/2022]
Abstract
Introduction Heated tobacco products (HTPs) are being marketed in several countries around the world with claims that they are less harmful than combusted cigarettes, based on assertions that they expose users to lower levels of toxicants. In the USA, Philip Morris International (PMI) has submitted an application to the Food and Drug Administration (FDA) in 2016 seeking authorisation to market its HTPs, IQOS, with reduced risk and reduced exposure claims. Methods We examined the PMI’s Perception and Behavior Assessment Studies evaluating perceptions of reduced risk claims that were submitted to the FDA and made publicly available. Results Qualitative and quantitative studies conducted by PMI demonstrate that adult consumers in the USA perceive reduced exposure claims as reduced risk claims. Conclusion The data in the PMI modified risk tobacco product IQOS application do not support reduced risk claims and the reduced exposure claims are perceived as reduced risk claims, which is explicitly prohibited by the FDA. Allowing PMI to promote IQOS as reduced exposure would amount to a legally sanctioned repeat of the ‘light’ and ‘mild’ fraud which, for conventional cigarettes, is prohibited by the US law and the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Lauren Kass Lempert
- Center for Tobacco Control Research & Education, University of California, San Francisco, California, USA
| | - Stanton A Glantz
- Center for Tobacco Control Research & Education, University of California, San Francisco, California, USA.,Department of Medicine, Cardiovascular Research Institute, Philip R. Lee Institute for Health Policy Studies, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, California, USA
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McKelvey K, Popova L, Kim M, Lempert LK, Chaffee BW, Vijayaraghavan M, Ling P, Halpern-Felsher B. IQOS labelling will mislead consumers. Tob Control 2018; 27:s48-s54. [PMID: 30158208 PMCID: PMC6252493 DOI: 10.1136/tobaccocontrol-2018-054333] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 11/06/2022]
Abstract
Background Philip Morris International (PMI) continually expands and diversifies their nicotine product portfolio, which includes IQOS, a heated tobacco product. In December 2016, PMI filed a modified risk tobacco product (MRTP) application with the US Food and Drug Administration (FDA), seeking authorisation to market IQOS in USA with three claims of reduced harm: ‘switching completely from conventional cigarettes to the IQOS system…’ (1) ‘can reduce the risks of tobacco-related diseases;’ (2) ‘significantly reduce[s] your body’s exposure to harmful or potentially harmful chemicals;’ and (3) ‘presents less risk of harm than continuing to smoke cigarettes.’ Consumers may misunderstand what is meant by ‘switching completely'. Methods We critically reviewed study reports submitted to FDA by PMI in support of proposed marketing claims in its MRTP application for IQOS and focused on the statement that switching completely to IQOS reduces risk. Results We found deficiencies with evidence provided by PMI supporting their assertions that: current smokers will understand what is meant by the phrase ‘switching completely'; the proposed claims will not decrease smokers’ intentions to quit; and IQOS users will in fact ‘switch completely’ from smoking cigarettes to using IQOS. The studies and measurement instruments employed by PMI suffer from design flaws and their reporting of associated findings is misleading. Conclusion Consumers will not understand the condition of the claims—that they must quit using cigarettes completely to achieve the inferred health benefits of IQOS. Rather, they are likely to misunderstand the unsupported claims of reduced risks to mean IQOS are harm-free.
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Affiliation(s)
- Karma McKelvey
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, Georgia, USA
| | - Minji Kim
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Lauren Kass Lempert
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Benjamin W Chaffee
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA.,Division of Oral Epidemiology and Dental Public Health, University of California, San Francisco, California, USA
| | - Maya Vijayaraghavan
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA.,General Internal Medicine/Zuckerberg San Francisco General Hospital, University of California, San Francisco, California, USA
| | - Pamela Ling
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Bonnie Halpern-Felsher
- Department of Pediatrics, Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Morgan JC, Moracco KE, Mendel JR, Kelley DE, Noar SM, Brewer NT. Increasing Effectiveness of Messages about Chemicals in Cigarette Smoke. TOB REGUL SCI 2018; 4:50-62. [PMID: 34141828 PMCID: PMC8208641 DOI: 10.18001/trs.4.4.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Federal law requires informing the public on toxic chemicals in cigarette smoke. We sought the public's advice about communicating information about these chemicals. METHODS Adolescents, young adults, and adults (N = 59), including smokers and non-smokers, participated in 9 focus groups that discussed inclusion of messages about toxic chemicals on cigarette packs, in media campaigns, and on a website. We transcribed, coded, and analyzed focus group audio-recordings. RESULTS Participants had 3 suggestions for message content to increase the impact of messages about cigarette smoke chemicals. First, they wanted to see messages rotated more frequently to increase message novelty. Second, they recommended using stories and pictures to help connect people to the abstract idea of chemicals in smoke. Third, they cautioned against making messages that might seem overblown and could appeal to the rebellious nature of adolescents. Some participants mentioned that chemical information on a website might discourage people from smoking; others mentioned that people might use it to choose which brand to smoke. CONCLUSIONS Legislation provides the impetus to design new chemical disclosure messages for cigarette packs and other media. Our findings can help increase the impact of these messages.
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Affiliation(s)
- Jennifer C Morgan
- Health Communication, Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA
| | - Kathryn E Moracco
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, NC
| | - Jennifer R Mendel
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, North Carolina, NC
| | | | - Seth M Noar
- School of Media and Journalism, University of North Carolina at Chapel Hill, North Carolina, NC
| | - Noel T Brewer
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, NC
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Philpott SE, Gehlert S, Waters EA. Smokers' unprompted comments on cigarette additives during conversations about the genetic basis for nicotine addiction: a focus group study. BMC Public Health 2018; 18:495. [PMID: 29653524 PMCID: PMC5899393 DOI: 10.1186/s12889-018-5395-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/03/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Research designed to elicit smokers' cognitive and affective reactions to information about chemicals that tobacco companies add to cigarettes ("additives") found that knowledge is limited. However, little is known about smokers' unprompted thoughts and feelings about additives. Such information could be used to shape future communication efforts. We explored the content and possible functions of spontaneous statements about cigarette additives made by smokers during a study examining reactions to learning about the genetic link to nicotine addiction. METHODS Adult smokers (N = 84) were recruited from a medium-sized Midwestern city. Focus groups (N = 13) were conducted between April-September 2012. Data were analyzed by 2 coders using thematic analysis. RESULTS Comments about cigarette additives arose without prompting by the focus group moderator. Three main themes were identified: (1) discussing additives helped participants navigate the conceptual link between smoking and genetics, (2) additives were discussed as an alternative mechanism for addiction to cigarettes, and (3) additives provided an alternative mechanism by which cigarette smoking exacerbates physical harm. Notably, discussion of additives contained a pervasive tone of mistrust illustrated by words like "they" and "them," by statements of uncertainty such as "you don't know what they're putting into cigarettes," and by negative affective verbalizations such as "nasty" and "disgusting". CONCLUSIONS Participants had distinct beliefs about cigarette additives, each of which seemed to serve a purpose. Although mistrust may complicate communication about the health risks of tobacco use, health communication experts could use smokers' existing beliefs and feelings to better design more effective anti-smoking messages.
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Affiliation(s)
- Sydney E. Philpott
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri USA
| | - Sarah Gehlert
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri USA
| | - Erika A. Waters
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri USA
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Popova L, Owusu D, Weaver SR, Kemp CB, Mertz CK, Pechacek TF, Slovic P. Affect, risk perception, and the use of cigarettes and e-cigarettes: a population study of U.S. adults. BMC Public Health 2018; 18:395. [PMID: 29566752 PMCID: PMC5863900 DOI: 10.1186/s12889-018-5306-z] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 03/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tobacco companies argue that the decision to smoke is made by well-informed rational adults who have considered all the risks and benefits of smoking. Yet in promoting their products, the tobacco industry frequently relies on affect, portraying their products as part of a desirable lifestyle. Research examining the roles of affect and perceived risks in smoking has been scant and non-existent for novel tobacco products, such as electronic cigarettes (e-cigarettes). METHODS We examined the relationship between affect, perceived risk, and current use for cigarettes and e-cigarettes in 2015 in a nationally representative sample of 5398 U.S. adults who were aware of e-cigarettes. RESULTS Participants held various affective associations with tobacco products, and affect towards cigarettes was more negative than affect towards e-cigarettes. Using structural equation modeling (SEM), affect towards cigarettes and e-cigarettes was associated with cigarette smoking and e-cigarette use respectively, and these associations were both direct and partially mediated by risk perceptions towards smoking and e-cigarette use. More positive affect towards cigarettes or e-cigarettes was associated with lower perceived risks, which in turn was associated with higher odds of being a current cigarette or e-cigarette user. CONCLUSIONS In developing models explaining tobacco use behavior, or in creating public communication campaigns aimed at curbing tobacco use, it is useful to focus not only on the reason based predictors, such as perceptions of risks and benefits, but also on affective predictors. Educational efforts aimed at further smoking reductions should highlight and reinforce negative images and associations with cigarettes.
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Affiliation(s)
- Lucy Popova
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA.
| | - Daniel Owusu
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Scott R Weaver
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Catherine B Kemp
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - C K Mertz
- Decision Research, 1201 Oak Street, Suite 200, Eugene, OR, 97401, USA
| | - Terry F Pechacek
- School of Public Health and Tobacco Center of Regulatory Science, Georgia State University, P.O. Box 3995, Atlanta, GA, 30302-3995, USA
| | - Paul Slovic
- Decision Research, 1201 Oak Street, Suite 200, Eugene, OR, 97401, USA.,Department of Psychology, University of Oregon, Eugene, OR, USA
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Brand switching and toxic chemicals in cigarette smoke: A national study. PLoS One 2018; 13:e0189928. [PMID: 29324749 PMCID: PMC5764241 DOI: 10.1371/journal.pone.0189928] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 12/05/2017] [Indexed: 12/03/2022] Open
Abstract
Introduction US law requires disclosure of quantities of toxic chemicals (constituents) in cigarette smoke by brand and sub-brand. This information may drive smokers to switch to cigarettes with lower chemical quantities, under the misperception that doing so can reduce health risk. We sought to understand past brand-switching behavior and whether learning about specific chemicals in cigarette smoke increases susceptibility to brand switching. Methods Participants were US adult smokers surveyed by phone (n = 1,151, probability sample) and online (n = 1,561, convenience sample). Surveys assessed whether smokers had ever switched cigarette brands or styles to reduce health risk and about likelihood of switching if the smoker learned their brand had more of a specific chemical than other cigarettes. Chemicals presented were nicotine, carbon monoxide, lead, formaldehyde, arsenic, and ammonia. Results Past brand switching to reduce health risk was common among smokers (43% in phone survey, 28% in online survey). Smokers who were female, over 25, and current “light” cigarette users were more likely to have switched brands to reduce health risks (all p < .05). Overall, 61–92% of smokers were susceptible to brand switching based on information about particular chemicals. In both samples, lead, formaldehyde, arsenic, and ammonia led to more susceptibility to switch than nicotine (all p < .05). Conclusions Many US smokers have switched brands or styles to reduce health risks. The majority said they might or would definitely switch brands if they learned their cigarettes had more of a toxic chemical than other brands. Brand switching is a probable unintended consequence of communications that show differences in smoke chemicals between brands.
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Gratale SK, Maloney EK, Sangalang A, Cappella JN. Influence of Natural American Spirit advertising on current and former smokers’ perceptions and intentions. Tob Control 2017; 27:498-504. [DOI: 10.1136/tobaccocontrol-2017-053881] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/23/2017] [Accepted: 09/25/2017] [Indexed: 11/04/2022]
Abstract
ObjectiveThis study sought to demonstrate causal effects of exposure to Natural American Spirit (NAS) advertising content on misinformed beliefs of current and former smokers, and to empirically establish these beliefs as a mechanism driving intentions to use NAS.MethodsOur study employed a randomised experimental design with 1128 adult daily, intermittent and former smokers. We compared participants who were exposed to NAS advertisements or claims made in the advertisements with those in a no-message control group to test the effects of NAS advertising content on inaccurate beliefs about NAS and attitudes and intentions towards the product.ResultsOne-way analysis of variance revealed that exposure to NAS advertisements produced inaccurate beliefs about the composition of NAS cigarettes among current and former smokers (p<0.05). Planned contrasts indicated a compilation of arguments taken directly from NAS advertisements resulted in significantly greater beliefs that NAS cigarettes are healthier/safer than other cigarettes (for former smokers, t(472)=3.63, p<0.001; for current smokers, t(644)=2.86, p=0.004), demonstrating that suggestive claims used in the brand’s marketing have effects on beliefs not directly addressed in the advertisements. Regression and mediation analyses showed that health-related beliefs predict attitudes towards NAS for current and former smokers, and mediate intentions to use NAS.ConclusionsThe findings of this study provide causal support for the need for further regulatory action to address the potentially harmful ramifications of claims used in NAS advertising.
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Popova L, McDonald EA, Sidhu S, Barry R, Richers Maruyama TA, Sheon NM, Ling PM. Perceived harms and benefits of tobacco, marijuana, and electronic vaporizers among young adults in Colorado: implications for health education and research. Addiction 2017; 112:1821-1829. [PMID: 28449191 PMCID: PMC5593776 DOI: 10.1111/add.13854] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/15/2016] [Accepted: 04/26/2017] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate how young adults perceive and compare harms and benefits of marijuana and tobacco products in the context of a legal marijuana market in Colorado. DESIGN Semi-structured qualitative interviews. SETTING Denver, CO, USA. PARTICIPANTS Thirty-two young adults (aged 18-26 years) who used tobacco/marijuana/vaporizers. MEASUREMENTS Semi-structured interviews addressed perceived harms and benefits of various tobacco and marijuana products and personal experiences with these products. FINDINGS Young adults evaluated harms and benefits using five dimensions: (1) combustion-smoking was considered more harmful than non-combustible products (e.g. e-cigarettes, vaporizers and edibles); (2) potency-edibles and marijuana concentrates were perceived as more harmful than smoking marijuana flower because of potential to receive too large a dose of tetrahydrocannabinol (THC); (3) chemicals-products containing chemical additives were seen as more harmful than 'pure' or 'natural' plant products; (4) addiction-participants recognized physiological addiction to nicotine, but talked primarily about psychological or life-style dependence on marijuana; and (5) source of knowledge-personal experiences, warning labels, campaigns, the media and opinions of product retailers and medical practitioners affected perceptions of harms and benefits. CONCLUSIONS Among young adults in Colorado, USA, perceived harms and benefits of tobacco and marijuana include multiple dimensions. Health educational campaigns could benefit from addressing these dimensions, such as the potency of nicotine and cannabis concentrates and harmful chemicals present in the organic material of tobacco and marijuana. Descriptors such as 'natural' and 'pure' in the promotion or packaging of tobacco and marijuana products might be misleading.
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Affiliation(s)
- Lucy Popova
- School of Public Health, Georgia State University
| | - Emily Anne McDonald
- Department of Anthropology, City University of New York, John Jay College of Criminal Justice
| | - Sohrab Sidhu
- Internal Medicine and Preventive Medicine Residency, Kaiser Permanente San Francisco and University of California, San Francisco
| | - Rachel Barry
- School of Social and Political Science, University of Edinburgh
| | - Tracey A. Richers Maruyama
- Tobacco Prevention and Education Program, Health Promotion Division, Denver Public Health, Denver Health and Hospital Authority
| | - Nicolas M. Sheon
- Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco
| | - Pamela M. Ling
- Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco
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Moran MB, Pierce JP, Weiger C, Cunningham MC, Sargent JD. Use of imagery and text that could convey reduced harm in American Spirit advertisements. Tob Control 2017; 26:e68-e70. [PMID: 27609781 PMCID: PMC5342944 DOI: 10.1136/tobaccocontrol-2016-053251] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/11/2016] [Accepted: 08/15/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2015, the US Food and Drug Administration issued warning letters to three tobacco companies regarding use of the terms 'natural' and/or 'additive-free' to describe their products, as these terms inaccurately convey reduced harm. Yet, tobacco companies engage in a variety of alternate techniques to attempt to convey the same 'natural' (and thus reduced harm) message. It is critical to monitor these practices to inform regulatory action. OBJECTIVE To describe the marketing techniques used in Natural American Spirit (American Spirit) ads that could convey a natural and less harmful product image. METHODS Trained coders content analysed 142 American Spirit ads from 2012 to 2016. RESULTS In addition to use of the terms 'natural' and 'additive-free', American Spirit ads engage in a variety of other linguistic and iconic techniques that could convey reduced harm, such as references to small, local or organic farming, eco-friendly practices, and plant, farming and other nature-related imagery. CONCLUSIONS American Spirit ads use a wide range of marketing techniques to convey a natural product image, which could subsequently communicate reduced harm.
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Affiliation(s)
- Meghan Bridgid Moran
- Department of Health, Behavior & Society, Johns Hopkins
Bloomberg School of Public Health
| | - John P. Pierce
- Department of Family Medicine & Public Health, UC-San Diego
School of Medicine and Division of Population, Moores Cancer Center
| | - Caitlin Weiger
- Department of Health, Behavior & Society, Johns Hopkins
Bloomberg School of Public Health
| | - Mary C. Cunningham
- Department of Health, Behavior & Society, Johns Hopkins
Bloomberg School of Public Health
| | - James D Sargent
- C. Everett Koop Institute, Norris Cotton Cancer Center, Geisel
School of Medicine at Dartmouth
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47
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Pearson JL, Johnson A, Villanti A, Glasser AM, Collins L, Cohn A, Rose SW, Niaura R, Stanton CA. Misperceptions of harm among Natural American Spirit smokers: results from wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013-2014). Tob Control 2016; 26:e61-e67. [PMID: 27924008 DOI: 10.1136/tobaccocontrol-2016-053265] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 10/05/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This study estimated differences in cigarette harm perceptions among smokers of the Natural American Spirit (NAS) brand-marketed as 'natural', 'organic' and 'additive-free'-compared to other smokers, and examined correlates of NAS use. METHODS Data were drawn from wave 1 of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative study of US adults (2013-2014). Weighted analyses using a subset of current adult smokers (n=10 565) estimated the prevalence of NAS use (vs all other brands) and examined associations between NAS use and sociodemographics, tobacco/substance use, tobacco harm perceptions, quit intentions, quit attempts and mental/behavioural health. RESULTS Overall, 2.3% of adult smokers (920 000 people in the USA) reported NAS as their usual brand. Nearly 64% of NAS smokers inaccurately believed that their brand is less harmful than other brands compared to 8.3% of smokers of other brands, after controlling for potential confounders (aOR 22.82). Younger age (18-34 vs 35+; aOR 1.54), frequent thinking about tobacco harms (aOR 1.84), past 30-day alcohol use (aOR 1.57), past 30-day marijuana use (aOR 1.87) and sexual orientation (lesbian, gay, bisexual, 'other' or 'questioning' vs heterosexual; aOR 2.07) were also associated with increased odds of smoking NAS. CONCLUSIONS The majority of NAS smokers inaccurately believes that their cigarettes are less harmful than other brands. Given the brand's rapid growth and its more common use in vulnerable groups (eg, young adults, lesbian, gay, bisexual, 'other' or 'questioning' adults), corrective messaging and enforcement action are necessary to correct harm misperceptions of NAS cigarettes.
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Affiliation(s)
- Jennifer L Pearson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Amanda Johnson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Andrea Villanti
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Allison M Glasser
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Lauren Collins
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Amy Cohn
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Shyanika W Rose
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Cassandra A Stanton
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA.,Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.,Westat, Rockville, Maryland, USA
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48
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Leas EC, Ayers JW, Strong DR, Pierce JP. Which cigarettes do Americans think are safer? A population-based analysis with wave 1 of the PATH study. Tob Control 2016; 26:e59-e60. [PMID: 27742918 DOI: 10.1136/tobaccocontrol-2016-053334] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/23/2016] [Indexed: 11/03/2022]
Affiliation(s)
- Eric C Leas
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA.,Joint Doctoral Program in Public Health, San Diego State University and University of California San Diego, San Diego, California, USA
| | - John W Ayers
- Graduate School of Public Health, San Diego State University, San Diego, California, USA
| | - David R Strong
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA.,UC San Diego Moores Cancer Center, University of California, San Diego, California, USA
| | - John P Pierce
- Department of Family Medicine and Public Health, University of California, San Diego, California, USA.,UC San Diego Moores Cancer Center, University of California, San Diego, California, USA
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49
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O'Connor RJ, Lewis MJ, Adkison SE, Bansal-Travers M, Cummings KM. Perceptions of "Natural" and "Additive-Free" Cigarettes and Intentions to Purchase. HEALTH EDUCATION & BEHAVIOR 2016; 44:222-226. [PMID: 27281493 DOI: 10.1177/1090198116653935] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In August 2015, the Food and Drug Administration (FDA) issued warning letters to cigarette manufacturers promoting brands as "natural" or "additive-free" because of concerns that such marketing claims might mislead consumers into believing that these brands are less dangerous to smoke than others. The current study examined consumer beliefs about the relative harms of "natural" cigarettes, and whether these beliefs influenced perceptions of advertising and purchase intentions when participants were shown an advertisement for American Spirit cigarettes. Data were collected using a web-based survey conducted in 2013 among 3,006 U.S.-based web panel members aged 15 to 65 years. Ratings of "natural" cigarette health risks (i.e., misperceptions) differed by sex, race, education, smoking status, and age. Controlling for perceived risks of other cigarette types, never smokers ( B = -0.31, p < .001) and ever/former smokers ( B = -0.15, p = .002) had significantly fewer misperceptions of "natural" cigarettes than current smokers. Current smoking (odds ratio [OR] = 17.8), believing the ad was truthful (OR = 1.18), and having more misperceptions about "natural" cigarette health risks (OR = 1.13) were independently associated with greater purchase intention. Consumers perceived cigarettes marketed as "natural" or "additive-free" as less harmful, and this influenced their perceptions of advertising claims and intention to purchase, controlling for other factors. These findings underscore Food and Drug Administration's recent warning letters.
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Affiliation(s)
| | - M Jane Lewis
- 2 Rutgers School of Public Health, New Brunswick, NJ, USA
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