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Cummings KM, Roberson A, Carroll DM, Stepanov I, Hatsukami D, Rees VW, O’Connor RJ. Illusion of filtration: Evidence from tobacco industry documents. Tob Induc Dis 2023; 21:85. [PMID: 37360043 PMCID: PMC10288540 DOI: 10.18332/tid/166093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/05/2023] [Accepted: 05/11/2023] [Indexed: 06/28/2023] Open
Abstract
INTRODUCTION We compared the design features of popular filtered and non-filtered cigarettes sold in the United States between 1960 and 1990, to assess the relationship between cigarette filter and tobacco weight. METHODS We analyzed data on the design features of six popular filtered and three non-filtered cigarette brands sold in the US including the weight of tobacco used provided in the Cigarette Information Reports produced by Philip Morris Tobacco Company between 1960 and 1990. We also collected information on other design features such as stick length and circumference, the percentage of reconstituted tobacco in the blend, among other product parameters. We used joinpoint regression to test for trends in outcome variables for each brand assessed between 1960 and 1990. RESULTS In all years, filtered cigarettes had less tobacco by weight compared to non-filtered cigarettes. The lower average weight of tobacco found in filtered cigarettes appears to be due to a combination of factors including stick and filter length, and the amount of reconstituted tobacco in the blend. The average percentages of total alkaloids and expanded tobacco increased over time but were similar between filtered and non-filtered brands. CONCLUSIONS While various design features of popular filtered and non-filtered brands changed between 1960 and 1990, the observed reduction in tobacco weight among filtered brands was perhaps the most salient in terms of disease risk. Less tobacco in a filtered cigarette calls into question the presumed exclusive role of cigarette filter tips in the reduced health risks of filtered versus non-filtered cigarette smoking.
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Affiliation(s)
- K. Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Avery Roberson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Dana M. Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, United States
| | - Irina Stepanov
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, United States
| | - Dorothy Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, United States
| | - Vaughan W. Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, United States
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
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Freitas-Lemos R, Tegge AN, Athamneh LN, Yeh YH, Craft WH, Stein JS, Smith TT, Stepanov I, Rees VW, Cummings KM, O'Connor RJ, Shields PG, Hatsukami DK, Bickel WK. Is perception reality? Associations among "light" cigarettes and number of cigarettes smoked per day. Drug Alcohol Depend 2023; 244:109709. [PMID: 36642000 PMCID: PMC10081565 DOI: 10.1016/j.drugalcdep.2022.109709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 11/10/2022] [Accepted: 11/10/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Cigarette filter ventilation and light descriptors are associated with lowered perceptions of risk and smoking more cigarettes per day (CPD). This study examined the relationship between usual cigarette ventilation, perception, and CPD. METHODS A crowdsourced sample (N = 995) of individuals who smoke higher-ventilated (=>20% ventilation) or lower-ventilated (=<10% ventilation) cigarettes identified their usual cigarette as "light" or "full flavor", and reported their average CPD. RESULTS We found: 1) no association between ventilation status and perception of light versus full flavor (AUC=0.58), with the inaccurate perception being more prevalent in younger individuals (p = 0.041) and those who smoke L&M (73%, p < 0.001) and Camel (61%, p = 0.006) brands; and 2) perception, but not ventilation of usual cigarette, was significantly associated with CPD (p = 0.006), with individuals who perceived their cigarettes as light reporting an average of 13% more cigarettes per day (2.6 CPD), compared to those who perceived their cigarette as full flavor. CONCLUSIONS Perceptions of light versus full-flavor, but not ventilation status, predicted CPD. These findings may inform anti-smoking health communication strategies and smoking cessation interventions. IMPLICATIONS Tobacco control policies should eradicate the perception of cigarettes as light or full-flavored. Future research investigating the associations between cigarette filter ventilation and smoking behavior should consider the confounding effects that may lie in an individual's perceptions of their cigarettes.
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Affiliation(s)
| | - Allison N Tegge
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA; Department of Statistics, Virginia Tech, Blacksburg, VA, USA
| | - Liqa N Athamneh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Yu-Hua Yeh
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - William H Craft
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Jeffrey S Stein
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA
| | - Tracy T Smith
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Irina Stepanov
- Division of Environmental Health Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard University T H Chan School of Public Health, Boston, MA, USA
| | - K Michael Cummings
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Peter G Shields
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
| | - Dorothy K Hatsukami
- Department of Psychiatry and Behavioral Sciences, University of Minnesota Twin Cities, Minneapolis, MN, USA
| | - Warren K Bickel
- Fralin Biomedical Research Institute at Virginia Tech Carilion, Roanoke, VA, USA.
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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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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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Pierce JP, Strong DR, Stone MD, Villaseñor A, Dimofte CV, Leas EC, Oratowski J, Brighton E, Hurst S, Pulvers K, Kealey S, Chen R, Messer K. Real-world exposure to graphic warning labels on cigarette packages in US smokers: The CASA randomized trial protocol. Contemp Clin Trials 2020; 98:106152. [PMID: 32966877 PMCID: PMC7502239 DOI: 10.1016/j.cct.2020.106152] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 09/11/2020] [Accepted: 09/14/2020] [Indexed: 01/29/2023]
Abstract
BACKGROUND The US lags behind >120 countries in implementing graphic warning labels (GWLs) on cigarette packs. US courts prevented implementation of FDA's 2012 rule requiring GWLs citing the need for more evidence on effectiveness. After more research, in 2020, the FDA proposed a revised rule mandating GWLs. This trial will test how the introduction of GWLs influence cognitions and behavior in US smokers. METHOD To investigate the "real-world" impact of GWLs in US smokers, we are conducting a randomized trial involving a 3-month intervention and 8-month follow-up. The study recruited California smokers between September 2016 through December 2019 and randomly assigned them into 3 groups (1) Blank Pack devoid of any cigarette branding; (2) GWL Pack featuring 1 of 3 rotating images added to blank pack; or (3) their usual Standard US Pack. Throughout the 3-month intervention, participants purchased study-packaged cigarettes and reported daily cognitions and behavior through ecological momentary assessments. We will validate self-reported tobacco use with saliva cotinine concentrations following the 3-month intervention and 8-month follow-up. RESULTS The trial enrolled 359 participants (average age 39 years; average cigarette consumption half a pack/day). The 3 study groups were balanced on age, gender, race-ethnicity, education and income (17% low income) as well as on smoking related variables. CONCLUSIONS This 3-month real-world randomized trial will test the effect of repackaging cigarettes from standard US packs to GWL plain packs on smokers' perceptions of the risks of smoking, their perception of the appeal of their cigarettes, and on their smoking behavior.
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Affiliation(s)
- John P. Pierce
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States,Corresponding author at: Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - David R. Strong
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Matthew D. Stone
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Adriana Villaseñor
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Claudiu V. Dimofte
- Department of Marketing, San Diego State University, 5500 Campanile Dr, San Diego, CA 92182, United States
| | - Eric C. Leas
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Jesica Oratowski
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Elizabeth Brighton
- Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Samantha Hurst
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - Kimberley Pulvers
- Department of Psychology, Social and Behavioral Sciences Building, California State University, San Marcos 200 E Barham Dr, San Marcos, CA, 92096, United States
| | - Sheila Kealey
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States
| | - Ruifeng Chen
- Division of Biostatistics, Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
| | - Karen Messer
- Cancer Control Program, Moores Cancer Center, UC San Diego, 3855 Health Sciences Drive, La Jolla, CA 92093-0901, United States,Division of Biostatistics, Department of Family Medicine and Public Health, UC San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States
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Smiley SL, Kim S, Mourali A, Allem JP, Unger JB, Boley Cruz T. Characterizing #Backwoods on Instagram: "The Number One Selling All Natural Cigar". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4584. [PMID: 32630567 PMCID: PMC7345638 DOI: 10.3390/ijerph17124584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
We sought to assess the proportion of Backwoods (Imperial Tobacco Group Brands LLC) cigar-related posts to Instagram that may contain misleading claims, nature-evoking imagery, and appealing flavors. Inclusion criteria for this study included an Instagram post with the hashtag "#backwoods" from 30 August to 12 September 2018. Rules were established to content analyze (n = 1206) posts. Categories included misleading packaging (i.e., the post contained an image of a Backwoods product with the descriptor "natural" on the packaging), misleading promo (i.e., the corresponding caption to the post contained hashtag(s) like "#natural", "#authentic", "#alwaystrue"), nature-evoking imagery (i.e., the post contained images of grass, water, and pastural views along with a Backwoods product), flavors (i.e., the post contained a Backwoods product with brand-specific flavors on the packaging), flavor promo (i.e., the corresponding caption to the post contained hashtag(s) of Backwoods' brand-specific flavors), marijuana-related (i.e., the post contained an image of marijuana next to a Backwoods pack, rolled cigars visibly contained marijuana, or hollowed-out cigars next to marijuana), smoking (the post contained an image of smoke or a lit cigar), brand-specific promo (i.e., the post contained an image of a Backwoods t-shirt, sweatshirt, hat, etc.), and perceived gender. Among the posts analyzed, 645 (53.5%) were marijuana-related, 564 (46.8%) were flavors, 463 (38.4%) were misleading packaging, 335 (27.8%) were flavor promo, 309 (25.6%) were misleading promo, 188 (15.6%) were nature-evoking imagery, 165 (13.7%) were smoking, 157 (13.0%) were brand-specific promo, and 239 (19.8%) were perceived male gender. Backwoods cigar-related posts to Instagram often contained misleading images and promotions of a "natural" tobacco product, images of marijuana use (in the form of blunt-making), brand-specific flavors, smoking, and promotional merchandise. Misleading images and the depictions of marijuana use in addition to the variety of flavor options may increase product appeal to consumers. These results underscore the need for comprehensive regulation of cigar products similar to cigarettes.
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Affiliation(s)
- Sabrina L. Smiley
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032-3628, USA; (S.K.); (A.M.); (J.-P.A.); (J.B.U.); (T.B.C.)
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Pearson JL, Moran M, Delnevo CD, Villanti AC, Lewis MJ. Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey. Nicotine Tob Res 2020; 21:970-973. [PMID: 30722066 DOI: 10.1093/ntr/ntz015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/29/2019] [Indexed: 11/14/2022]
Abstract
SIGNIFICANCE US smokers of Natural American Spirit, a brand marketed as "organic" and "additive-free," are more likely than other cigarette smokers to believe that their brand might be less harmful than other brands. This article (1) describes the prevalence of belief that "organic" and "additive-free" tobacco is less harmful than regular tobacco products in the US population and (2) describes the sociodemographic characteristics of adults who believe tobacco products with these descriptors are less harmful. METHODS Data were drawn from the 2017 Health Information National Trends Survey (HINTS), a nationally representative survey of US adults. Logistic regression models were used to examine correlates of the belief that "organic" or "additive-free" tobacco products are less harmful than regular tobacco products. RESULTS Overall, 26.7% of US adults and 45.3% of adult smokers believe that "organic" tobacco products are less harmful than regular tobacco products. Similarly, 35.2% of US adults and 47.1% of smokers believe that "additive-free" tobacco products are less harmful. When examining gender, age, education, race/ethnicity, sexual orientation, and smoking status, only age (adjusted odds ratio [aOR] ~0.98, 95% confidence interval [CI]: 0.97, 0.99 for both outcomes) and smoking status (current vs. never smokers, aOR ~1.78, 95% CI 1.03, 3.07 for both outcomes) were correlates of believing that "organic" or "additive-free" tobacco is less harmful than regular tobacco products. CONCLUSIONS Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread. Younger adults and current smokers are most likely to be misinformed by "organic" or "additive-free" tobacco product descriptors. IMPLICATIONS Belief that "organic" and "additive-free" tobacco products are less harmful than other products is widespread among US adults and most prevalent among smokers. Removal of terms that incorrectly imply reduced harm may correct current and future consumers' misperceptions about the brand.
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Affiliation(s)
- Jennifer L Pearson
- School of Community Health Sciences, University of Nevada, Reno, NV.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Meghan Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Andrea C Villanti
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.,Department of Psychiatry, University of Vermont, Burlington, VT
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
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Epperson AE, Johnson TO, Schleicher NC, Henriksen L. The Price of Natural American Spirit Relative to Other Cigarette Brands. Nicotine Tob Res 2019; 21:1715-1720. [PMID: 30759248 PMCID: PMC6861830 DOI: 10.1093/ntr/ntz018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 02/07/2019] [Indexed: 12/28/2022]
Abstract
INTRODUCTION American Spirit cigarettes feature American Indian/Alaska Native (AI/AN) imagery in the branding and are marketed as environmentally friendly, without additives, and four varieties contain organic tobacco. This study is the first to examine retail price of American Spirit relative to other cigarette brands and to assess how its price varies by neighborhood demography. METHODS In a random sample of licensed tobacco retailers (n = 1277), trained data collectors recorded availability and price of American Spirit, Pall Mall, Newport, Marlboro, and the cheapest cigarettes regardless of brand. Data were collected in January-March 2017 in California, the state with the largest AI/AN population. Paired t tests assessed prices (before sales tax) of American Spirit relative to others. Ordinary least squares regressions modeled prices as a function of neighborhood demography, adjusting for store type. RESULTS American Spirit was sold in 77% of stores at an average price of $7.03 (SD = 0.66), which was $0.75-$1.78 (12.0%-34.4%) higher than Pall Mall, Newport, and Marlboro in the same stores. American Spirit costs significantly less in neighborhoods with a higher proportion of school-age residents; however, this pattern was not unique to that brand. Contrary to expectation, American Spirit did not cost less in neighborhoods with a higher proportion of AI/ANs. CONCLUSION This study is the first to document lower prices for American Spirit in neighborhoods with a higher proportion of school-age youth. Future research should consider whether the ultra-premium price of American Spirit contributes to misperceptions that the brand is organic and less harmful than other cigarettes. IMPLICATIONS In a large random sample of licensed tobacco retailers in California, American Spirit costs significantly more than other brands, 12.0%-34.4% more than Pall Mall, Newport, and Marlboro in the same stores. After controlling for store type, American Spirit price was significantly lower in neighborhoods with a higher proportion of school-age residents. Research about how an ultra-premium price contributes to misperceptions that all American Spirit varieties are organic and the brand is less harmful and less addictive than other cigarette brands would be informative for ongoing litigation and product regulation.
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Affiliation(s)
- Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Trent O Johnson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Nina C Schleicher
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA
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9
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Epperson AE, Lambin EF, Henriksen L, Baiocchi M, Flora JA, Prochaska JJ. Natural American Spirit's pro-environment packaging and perceptions of reduced-harm cigarettes. Prev Med 2019; 126:105782. [PMID: 31325524 DOI: 10.1016/j.ypmed.2019.105782] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/04/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
Natural American Spirit (NAS) cigarettes feature a pro-environment marketing campaign on the packs. The NAS "Respect for the Earth" campaign is the first example of on-the-pack corporate social responsibility advertising. In a randomized survey design, we tested perceptions of NAS relative to other cigarette brands on harms to self, others, and the environment. Never (n = 421), former (n = 135), and current (n = 358) US adult smokers were recruited for an online survey from January through March 2018. All participants viewed packs of both NAS and Pall Mall. Participants were randomized to view NAS vs. Pall Mall and to pack color (blue, green, or yellow/orange), which was matched between brands. Survey items assessed perceptions of health risk of the cigarette brand to self, others, and the environment and corporate perceptions. Consistently on all measures, NAS cigarettes were rated as less harmful for oneself, others, and the environment relative to Pall Mall (p's < .001). Though Reynolds American owns both brands, participants rated the company behind NAS as more socially responsible than the company behind Pall Mall, F[1, 909] = 110.25, p < .001. The NAS advantage was significant irrespective of smoking status, pack color, and brand order, with findings stronger for current than never smokers. Pro-environmental marketing on NAS cigarette packs contributes to misperceptions that the product is safer for people and the environment than other cigarettes and made by a company that is more socially responsible. Stricter government regulations on the use of pro-environment terms in marketing that imply modified risk are needed.
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Affiliation(s)
- Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Eric F Lambin
- School of Earth, Energy & Environmental Sciences, Woods Institute for the Environment, Stanford University, Stanford, CA, USA; Georges Lemaître Earth and Climate Research Centre, Earth and Life Institute, Université catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michael Baiocchi
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - June A Flora
- Solutions Science Lab, Department of Pediatrics, Stanford University, Stanford, CA, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA.
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Kistler CE, Ranney LM, Sutfin EL, Chrzan K, Wretman CJ, Enyioha C, Meernik C, Berman M, Zarkin GA, Goldstein AO. Product attributes important to US adult consumers' use of electronic nicotine delivery systems: a discrete choice experiment. BMJ Open 2019; 9:e027247. [PMID: 31420386 PMCID: PMC6701580 DOI: 10.1136/bmjopen-2018-027247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To understand the importance of electronic nicotine delivery systems (ENDS) product attributes to adult consumers in the USA by age and gender. DESIGN Cross-sectional survey with a discrete choice experiment (best-worst, case 2, scaling) of 19 choice tasks in which participants answered what would make them most want to use and least want to use an ENDS product. SETTING AND PARTICIPANTS A national sample of adults (aged 18+ years) in the USA who had tried an ENDS product at least once. MEASURES We included 9 ENDS attributes with levels that varied across 19 choice tasks. We performed a multinomial logistic regression to obtain overall importance scores, attribute-level part-worth utilities and most important attribute. RESULTS Of 660 participants, 81% were white, 51% women and 37% had at least a 4-year college degree with an average age of 42.0 years (SD ±19.4). The attributes had the following importance: harms of use 17.6%; general effects 14.1%; cessation aid 12.6%; purchase price 12.1%; monthly cost 12.0%; nicotine content 11.4%; flavour availability 8.4%; device design 7.2%; modifiability 4.6%. Harms of use was the most important attribute for all ages and genders (p<0.05); variation in other important attributes existed by age though not by gender. CONCLUSION This study identified the importance of nine ENDS attributes. Perceived harms of use of ENDS use appeared most important, and modifiability was least important. Variation by consumer group existed, which may allow for targeted interventions to modify ENDS use.
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Affiliation(s)
- Christine E Kistler
- Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Leah M Ranney
- Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Erin L Sutfin
- Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Keith Chrzan
- Sawtooth Analytics, Sawtooth Software, Inc., Provo, Utah, USA
| | - Christopher J Wretman
- Cecil G. Sheps Center for Health Services Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Chineme Enyioha
- Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Clare Meernik
- Epidemiology, University of North Carolina Gillings School of Global Public Health, Chapel Hill, North Carolina, USA
| | - Micah Berman
- Health Services Management and Policy, Ohio State University College of Public Health, Columbus, Ohio, USA
| | - Gary A Zarkin
- RTI International, Research Triangle Park, North Carolina, USA
| | - Adam O Goldstein
- Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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11
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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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12
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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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13
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Epperson AE, Anzai NE, Prochaska JJ. Natural American Spirit Brand Preference among Smokers with Mental Illness. Tob Induc Dis 2019; 16. [PMID: 31210981 PMCID: PMC6576234 DOI: 10.18332/tid/94456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Despite a steady decline in the US smoking prevalence over the past 50 years, Natural American Spirit cigarettes (NAS), marketed as ‘natural’ and ‘organic’, have seen a 400% rise in sales. In a sample of smokers with mental illness, based on previous research, we hypothesized that preference for NAS would be associated with younger age, higher education, and a stronger health-orientation. METHODS Adult smokers were interviewed during acute psychiatric hospitalization in California between 2009–2013, reporting their preferred top three brands of cigarettes, smoking behaviors, self-rated health, and dietary and physical activity behaviors. The sample (N=956; Mean age=38.7 years, SD=13.5; 48.7% women) identified as 14.5% Hispanic ethnicity, 49.6% White, 23.7% African American, and 23.8% other. RESULTS NAS was identified as a top preferred brand by 15.2% of the participants and was the fourth most popular brand for the sample overall. In a multivariate logistic regression, preference for NAS was significantly greater among participants who were younger (OR=0.97), had some college education or more (OR=2.64 to 4.31), ate a low-fat diet (OR=1.56) and reported better overall health (OR=1.26), with p<0.05. Identifying as Hispanic (OR=1.80) or White (OR=3.00) also predicted NAS preference, p<0.05. NAS preference did not differ by gender or psychiatric diagnosis. CONCLUSIONS Study findings indicate greater NAS brand appeal among smokers living with mental illness who are younger, more highly educated, and have a stronger orientation to health, perhaps because they perceive NAS to be a ‘healthier’ cigarette to smoke. Marketing language that obscures the harms of smoking ought to be prohibited.
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Affiliation(s)
- Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Nicole E Anzai
- Stanford Prevention Research Center, Department of Medicine, Stanford University
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University
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14
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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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15
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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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16
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Epperson AE, Prochaska JJ, Henriksen L. The flip side of Natural American Spirit: corporate social responsibility advertising. Tob Control 2018; 27:355-356. [PMID: 28237942 PMCID: PMC5572748 DOI: 10.1136/tobaccocontrol-2016-053576] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Anna E Epperson
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Judith J Prochaska
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
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17
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Sanders-Jackson A, Tan ASL, Yie K. Effects of health-oriented descriptors on combustible cigarette and electronic cigarette packaging: an experiment among adult smokers in the United States. Tob Control 2017; 27:534-541. [DOI: 10.1136/tobaccocontrol-2017-053795] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 08/15/2017] [Accepted: 08/23/2017] [Indexed: 01/07/2023]
Abstract
ObjectiveCertain tobacco companies use health-oriented descriptors (eg, 100% organic) on product packaging and advertising of combustible cigarettes or electronic cigarettes (e-cigarettes) that create a ‘health halo’ around smoking and vaping. Previous observational research suggests that such language may be associated with more favourable attitudes and reduced risk perceptions toward these brands compared with others. This study aimed to determine the effects of health-oriented descriptors on smokers’ attitude toward the brand, perception of packaging information, comparative harm versus other brands and intention to purchase either combustible cigarettes or e-cigarettes.MethodUS adult smokers were randomly assigned to view either a health-oriented language package (‘100% organic,’ ‘all natural’ or ‘no additives’), traditional marketing language package (‘fine quality,’ ‘premium blend’ or ‘100% original’) or a no-language package of a combustible cigarette brand (Study 1, n=405) or an e-cigarette brand (Study 2, n=396) in an experimental design.ResultsStudy 1: Participants in the health-oriented condition reported more favourable perceptions toward the package information, lower comparative harm and higher intention to purchase combustible cigarettes versus the no language control. In addition, participants in the health-oriented condition reported more positive attitude toward the brand and lower comparative harm versus the traditional marketing condition. Study 2: Compared with the traditional marketing condition, participants in the health-oriented condition reported greater intention to purchase Absolute e-cigarettes. There were no significant differences in attitude toward the brand, perception of packaging information and comparative harm versus other brands across conditions.ConclusionsThe effect of health-oriented language was significant for combustible cigarettesand e-cigarette packages. Policies to restrict health-oriented language on cigarette and e-cigarette packaging are recommended.
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