Objectives We sought to investigate adolescents’ and adults’ perceptions of an American Spirit advertisement with ‘natural’, ‘organic’ and ‘additive-free’ descriptors and related disclaimers.

Methods We conducted nine focus group discussions in the Southern USA, with 59 participants aged 13–64 years (30 male, 29 female), stratified by age, smoking status and susceptibility to smoking. We conducted thematic content analysis of the transcripts.

Results Many participants were sceptical or confused about the ‘natural’, ‘organic’ and ‘additive-free’ descriptors. Many participants viewed American Spirit cigarettes as being less, or possibly less harmful than other cigarettes, even though the ad contained disclaimers explicitly stating that these cigarettes are not safer. Some participants said that people tend to ignore disclaimers, a few expressed doubt that the disclaimers were fully true, and others did not notice the disclaimers. A few smokers said they smoke American Spirit cigarettes because they think they are not as bad for them as other cigarettes.

Conclusions Disclaimers intended to prevent consumers from attributing a health benefit to cigarettes labelled as ‘natural’, ‘additive-free’, or ‘organic’ may be insufficient. A ban on these descriptors may be a more appropriate remedy than disclaimers.