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Misperceptions of harm among Natural American Spirit smokers: results from wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013–2014)
  1. Jennifer L Pearson1,2,
  2. Amanda Johnson1,
  3. Andrea Villanti1,2,
  4. Allison M Glasser1,
  5. Lauren Collins1,
  6. Amy Cohn1,3,
  7. Shyanika W Rose1,
  8. Raymond Niaura1,2,
  9. Cassandra A Stanton1,3,4
  1. 1Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC, USA
  2. 2Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA
  4. 4Westat, Rockville, Maryland, USA
  1. Correspondence to Dr Jennifer Pearson, Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, 900 G St NW, Fourth floor, Washington, DC 20001, USA; jpearson{at}


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.

  • Advertising and Promotion
  • Packaging and Labelling
  • Tobacco industry

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  • Twitter Follow Shyanika Rose at @ShyanikaRose

  • Contributors JLP conceived the manuscript topic, lead the analysis team and wrote the first draft of the paper. AJ conducted the analyses. AJ, AV, AMG, LC, AC, SWR, RN and CAS contributed to the analysis plan, interpretation of results and manuscript writing.

  • Funding This research was supported by internal funds from Truth Initiative.

  • Competing interests JLP is a pending expert witness in litigation against Santa Fe Natural Tobacco Company.

  • Ethics approval The study was determined to be exempt as non-human research by Chesapeake IRB (Pro00015910).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement PATH data are available from the National Addiction & HIV Data Program at