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.
- advertising and promotion
- harm reduction
- packaging and labelling
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Contributors ECL, JPP, CVD and DRS designed data collection tools. ECL wrote the statistical analysis plan and cleaned and analysed the data. CVD monitored data collection for the whole study. All authors drafted and revised the paper.
Funding Research reported in this publication was supported by 1R01CA190347 from the National Cancer Institute. ECL was also supported by T32HL007034 from the National Heart, Lung and Blood Institute.
Competing interests None declared.
Patient consent Obtained.
Ethics approval University of California, San Diego.
Provenance and peer review Not commissioned; externally peer reviewed.