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Native owned and grown or demeaning and offensive? American Indian adults’ perspectives on Natural American Spirit branded cigarettes
  1. Anna E Epperson1,
  2. Judith J Prochaska2
  1. 1 Department of Psychological Sciences, University of California, Merced, Merced, California, USA
  2. 2 Stanford Prevention Research Center, Department of Medicine, Stanford, California, USA
  1. Correspondence to Dr Anna E Epperson, Department of Psychological Sciences, University of California, Merced, Merced, California, USA; aepperson{at}


Introduction Owned by a major US tobacco company with no American Indian/Alaska Native (AI/AN) tribal affiliation, Natural American Spirit (NAS) cigarette packs feature an American Indian warrior, thunderbird and peace pipe. The current study examined AI/AN adults’ perceptions of NAS cigarette packs in the US, which have not been reported on prior.

Methods AI/AN adults were recruited via Qualtrics national panels (n=500; 64% female, age M=39.9 years, 47% current smokers) in 2020. After viewing NAS pack images online (front, back and sides), participants were asked about NAS tribal affiliation, health perceptions and purchase intentions. Participants also wrote-in what the NAS pack logos meant to them.

Results Most participants (65%) believed NAS is AI/AN-owned and/or grown on tribal lands. Among current smokers, beliefs of an AI/AN affiliation were associated with misperceptions of NAS being a healthier cigarette and with greater intention to purchase NAS cigarettes (p’s<0.01). Participants who did not believe NAS was grown or owned by AI/AN tribes were more likely to describe the NAS warrior logo as cultural misappropriation (17%) than participants who believed NAS was AI/AN tribally affiliated (4%, p<0.001).

Conclusions The findings indicate a dichotomy in beliefs among surveyed AI/AN adults regarding NAS brand cigarettes. A majority held the misconception that NAS is tribally affiliated, while an informed and concerned minority characterised the branding as cultural misappropriation. The current packaging is reasonably expected to result in beliefs that NAS cigarettes are AI/AN tribally affiliated, and these beliefs may be associated with misperceptions of lesser harm.

  • social marketing
  • priority/special populations
  • disparities
  • advertising and promotion

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  • Contributors AEE and JJP both conceived the study, oversaw data collection, completed the analyses, drafted the paper and approved the final version for publication.

  • Funding This work was supported by an Environmental Venture grant from the Stanford Woods Institute for the Environment (no available grant number). AEE is also supported by the California Tobacco-related Disease Research Program (CA TRDRP) Grant #28PC-0044.

  • Disclaimer The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests JJP has provided consultation to pharmaceutical and technology companies that make medications and other treatments for quitting smoking and has served as an expert witness in lawsuits against the tobacco companies. AEE has no conflicts of interest to declare.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.