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Naturally leading: a content analysis of terms, themes and word associations in Natural American Spirit advertising, 2000–2020
  1. Stefanie K Gratale1,
  2. Ollie Ganz1,2,
  3. Olivia A Wackowski1,2,
  4. M Jane Lewis1,2
  1. 1 Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
  2. 2 Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, New Jersey, USA
  1. Correspondence to Dr Olivia A Wackowski; wackowol{at}


Background Natural American Spirit (NAS) is a cigarette brand distinguished by supposed ‘natural’, ‘additive-free’ characteristics, marketing of which is tied to misperceptions of reduced harm. In 2017, NAS’s manufacturer agreed (with the Food and Drug Administration) to remove ‘natural’/‘additive-free’ from US marketing. Prior research has explored NAS marketing immediately post-agreement. This study sought to identify prominent post-agreement terms and themes and analyse how they had been used in pre-agreement ads.

Methods We conducted a content analysis of NAS ads from 2000 to 2020 (N=176), documenting prominent pre-agreement and post-agreement terms/themes and examining how they are used in NAS ads. We coded for descriptors, themes, imagery and promotions, and extended prior research by analysing how leading post-agreement terms were used in conjunction and thematically associated with ‘additive-free’ and ‘natural’ before the agreement.

Results Results indicated ‘tobacco and water’ and ‘Real. Simple. Different.’ increased post-agreement, as did environmental imagery. ‘Organic’ was prominent pre-agreement and post-agreement. The descriptors used most often in post-agreement ads almost always appeared in conjunction with (and were thematically linked to) ‘natural’ and ‘additive-free’ in pre-agreement ads.

Conclusions In the years since the agreement, NAS ads have heavily relied on still-allowable descriptors that may invite reduced risk misperceptions. Notably, these descriptors were consistently used alongside the banned terminology before the agreement and presented as if affiliated conceptually, possibly prompting similar connotations. Findings indicate a continuing need for research into NAS advertising effects and a potential role for additional regulatory action.

  • advertising and promotion
  • tobacco industry
  • public policy

Data availability statement

Data are available upon reasonable request. The coding materials for this article can be made available upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The coding materials for this article can be made available upon reasonable request.

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  • Contributors SKG contributed to data analysis and paper writing and editing. OG contributed to study design, data analysis and paper writing. OAW contributed to paper writing and editing, and acts as the guarantor of content. MJL conceptualised the study design, obtained study funding and contributed to paper writing.

  • Funding This work was supported by the National Cancer Institute at the National Institutes of Health and the US Food and Drug Administration (U54CA229973).

  • Competing interests None declared.

  • 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.