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Smokers’ awareness of filter ventilation, and how they believe it affects them: findings from the ITC Four Country Survey
  1. Bill King1,
  2. Ron Borland1,
  3. Michael Le Grande1,
  4. Richard O'Connor2,
  5. Geoffrey Fong3,4,
  6. Ann McNeill5,
  7. Dorothy Hatsukami6,
  8. Michael Cummings7
  1. 1Melbourne Centre for Behaviour Change, School of Psychological Sciences, The University of Melbourne - Parkville Campus, Melbourne, Victoria, Australia
  2. 2Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
  3. 3Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
  4. 4Ontario Institute for Cancer Research, Toronto, Ontario, Canada
  5. 5UK Centre for Tobacco Control Studies, National Addiction Centre, Institute of Psychiatry, King’s College London, London, UK
  6. 6Psychiatry, University of Minnesota, Minneapolis, Minnesota, USA
  7. 7Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
  1. Correspondence to Dr Ron Borland, School of Psychological Sciences, University of Melbourne, Melbourne, VIC 3052, Australia; rborland{at}


Background Filter ventilation creates sensations of ‘lightness’ or ‘smoothness’ and is also highly effective for controlling machine-tested yields of tar, nicotine and carbon monoxide. Nearly all factory-made cigarettes (FMC) now have filter ventilation in countries such as Australia, Canada, the UK and the USA. Research conducted before ‘light’ and ‘mild’ labelling was banned found low smoker awareness of filter ventilation and its effects. This study explores current levels of awareness of filter ventilation and current understanding of its effects in these four countries.

Methods We used data from the 2018 wave of the ITC Four Country Smoking and Vaping Survey with samples from USA, England, Canada and Australia. Analyses were conducted initially on a weighted sample of 11 844, and subsequently on 7541 daily FMC smokers.

Findings Only 40.3% of all respondents reported being aware of filter ventilation. Among daily FMC smokers, only 9.4% believed their cigarettes had filter ventilation. Believing that their usual cigarettes are smoother was positively associated with believing they are also less harmful. Both these beliefs independently predict believing their cigarettes are ventilated (smoother OR=1.97 (95% CI 1.50 to 2.59) and less harmful OR=2.41 (95% CI 1.66 to 3.49) in relation to those believing each characteristic is average.

Interpretation Awareness of filter ventilation is currently low, despite decades of public ‘education efforts around the misleading nature of ‘light’ and ‘mild” descriptors. Few smokers realise that their cigarettes almost certainly are vented. Smokers who believed their cigarettes have filter ventilation were more likely to believe they were both smoother and less harmful. Awareness of the technology appears to be insufficient to prevent smokers being deceived by it. Filter ventilation is inherently misleading to smokers and it is time to ban it.

  • tobacco industry
  • public policy
  • packaging and labelling

Data availability statement

Data are available on reasonable request. Interested parties may email the corresponding author with reasonable requests for data access.

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Data availability statement

Data are available on reasonable request. Interested parties may email the corresponding author with reasonable requests for data access.

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  • Contributors GF, MC, AM and RB are senior investigators on the ITC 4C project. GF, MC, AM, RO, DH, MLG and BK designed the study. BK, MLG and RB conducted the data analysis. BK drafted the paper and BK and RB revised it with comments from GF, MC, AM, RO, DH and MLG.

  • Funding The ITC Four Country Smoking and Vaping Project in Australia, Canada, USA and England was supported by the National Health and Medical Research Council of Australia (APP1106451), US National Cancer Institute (P01CA200512) and Canadian Institutes of Health Research (FDN-148477). GF was supported by a Senior Investigator Grant from the Ontario Institute for Cancer Research.

  • Competing interests RO discloses that he has consultancies with WHO and the FDA. GF has served as an expert witness on behalf of governments in litigation involving the tobacco industry. MC has been a consultant and received grant funding from Pfizer Inc in the past 5 years. He has also been a paid expert witness in litigation against the tobacco industry.

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