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Responses to reduced nicotine cigarette marketing features: a systematic review
  1. Andrea C Johnson1,2,
  2. Melissa Mercincavage1,2,
  3. Valentina Souprountchouk1,2,
  4. Sasha Rogelberg1,
  5. Anupreet K Sidhu1,2,
  6. Cristine D Delnevo2,3,
  7. Andrew A Strasser1,2,4
  1. 1Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  2. 2University of Pennsylvania-Rutgers University Tobacco Center of Regulatory Science, Philadelphia, Pennsylvania, USA
  3. 3Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
  4. 4Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania, USA
  1. Correspondence to Dr Andrea C Johnson, Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA 19104, USA; andrea.johnson1{at}


Objective To systematically review the literature regarding responses to commercial and public health marketing features for reduced nicotine cigarettes (RNCs) to anticipate potential industry and regulatory actions should an RNC product standard be issued.

Data sources We searched PubMed for English-language articles using several keywords for reduced nicotine products, cigarettes and marketing features published through 2020.

Study selection Of 4092 records, 26 studies were retained for review that met criteria focusing on responses to RNC marketing features.

Data extraction Search terms created by the research team were used for review and included independent extraction and coding by two reviewers. Coding was categorised using study design terminology, commercial and public health features in tobacco regulatory science, and their association with individual responses outlined by several message processing outcomes.

Data synthesis Most studies focused on current cigarette smokers and were cross-sectional. Reactions to RNCs and attitudes and beliefs were the most common outcomes measured. For commercial features, articles generally studied RNC advertisements, products and/or descriptors. For public health features, articles studied counter-messaging (eg, warning labels) or general descriptors about nicotine or a reduced nicotine product standard. Commercial features were generally associated with favourable responses. Public health features offset favourable responses across most outcomes, though their efficacy was mixed. Contrasts in results by smoking status are discussed.

Conclusions Commercial marketing of RNCs is appealing and may need stronger regulations or communication campaigns to accurately convey risks. Opportunities exist for future research within tobacco regulatory science.

  • nicotine
  • addiction
  • advertising and promotion
  • packaging and labelling
  • public policy

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  • Twitter @AndreaC_PhD, @melmercincavage, @crisdelnevo

  • Contributors AAS, MM and ACJ conceptualised and designed the study and methodology. VS monitored and oversaw methodology. ACJ and SR conducted initial coding. MM was a third coder. ACJ analysed the results and wrote the initial paper draft, with subsequent contributions from all authors. AAS and CDD received funding and provided administrative and technical support for the study. All authors contributed to paper revisions and have approved the final version of the manuscript.

  • Funding Research reported in this publication was supported by the National Cancer Institute (NCI) of the National Institutes of Health (NIH) and the US Food and Drug Administration (FDA) Center for Tobacco Products under Award Number U54CA229973 and by NCI Award Number K07218366.

  • Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.

  • 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.