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Shifts in preference for Natural American Spirit and associated belief that one’s own cigarette brand might be less harmful than other brands: results from Waves 1–4 of the Population Assessment of Tobacco and Health (PATH) Study (2013–2018)
  1. Jennifer Pearson1,2,
  2. Ollie Ganz3,4,
  3. Pamela Ohman-Strickland5,
  4. Olivia A Wackowski3
  1. 1Division of Social and Behavioral Health/Health Administration and Policy, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
  2. 2Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  3. 3Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers The State University of New Jersey, New Brunswick, New Jersey, USA
  4. 4Department of Health Behavior, Rutgers School of Public Health, Piscataway, New Jersey, USA
  5. 5Department of Epidemiology and Statistics, Rutgers School of Public Health, Piscataway, New Jersey, USA
  1. Correspondence to Dr Jennifer Pearson, School of Public Health, University of Nevada Reno, Reno, NV 89557, USA; jennipearson{at}unr.edu

Abstract

Introduction People believe that cigarettes using ‘organic,’ ‘additive-free’ or similar descriptors are less harmful than other cigarettes. Natural American Spirit (NAS) is the most popular US cigarette brand using these descriptors. This cohort study describes changes in US smokers’ odds of preferring NAS and changes in NAS smokers’ odds of believing their brand might be less harmful than other brands.

Methods Data come from four waves (2013–2018) of the Population Assessment of Tobacco and Health (PATH) Study. Generalised estimating equations produced population-averaged estimates of relationships between (1) NAS brand preference and wave and (2) belief that one’s own brand might be less harmful than other brands, wave and NAS brand preference. Models tested interactions by age group and sexual minority status.

Results The odds that smokers preferred NAS increased by 60% in W4 relative to W1. Disproportionate preference by younger adult and sexual minority smokers was observed. The odds that NAS smokers believed their own brand might be less harmful decreased by 50% between W1 and W4, but this perception was still 16 times higher for NAS compared with non-NAS smokers. Given the increasing preference for NAS, there was no significant change in the absolute number of NAS smokers who believed their own brand might be less harmful (W1: 562 122 (95% CI 435 190 to 689 055) vs W4: 580 378 (95% CI 441 069 to 719 689)).

Conclusions Both brand popularity and concentration of brand-related harm perceptions are important for understanding population impact of changes in cigarette marketing.

  • packaging and labelling
  • priority/special populations
  • public policy
  • disparities

Data availability statement

Data are available in a public, open access repository. Public Use File data for the Population Assessment of Tobacco and Health (PATH) Study are publicly available from https://www.icpsr.umich.edu/web/NAHDAP/studies/36498.

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Data availability statement

Data are available in a public, open access repository. Public Use File data for the Population Assessment of Tobacco and Health (PATH) Study are publicly available from https://www.icpsr.umich.edu/web/NAHDAP/studies/36498.

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Footnotes

  • Contributors JP conceived the manuscript and lead the writing team. PO-S and OG oversaw the analytical plan and write-up of results. OG, PO-S and OAW reviewed results and contributed to manuscript draft writing. JP is the guarantor of the article.

  • Funding JP, PO-S, OG and OAW were supported by NCI and FDA Centre for Tobacco Products (CTP) under U54CA229973. OG and PO-S were also supported in part by the Rutgers Cancer Institute of New Jersey under P30CA07270-5931.

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

  • Competing interests JP is a paid expert witness for the Plaintiffs in a Multi-District Litigation invoking American Spirit Cigarettes. This arrangement has been reviewed and approved by the University of Nevada, Reno in accordance with their conflicts of interest policies.

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

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