Introduction While previous research has examined misperceptions related to Natural American Spirit (NAS), a premium cigarette brand using ‘natural’-themed marketing, the longitudinal relationship between NAS-related harm beliefs and switching to NAS has not been established.
Methods Using data from the PATH study, we modelled the longitudinal relationship between (1) brand switching and subsequent belief that one’s own brand might be less harmful than other brands (Waves 1–5); (2) belief that organic and/or additive-free tobacco products are less harmful and subsequent brand switching (Waves 3–5); and (3) belief that some types of cigarettes are less harmful and subsequent brand switching (Waves 3–5) for NAS and two leading comparator brands (Camel and Marlboro).
Results Among people who did not think their prior brand might be less harmful, switching to NAS or maintaining NAS preference increased the odds of believing one’s own brand might be less harmful (aOR 19.4; 95% CI: 15.19, 24.8; aOR 6.1; 95% CI: 4.23, 8.67, respectively). Prior belief that organic and additive-free tobacco products were less harmful increased the odds of switching to (aOR 2.5; 95% CI: 1.68, 3.74) and decreased the odds of switching away (0.57; 955 CI: 0.36, 0.92) from NAS in the subsequent wave. Parallel analyses for Marlboro/Camel were largely null or in the opposite direction.
Conclusions NAS use may maintain or shape new beliefs that the brand may be less harmful than other brands; holding pre-existing beliefs about the relative harm of some tobacco products may increase risk for NAS use.
- Tobacco industry
- Advertising and Promotion
- Packaging and Labelling
Data availability statement
Data are available in a public, open access repository. PATH data are available on the National Addiction and HIV Data Archive Program website at https://www.icpsr.umich.edu/web/NAHDAP/series/606.
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.
Contributors JP conceived the manuscript, led the writing team and conducted the analyses. PO-S and OG oversaw the analytical plan and write-up of results. SKG, OAE, OG, PO-S and OAW reviewed results and contributed to manuscript draft writing. JP is the guarantor of the article.
Funding JP, MJL, PO-S, OG and OAW were supported by in part by NCI and FDA Center for Tobacco Products (CTP) under U54CA229973. PO-S was 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 Natural American Spirit Cigarettes and a paid expert witness for the Plaintiffs in Derivative Litigation invoking Altria Group, Inc. 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.
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.