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Cigarette unit sales volume for brands using ‘natural’, ‘organic’ and ‘tobacco and water’ pack terms in the USA, 2018–2022
  1. Olufemi Erinoso1,
  2. Alex C Liber2,
  3. Alexis Hogan1,
  4. Bianca Martínez3,
  5. Felicia Miller1,
  6. Donald Kue1,
  7. Dotun Sangoleye1,
  8. Jennifer Pearson1,4
  1. 1School of Public Health, University of Nevada Reno, Reno, Nevada, USA
  2. 2Policy and Regulatory Science Program, RTI International Social Statistical and Environmental Sciences Unit, Research Triangle Park, North Carolina, USA
  3. 3Desert Research Institute, Reno, Nevada, USA
  4. 4Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
  1. Correspondence to Dr Jennifer Pearson, School of Public Health, University of Nevada Reno, Reno, NV 89557, USA; jennipearson{at}


Background Terms such as ‘natural’, ‘organic’ and ‘tobacco and water’ on cigarette packs may communicate misleading reduced harm messages to consumers. This study describes sales volume and price for brands that used these misleading descriptors in the USA by year, brand and state.

Methods The data come from Information Resources Incorporated sales data collected in 44 US states from January 2018 to January 2023. Trained coders used Universal Product Codes, purchased packs and internet searches to identify cigarettes sold with ‘natural’, ‘organic’ and ‘tobacco and water’ on packs. We report cigarette pack unit sales counts (sales volume) and average price per pack by year, as well as per cent year-over-year change in sales volume and price and annual market share by descriptor terms.

Results Overall, pack sales volume decreased year-over-year from 2019 to 2022. Sales volume for packs with ‘natural’, ‘tobacco and water’ and ‘organic’ decreased less than overall; in some cases, they increased. In 2022, packs with ‘natural’ accounted for the greatest share of cigarette unit sales (5.42% or 33 605 036 packs), followed by ‘tobacco and water’ (2.25% or 12 959 905 packs) and ‘organic’ (0.53% or 4 614 592 packs). Natural American Spirit (NAS) and Winston accounted for most sales with ‘natural’ and ‘tobacco and water’; NAS accounted for nearly all sales with ‘organic’. Packs with ‘natural’, ‘tobacco and water’ or ‘organic’ made up the largest portion of sales in western (Oregon, Idaho, California, Colorado and Washington) and northeastern (Vermont, Massachusetts and New Hampshire) US states.

Conclusion Brands using ‘natural’, ‘tobacco and water’ and ‘organic’ on packs increased their market share between 2019 and 2022; in some states, market share was over 10% in 2022. Our findings emphasise the importance of regulating these terms and continually monitoring their population impact.

  • Advertising and Promotion
  • Packaging and Labelling
  • Surveillance and monitoring
  • Tobacco industry

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  • X @olufemierinoso

  • Contributors OE, ACL and JP conceptualised and designed the methodology. ACL conducted the formal analysis and data curation. AH, BM, FM, DK and DS supported the methodology and formal analysis. OE and JP wrote the original draft. All authors reviewed and edited the original draft. All authors approved the final version.

  • Funding This study is funded by a grant from the National Institute on Drug Abuse of the National Institutes of Health, R01DA053619-03, awarded to JP.

  • Competing interests No, there are no competing interests.

  • 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.