TY - JOUR T1 - Emergence and growth of ‘natural’ cigars in the USA JF - Tobacco Control JO - Tob Control DO - 10.1136/tobaccocontrol-2022-057396 SP - tobaccocontrol-2022-057396 AU - Ollie Ganz AU - Olivia A Wackowski AU - Andrew A Strasser AU - Michelle Jeong AU - Andrea C Villanti AU - Erin Miller Lo AU - Eugene M Talbot AU - Cristine D Delnevo Y1 - 2022/06/03 UR - http://tobaccocontrol.bmj.com/content/early/2022/06/02/tobaccocontrol-2022-057396.abstract N2 - Evidence of the impact of misleading descriptors on cigarette packaging and advertising on consumer perceptions and use intentions is well documented.1–4 Prominent examples include use of descriptors such as ‘natural’, ‘organic,’ and ‘additive-free’ by the brand Natural American Spirit (NAS), which have been found to mislead consumers to believe that NAS cigarettes are less harmful than other cigarette brands.2 5 This strategy has been successful for NAS, which saw a 97% increase in market share in the USA from 2014 to 2019,6 despite overall declines in cigarette smoking over this time period.7In 2015, the US Food and Drug Administration (FDA) sent a warning letter to Santa Fe Natural Tobacco Company (SFNTC), a subsidiary of Reynolds American Inc. (RAI), for using descriptors in NAS marketing that communicated reduced risk without an FDA order to do so.8 An agreement between FDA and SFNTC/RAI was reached in 2017 specifying that the company would remove ‘additive-free’ and ‘natural’ from their packaging and advertising, with the exception of their brand name which remained Natural American Spirit.9 The terms of this agreement appear to have been specific to NAS and have not discouraged other cigarette brands from using similar descriptors.10 11 As we previously highlighted,10 non-cigarette tobacco products also appear to be mimicking NAS’ marketing strategy. For example, Backwoods, a mass merchandise cigar/cigarillo brand, which has promoted their ‘all-natural leaf wrapper’ since at least 2018,12 is the fastest growing cigar brand, with the largest increase in market share (16.1% average annual percentage change (AAPC)) from 2009 to 2020, compared with other major cigar brands.13Recent marketing efforts in business-to-business (B2B) … ER -