Smoker Awareness of and Beliefs About Supposedly Less-Harmful Tobacco Products

Background

Cigarette manufacturers in the United States have begun marketing cigarette brands claiming to reduce smokers’ exposure to selected toxins in tobacco smoke. Little data exist on smokers’ awareness, use, and beliefs about these products.

Methods

Data from the U.S. arm of the International Tobacco Control Policy Four-Country Survey (ITC-4), a telephone survey of 2028 adult current cigarette smokers in the United States conducted between May and September 2003, were analyzed. Respondents were asked to report their awareness, beliefs, and use of products marketed as less harmful than traditional cigarettes and of smokeless tobacco (SLT) products.

Results

Close to 39% of smokers were aware of “less-harmful” cigarettes, but only 27% of them could name a specific brand of such cigarettes. The brand named most often was Quest (25.7%), followed by Eclipse (7.6%), Winston (5.7%), herbal cigarettes (3.3%), “smoke-free” cigarettes (2.9%), Marlboro Blend #27 (1.9%), and Omni (1.9%). Of those who named a brand, 25% believed such products were less harmful than “ordinary cigarettes.” In contrast, 82% of cigarette smokers were aware of SLT products, but only 10.7% of these believed that SLTs were less harmful than ordinary cigarettes.

Conclusions

Smokers hold beliefs about the relative safety of supposedly less-harmful tobacco products that are opposite to existing scientific evidence. These results highlight the need to educate smokers about the risks of alternatives to conventional cigarettes, and the need to regulate the advertising and promotion of such alternatives.

Introduction

In the past decade, cigarette manufacturers in the United States have introduced and marketed a variety of so-called “reduced exposure” products.1, 2, 3 For example, in 2000, Vector Tobacco introduced Omni^®, which promised exposure to fewer carcinogens than conventional cigarette brands. In 2001, Brown and Williamson Tobacco Company began marketing Advance^®, which touted a new filter and different type of tobacco that reduced exposure to harmful chemicals in tobacco smoke. In 1996, RJ Reynolds Tobacco Company (RJR) introduced Eclipse^®, initially marketed with claims of less secondhand smoke, and later with claims of reduced cancer risk. Philip Morris USA test marketed Accord^®,⁴ an electrically heated cigarette that allegedly reduced exposure to toxins found in conventional cigarettes. Finally, in 2002, Vector introduced Quest^®, a new line of cigarettes with varying levels of nicotine. The Institute of Medicine (IOM)⁴ reviewed the scientific evidence regarding these products and labeled them “potential reduced exposure products” (PREPs). The IOM committee expressed concern that PREPs could encourage smokers to continue smoking, entice former smokers to return to tobacco use, and even recruit nonsmokers to use these supposedly safer products.⁴

The IOM’s concerns underscore the importance of consumers’ perceptions in the overall evaluation of PREPs. To date, however, there have been relatively few efforts made to document consumer awareness, beliefs, and use of PREPs. Shiffman et al.⁵ surveyed 1000 current cigarette smokers to ascertain their opinions about RJR’s Eclipse product. Respondents were read descriptions of the product based on advertisements and asked to rate their interest in purchasing Eclipse, and the perceived risk from Eclipse compared to smoking regular cigarettes. Respondents were also asked whether Eclipse might affect their decision to stop smoking. After hearing the description of the product, 57% of smokers said that they were at least somewhat likely to purchase Eclipse in the next 6 months. Nearly all current smokers (91.4%) believed that Eclipse was safer than smoking regular cigarettes, with 24% believing that Eclipse was completely safe based on the description from the advertisement. Although most smokers (60.3%) said Eclipse would not change their plans about quitting, 21.4% of those smokers contemplating quitting in the next 6 months lost interest in quitting after hearing about Eclipse.

Hamilton et al.⁶ conducted a mall intercept survey of 600 adult smokers to assess their reactions to advertisements for PREPs (Eclipse, Advance, Omni), light cigarettes, and regular cigarettes. Since none of the PREPs were being marketed in Massachusetts at the time of the study, respondents’ ratings about the relative health risks of PREPs were based solely on the advertising they were exposed to in the study. Respondents consistently rated the PREPs as having lower health risks and lower carcinogens compared to light and regular cigarettes.

Data from a 2002 U.S. national survey⁷ of smokers found that one third of smokers had heard of at least one supposedly less-harmful product when read the names of a series of such products. However, little is known about whether smokers who are not prompted with product names or given product information are aware of supposedly less-harmful products or have beliefs concerning their safety compared to smoking. Additionally, no surveys have compared knowledge of modified cigarettes and cigarette-like products to knowledge of smokeless tobacco (SLT), another class of products that could potentially reduce smoking-related health risks.

This paper reports data from the U.S. arm of the 2003 wave of the International Tobacco Control Policy Evaluation Project Four-Country Survey (ITC-4), a nationally representative sample telephone survey of 2028 adult smokers. This study reports data from questions that measured awareness of and beliefs about the risks of supposedly less-harmful tobacco products (including SLT). Smokers’ beliefs about alternatives to conventional cigarettes were examined.