Misperceptions of harm among Natural American Spirit smokers: results from wave 1 of the Population Assessment of Tobacco and Health (PATH) study (2013–2014)

TLDR

The study estimated differences in harm perceptions between Natural American Spirit smokers and other smokers and examined correlates of NAS use. Using weighted analyses of 10,565 adult smokers from PATH wave 1, the authors estimated NAS prevalence and examined its associations with sociodemographics, tobacco use, harm perceptions, quit intentions, and mental health. Only 2.3% of smokers used NAS, yet nearly 64% of them mistakenly believed it was less harmful than other brands, a misperception strongly linked to younger age, substance use, and LGBTQ+ identity, underscoring the need for corrective messaging.

Abstract

<h3>Introduction</h3> This study estimated differences in cigarette harm perceptions among smokers of the Natural American Spirit (NAS) brand—marketed as 'natural', 'organic' and 'additive-free'—compared to other smokers, and examined correlates of NAS use. <h3>Methods</h3> Data were drawn from wave 1 of the Population Assessment of Tobacco and Health (PATH) study, a nationally representative study of US adults (2013–2014). Weighted analyses using a subset of current adult smokers (n=10 565) estimated the prevalence of NAS use (vs all other brands) and examined associations between NAS use and sociodemographics, tobacco/substance use, tobacco harm perceptions, quit intentions, quit attempts and mental/behavioural health. <h3>Results</h3> Overall, 2.3% of adult smokers (920 000 people in the USA) reported NAS as their usual brand. Nearly 64% of NAS smokers inaccurately believed that their brand is less harmful than other brands compared to 8.3% of smokers of other brands, after controlling for potential confounders (aOR 22.82). Younger age (18–34 vs 35+; aOR 1.54), frequent thinking about tobacco harms (aOR 1.84), past 30-day alcohol use (aOR 1.57), past 30-day marijuana use (aOR 1.87) and sexual orientation (lesbian, gay, bisexual, 'other' or 'questioning' vs heterosexual; aOR 2.07) were also associated with increased odds of smoking NAS. <h3>Conclusions</h3> The majority of NAS smokers inaccurately believes that their cigarettes are less harmful than other brands. Given the brand9s rapid growth and its more common use in vulnerable groups (eg, young adults, lesbian, gay, bisexual, 'other' or 'questioning' adults), corrective messaging and enforcement action are necessary to correct harm misperceptions of NAS cigarettes.