Standardised cigarette packaging may reduce the implied safety of Natural American Spirit cigarettes

Abstract

BackgroundOver two-thirds of Natural American Spirit (NAS) smokers believe their cigarettes might be ‘less harmful’, but toxicological evidence does not support this belief. We assessed whether standardised packaging could reduce the possibility of erroneous inferences of ‘safety’ drawn from NAS cigarette packaging.MethodsUS adult smokers (n=909) were recruited to a between-subject survey experiment (3 brands×3 packaging/labelling styles) through Amazon Mechanical Turk and rated their perception of whether a randomly assigned cigarette package conveyed that the brand was ‘safer’ on a three-item scale (Cronbach’s α=0.92). We assessed whether NAS packs were rated higher on the ‘implied safety’ scale than two other brands and estimated the effect that plain packaging (ie, all branding replaced with a drab dark brown colour) and Australian-like packaging (ie, all branding replaced with a drab dark brown colour and a graphic image and text on 75% of the pack surface) had on perceptions of the NAS cigarette package.ResultsSmokers’ ratings of the standard NAS pack on the implied safety scale (mean=4.6; SD=2.9) were 1.9 times (P <0.001) higher than smokers’ ratings of a Marlboro Red pack (mean=2.4; SD=2.3) and 1.7 times (P <0.001) higher than smokers’ ratings of a Newport Menthol pack (mean=2.7; SD=2.4). These perceptions of implied safety were lower when plain packaging was used (Cohen’s d=0.66; P <0.001) and much lower when Australian-like packaging was used (Cohen’s d=1.56; P <0.001).ConclusionThe results suggest that NAS cigarette packaging conveys that its cigarettes are ‘safer’ and that such perceptions are lower with standardised packaging, both with and without warning images.

Widespread Belief That Organic and Additive-Free Tobacco Products are Less Harmful Than Regular Tobacco Products: Results From the 2017 US Health Information National Trends Survey

“…Removal of terms that incorrectly imply reduced harm may somewhat correct current and future consumers' misperceptions about the brand, though stronger action such as plain packaging may be necessary to eliminate erroneous beliefs. 9,12…”

“The Packaging Is Very Inviting and Makes Smokers Feel Like They’re More Safe”: The Meanings of Natural American Spirit Cigarette Pack Design to Adult Smokers

“…Prior research has focused on the impact of “health-oriented” text descriptors, finding these can change perceptions of harm (Kelly & Manning, 2014; Pearson et al, 2016). Additionally, Leas et al (2018) tested plain packaging and graphic warning labels on NAS packs, finding these policy options, which are not currently available in the United States, can reduce consumer misperceptions of reduced harm. Similarly, our findings align with and extend previous studies that examined the impact of NAS imagery in print advertisements (Byron et al, 2016; Gratale, Maloney, Sangalang, & Cappella, 2017; Moran et al, 2018).…”

“…However, this does not apply to the word “Natural” in the NAS trademarked brand name that appears prominently on the pack. Previous studies have examined the impact of NAS cigarette pack design elements on health and brand perceptions (Kelly & Manning, 2014; Leas, Pierce, Dimofte, Trinidad, & Strong, 2018; Pearson et al, 2016). Two of these studies focused mainly on the impact of text descriptors that might convey reduced harm, such as “natural,” “100% additive-free,” and “organic.” After exposure to images of NAS packs with and without the terms “natural” and “100% additive-free,” high school–aged youth were more likely to report decreased beliefs that these cigarettes cause disease compared with Camels (Kelly & Manning, 2014).…”

“…Only one study to date has examined the impact of the visual features of NAS pack design, where the current design of NAS packs was compared with plain packaging and packaging with warning imagery used in Australia (image of a gangrenous foot). Leas et al (2018) found that both plain packaging and packaging with a graphic warning reduced the perception that NAS cigarettes are safer. However, the study did not examine which specific attributes might contribute to perceptions of reduced harm.…”

Researching policy impacts

“…Leas et al 9 conducted a between-subject survey experiment to assess whether standardised packaging could reduce the possibility of erroneous ‘safety’ messages being drawn from the packaging of one popular cigarette brand in the USA, Natural American Spirit. Plain packaging was demonstrated to reduce smokers’ ratings of packs on an implied safety scale, even more when Australian-type packaging was used.…”