Beyond 'Natural': Cigarette Ad Tactics That Mislead About Relative Risk

Objectives: In 2016 the US Food and Drug Administration (FDA) and Santa Fe Natural Tobacco Company entered into a settlement agreement restricting use of the terms "additive free" and "natural" in American Spirit ads. American Spirit uses a variety of other tactics that could contribute to inaccurate reduced risk perceptions; yet, no research has examined the effects of these tactics. The current study examines the effect of the phrase 'tobacco and water', references to eco-friendly business practices, and plant imagery on young adults' perceptions of product harm, addictiveness, and nicotine content. Methods: We conducted a between-subjects experiment that randomized the presentation of 5 ad tactics (control, 'tobacco and water, eco-friendly reference, plant imagery, or all 3 tactics present) in 2 brands (American Spirit vs Marlboro) with a sample of 3054 18-24 year-old US young adults recruited via Amazon Mechanical Turk. Results: When used in an American Spirit ad, adding eco-friendly language (OR = 1.50, AOR = 1.51) or "tobacco and water" (OR = 1.48, AOR = 1.1.6) was associated with greater odds of misperceiving reduced harm compared to the control condition. Conclusions: Our findings provide additional support for FDA enforcement actions against tobacco companies using these misleading tactics.