Health Beliefs of American Indian Imagery on Natural American Spirit Packs

369 Natural American SpiritTM (NAS), a superpremium cigarette brand, has increased in popularity in the United States (US), rising over 400% in market share from 2002 to 2013,1 and at 3.4% in 2018.2 According to prior research, marketing claims of natural, additive-free and organic are associated with misperceptions that NAS offers a safer and less harmful product relative to other commercial cigarettes.3-10 These health misperceptions were associated with an increased intention to purchase NAS in the future.9 In response to the US Food and Drug Administration’s (FDA) warnings more than 2 years prior, NAS ceased use of the text descriptors natural and additive-free in 2017.11 However, natural was retained in the trademarked brand name,11 and the product ingredients are listed as “tobacco plus water,” still implying that the product is additive-free.12 Natural American SpiritTM packaging also retains the iconic image of a fictional American Indian in ceremonial headdress smoking a peace pipe with a thunderbird above in a distinctive American Indian (Native) design. In many Native cultures, the thunderbird is a sacred spirit-being and a symbol of protection.13 Since its inception, the packaging has emphasized the brand’s ties to the southwest-

[1]  S. Glantz,et al.  Tobacco Industry Promotional Strategies Targeting American Indians/Alaska Natives and Exploiting Tribal Sovereignty. , 2019, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[2]  Joseph G. L. Lee,et al.  “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 , 2019, Health education & behavior : the official publication of the Society for Public Health Education.

[3]  Jennifer L. Pearson,et al.  Beyond 'Natural': Cigarette Ad Tactics that Mislead about Relative Risk , 2018, Tobacco Regulatory Science.

[4]  Y. Inaba,et al.  Spectrophotometric determination of ammonia levels in tobacco fillers of and sidestream smoke from different cigarette brands in Japan , 2018, Environmental Health and Preventive Medicine.

[5]  J. D'Silva,et al.  Tobacco industry misappropriation of American Indian culture and traditional tobacco , 2018, Tobacco Control.

[6]  D. Strong,et al.  Standardised cigarette packaging may reduce the implied safety of Natural American Spirit cigarettes , 2017, Tobacco Control.

[7]  J. Cappella,et al.  Influence of Natural American Spirit advertising on current and former smokers’ perceptions and intentions , 2017, Tobacco Control.

[8]  T. Dewhirst.  Into the black: Marlboro brand architecture, packaging and marketing communication of relative harm , 2017, Tobacco Control.

[9]  Sarah E. Adkison,et al.  Perceptions of “Natural” and “Additive-Free” Cigarettes and Intentions to Purchase , 2017, Health education & behavior : the official publication of the Society for Public Health Education.

[10]  J. Ayers,et al.  Which cigarettes do Americans think are safer? A population-based analysis with wave 1 of the PATH study , 2016, Tobacco Control.

[11]  J. Pierce,et al.  Use of imagery and text that could convey reduced harm in American Spirit advertisements , 2016, Tobacco Control.

[12]  Thomas R. Kirchner,et al.  American Spirit Pack Descriptors and Perceptions of Harm: A Crowdsourced Comparison of Modified Packs. , 2016, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[13]  G. Boudreau,et al.  Why the World Will Never Be Tobacco-Free: Reframing "Tobacco Control" Into a Traditional Tobacco Movement. , 2016, American journal of public health.

[14]  K. Cummings,et al.  Trends in market share of leading cigarette brands in the USA: national survey on drug use and health 2002–2013 , 2016, BMJ Open.

[15]  S. Fortmann,et al.  Effect of warning statements in e-cigarette advertisements: an experiment with young adults in the United States. , 2015, Addiction.

[16]  C. Vardavas,et al.  Cigarette design and marketing features are associated with increased smoking susceptibility and perception of reduced harm among smokers in 27 EU countries , 2014, Tobacco Control.

[17]  K. Kelly,et al.  The Effects of Natural Cigarette Claims on Adolescents' Brand-Related Beliefs, Attitudes, and Intentions , 2014, Journal of health communication.

[18]  C. Watson,et al.  Toxic metal concentrations in mainstream smoke from cigarettes available in the USA. , 2014, Journal of analytical toxicology.

[19]  D. Hammond,et al.  The impact of cigarette pack shape, size and opening: evidence from tobacco company documents. , 2013, Addiction.

[20]  Eunju Ko,et al.  Authenticity in traditional culture marketing: consumers' perceptions of Korean traditional culture , 2013 .

[21]  K. Cummings,et al.  What do cigarette pack colors communicate to smokers in the U.S.? , 2011, American journal of preventive medicine.

[22]  Patricia A. McDaniel,et al.  “I always thought they were all pure tobacco”: American smokers’ perceptions of “natural” cigarettes and tobacco industry advertising strategies , 2007, Tobacco Control.

[23]  J. Unger,et al.  Perceptions of ceremonial and nonceremonial uses of tobacco by American-Indian adolescents in California. , 2006, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[24]  Michael K. Green.  Images of Native Americans in advertising: Some moral issues , 1993 .

[25]  Jacob Cohen.  Statistical Power Analysis for the Behavioral Sciences , 1969, The SAGE Encyclopedia of Research Design.

[26]  Tormod Næs,et al.  General image and attribute perceptions of traditional food in six European countries , 2011 .