title: American Spirit Pack Descriptors and Perceptions of Harm: A Crowdsourced Comparison of Modified Packs.
abstract: In 2015, the Food and Drug Administration issued warnings to three tobacco manufacturers who label their cigarettes as "additive-free" and/or "natural" on the grounds that they make unauthorized reduced risk claims. The goal of this study was to examine US adults' perceptions of three American Spirit (AS) pack descriptors ("Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown Tobacco") to assess if they communicate reduced risk.
  
  
  
  In September 2012, three cross-sectional surveys were posted on Amazon Mechanical Turk. Adult participants evaluated the relative harm of a Marlboro Red pack versus three different AS packs with the descriptors "Made with Organic Tobacco," "100% Additive-Free," or "100% US Grown Tobacco" (Survey 1; n = 461); a Marlboro Red pack versus these AS packs modified to exclude descriptors (Survey 2; n = 857); and unmodified versus modified AS pack images (Survey 3; n = 1001).
  
  
  
  The majority of Survey 1 participants rated the unmodified AS packs as less harmful than the Marlboro Red pack; 35.4%-58.8% of Survey 2 participants also rated the modified (no claims) packs as less harmful than Marlboro Red. In these surveys, prior use of AS cigarettes was associated with reduced perceptions of risk (adjusted odds ratio [AOR] 1.59-2.40). "Made with Organic Tobacco" and "100% Additive-Free" were associated with reduced perceptions of risk when comparing the modified versus the unmodified AS packs (Survey 3).
  
  
  
  Data suggest that these AS pack descriptors communicate reduced harm messages to consumers. Findings have implications for regulatory actions related to product labeling and packaging.
  
  
  
  These findings provide additional evidence that the "Made with Organic Tobacco," "100% Additive-Free," and "100% US Grown" descriptors, as well as other aspects of the AS pack design, communicate reduced harm to non-, current, and former smokers. Additionally, they provide support for the importance of FDA's 2015 warning to Santa Fe Natural Tobacco Company on "100% Additive Free" as an unauthorized modified risk claim.
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; jpearson@truthinitiative.org.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Pearson
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Amanda
authors.initials: A
authors.lastname: Richardson
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC;
authors.forename: Shari P
authors.initials: SP
authors.lastname: Feirman
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD;
authors.forename: Andrea C
authors.initials: AC
authors.lastname: Villanti
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Evaluation Science and Research, Truth Initiative, Washington, DC;
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cantrell
authors.affiliation: The Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, DC;
authors.forename: Amy
authors.initials: A
authors.lastname: Cohn
authors.affiliation: Survos, Washington, DC;
authors.forename: Michael
authors.initials: M
authors.lastname: Tacelosky
authors.affiliation: Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; College of Global Public Health, New York University, New York, NY.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Kirchner
mesh_terms: D000328:Adult; D000329:Advertising; D003258:Consumer Behavior; D003430:Cross-Sectional Studies; D063045:Crowdsourcing; D005006:Ethnicity; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D011356:Product Labeling; D012907:Smoking / Q000523:psychology*; D011795:Surveys and Questionnaires; D062789:Tobacco Products; D014481:United States