Abstract
INTRODUCTION: This study describes the prevalence and correlates of beliefs that "organic" and "additive-free" tobacco products are less harmful than conventional tobacco products among US adults, stratified by smoking status and preference for Natural American Spirit (NAS), a brand that uses "organic" and historically used "additive-free." METHODS: We analyzed Population Assessment of Tobacco and Health Study Wave 6 data (n = 29 516) for adults aged 18+ years and generated weighted prevalence estimates. We used weighted logistic regressions to model the odds of believing organic/additive-free tobacco products are "less harmful" versus "about the same" or "more harmful." RESULTS: Overall, 10.0% of adults, 15.3% of adults who smoke cigarettes, and 34.0% of adults who smoke NAS believed "organic" tobacco products were less harmful, with similar findings for "additive-free." Belief that "organic" products were less harmful was greater among people who were ages 18-34 (adjusted odds ratio [aOR]: 1.6; 95% confidence interval [CI]: 1.4, 1.9) or 35-54 (aOR: 1.4; 95% CI: 1.1, 1.6), were Black (aOR: 1.3; 95% CI: 1.2, 1.5), currently smoke (aOR: 2.0; 95% CI: 1.7, 2.3), or formerly smoke (aOR: 1.4; 95% CI: 1.2, 1.6). Belief that "additive-free" products were less harmful was greater among males (aOR: 1.3; 95% CI: 1.1, 1.4) and people aged 18-34 (aOR: 1.3; 95% CI: 1.1, 1.5), who currently smoke (aOR: 2.0; 95% CI: 1.7, 2.4) or who formerly smoke (aOR: 1.7; 95% CI: 1.4, 2.0). CONCLUSIONS: Many adults who smoke, particularly those who smoke NAS, believe organic and additive-free tobacco products are less harmful than regular cigarettes. IMPLICATIONS: In light of recent changes in the tobacco marketing environment, this study provides an update on harm perceptions from "organic" and "additive-free" cigarette product descriptors. Results indicate that many US adults continue to believe that "organic" and "additive-free" tobacco products are less harmful tobacco products. These beliefs may continue to mislead people, as they are more prevalent among young people, people who identify as Black, males, people who smoke cigarettes, and those who smoke NAS cigarettes.