Decoding consumers' interpretations of 'additive-free' and 'tobacco & water' cigarette advertising claims

Objectives: In the USA, some tobacco companies replaced the marketing phrase '100% natural additive-free tobacco' with 'tobacco ingredients: tobacco & water' (T&W) after receiving warnings from the US Food and Drug Administration. This study assesses how people interpret the now-restricted additive-free claims and newer T&W claims on Natural American Spirit (NAS) and L&M cigarette packs. Methods: An online between-subjects experiment randomised 2526 US adults to view one of three packs: an NAS additive-free pack, an NAS T&W pack or an L&M T&W pack. Participants provided their interpretations of the claim they viewed in an open-text response box. n=810 responses were coded, with frequency reported overall, by experimental condition, and by product harm perceptions. Results: Interpreting the claim as meaning 'fewer chemicals/harmful ingredients' was significantly more frequent in the NAS additive-free (47.7%) condition but remained common among those in the NAS T&W (27.2%) and L&M T&W (20.3%) conditions (p<0.01). For all conditions, the 'fewer chemicals' interpretation was more common among those who believed the product was less harmful than other cigarettes (p<0.001). Some participants (8%-15%) interpreted the claim they saw to mean the product was less addictive or had less nicotine than other cigarettes, with no significant differences by condition. Conclusions: Like 'additive-free', 'tobacco and water' marketing claims are commonly interpreted as meaning cigarettes have fewer chemicals or harmful ingredients, suggesting they may similarly function as unauthorised modified exposure claims. Regulatory action and educational interventions are warranted to reduce use of these misleading claims and to correct misperceptions.