Objective: To examine how the US tobacco industry markets cigarettes as "natural'' and American smokers' views of the "naturalness'' (or unnaturalness) of cigarettes.
Methods: Internal tobacco industry documents, the Pollay 20th Century Tobacco Ad Collection, and newspaper sources were reviewed, themes and strategies were categorised, and the findings were summarised.
Results: Cigarette advertisements have used the term "natural'' since at least 1910, but it was not until the 1950s that "natural'' referred to a core element of brand identity, used to describe specific product attributes (filter, menthol, tobacco leaf). The term "additive- free'', introduced in the 1980s, is now commonly used to define natural cigarettes. Tobacco company market research, available from 1970 to 1998, consistently revealed that within focus group sessions, smokers initially had difficulty interpreting the term "natural'' in relation to cigarettes; however, after discussion of cigarette ingredients, smokers viewed "natural'' cigarettes as healthier. Tobacco companies regarded the implied health benefits of natural cigarettes as their key selling point, but hesitated to market them because doing so might raise doubts about the composition of their highly profitable "regular'' brands.
Conclusion: Although our findings support the idea advanced by some tobacco control advocates that informing smokers of conventional cigarettes' chemical ingredients could promote cessation, they also suggest that such a measure could increase the ubiquity and popularity of "natural'' cigarettes. A more effective approach may be to "denaturalise'' smoking.