UC Merced

Introduction

Despite steady declines in the US smoking prevalence over the past 50 years, Natural American Spirit cigarettes (NAS), marketed as natural and organic, have seen a 400% rise in sales. In a sample of smokers with mental illness, based on previous research, we hypothesized that preference for NAS would be associated with younger age, higher education, and a stronger health-orientation.

Methods

Adult smokers were interviewed during acute psychiatric hospitalization in California between 2009-2013, reporting their preferred top 3 brands of cigarettes, smoking behaviors, self-rated health, and dietary and physical activity behaviors. The sample (N=956; M age=38.7, SD=13.5; 48.7% women) identified as 14.5% Hispanic ethnicity and 49.6% White, 23.7% African American, and 23.8% other race.

Results

NAS was identified as a top preferred brand by 15.2% of participants and was the fourth most popular brand for the sample overall. In a multivariate logistic regression, preference for NAS was significantly greater among participants who were younger (OR=0.97), had some college education or more (OR=2.64 to 4.31), ate a low-fat diet (OR=1.56) and reported better overall health (OR=1.26), p's<.05. Identifying as Hispanic ethnicity (OR=1.80) and White race (OR=3.00) also predicted NAS preference, p's<.05. NAS preference did not differ by gender or psychiatric diagnosis.

Conclusions

Study findings indicate greater NAS brand appeal among smokers living with mental illness who are younger, more highly educated, and have a stronger orientation to health, perhaps because they perceive NAS to be a healthier cigarette to smoke. Marketing language that obscures the harms of smoking ought to be prohibited.