Analyses of previously secret tobacco industry documents criticized tobacco companies, including Santa Fe Natural Tobacco Company, for appropriating AI/AN imagery, symbols, and the ceremonial use of traditional tobacco to market commercial tobacco products. In spite of significant declines in cigarette smoking over three decades, one of the smallest declines was observed among American Indians/Alaska Natives (AI/ANs), 7 a priority population with the highest smoking prevalence in the United States (31.8%) 8 and in California (32.2%), 9 where this research was conducted. In 2018, new packaging replaced the banned terms with the phrase “Tobacco Ingredients: Tobacco & Water.” Four of the 14 varieties of American Spirit are marketed as organic. The US Food and Drug Administration required the manufacturer (Santa Fe Natural Tobacco Company, owned by Reynolds America, a division of British American Tobacco) to remove the marketing terms “additive-free” and “natural” from American Spirit packaging and advertising, 6 but allowed the company to retain “natural” in its brand name. 3, 4 Cigarettes marketed as “natural” are more likely to be perceived by youth as less harmful to health, 5 and research examining perceptions about American Spirit has found that the brand appeals more to younger smokers (aged 18–34 years) than to older smokers. 2 In previous studies, smokers and nonsmokers were more likely to perceive American Spirit as the “healthier” option and rated the brand as less likely to cause harm to health compared to other cigarette brands. More than 2.5 million adult smokers incorrectly believe that their cigarettes are less harmful than others, 1 and American Spirit smokers are more than 20 times as likely as smokers of other brands to endorse this false belief.
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