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Restricting “Natural” and “Additive-free”: Did FDA’s Agreement with Santa Fe Natural Company Change Advertising for ?

Erin O’Gara, PhD Joanne D’Silva, PhD, MPH Caitlin Weiger, MHS Nicole T. Villaluz, BA Wendy Piedra, MHS Meghan Brigid Moran, PhD

Objectives: The US Food and Drug Administration (FDA) and Santa Fe Natural Tobacco Compa- ny reached an agreement in January 2017 to remove “additive-free” and “natural” from Natural American Spirit (NAS) marketing because these terms led consumers to perceive reduced harm inaccurately. This study sought to update previous research by examining brand marketing fol- lowing these restrictions. Methods: A content analysis was conducted on 244 ads from 2015- 2018. Two coders coded text descriptors, references, and imagery that implied or referenced natural or environmental qualities, and American Indian symbols. Results: From 2015-2018, NAS used descriptors that could imply a natural product, including “organic,” “tobacco and wa- ter,” and “whole leaf.” Imagery included natural images such as plants (79.5%), farms (60.7%), or wood (85.2%). Most ads contained American Indian imagery (90.6%). There were 20 apparent violations of the FDA agreement restricting “natural” and “additive-free” in the 3 months after it went into effect (September-November 2017).Conclusions: Although “natural” and “additive- free” were eliminated from marketing in 2017, NAS relied on a variety of other descriptors and images that could imply a natural product. Research should examine whether these tactics simi- larly convey inaccurate reduced harm to consumers.

Key words: FDA regulation; Natural American Spirit; marketing; harm perception; American Indian imagery Tob Regul Sci.™ 2019;5(4):332-338 DOI: https://doi.org/10.18001/TRS.5.4.3

outed as a premium brand, Natural Ameri- the Tobacco Group purchased international can Spirit (NAS) have become rights in 2016.1 Since the 2002 RJR acquisition, increasingly popular among consumers. NAS has become one of the fastest-growing ciga- TOriginally owned by Santa Fe Natural Tobacco rette brands in the (US).2 Despite Company (SFNTC), NAS and SFNTC were ac- declining prevalence, NAS’s market share quired in 2002 by R.J. Reynolds (RJR), now a di- rose from 1.4% in 2013, to 2.2% in 2016;3 a 157% vision of Incorporated (RAI). increase in only 3 years.4 Whereas RJR retains the domestic rights to NAS, In January 2017, the makers of NAS signed an

Erin O’Gara, Associate Director of Research Programs, ClearWay Minnesota, Minneapolis, MN. Joanne D’Silva, Director of Health Equity Research, ClearWay Minnesota, Minneapolis, MN. Caitlin Weiger, PhD student, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Nicole T. Villaluz, Senior Community Development Manager, ClearWay Minnesota, Minneapolis, MN. Wendy Piedra, Research Assistant, Department of Biochemistry and Molecular Biology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Meghan Brigid Moran, Assistant Professor, Department of Health, Behavior & Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Correspondence Dr O’Gara; [email protected]

332 O’Gara et al agreement with the US Food and Drug Admin- nature and the natural world,9 and appeals to envi- istration’s (FDA) Center for Tobacco Products to ronmental consciousness15 to create brand identity. remove the phrase “additive-free” and the descrip- NAS marketing is also influenced heavily by Amer- tor “natural” from “labels, labeling, advertising, ican Indian traditional tobacco practices.16 Previous and promotional materials” following a 2015 FDA research found that at one time, NAS direct mail warning letter stating that use of these terms violat- marketing included text describing a Pueblo legend ed the 2009 Act.5 Research has in- of sacred tobacco and offered for sale other cultur- dicated that the terms “additive-free” and “natural” ally significant items, such as a “pow-wow blend,” led consumers to perceive inaccurately that NAS and a “Book of Elders” containing interviews with cigarettes were less harmful than other brands.6-8 Indigenous leaders in America and Canada.17 National data have shown that NAS smokers were In light of the 2017 restrictions, this study sought 22 times likely than smokers of other brands to update previous research on NAS marketing9 – to perceive their brand as less harmful,7 and that specifically, to examine how advertising may have the descriptors “additive-free” and “organic” con- changed following the FDA agreement prohibit- tribute to these perceptions.6 In fact, NAS market- ing terms “additive-free” and “natural.” Findings ing employed specific words (eg, natural, organic, have the potential to inform future regulations on tobacco and water, whole leaf), which have the po- descriptors and other tobacco industry marketing tential to convey reduced harm.9 These findings are tactics. bolstered by several studies noting that cigarettes labeled as natural, organic, or additive-free are per- METHODS ceived as healthier or less harmful alternatives by consumers, despite the lack of evidence to substan- A descriptive content analysis was conducted tiate these beliefs.8,10,11 on a sample of 244 unique NAS ads from January 2015 through June 2018. This timeframe reflects The 2017 agreement was only the most recent in 2 years prior to and one year and 6 months fol- a series of warnings and complaints about NAS’s lowing the FDA agreement (January 2017), which deceptive advertising. The Federal Trade Com- went into effect 7 months later (August 2017). Ads mission first cited SFNTC in 2000 for their mis- were identified and accessed through Rutgers Uni- leading use of “additive-free” and mandated that versity’s Trinkets and Trash repository (N = 92), NAS ads include the disclosure: “No additives in 12 Competitrack’s ad database (N = 9), and Mintel’s our tobacco does NOT mean a safer .” Comperemedia service (N = 143). Trinkets and In 2010 (when NAS was a part of RAI), attorneys Trash documents tobacco industry marketing and general from 33 states and the District of Colum- promotional tactics including ads, direct mail- bia threatened a lawsuit over use of the term “or- ings, e-mails, sweepstakes, and coupons. The site ganic,” which resulted in an agreement to include and its contents are free and publicly available at the following warning for all products marketed www.trinketsandtrash.org. Competitrack (now as “organic”: “Organic tobacco does NOT mean 13 called Numerator) is a market research firm that safer cigarettes.” However, subsequent research conducts surveillance of advertising by monitor- has found that statements such as the organic and ing print, digital, outdoor, and broadcast ads. no-additives have minimal influence on consum- 11,14 Mintel is a market research firm that maintains a ers’ perceptions of harm. panel of US adults and collects the direct mail and Although the 2017 agreement with FDA restrict- email advertisements that panelists receive. Each ed use of “natural” and “additive-free,” SFNTC was of these databases allows researchers to identify allowed to retain the term “natural” in the Natural ads by brand. Our search was limited to the brand American Spirit brand name and trademarks and “Natural American Spirit” between the years 2015 was explicitly granted permission to continue us- and 2018. Trinkets and Trash ads were accessed in ing the phrase “Tobacco Ingredients: Tobacco & June 2018, and Competitrack and Mintel ads were Water.” Beyond this phrase, NAS marketing uti- accessed in April 2018. All ads from each source lizes a range of other tactics, including bold colors, were included and duplicates were eliminated. Two American Indian imagery, themes and imagery of trained researchers coded the ads and reliability

Tob Regul Sci.™ 2019;5(4):332-338 DOI: https://doi.org/10.18001/TRS.5.4.3 333 Restricting “Natural” and “Additive-free”: Did FDA’s Agreement with Santa Fe Natural Tobacco Company Change...

Table 1 Frequency of Descriptors, Text References and Imagery in NAS Advertising, 2015 – 2018 Total (across 2015 2016 2017 2018 all years) N (%) N (%) N (%) N (%) N (%) Text Descriptors Natural 23 (74.2) 92 (88.5) 58 (66.7) 0 173 (70.9) As nature intended 4 (12.9) 6 (5.8) 11 (12.6) 0 21 (8.6) Additive-free 22 (71) 83 (79.8) 57 (65.5) 0 162 (66.4) Organic 14 (45.2) 65 (62.5) 43 (49.4) 5 (22.7) 127 (52) Whole leaf 0 28 (26.9) 19 (21.8) 5 (22.7) 52 (21.3) Tobacco and (+) water 0 30 (28.8) 34 (39.1) 10 (45.5) 74 (30.3) Real 0 0 12 (13.8) 21 (95.5) 33 (13.5) Simple 0 2 (1.9) 14 (16.1) 21 (95.5) 37 (15.2) Different 7 (22.6) 66 (63.5) 42 (48.3) 21 (95.5) 136 (55.7) Printed on recycled paper 18 (58.1) 90 (86.5) 63 (72.4) 8 (36.4) 179 (73.4) Text References US-grown tobacco 6 (19.4) 29 (27.9) 10 (11.5) 5 (22.7) 50 (20.5) SFNTC as small business 0 4 (3.8) 8 (9.5) 6 (27.3) 18 (7.4) Local or small farms 2 (6.5) 28 (26.9) 10 (11.5) 3 (13.6) 43 (17.6) Eco-friendly or sustainable practices 12 (38.7) 49 (47.1) 38 (43.7) 14 (63.6) 113 (46.3) Farms, farmers or farming 6 (19.4) 72 (69.2) 24 (27.6) 9 (40.9) 63 (25.8) Imagery Farms 15 (48.4) 72 (69.2) 52 (59.8) 9 (40.9) 148 (60.7) Plants 17 (54.8) 87 (83.7) 71 (81.6) 19 (86.4) 194 (79.5) Bugs and wildlife 0 25 (24) 8 (9.2) 2 (9.1) 35 (14.3) Water 10 (32.3) 36 (34.6) 19 (21.8) 1 (4.5) 66 (27) Wood or other natural substance 17 (54.8) 92 (88.5) 77 (88.5) 22 (100) 208 (85.2) American Indian imagery 25 (80.6) 92 (88.5) 82 (94.3) 22 (100) 221 (90.6) Recycling symbol 18 (58.1) 90 (86.5) 63 (72.4) 8 (36.4) 179 (73.4) Total Ads 31 104 87 22 244

Note. Because each ad was coded for the presence of multiple descriptors, columns do not add to 100%.

was assessed using Cohen’s kappa (ĸ ≥.90 across all free,” or unique aspects of the product (such as ads). Inconsistencies were resolved through follow- “tobacco and water,” “whole leaf,” “organic”) were up discussions between coders. coded as exact text. References to how the tobacco Ads were coded for the presence of text descrip- was grown and environmentally friendly practices tors (limited to specific words or phrases), text ref- were coded only when there was an explicit refer- erences (more general textual claims), and imagery ence. For a complete description of codes related that implied or referenced a variety of natural or to natural and environmentally friendly text and environmental qualities, as well as American In- imagery, see Moran et al.9 Codes for the presence dian symbols and references to traditional tobacco. of Native imagery and traditional tobacco were Text descriptors that included “natural,” “additive- created based on previous research on tobacco in-

334 O’Gara et al

Figure 1 Presence of “Natural” and “Additive-free” Descriptors in NAS Ads, August 2015 - December 2017

120 111

100 98 90 "Natural" "Additive-Free" Total number of ads included for time period 80

60

Number of ads Number 48

40 34 35 30

20 19 20

0 Post-FDA warning letter: FDA agreement implementation period: FDA restrictions in effect: August 2015 - January 2017 January 2017 - August 2017 September 2017 - December 2017

dustry use of American Indian culture.17 To assess 2017, the 7-month implementation window al- our study objective, we calculated frequencies and lowed by the FDA. However, 20 ads included “ad- prevalence rates of each code for the time periods ditive-free” or “natural” from September 2017 to before and after FDA regulatory activity. November 2017 (Figure 1). Other descriptors that may convey “natural” as- RESULTS pects of the product, such as “organic,” “tobacco Results indicate that NAS continued to use text and water,” and “whole leaf” remained throughout descriptors that may imply that their brand was the period examined. Over half (55.7%) the ads “natural” across the entire 2015-2018 timeframe included the word “different” or a variation there- (Table 1). Most ads contained “natural” (70.9%) of. Although “different” appears as an integral part and “additive-free” (66.4%). Despite the 2015 of NAS’s “Real. Simple. Different.” campaign un- FDA warning letter, the prevalence of “natural” veiled in 2017 (Figure 2), it also was included in and “additive-free” increased in ads in 2016 com- ads preceding the launch of the campaign. In 2018, pared to 2015 (natural: 74.2% in 2015 vs 88.5% all but one ad included “Real. Simple. Different.” in 2016; additive-free: 71% in 2015 vs 79.8% in whereas the terms “natural,” “additive-free,” and “as 2016) before decreasing slightly in 2017 (natural: nature intended” no longer appeared. 66.7%; additive-free: 65.5%) and then phasing out Imagery of plants (79.5%) and farms (60.7%) completely in 2018. NAS continued to use the re- appeared in over half the ads, and almost all con- stricted terms between January 2017 and August tained wood as a “natural” background (85.2%).

Tob Regul Sci.™ 2019;5(4):332-338 DOI: https://doi.org/10.18001/TRS.5.4.3 335 Restricting “Natural” and “Additive-free”: Did FDA’s Agreement with Santa Fe Natural Tobacco Company Change...

Figure 2 Examples of Natural American Spirit Print Advertisements Before (left) and After (right) the 2017 FDA Agreement

In addition to the NAS logo, most ads contained ble that the date of ad placement occurred prior Native imagery (90.6%) such as a Thunderbird, or to the agreement. At this time, FDA investigation a mandala-like background, similar in shape and of these apparent violations is unknown. Ongoing design to those used by many southwestern US monitoring of NAS marketing is warranted. tribes or in star quilts created by other Native com- NAS continued to rely on a variety of tactics munities. NAS also promoted use of recycled ma- that could implicitly communicate naturalness. terials. Most ads (73.4%) (including all direct mail) Environmental consciousness – exemplified by contained a recycling logo and message indicating support for community programs, NAS supplier that the ad was printed on recycled paper. farming practices, and recycling initiatives – con- tinue to play a noteworthy role in brand market- Conclusions ing, as do other elements of nature and the natural We found that although NAS eliminated de- world, such as imagery of plants and farms, and scriptors “natural” and “additive-free” from mar- wooden backgrounds. NAS previously used packs keting materials beginning in 2018, the brand used to advertise a corporate social responsibility cam- ads featuring these terms for the entire 7-month paign called “Respect for the Earth,” touting their implementation period between the agreement use of ‘100% zero-waste-to-landfill’ manufacturing signing and going into effect. We noted 20 ads facilities, ‘earth-friendly tobacco’, and easier pack that appeared to be in violation of the FDA agree- recycling to portray an environmentally conscious brand with strong ethics regarding care for the nat- ment in the 3 months after it went into effect (from 15 September 2017 to November 2017). It is possi- ural world. The use of natural backgrounds, plant

336 O’Gara et al imagery, and references to environmentally-friend- IMPLICATIONS FOR TOBACCO ly or sustainable practices increased as the more REGULATION overt forms of portraying a “natural” image (such Although NAS has removed “additive-free” and as the now restricted “natural” and “additive-free”) “natural” from their advertising, there remain decreased or disappeared from marketing materi- many elements of brand image and messaging that als. This is particularly problematic given research could imply reduced harm. The current “Real. identifying eco-friendly references, as well as the Simple. Different.” campaign, in conjunction with still-permitted phrase “tobacco and water” as con- the continued use of the word “natural” in the NAS tributing to reduced risk perceptions.18 brand name, environmental messages and contin- The associations of American Indian imagery ued use of Native imagery may implicitly com- and traditional tobacco exploit culture and may municate that NAS cigarettes are less harmful and connote tobacco uses viewed as sacred by many “different” from other cigarette brands. Given the people. However, FDA action and most prior re- resources that the tobacco industry applies to prod- search on NAS does not address this important uct marketing, it is unlikely that restricting a few aspect of the company’s marketing.10 Not only is specific terms will sufficiently change brand image, this element of brand identity disrespectful toward identity, and resulting consumer perceptions of re- what is a sacred medicine for many communities, duced harm. One viable policy option to reduce it also may convey a unique lack of harm to con- the impact of marketing is plain packaging. Experi- sumers by implying the sacred aspects of tradi- mental evidence has demonstrated that standardiz- tional tobacco are present in their manufactured ing packs through plain packaging results in parity product. Further research on the specific harms between brands and more realistic consumer per- of American Indian imagery and cultural symbols ceptions of harm.21 Further research should be con- used by NAS is necessary. In particular, research is ducted on the various aspects of brand marketing needed to understand the impact of these images that continue to influence consumer perceptions, on Native smokers. FDA should seek American and additional FDA action, including pursuing Indian tribal consultation in regulating these as- plain packaging policies, should be taken to limit pects of cigarette marketing. these marketing tactics. A limitation of this study is that we cannot be sure that the 3 advertising databases provided a Human Subjects Statement completely comprehensive sample of NAS adver- This study did not involve human participants. tising. Additionally, the dates of ads were obtained from these databases and we did not have the abil- ity to verify their accuracy. Conflict of Interest Statement This content analysis illustrates that NAS uses The authors have no conflicts to disclose. many tactics that could contribute to the overall “natural” image that the brand has cultivated. Thus, Acknowledgements the removal of only 2 specific terms may be insuf- The authors acknowledge Dr. Jane Lewis and ficient to challenge NAS brand image and identity. the researchers and staff at the Rutgers School of The tobacco industry has a long history of circum- Public Health who maintain the Trinkets and Trash venting restrictions, such as introducing different database. color packaging to reflect strength when “light” Dr. Moran’s effort is supported by NIDA and and “mild” were banned as descriptors following the FDA Center for Tobacco Products (CTP) the Tobacco Control Act,19 thereby continuing (K01DA037903, PI: Moran). The content is solely to suggest reduced risk to consumers.20 Although NAS is adhering to FDA stipulations, their brand the responsibility of the authors and does not nec- marketing continues to suggest a natural product. essarily represent the official views of the NIH or Additional research to examine whether these tac- the Food and Drug Administration. tics are associated with inaccurate reduced harm Dr. O’Gara, Dr. D’Silva, and Ms. Villaluz’s ef- perceptions is warranted. forts were supported by ClearWay Minnesota.

Tob Regul Sci.™ 2019;5(4):332-338 DOI: https://doi.org/10.18001/TRS.5.4.3 337 Restricting “Natural” and “Additive-free”: Did FDA’s Agreement with Santa Fe Natural Tobacco Company Change...

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