Perceived harm of branded and non-branded cigarettes and snus among US smokers

Background: Little information exists on smokers' perceptions of relative harm of smoking cigarettes and using smokeless tobacco, particularly new smokeless tobacco products, such as snus. Furthermore, researchers typically measure perceived harm of tobacco products without specifying brands. We examined comparative harm perceptions of both branded and unbranded cigarettes and snus. Methods: Online cross-sectional survey of a national sample of 1,266 current or recently quit (within last two years) smokers. Results: Cigarettes (branded and non-branded) were consistently rated as more harmful than snus (branded and non-branded). Participants rated branded cigarettes (Marlboro=5.99, Camel=6.06, Newport=6.07) as more harmful than cigarettes in general (5.87, ps<.001) and branded snus (Marlboro=5.41, Camel=5.37) as more harmful than snus in general (5.08, ps<.001). Perceptions of harm were strongly correlated (rs=0.5-0.6) within products (e.g., comparing snus with branded snus) and for branded products (comparing branded snus with branded cigarettes) regardless of the brand (across and within brands). This pattern of findings was consistent for smokers of different brands and for current and former smokers. Conclusion: Most research on perceptions of harm asks questions about unbranded tobacco products. However, smokers evaluate the harm of branded cigarettes and snus differently than harm of equivalent products without brand names. Because of consistent strong correlations between either Camel or Marlboro snus with either Camel, Marlboro, or Newport cigarettes it is not the brand, but the fact that the product is branded, that elicits different ratings of harm. Future research on consumer perceptions of harm should consider the effect of tobacco product branding.