Smoking expectancies for flavored and non-flavored cigarettes among college students

Addictive Behaviors 32 (2007) 1252 – 1261

Smoking expectancies for flavored and non-flavored cigarettes among college students Rebecca L. Ashare a , Larry W. Hawk Jr. a,⁎, K. Michael Cummings b , Richard J. O'Connor b , Brian V. Fix b , William C. Schmidt a b

a Department of Psychology, University at Buffalo, Buffalo, NY 14260, USA Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY 14263, USA

Abstract Several tobacco companies have introduced specially flavored cigarettes, yet little is known about their appeal among college student nonsmokers, regular smokers, and those susceptible to smoking. Undergraduates (N = 424) rated 12 brands of cigarettes on multiple attributes based on manufacturer advertisements. This paper focused on two brands with flavored and non-flavored versions (Camel and Salem). Despite brand, regular smokers and those susceptible to smoking initiation had higher positive expectancies and lower negative expectancies about smoking than nonsmokers. Flavored cigarettes elicited higher positive expectancies than non-flavored counterparts across all groups, including nonsmokers. Indeed, the degree to which flavored Camels had higher positive expectancies than Camel Lights was at least as large in a group of susceptible nonsmokers and experimenters (susceptible/experimenters). Despite being present in nonsmokers and susceptible/experimenters, negative expectancies were significantly lower for flavored versus non-flavored brands. Logistic regressions revealed that positive expectancies predicted “intention to try” each brand for regular smokers and susceptible/ experimenters. These findings suggest that targeting the marketing of positive attributes may be useful in preventing smoking behavior. © 2006 Elsevier Ltd. All rights reserved. Keywords: Smoking; Flavored cigarettes; Expectancies; Advertising; College students

⁎ Corresponding author. Department of Psychology, University at Buffalo, 230 Park Hall, Box 604110, Buffalo, NY 14260-

4110, USA. Tel.: +1 716 645 3650x231; fax: +1 716 645 3801. E-mail address: [email protected] (L.W. Hawk). 0306-4603/$ - see front matter © 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.addbeh.2006.08.011

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1. Introduction Cigarette manufacturers have been using special flavorings in their products such as menthol and licorice to increase the appeal of their brands for decades. However, two major cigarette manufacturers, R. J. Reynolds (RJR) and Brown and Williamson (B and W), have aggressively marketed established cigarette brands with new flavored varieties over the past 5 years (Connolly, 2004). Both companies claim that flavored cigarette varieties are intended solely for adult, regular smokers and were introduced to capitalize on consumer demand for special flavorings in products such as coffee and liquor. Despite these claims, data from two nationally representative surveys found that younger smokers were much more likely to have tried flavored cigarettes than older, established smokers (Giovino et al., 2005). Additionally, tobacco company documents indicate that flavored cigarettes may promote “part-time” smoking (most common among 18- to 24-year-olds; Lewis & Wackowski, 2006). Industry documents also suggest that flavoring masks the harshness and irritation of smoking, which may be especially important to new smokers (Cummings, Morley, Horan, Steger, & Leavell, 2002; Wayne & Connolly, 2002). Further, in 1992, Phillip Morris stated that possible benefits from flavored cigarettes included increased “curiosity to try”, social acceptance (due to better smell and taste), and enjoyment (Carpenter, Wayne, Pauly, Koh, & Connolly, 2005). Overall, flavors may increase positive expectancies regarding smoking. Expectancies are psychological processes that use previous experience and/or beliefs to guide future behavior (Del Boca, Darkes, Goldman & Smith, 2002). For smoking, expectancies may be positive (e.g., beliefs that smoking will enhance positive affect and control weight) or negative (e.g., health risks). Positive expectancies appear to be more strongly related to the initiation of drug use than are negative expectancies (e.g., Brandon & Baker, 1991; Del Boca et al., 2002). For example, among college students, expectancies of positive sensory effects of smoking (e.g., look, feel, and taste) were among the most important factors that differentiated daily smokers from occasional smokers and nonsmokers (Brandon & Baker, 1991). Among adolescents, the relationship between current and future smoking behavior was partially mediated by expectancies about the role of smoking in reducing negative affect (Hine, McKenzie-Richer, Lewko, Tilleczek, & Perreault, 2002; see also Wahl, Turner, Mermelstein, & Flay, 2005). Negative expectancies also vary with smoking status. Not surprisingly, nonsmokers have stronger expectancies for negative health consequences of smoking than do smokers (Brandon & Baker, 1991; Copeland, Brandon, & Quinn, 1995). Although negative expectancies distinguish smokers and nonsmokers, these beliefs appear to be more closely related to cessation among regular smokers, rather than the initiation or escalation of smoking (Copeland et al., 1995; Myers, MacPherson, McCarthy, & Brown, 2003). Despite industry claims, we believe that flavored cigarettes are primarily intended to appeal to younger persons, both smokers and nonsmokers alike. Since many ads for flavored cigarettes appear where college students are likely to see them (Lewis & Wackowski, 2006) and because college students are at an increased risk for initiating smoking relative to those who have never attended college (Gilpin, White, & Pierce, 2005), the present study focused on college students. Specifically, undergraduates examined advertisements for both flavored and non-flavored varieties of Camel and Salem cigarettes and rated each product on a range of positive and negative attributes. Based on prior research (Brandon & Baker, 1991), we hypothesized that regular smokers would have higher positive expectancies than nonsmokers. We expected that nonsmokers would report higher negative expectancies compared to smokers across all

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brands and brand styles. Of greater interest, we included participants with a range of smoking experience in order to test the hypothesis that flavoring would have little effect on committed nonsmokers but relatively large effects on smokers and susceptible nonsmokers and people experimenting with smoking. Relationships among expectancies, smoking status, and intention to try each brand were also examined. Based on prior literature, we hypothesized that positive expectancies would be more strongly related to intentions than would negative expectancies (Brandon & Baker, 1991; Copeland et al., 1995). We also expected that the relationship between expectancies and intentions would be weak among committed nonsmokers but, for flavored cigarettes, would be at least as strong among susceptible nonsmokers and experimenters as among regular smokers. 2. Methods 2.1. Participants Study participants were 424 (240 female, 57%) undergraduates who received experimental credit in introductory psychology for completing the survey. Because smoking patterns vary widely among college students, standard definitions of smoking status are often replaced with alternative classifications (Gilpin et al., 2005; Mayhew, Flay, & Mott, 2000). We utilized statements similar to those of Gilpin et al. (2005) to classify smoking behavior. Non-susceptible nonsmokers (Nonsmokers; n = 250), had not smoked in the past year and reported I never smoked and never will or I’ve tried smoking a few times, and won’t smoke again. Susceptible nonsmokers/experimenters (Susceptible/Experimenter; n = 110), reported that I never smoked, but might try it, or I tried smoking a few times and might try it again. This group included those

Table 1 Demographic and smoking characteristics of the three smoking status groups Smoking status

Gender (% female) Age, mean (SD) Race/Ethnicity White, Non-Hispanic African-American Hispanic Asian/Pacific Islander Usual Brand Camel Salem Marlboro Prior Exposure to Ad Camel Light Camel Exotic Salem Regular Salem Silver Label

Nonsmoker n = 250

Susceptible/Experimenter n = 110

Regular n = 64

56% 19.2 (2.2)

58% 19.3 (3.4)

58% 19.3 (2.1)

67% 9% 5% 19%

79% 0% 6% 17%

56% 2% 9% 32%

N/A N/A N/A

10%a 0%a 42%a

8% 1% 60%

50% 23% 43% 24%

53% 40% 62% 40%

58% 52% 67% 27%

N/A = not applicable. a Among the 60% of susceptible/experimenter participants who reported smoking within the last 30 days.

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who reported smoking occasionally without buying cigarettes, as well as those who described themselves as former smokers. Regular smokers (n = 64) reported buying their own cigarettes and smoking in the last 30 days (Mayhew et al., 2000). Table 1 presents demographic and smoking information across smoking groups. The groups were similar in gender composition (χ 2 b 1) and age (F(2,421) = 0.22, p = 0.81). However, African-Americans were better represented among nonsmokers and Asian/Pacific Islander participants were more strongly represented among regular smokers (χ 2 = 24.6, p b 0.001).1 As shown in Table 1, few participants smoked either Camel or Salem; Marlboro was the most popular usual brand for both smoking groups. 2.2. Web-based survey The web-based survey (available from the authors) required 1 h to complete. After providing demographic and smoking information, respondents viewed ads for 12 brands of cigarettes, including Camel (Exotics, Lights, Turkish Blend), Marlboro (Red, Lights, Ultra Lights), Salem (Regular, Silver Label), and Kool Smooth Fusion, Basic, Quest, and Eclipse. Advertisement order was randomized across participants. For each advertisement, respondents rated each of 28 characteristics using a Likert-type scale ranging from −3 (completely unlikely) to + 3 (completely likely).2 Respondents also rated their intention to try each brand (“If offered [brand], would you try it?”) on a scale from 1 (‘definitely will’) to 4 (‘definitely will not’). The three groups differed in prior exposure to the ads for Camel Exotics, Salem Silver, and Salem Regular (χ2 N 9, p's b 0.02), but not for Camel Light (see Table 1). For Salem Regular and Camel Exotic, prior exposure was greatest among regular smokers and least among nonsmokers. For Salem Silver, the susceptible/experimenter group reported somewhat greater prior exposure compared to the other two groups. 2.3. Data analysis To reduce the number of variables in a manner consistent with prior research on expectancies (e.g. Lewis-Esquerre, Rodrigue, & Kahler, 2005; Myers, MacPherson, McCarthy, & Brown, 2003), we conducted factor analyses (Oblimin rotation) on the ratings for each brand extension. In preliminary analyses, we extracted factors with Eigenvalues N 1. However, because the majority of the variance was accounted for by the first two factors, subsequent analyses extracted only 2 factors. The following items had factor loadings N 0.50 on Factor 1, communalities N 0.3, and loadings b 0.25 on Factor 2 for all brands: satisfying, fun, exciting, interesting, smell good, taste good, friends would like, stimulating, good with a 1

To determine whether race played a strong role in the effects we observed, all analyses were conducted with a sub-sample of only Caucasian participants. All results were comparable to those obtained for the full sample. 2 Six items (satisfying, stimulating, taste good, hard to quit, cause cancer, and addictive) were from the Smoking Consequences Questionnaire-Adult (SCQ-A; Copeland et al, 1995). Three items (feminine, macho, and sophisticated) were from a supplementary scale of the Smoking Effects Questionnaire (SEQ; Rohsenow et al., 2003). Two items (make me eat less and make me cough) appeared on both measures. Two items (friends would like and low tar) were adapted from a previous study of responses to cigarette ads (Hamilton et al., 2004). Six items (fun, exciting, stupid, bad breath, addictive, and good with a drink) were previously related to smoking expectancies (Hendricks & Brandon, 2005; Rohsenow, Colby, Martin, & Monti, 2005). The remaining 9 items appeared relevant to the ads and/or the college sample: interesting, smell good, mature, mild, dangerous, harsh, make me nauseated, for a kid, and for an older person.

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drink, sophisticated, mature, mild, and low tar. The following variables exhibited high factor loadings and communalities on Factor 2 and low loadings on Factor 1 for all products: hard to quit, cause cancer, dangerous, bad breath, stupid, addictive, make me cough, harsh, and make me nauseated. Based on the content of these scales, and comparisons with the SCQ and SEQ, we labeled Factor 1 “Positive Expectancies” and Factor 2 “Negative Expectancies” (Brandon & Baker, 1991; Rohsenow et al., 2003). The remaining items had communalities b 0.3 and/or factor loadings b 0.4 and were eliminated. Scale scores for each factor were computed as the mean of the relevant items, yielding scores from −3 to + 3. Internal consistency was high (Cronbach's α = 0.92–0.95) across brands for both Positive Expectancies and Negative Expectancies. Repeated-measures ANOVAs (3 Smoking Status × 4 Brand Types) were conducted on positive and negative expectancies. Smoking status was a between-subjects factor, whereas brand was a withinsubjects factor. Given the focus on differences in response to flavored and non-flavored cigarette ads, planned comparisons contrasted Camel Exotic vs. Camel Light and Salem Silver vs. Salem Regular. To examine relations among intentions to try a brand, expectancies, and smoking status, separate logistic regressions were conducted for each brand. Intention to try a brand (recoded as either willing or not willing) was the outcome variable. Positive and negative expectancies and smoking status were predictors. Nonsmokers were the reference group. To examine the degree to which smoking status moderated the effect of expectancies, interaction terms were included. 3. Results 3.1. Positive expectancies Fig. 1 presents mean positive expectancy scores for all Smoking Status × Brand Types. As predicted, positive expectancies were highest among regular smokers and lowest among nonsmokers (F(2,421) = 24.4, p b 0.001, partial η2 = 0.10). Positive expectancies were also influenced by flavor, with higher positive expectancies for Salem Silver compared to Salem Regular across smoking status (brand F(1,421) = 155.6, p b 0.001, partial η2 = 0.27; Salem Silver vs. Regular × Smoking Status, F b 1). Similarly, Camel Exotics produced greater positive expectancies than did Camel Lights (brand F(1,421) = 38.4, p b 0.001, partial η2 = 0.08). Interestingly, this difference was at least as strong among susceptible/experimenters (M = 0.45, F (1,109) = 30.6, p b 0.01, partial η2 = 0.22) as it was for regular smokers (M = 0.43, F(1,63) = 8.6, p b 0.01, partial η2 = 0.12), with only a modest effect among committed nonsmokers (M = 0.14, F(1,249) = 5.4, p b 0.05, partial η2 = 0.02; Camel Exotic vs. Light × Smoking Status F(2,421) = 4.9, p b 0.01, partial η2 = 0.02). 3.2. Negative expectancies Mean negative expectancy scores for all Smoking Status × Brand Types are presented in Fig. 2. As expected, negative expectancies were greatest among nonsmokers and lowest among regular smokers (F (2,421) = 6.9, p b 0.01, partial η2 = 0.03). Across all groups, Camel Lights were rated more negatively than were Camel Exotics (F(1,421) = 8.2, p b 0.01, partial η2 = 0.02), an effect that did not reliably vary by smoking status (F(2,421) = 2.0, p = 0.11). For Salem, the non-flavored product was also rated more negatively than the flavored product; however, this effect was reliable among the nonsmoker and susceptible/experimenter groups (F(1,249) = 37.6, p b 0.01, partial η 2 = 0.13 and F(1,109) = 10.1,

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Fig. 1. Positive expectancies for each smoking status group and cigarette brand.

p b 0.01, partial η 2 = 0.09, respectively; Salem vs. Salem Silver × Smoking Status F(2, 421) = 3.3, p b 0.05), but not the regular smokers (F b 1). 3.3. Relationship between expectancies and intention to try To predict intention to try a cigarette, separate logistic regressions were conducted for each brand type (see Table 2). Not surprisingly, across all brands susceptible/experimenters were significantly more

Fig. 2. Negative expectancies for each smoking status group and cigarette brand.

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Table 2 Logistic regression analyses of “Intention to Try” as a function of smoking status, positive expectancies, and negative expectancies % Intend to Try Camel Exotic

Camel Light

Salem Silver

Salem Regular

Non Suscept Reg PE NE Non Suscept Reg PE NE Non Suscept Reg PE NE Non Suscept Regular PE NE

5.2 44.5 72

1.2 30 61

1.6 38.2 61

1.0 18.2 52

B

Wald z-statistics

2.4⁎⁎ 3.6⁎⁎ 0.88⁎⁎ 0.11

45.8 73.6 23.8 0.95

3.5⁎⁎ 4.8⁎⁎ 0.6⁎⁎ −0.09

31.8 54.3 14.3 0.51

3.6⁎⁎ 4.5⁎⁎ 0.67⁎⁎ −0.15

42.5 59.3 15.1 1.3

3.0⁎⁎ 4.5⁎⁎ 0.46⁎ −0.30+

16.1 35.4 7.9 4.7

Odds ratio ref 11.3 36 2.4 1.1 ref 34 120 1.8 0.91 ref 38 90 2 0.86 ref 21 92 1.6 0.08

95% C.I. 5.6, 22.9 15.9, 81.7 1.7, 3.4 0.9, 1.4 10.0, 116.9 33.7, 430.4 1.3, 2.5 0.7, 1.2 12.7, 113.8 28.7, 283.5 1.4, 2.7 0.7, 1.1 4.8, 93.1 20.7, 406.3 1.2, 2.2 0.6, 1.0

p b 0.05 , ⁎⁎p b 0.001, ⁎p b 0.01. NE = negative expectancies, PE = positive expectancies.

+

likely to try each brand than were committed nonsmokers ( p b 0.001), and regular smokers were even more likely than nonsmokers to try each brand ( p b 0.001). Likewise, across all brands, positive expectancies significantly predicted the likelihood one would try a brand. Odds-ratios indicated that as positive expectancies increased one point, participants were 1.5 (Salem Regular) to 2.4 (Camel Exotics) times more willing to try that particular brand. By contrast, negative expectancies were not reliably related to intention to try Camel Light, Camel Exotic, or Salem Silver. Negative expectancies did predict a modest reduction in intention to try Salem Regulars. Somewhat surprisingly, no Smoking Status × Expectancy interaction terms were significant, p's N 0.2. Therefore, these terms were removed from the final models. 4. Discussion The present study investigated college students' positive and negative expectancies for flavored and non-flavored cigarettes and the degree to which expectancies and smoking status predicted intentions to try a brand. Replicating previous research, positive expectancies were higher and negative expectancies were lower among regular smokers compared to nonsmokers (Brandon & Baker, 1991; Copeland et al., 1995). Regular smokers were also more likely to report willingness to try each brand than were nonsmokers. Of greatest interest in the present study were differences between flavored and non-flavored cigarettes and consideration of a susceptible group of nonsmokers and irregular or former smokers.

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4.1. Positive expectancies Tobacco industry documents predicted that flavored cigarettes would appeal to younger smokers (Carpenter et al., 2005). Certainly this was verified in the present study of college students. All groups, including committed nonsmokers (over 68% of whom had never smoked), reported greater positive expectancies for flavored compared to non-flavored cigarettes. For Camel, the susceptible/experimenter group exhibited the greatest increase in positive expectancies for flavored compared to non-flavored cigarettes. Whether this group is a specific target of the cigarette industry's proliferation of flavored cigarettes cannot be addressed by the current data. However, it was clear that flavored cigarettes did not appeal specifically to regular smokers, and there was some evidence that flavored products particularly enhance positive expectancies among young adults who may be susceptible to initiation or escalation of smoking. The finding that college students rated flavored cigarettes more positively is concerning given that expectancy theory posits that expectancies guide behavior (Wahl et al., 2005). In the present study, positive expectancies robustly predicted intentions to try each brand. This is consistent with evidence that, among undergraduate smokers, positive expectancies are strong predictors of cigarette consumption (Brandon, Wetter, and Baker, 1996). More broadly, perceptions about sensory effects of cigarettes predict smoking among adolescents and young adults (e.g., Brandon & Baker, 1991; Lewis-Esquerre et al., 2005). We expected that the relationship between positive expectancies and intentions would be moderated by smoking status. In particular, we anticipated that committed nonsmokers would be relatively invulnerable to trying cigarettes. The absence of such interactions, despite a relatively large sample size, was both surprising and concerning. These results suggest that in addition to group differences in intentions, there is considerable within-group variability, and that positive expectancies account for some of that variability. From a marketing perspective, such broad-spectrum impact seems to be good news for tobacco companies. Enhancing positive expectancies with flavoring may lead to a greater market share of current smokers, and may recruit new smokers or facilitate escalation of smoking. 4.2. Negative expectancies In contrast, negative expectancies were generally unrelated to intentions to try cigarettes. Negative expectancies did show the expected pattern across smoking status (higher in nonsmokers relative to smokers) and were lower for flavored compared to non-flavored cigarettes. It is somewhat troubling that negative expectancies were modest, hovering near the neutral midpoint of the scale. The nature of the items included on the current scale may have influenced our findings. Beliefs about long-term negative consequences of smoking (e.g., causes cancer) may be less relevant to adolescents and young adults than are expectancies about negative social impressions (e.g., smoking makes people less attractive; LewisEsquerre et al., 2005; Myers et al., 2003). The current negative expectancies scale assessed the former, not the latter. Future work including negative social impressions may reveal stronger between-group differences in negative expectancies, as well as stronger relationships to behavioral intentions. Another limitation of our negative expectancies data warrants mention. The ads for the non-flavored cigarettes featured the Surgeon General's Warning, whereas neither ad for the flavored cigarettes included this warning because these ads were flyers or product inserts. However, the effect of this confound appears to have been relatively weak. That is, the differences between flavored and non-flavored

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cigarettes on negative expectancies were generally small. Again, adolescents and young adults may not consider long-term health consequences to be very relevant or important. In sum, the present study demonstrated that flavored cigarettes increased positive expectancies and decreased negative expectancies for smoking, that positive expectancies predicted greater intentions to smoke, and that none of these relationships was specific to regular smokers. This pattern seems consistent with the view that flavored cigarettes serve as “starter” products (Carpenter et al., 2005), rather than as specialty products for regular smokers. This study adds to a growing literature that calls for greater attention to industry strategies that may enhance positive expectancies for smoking. Whether through regulation of flavored cigarettes and related product design features (e.g., Cummings, Brown, & Douglas, in press), consideration of these attributes in prevention programs, or both, attention to factors that influence positive expectancies may reduce the initiation and escalation of smoking by young people. Acknowledgements Portions of this research served as part of doctoral program requirements for Rebecca Ashare at the University at Buffalo under the direction of Larry Hawk. The authors thank Craig Colder for comments on a previous draft of this manuscript. References Brandon, T. H., & Baker, T. B. (1991). The Smoking Consequences Questionnaire: The subjective expected utility of smoking in college students. Psychological Assessment, 3(3), 484−491. Carpenter, C. M., Wayne, G. F., Pauly, J. L., Koh, H. K., & Connolly, G. N. (2005). New cigarette brands with flavors that appeal to youth: tobacco marketing strategies. Health Affairs (Millwood, Va.), 24(6), 1601−1610. Connolly, G. N. (2004). Sweet and spicy flavours: new brands for minorities and youth. Tobacco Control, 13(3), 211−212. Copeland, A. L., Brandon, T. H., & Quinn, E. P. (1995). The Smoking Consequences Questionnaire-Adult: Measurement of smoking outcome expectancies of experienced smokers. Psychological Assessment, 7(4), 484−494. Cummings, K.M., Brown, A, & Douglas, C.E. (in press). Consumer Acceptable Risk: How cigarette companies have responded to accusations that their products are defective. Tobacco Control. Cummings, K. M., Morley, C. P., Horan, J. K., Steger, C., & Leavell, N. R. (2002). Marketing to America's youth: evidence from corporate documents. Tobacco Control, 11(Sup 1), 15−17. Del Boca, F. K., Darkes, J., Goldman, M. S., & Smith, G. T. (2002). Advancing the expectancy concept via the interplay between theory and research. Alcoholism, Clinical and Experimental Research, 26(6), 926−935. Gilpin, E. A., White, V. M., & Pierce, J. P. (2005). What fraction of young adults are at risk for future smoking, and who are they? Nicotine and Tobacco Research, 7(5), 747−759. Giovino, G. A., Yang, J., Tworek, C., Cummings, K. M., O'Connor, R. J., Donohue, K., et al. (2005). Use of Flavored Cigarettes Among Older Adolescent and Adult Smokers: United States, 2004. Chicago, IL: National Conference on Tobacco and Health. Hamilton, W. L., Norton, G. D., Ouellette, T. K., Rhodes, W. M., Kling, R., & Connolly, G. N. (2004). Smokers' responses to advertisements for regular and light cigarettes and potential reduced-exposure tobacco products. Nicotine & Tobacco Research, 6(Supplement 3), S353−S362. Hendricks, P. S., & Brandon, T. H. (2005). Smoking expectancy associates among college smokers. Addictive Behaviors, 30(2), 235−245. Hine, D. W., McKenzie-Richer, A., Lewko, J., Tilleczek, K., & Perreault, L. (2002). A comparison of the mediational properties of four adolescent smoking expectancy measures. Psychology of Addictive Behaviors, 16(3), 187−195. Lewis, M. J., & Wackowski, O. (2006). Dealing with an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands. American Journal of Public Health, 96(2), 244−251.

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