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CHAPTER5:MARKETINGANDCONSUMERPERCEPTION INTRODUCTION Thischapterisconcernedwithaddressingthequestionastowhethertobaccocompanymarketingof mentholcigarettesincreasestheprevalenceofsmokingbeyondtheanticipatedprevalenceifsuch cigaretteswerenotavailable,andifthisisthecaseinsubgroupswithinthepopulation.Accordingly, chapter5reviewsmentholcigarettemarketingstrategies,againstthebackgroundofbroader tobaccomarketingstrategiesandwithreferencetogeneralmarketingprinciples.Inaddition,this chapterexaminesconsumerbeliefsrelevanttomentholcigarettes. Specifically,Chapter5willaddressthefollowingquestions: Howismentholmarketingdifferentfromandsimilartononmentholmarketing,intermsof product,place,price,promotionandpackaging? Whathealthreassurancemessageswere/areusedinmentholmarketingmessages? Whatothermessageswere/areconveyedtopotentialconsumersbymentholmarketing messages? Whoarethetargetpopulationsformentholmarketing?Isthereevidencetoshowthatyouth, women,andspecificracial/ethnicgroupsweretargeted? Doesmentholmarketinginfluencetheperceivedtasteand/orsensoryexperienceofmenthol cigarettes? Doconsumersperceivementholcigarettesassaferorlessharmfulthannonmentholcigarettes? Chapter4containsadditionalinformationonthehistoryofmentholcigarettemarketing. METHODS Chapter2providedthegeneralframeworkforthereportandtheTobaccoProductsScientific AdvisoryCommittees(TPSAC)approachtogathering,reviewingandweighingevidence.Usingthis approach,chapter5drewonpeerreviewedpapersandgovernmentreports;whitepapersand analyseseitherwrittenorcommissionedbytheFDA;tobaccocompanypresentationsandwritten submissions;andpublicpresentationsandcommentstoTPSACthatprovideddatarelevanttothe topicathand.

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HOWISMENTHOLMARKETINGDIFFERENTFROMANDSIMILARTONONMENTHOLMARKETING, INTERMSOFPRODUCT,PLACE,PRICE,PROMOTIONANDPACKAGING? Thissectionaddressessimilaritiesanddifferencesbetweenmentholandnonmentholmarketing. Thestudiesandreportswereorganizedaccordingtotheelementsthatmakeupthetobacco marketingmix.Likethemarketingofotherproducts,cigarettemarketingstrategytypicallyinvolves specifyingatargetaudienceandestablishinganappropriatemarketingmixknownasthe4Ps, involvingproduct,place,price,andpromotion(NCI2008).Productreferstobrandnameandvariety, aswellasmoretangiblephysicalaspectsoffunctionality.Placereferstowheretobaccoproducts aresoldandtheiravailabilitytoconsumers.Priceincludeswholesaleandretailpricing,andother discountstrategies.Promotionincludesadvertisingintraditionalandnontraditionalmedia,aswell assponsorship,sampling,directmarketingandotherstrategies.AfifthPpackagingis sometimesaddedinmorerecentformulationsofthe4Psmodel,althoughpackagingcanalsobe includedeitheraspartofProductorPromotion. Product Mentholcigarettesaccountedfor27percentofallcigarettessoldintheU.S.in2009(AltriaClient Services,July,2010;Graves/R.J.ReynoldsTobaccoCo.,July,2010).AccordingtotheFederalTrade CommissionsCigaretteReportfor2006(themostrecentavailable),mentholmarketshareincreased from16percentin1963to27percentin2005ofallcigarettesales,thendecreasedto20percentin 2006(FederalTradeCommission2009).However,thisdropinmarketsharewasnotreflectedinthe datathattobaccocompaniesprovidedtoFDA.Mentholmarketsharehasbeenincreasingsince 2005,andthecurrentshareisashighasithasbeensincethe1980s.Thesepatternswerereportedin submissionsfromthethreemajortobaccocompanies,Altria(manufacturerofMarlboro),R.J. ReynoldsTobaccoCompany(manufacturerofKool,Salem,andCamel),andLorillard(manufacturer ofNewport).Theprevalencesurveysreviewedinchapter4alsoreflectincreasingpreferencefor mentholcigarettesamongsmokers. Loomis(Oct2010)describedsalestrendsusingACNielsenscannerdatathatwerecollectedbetween August2008andJuly2010fromconveniencestoresandacombinationoffoodretailers,drugstores, andmassmerchandisers.Consistentwiththeindustrysreports,thepercentoftotalsalesfor mentholcigarettesincreasedslightly,to27.0percentfrom25.1percentinconveniencestoresandto 25.7percentfrom24.5percentinthecombinedchannel.Approximately80percentof195different brandfamiliesfeaturedatleastonementholvariety.Mentholvarietiesaccountedfor36.5percent ofthe1,401varietiesofcigarettessold. Therearemorethan350differentvarietiesofmentholcigarettes(R.J.ReynoldsTobaccoCompany, July,2010),butfivebrandfamiliesaccountedfor20.6percentoftotalmarketsharein2009(Altria ClientServices,July2010,Figure2.2).AsshowninAltriasfigure,marketsharewas9.8percentfor Newport,5.4percentforMarlboroMenthol,2.5percentforKool,and1.6percentforSalem.In addition,a1.3percentmarketshareforCamelMentholwasreportedseparatelybyAltria.The patternformarketshareisreflectedinthebrandpreferencesofadultsmokersaged20orolder: 11.6percentsmokedNewport;5.9percent,MarlboroMenthol;2.7percent,Kool;1.2percent, Salem;and8.9percentsmokedothermentholbrands(NHANES200708,seeCaraballo&Asman 2010).Additionalcomparisonsofbrandpreferencebyrace/ethnicity,gender,andagegroupare summarizedinchapter6.

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Newporthasbeenthemostpopularmentholbrandsince1993(LorillardJuly,2010).Itisthemost popularcigarettebrandamongAfricanAmericansmokers,preferredby49.5percentofAfrican Americansmokersaged12orolder(NSDUH2005,seeNSDUHReport2007).Newportisdistinctly morepopularwithyoungersmokers:23.2percentofadolescentsmokers(ages1217)and17.8 percentofyoungadultsmokers(ages1825)smokedNewport,butonly8.7percentofolder smokerspreferredthebrand(NSDUH2005,seeNSDUHReport2007).Thebrandspopularitywith youngersmokersisevidentinallthreeracial/ethnicsubgroupsthatwereexaminedintheanalysisof theNSDUH2000databyGiovinoetal.(2004).AmongAfricanAmericans,Newportwasthemost frequentlyusedbrand.OfAfricanAmericanswhosmokedinthepast30days,79.2percentof1217 yearolds,76.7percentof1825yearolds,and31.5percentofadultsaged26oroldersmoked Newport.AmongHispanicsmokers,Newportwasthesecondmostpopularcigarettebrand, preferredby31.4percentof1217yearolds,16.7percentof1825yearolds,and7.1percentof adultsaged26orolder.NewportwaslesspopularamongnonHispanicwhitesmokers,butpreferred by18.0percentof1217yearolds,9.3percentof1825yearolds,and2.9percentofadultsaged26 orolder.Fromitsintroductionin1957,Newportwasanexclusivelymentholbrand,butnonmenthol varietiesweretestmarketedinthe1980s(Stein1982)andNewportRed,anonmentholvariety,was introducedin2010. KoolandSalem(bothmanufacturedbyR.J.ReynoldsTobaccoCompany)havebeenexclusively mentholbrandssincetheirintroductionandgainedthelargestmarketshareinthe1960s.Koolisthe secondmostpopularcigarettebrandamongAfricanAmericansmokers,preferredby11.4percentof AfricanAmericansmokersaged12orolder(NSDUH2005,seeNSDUHReport2007).Thebrandis morepopularwitholdersmokers:AmongAfricanAmericans,Koolwasthecigarettebrandusedmost oftenby14.1percentofadultsaged26orolder,4.6percentof1825yearolds,and2.1percentof 1217yearoldswhosmokedduringthepast30days(NSDUH2000,seeGiovinoetal.2004).Salemis alsopreferredbyoldersmokersandisthefourthmostpopularcigarettebrandamongAfrican Americansmokers:6.9percentofadultsaged26orolder,and1.9percentof1825yearoldsandof 1217yearoldsusedSalemmostoften(NSDUH2000,seeGiovinoetal.2004).AmongHispanic smokersaged26orolder,3.6percentsmokedKooland3.4percentsmokedSalem.Salemwas slightlymorepopularthanKoolamongnonHispanicwhitesmokersaged26orolder(3.0percentvs. 1.8percent).AmongHispanicsandnonHispanicwhites,lessthan1percentofyoungersmokers reportedsmokingthesebrands.Salemisalsofavoredprimarilybyfemalesmokers(Giovinoetal. 2004).

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Introducedin1965,MarlboroMenthol(manufacturedbyAltria/PhilipMorrisUSA)isnowthesecond leadingbrandofmentholcigarettesintheU.S.;itsurpassedKoolandSaleminpopularityafterthe introductionofMarlboroMildsin2000(AltriaJuly,2010).Itsincreaseinmarketshareisreflectedin theCaraballo(2010)analysisoftheNSDUHdata:Theproportionofsmokersaged20orolderfor whomMarlboroMentholwasthebrandusedmostoftenincreasedfrom3.9percentin20032004, to4.2percentin20052006,andto5.9percentin20072008(table5inCaraballo&Asman2010). Tobaccocompaniesmanipulatetheconcentrationofmentholtoachieveadesiredtaste,aroma,and coolingsensationbasedonanticipatedconsumerpreferenceanddemand.Asdiscussedinchapter3, manycigarettescontainmentholinquantitiesinsufficienttobeconsideredacharacterizingflavor. Lorillarddescribedthisuseofmentholasanalogoustotheuseofafewgrainsofsaltinasweet dish(Lorillard,July,2010,p.19).Lowerconcentrationsofmentholareknowntoappealtoyounger smokersandwomen(Kreslakeetal.2008NTR;Lee&Glantz,inpress).Asurveyofproducts purchasedandtestedin2003observedlowerconcentrationsofmentholincigaretteslabeledlight andultralight(Celebucki,Wayne,Connolly,etal.2005).Inthefullflavor,100mmvarieties, mentholconcentration(measuredinmilligramspergramoftobaccoweight)was2.44mg/gfor Newport,2.64mg/gforMarlboroMenthol,2.78mg/gforSalem,and3.56mg/gforKool(Celebucki etal.2005).AdifferentrankorderofbrandswasobservedinAltriassummaryofproductsthatwere testedin20082009:2.9mg/gforNewport,3.3mg/gforSalem,4.4mg/gforKool,and4.5mg/gfor MarlboroMenthol(alsofullflavor,100mmvarieties)(July,2010,Table1.3).Kreslakeetal.(2008, AJPH)comparedmentholconcentrationforeightproductstestedin2007withvaluesreportedin tobaccoindustrydocumentsforthesamebrands.Theauthorsobservedthattheconcentrationof mentholhaddecreasedinNewport,Kool,andSalembrandsbetween2000and2007,andincreased by25percentinMarlboroMenthol.Theyconcludedthatincreasingmentholcontentwasintended torepositionMarlboroMentholforoldersmokersandtodistinguishitfromMarlboroMilds,a varietywithalowermentholcontentthatappealedtoyoungersmokers.Lorillardpresenteddata indicatingthatthementholconcentrationofitsNewportbranddidnotdecreaseduringthistime period(July2010,Fig1).Additionalresearchaboutconsumerperceptionsofmentholcontentis addressedlaterinthischapterandinchapter6. Place Mentholandnonmentholcigarettesaredistributedinidenticalchannels.Theprimaryvenuesare retailoutlets:conveniencestores,smallgroceryorcornerstores,gasstations,liquorstores, supermarkets,massmerchants,pharmacies,andtobaccostores.ThetotalnumberofU.S.storesthat sellcigarettesisunknown.The2007EconomicCensusidentifiedatleast100differenttypesof businessesthatselltobaccoandestimatedsalesforapproximately235,000retailersintheU.S. (http://www.census.gov/econ/census07/).However,thatfigurelikelyunderestimatesthetotal numberofretailersbecausethesurveyislimitedtopayrollestablishments.Alargerestimateof 543,000retailerswasobtainedbyextrapolatingfromthesubsetofstatesthatmaintainedlicensing records(DiFranza,Pecketal.2001). Theretailchannelisideallypositionedtotargetthelowerincomeandracial/ethnicminority populationswhosmokementholcigarettes.Indeed,inequitiesintheconcentrationoftobacco retailersbyneighborhooddemographicsarewelldocumented.Forexample,thetobaccoretailer density(outletsperroadwaykilometer)wasalmostfourtimesgreaterinErieCountycensustracts withthelowestincomeresidentsthanintractswiththehighestincomeresidents;tobaccoretailer densitywastwotimesgreaterintractswiththehighestproportionsofAfricanAmericanresidents thanintractswiththelowestproportions(Hyland,Travers,etal.2003).Similardisparitiesintobacco outletdensitybyincome,race/ethnicityorbothwereobservedincensustractsinNewJersey(Yu, Peterson,Shefferetal.2010),Iowa(Schneider,Reid,Peterson,etal.2005),andChicago(Novak,

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Reardonetal.2006).Inaddition,moretobaccoretailerswerelocatednearCaliforniahighschools withlargerproportionsoflowincomeandHispanicstudents(Henriksen,Feigheryetal.2008).Such disparitiesintobaccoretailerdensitycontributetothegreateravailabilityofcigarettes,both mentholandnonmenthol,inareasofsocialandeconomicdisadvantage. Price Priceisacriticalfeatureoftobaccomarketingandinfluencesmyriadaspectsofsmokingbehavior. Higherpricesdiscourageinitiation,reduceconsumption,promotequitting,preventrelapse,andmay leadsmokerstosubstitutecheaperbrands(Chaloupkaetal.2010).AccordingtotheFederalTrade CommissionsCigaretteReport,thetobaccoindustryspendsthelargestshareofitsannualmarketing budget74percentof$12.5billionin2006onpricediscounts(FederalTradeCommission2009). Thissectionusesthetermpricepromotionstorefertodiscountsandotherstrategiesthatreduce thepriceofcigarettesatthepointofsale,suchasretailerpromotionalallowances,multipackoffers andgiftswithpurchase.Additionaldataaboutexpendituresforsalespromotionsinrelationtoother marketingactivitiesisprovidedinthesectiononPromotion. Informationaboutpriceandpricepromotionswasobtainedfrommultiplesources,including submissionstoFDAbytobaccocompaniesandotherpresentationstoTPSAC,aswellaspeer reviewedarticlesthatanalyzeddatafromretailscanners,orreceiptsfromsinglepackpurchases,or auditsofadvertisedpricesatpointofsale,orpurchasepricesreportedbysmokersthemselves.Most studiesexaminedreporteddatafromnationallyrepresentativesamplesofstoresorsmokers.The studiesbelowaregroupedbydatasource. Industrysubmissions InitssubmissiontoFDA,R.J.ReynoldsTobaccoCo.reportedthattheaveragepricepaidpercarton ofcigaretteswasslightlyhigherformentholthanfornonmentholcigarettesforeachyearfrom2000 to2009,withmorediscrepantpricesobservedinmorerecentyears(e.g.,anaverage$49for mentholand$46fornonmentholin2009)(presentationbyGraves/RJReynolds,July,2010).Dataon theaveragepricepaidperpack(whichconstitutesthewaythatthemajorityofsmokersbuytheir cigarettes)wasnotprovided,butinresponsetoaquestion,MonicaGravesfromR.J.Reynolds indicatedthesametrendsheldforpackprices.Thesedatawerepresentedinanaggregatedformfor theentireindustry,andnodatawerepresentedbycompanyorbyindividualbrand,precluding determinationoftheuseofdifferentpricingapproachesforindividualbrands.Inaddition,thedata didnotaddresswhethertherewasadifferentialpricepaidformentholandnonmentholcigarettes ingeographicareaswithdifferentproportionalrepresentationsofrace/ethnicity,orduringfocaltime periods(e.g.,whentobaccotaxeswereincreased). From2000to2009,theproportionofsalesvolumewithapricepromotionnearlydoubledfornon mentholcigarettes(to71percentfrom36percent)anditmorethandoubledformentholcigarettes (to67percentfrom26percent).However,thesedataweresimilarlyaggregatedoverbrandsand companies,andbygeographiclocation,andwerenotprovidedformorefinegrainedtimeperiodsin relationtotobaccotaxincreases.Inaddition,theseparticulardataonlyindicatewhetherornot somekindofpricepromotionwasappliedtomentholandnonmenthol,andnottherelativevalueof thepricepromotion.R.J.Reynoldsdrewattentiontothementholshareofshipmentsbeingflatfrom 2000to2004duringaperiodwhenthepercentageofvolumepromotedformentholincreased,and alsothatthementholshareofshipmentsgrewfrom2005to2009whenmentholpromotionallevels wererelativelystable.Thisinterpretationoverlooksthealternativethatthepercentageofvolume promotedmayhavereachedacriticalthresholdby2005,whichactedtoincreasetheshareof mentholshipmentsthereafter.

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Retailscannerdata CigarettepackpricesandsalesvolumederivedfromACNielsenscannerdataaredesignedto representnationalmarketsfordifferenttypesofretailoutlets(LoomisOct2010).Loomis(2010) comparedpriceandpromotionsformentholandnonmentholsalesintworetailchannels: conveniencestoresandfoodretailers(supermarkets,drugstoresandmassmerchantscombined) from2008to2010.Theaveragepackpricewashigherformentholthannonmentholcigarettesin bothretailchannels,and13centsmore(3percenthigher)inconveniencestores,whichistheretail channelthatsellsthelargestvolumeofcigarettes.Overtime,theuseofmultipackdiscountswas replacedbytheuseofcentsoffdiscountsforbothmentholandnonmentholsales.Inbothretail channels,promotedsalesaccountedforagreaterproportionoftotalsalesformentholthanfornon mentholcigarettes.Inconveniencestores,8.31percentofmentholsalesinvolvedapromotion, comparedwith5.11percentofnonmentholsales.Thesefigurescannotbecomparedwiththose reportedbyR.J.Reynoldsbecausethetwodescribedifferenttypesofpromotions(retailvs.what appearstobewholesale)anddifferentdenominators(totalpacksalesinconveniencestoresvs. volumeofshipments). UsingACNielsenscannerdatafromsupermarketsfortheperiod19942004,Farrellyetal.(2007) comparedestimatedchangeinpackpriceaswellastarandnicotinepercigaretteformentholand nonmentholbrands(Farrelly,Loomis,&Mann2007).Slightlyhigheraveragepriceswereobserved formentholthanfornonmentholpacks,andthediscrepancyincreasedafterthe1998Master SettlementAgreement(MSA),inwhichtobaccocompaniesagreedtorestrictcertainadvertising practices.Overtime,priceincreaseswereassociatedwithincreasesinsalesofcigarettesthat containedmoretarandnicotine,butthistrendwasmorepronouncedformentholthanfornon mentholcigarettesales.Theauthorsconcludedthatmentholsmokersaremorelikelythannon mentholsmokerstocompensateforpriceincreasesbysmokingcigaretteswithhigherlevelsoftar andnicotine. Onelimitationofstudyingretailscannerdataisthepotentialforunderreportingofpromotedsales duetomissinginformationforsometransactions.Inaddition,thescannerdataarederivedfroma proprietarymethodofprojectingtothepopulationandarenotarepresentativesampleofstores. Thisproprietarysamplingmethodalsoprecludesresearchersfromdeterminingwhetherpromoted saleswerehigherinregionsorneighborhoodswithdifferentraceandethnicgroupdistributions. Storeaudits Storeauditstypicallyusedtrainedcoderstorecordadvertisedpricesandsalespromotionsfor particularcigarettebrandsorflavorcategoriesinarandomsampleoftobaccoretailers.Forexample, Rueletal.(2004)conductedannualobservations(19992002)inageographicallystratifiedsampleof 11,703storesintheU.S.(Ruel,Mani,Sandovaletal.2004).Theyrecordedthelowestadvertisedpack pricefortheleadingmenthol(Newport)andleadingnonmenthol(Marlboro)brand.Overthethree years,theaveragepriceforNewportincreased78cents(25percentchange)comparedto85cents (29percentchange)forMarlboro.IncreasesinNewportpriceswereobservedforallregions(West, Midwest,South,Northeast)andlocales(urban,suburban,town,rural).Theproportionofstoresthat advertisedapricepromotionforNewportincreasedby19percentagepoints,buttheproportionof storeswithapromotionforMarlboroincreasedbyonly7percentagepoints.Inurbanareas,alinear increasewasobservedforNewportpromotionsbutnotforMarlboropromotions.Oneshortcoming ofthesecomparisonsisthatthetwobrandsrepresentdifferentcorporatemarketingstrategies. AccordingtoLorillard,NewportmaintainsthehighestaveragepriceofmajorU.S.cigarettebrands (LorillardJuly2010). Toomeyetal.(2009)observedthesamepatternofdifferentialpricingformentholandnonmenthol

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varietiesofthesamebrandfamily.Inarandomsampleof214Minneapolisconveniencestores,the averagedifferencebetweenthesinglepackpriceforthementholandnonmentholvarietiesofthe same(unidentified)brandwas37cents(11percentmoreformenthol).Mentholpricewasnot correlatedwiththeproportionofnonwhiteresidentsoryouthinthecensustractswherethestores werelocated;nonmentholpricewaspositivelycorrelatedwiththeproportionofnonwhite residentsandnegativelycorrelatedwiththeproportionofyouth.However,thestudydidnot examinetheavailabilityofdiscountsorotherpricepromotions. Populationsurveys Threesurveysillustrateddifferencesbetweenmentholandnonmentholsmokersinresponseto pricing.A2002surveyof4,618Californiasmokersfoundrelativelymoreofthosewhosmoked mentholbrandsreportedtakingadvantageofpricepromotionsthanthosewhosmokednon mentholbrands:percentageswere57.1percentforthosewhosmokedmentholonlybrands (NewportorKool),comparedto49.1percentforCameland34.8percentforMarlboro(given mentholvariantswereasmallpercentageofthemarketforboththesebrands)(Whiteetal.,2006). Thisfindingisconsistentwiththeresultsofthescannerdatashowingthatalargerproportionof mentholcomparedtononmentholcigarettesalesinvolvedpricepromotions(Loomis,2010).Among AfricanAmericansmokersintheCaliforniasurvey,65.4percentofmentholsmokerscomparedto 28.7percentofnonmentholsmokersreportedusingpromotionaloffers.Youngadults,women,and dailysmokerswerealsomorelikelytousepromotionaloffers,butthedifferencebetweenmenthol andnonmentholsmokersinthesesubgroupswasnotreported. Fernanderetal.(2010)undertookananalysisofthedatafromthe2003and20062007TobaccoUse SupplementtotheCurrentPopulationSurvey(TUSCPS)inordertocomparethedemographictraits andpurchasebehaviorsofmentholandnonmentholsmokers(Fernanderetal.2010).Alarger proportionofmentholsmokers(68.8percent)thannonmentholsmokers(59.2percent)reported buyingcigarettesbythepack.Adjustingforotherfactors,suchasgender,race/ethnicity,agegroup, educationlevel,income,smokingfrequencyandageofinitiation,theoddsofbeingamenthol smokerweresignificantlylowerforsmokerswhoreportedbuyingcigarettesbythecarton exclusively.Theauthorsconcludedthatthefindingisconsistentwithotherstudiessuggestingthat mentholsmokerssmokefewercigarettes. InaseparateanalysisoftheTUSCPS,Taurasetal.(2010)examinedquestionsaboutthetypeof cigarettesmokedandthepricethatsmokerslastpaidforeitherapackorcarton.Usingdata aggregatedovermultiplesurveywaves(2003and20062007),Taurasetal.(2010)estimatedstate specificpricesformentholandnonmentholpacks.Adjustedto2010dollars,theaveragementhol pricewas$3.88,whichwas9centsmorethantheaveragenonmentholprice. Taurasetal.(2010)alsoestimatedtheprobabilityofbeingamentholsmoker,basedondifferent statespecificpricesformentholandnonmentholcigarettesandadjustingforothercharacteristics ofsmokers.Holdingthesevariablesconstant,a10percentincreaseinthepriceofmenthol cigaretteswasassociatedwitha2.3percentdecreaseintheprobabilityofbeingamentholsmoker. A10percentincreaseinthepriceofnonmentholcigaretteswasassociatedwitha4.7percent increaseintheprobabilityofbeingamentholsmoker.Thesedifferentpriceelasticitiessuggestthat mentholandnonmentholcigarettesarenotclosesubstitutesforeachother.Theauthorsconcluded that,holdingotherfactorsconstant,mentholsmokerswouldbemuchlesslikelytoswitchtonon mentholcigarettesthannonmentholsmokerswouldbelikelytoswitchtomentholcigarettes.The patternofresultsdidnotdifferbygenderorincome.However,youngersmokers(aged1824)and AfricanAmericansmokerswereevenlesslikelytosubstitutenonmentholcigarettesformenthol cigarettes,indicatingstrongerpreferencetomentholcigarettesamongthepopulationsubgroups withahigherprevalenceofsmokingmenthol.Alimitationofthiscrosssectionalstudyisthatitcould notmodelchangeinsmokerbehavior(switchingorquitting)overtime.Inaddition,theanalysis

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excludedsmokerswhoindicatednopreferenceformentholornonmentholcigarettes.However, thiscomprisedonly2.3percentofthesample,indicatingthatthevastmajorityofadultsmokershad adefinitepreference. Summary.Pricesforbothmentholandnonmentholcigarettesareincreasingandtheaverageprice formentholcigarettesisslightlyhigherthanfornonmentholcigarettes.Thesepatternsemerged regardlessofthedifferentdatasourcesusedtostudyprice.Therewaslimitedinformationavailable onmentholpricingandpricepromotionbyneighborhoodrace/ethnicitycharacteristics,inrelationto tobaccotaxincreases,andinrelationtobrand.Theretailscannerdataindicatesthatalarger proportionofmentholthannonmentholsalesispromoted.Morementholsmokerstakeadvantage ofpricepromotionsthannonmentholsmokers,andthisisparticularlytrueforAfricanAmericans. Mentholsmokershavestrongerloyaltytotheircigarettepreferenceandarelesssensitivetoprice fluctuationsthannonmentholsmokers. Promotion ThemaingoalsofthePromotionpartofthemarketingmixaretoinform,persuadeandremind(NCI 2008).Informingisgenerallyconsideredimportantfornewlydevelopedproductsinordertotell consumerssomethingabouttheproduct.Promotionsaimedatremindingaretypicallyaimedat consumerswhoalreadyhavepositiveattitudestowardsthebrand.Promotionsthatpersuadetend tofocusontheadvantagesofonebrandoveranother.Brandingistheuseofaname,term,symbol ordesigntoidentifyaproductandthecreationofabrandimage,iskeytoasuccessfulpromotional strategy.Asexplainedfurtherinalatersectiononmentholmarketingmessages,cigarette advertisingisshortonfactualinformationandrichinimagerydesignedtoestablishandreinforce branding. Theaimofbrandingistocreateasetofassociationsorperceptionsaboutabrandinthemindof consumers,sothattheywillwanttobuytrytheproductandkeepbuyingit(NCI2008).Brandingisa keyaspectofmarketing,wherebymarketerscreateanimageforthebrandtheypromote,abrand imagethatpromisesthetargetmarketsomethingtheyvalue.Persuasionbasedpromotionsoften linkproductswithdesirableimages(suchaslifestyleorhealthfulimagery)andidentities(suchas slogansorbrandsymbols),inorderthatconsumersassociatethebrandwithpositiveemotionsor reducednegativeemotions(NCI2008).Inacomprehensivereviewoftheevidence,theNCIreview concludedthattobaccoadvertisinghasbeendominatedbythreebroadthemes:providing satisfaction(taste,freshness,mildnessetc.),assuaginganxietiesaboutthedangersofsmoking,and creatingassociationsbetweensmokinganddesirableoutcomes(independence,socialsuccess,sexual attraction,thinnessetc.)(NCI2008,p170). Latersectionsaboutmessagingandtargetingdescribethemessagethemesthatdistinguishmenthol fromnonmentholmarketing.Thissectiondescribessimilartypesofmarketingactivitiesusedto promotebothmentholandnonmentholcigarettes,notingsomedifferencesinpractice.Price promotionsthatwerediscussedinthepricesectionareincludedherebecausethesearereflectedin variousmarketingactivities,suchasretailadvertisinganddirectmail,andareessentialto understandthecontextoftobaccomarketingpractices. AsreportedtotheFederalTradeCommission,currentpromotionalactivitiesforcigarettesinclude advertising(printmediaandpointofsale),directmarketing(directmail,coupons,distributionof freecigarettesandspecialtyitems,companywebsite,otherinternetandtelephone),sponsorship, publicentertainment,promotionalallowancesforwholesalersandretailers,andretailprice promotions(asdescribedinthesectiononprice).AftertheMSAeliminatedbillboardandtransit advertisingandcurtailedsponsoredeventsbytobaccocompanies,theirannualspendingonretail marketingmorethandoubledto$10.7billionin2006from$4.7billionin1998(FederalTrade

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Commission2009).Overthesameperiod,retailmarketingexpendituresincreasedto86percent from70percentoftheindustrystotalannualmarketingdollars.Thesefiguresincluderetail advertising,promotionalallowances,andpricepromotions(discounts,bonuscigarettes,andgifts withpurchase).Whiletotalmarketingexpendituresdecreasedeveryyearsince2003,proportional expendituresonpointofsaleadvertisingnearlydoubledto1.9percentin2006from1.1percentin 2003.Proportionalexpendituresonpricepromotionsincreasedto80.4percentin2006from76.0 percentin2003. Tobaccocompaniesexercisestrictcontrolovertheretailoutlet,usingcontractualobligationswith storemerchantstomaximizethevisibilityofproductsandadvertisingforselectedbrands(Pollay 2007;Feighery,Ribisl,Clarketal.2003;John,Cheney,&Azad2009).Theshifttowardretail marketingisapparenttoconsumers;theaveragenumberofcigarettemarketingmaterialsperstore andtheproportionofstoreswithpricepromotionshaveincreasedsincetheMSA(Celebucki&Diskin 2002;Feighery,Schleicher,Cruz&Unger2008;Wakefieldetal.2000).Asdescribedintheprevious sectionaboutprice,alargerincreasewasobservedintheproportionofstoresthatpromoted NewportthanintheproportionofstoresthatpromotedMarlboro(Rueletal.2004). Lorillard(July,2010)describeditsmarketingplanintermsoffourcomponents:retailprice promotions,retailadvertising,printadvertising,anddirectmarketing.Thelattercategoryincludesa directmaillistfordistributingcouponsanditsP.S.PleasureScenemagazinethatwasstartedin 2003.Thecompanyreportedthatcouponsrepresentedthelargestproportionofitsdirectmailing expenditures,butdidnotdisclosetheamounts.In2008,Lorillardspent$19.7milliononmagazine advertising,acategorythatrepresentedlessthan1percentofitsannualmarketingbudgetin2009. Retailpricepromotionscomprisemorethan90percentofthecompanysannualmarketing expenditures.In2006,magazineadvertisingrepresented0.4percentofannualtobaccoindustry marketingexpendituresandpricepromotions(discountsandretailvalueadded)represented80.4 percentoftotalexpenditures(FederalTradeCommission2009). R.J.ReynoldsTobaccoCo.(July,2010)reportedusingpricepromotion,directmail,email,website promotion,eventpromotion,anddirectsalesinbarsandclubstopromotebothmentholandnon mentholbrands,butdidnotdiscloseexpendituresorcomparethembybrandtype.Thecompany proposedthatarecentshiftinpreferencestowardmentholcouldnotbeattributedtomarketing activitiesbecausetheseweresubstantiallyconstrainedandbecausementholadvertisinghas changedlittleinmessageandmediumduringthistimeframe(Graves/RJReynolds,July2010).In spiteofarestrictedenvironment,theindustrystotalexpendituresforcigarettemarketingincreased everyyearaftertheMSAuntil2003(FederalTradeCommission2009).Inaddition,evenifmessage andmediumremainedconstantformentholbrands,proportionalexpenditurestoadvertiseand promotementholbrandscouldhaveincreased. TheFTCdoesnotpublishexpendituresseparatelybymanufacturer,brand,orvarietyofcigarette (mentholvs.nonmenthol).However,expendituredataforsomemarketingchannelscanbe purchasedfromcommercialsources.Usingsuchdataforcigaretteadvertisinginmagazines,one studyfoundthatspendingfornonmentholbrandsdecreasedto$39.8millionin2005from$309.3 millionin1998,butspendingformentholbrandsincreasedto$43.8millionfrom$36.5millioninthe sametimeperiod(Kreslake,Wayne,Alpert,etal.2008).Theproportionofexpendituresformenthol brandsincreasedto52.4percentfrom10.6percentofthetotalexpendituresoverthistimeperiod, andthespendingformentholexceededspendingfornonmentholbrandsin2005.Thispattern suggestsgreaterefforttoadvertisementholthannonmentholbrandsinmagazinesduringaperiod ofincreasedadvertisingrestrictions. (b) (4)

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(b) (4)

Summary.Inarestrictedenvironment,retailhasbecomethedominantchannelfortobacco marketing.Tobaccocompaniesusesimilarmarketingactivitiestopromotementholandnon mentholbrands,butexpendituredatasuggestsomedifferencesinpractice.Inrecentyears,the tobaccoindustryspentasmuchormoreonmagazineadvertisingformentholasfornonmenthol (b) (4) brands,eventhoughmentholbrandsrepresentamuchsmallershareofthemarket

(b) (4)

.Furtherevidencethatspeakstodifferencesinpromotionalpracticesformenthol thatthemixofmarketingstrategiesusedtopromotethesebrandsaredeterminedbyneighborhood demographicsisaddressedinalatersectionontargeting. Packaging Cigarettepackagingplaysakeyroleinthecreationandreinforcementofbrandimagery(NCI2008) andtobaccocompaniesconductconsiderableconsumerresearchonallelementsofpackaging (Wakefieldetal.2002;DiFranzaetal.2002).Unlikemanyotherproductswherethepackagingis discardedafteropening,smokersgenerallykeeptheircigarettepackwiththemuntilallthe cigarettesinitaresmoked.Thismeansthatthepackisfrequentlybeingtakenoutandputon display.Thishighdegreeofsocialvisibilityleadscigarettestobedescribedbymarketersasbadge products.Theuseofabadgeproductassociatestheuserwiththebrandimage,givingthesmoker someoftheidentityofthebrandimage.Asonecigarettepackagedesigner,JohnDigianni,stated:A cigarettepackageisuniquebecausetheconsumercarriesitaroundwithhimallday...itsapartofa smokersclothing,andwhenhesauntersintoabarandplunksitdown,hemakesastatementabout himself.(Koten,citedinWakefieldetal.2002). Cigarettepackagingbecomesmoreimportantforoverallmarketingstrategy,astraditionalavenues forcigaretteadvertisingarerestricted.Inarestrictedadvertisingenvironment,asidefromitskey roleincommunicatingbrandimage,cigarettepackagingisusedtocreategreatersalienceforbrand familiesattheretaildisplay(NCI2008).Reviewsofinternaltobaccoindustrydocumentsoncigarette packagingshowthatthatvariantswithinonebrandfamilyaredesignedtobesufficientlysimilarto

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indicatemembershipoftheoverallparentbrand,anddifferentenoughforconsumerstobeableto distinguishbetweenthevariants.Inthisway,thearrangementofpacksfromthesamebrandfamily achievegreaterstandoutfromtheclutterofcompetingbrandsatthepointofsale(Wakefieldet al.2002;DiFranzaetal.2002). Forbothmentholandnonmentholcigarettes,differentshadesofthesamecolorandtheproportion ofwhitespacearecommonlyusedtodistinguishbetweenvariantsofthesamebrandfamily.Lighter colorsonpacksareusedtosignifylowertarcigarettes(Wakefieldetal,2002;DiFranzaetal.2002) andconsumersinterpretlightershadesoncigarettepackagingtoinferthatthecigarettesareless harmful(Hammond&Parkinson2009).Inthepresenceofabanontermssuchaslight,lowtar andmildwhichconnotereducedharm,tobaccocompaniesusealternativebranddescriptorssuch assmooth,colordescriptorssuchassilver,andtarnumbersthatareincorporatedintobrand names,andthatconsumersalsointerprettomeanreducedharm(Hammond&Parkinson2009). Therelationshipbetweenbrandingandconsumerperceptionsofharmandrelatedsensory experienceisdiscussedfurtherinalatersection. Giventhecentralroleofpackagingincigarettebrandingandmarketing(NCI2008),itissomewhat surprisingthatnostudyhasattemptedtoquantifyanddescribechangesincigarettepackingover timeordifferencesbetweenpackagingformentholandnonmentholbrands.However,historical examplesofcigarettepacksareavailableontheinternet http://www.cigarettespedia.com/index.php/Main Page(clickonbrandname)andmorerecently http://www.tobaccolabels.ca/cigarettepackagepictures/unitedstates.InasubmissiontoFDA,R.J. Reynolds(June30,2010)reportedusingcoolandfreshimageryformentholproductsandblueand greencolorsinpackagelabeling.AccordingtoconsumerperceptionstudiesconductedbyLorillard, smokersgenerallyassociateandprefergreenpackagingwithmentholcigarettes(LorillardJuly, 2010).However,thesestudieswerenotdescribedinthecompanysreport.Colortheoriessuggest thatgreeniscommonlyassociatedwithhealthandhealing,inadditiontonature,renewal, newbeginnings,andharmony(Frazer&Banks,2004inNCI,2008).Greenalsoconnotespositive affectivestates,suchascalming,gentle,andpeaceful(citeinAnderson,Ling,&Glantz2007). Thefollowingsectiondescribestheuseofimageryandothermessagesinmentholmarketingin moredetailinconnotinghealthreassurance. WHATHEALTHREASSURANCEMESSAGESWERE/AREUSEDINMENTHOLMARKETINGMESSAGES? Inthissection,wedistinguishbetweentwomaintypesofmessagesthatmayprovidehealth reassurancetoconsumers.First,messagesmaybeexplicitinnature,inthattheymakeanobvious anddirectconnectionbetweenuseoftheproductandaconsequentexpectedhealthbenefitor reductionofhealthrisk.Anexampleofanexplicithealthclaimmightbeacigarettetosootheasore throat.Thisclaimovertlypromisesthattheproductconfersamedicinalbenefitinrelievingthe symptomsofaspecifichealthcondition.Second,messagesmaybeimplicit,inthattheyconnote somekindofbenefitrelatedtohealthorwellbeing,withoutexpresslysayingso.Theseimplicit messagestendtobemoreindirectandmakeuseofimagery,associationsand/ordescriptive language.Anexampleofanimplicithealthclaimmightbeacigaretteasfreshasamountain stream.Byassociatingitsproductwithafreshmountainstream,thisphraseinvokesimageryof natureandcleanlinessandtherebyinfershealthiness.Implicitmessagescanbehighlyeffectiveas communicationtools,incovertlyshapingconsumersexpectationsaboutaproduct.Inaddition,their ambiguitymakesthemdifficultforconsumerstodiscount. Duringthe1950s,growingconcernamongconsumersaboutthehealthharmsofcigarettescreated considerabledissonancewithinsmokers,whowereanxiousaboutthefactthattheywereincurringa healthrisk,butfoundthemselvesunabletoquit.Thiscognitivedissonancemadesmokersopento

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messagesthatmightreassuretheirhealthconcerns(Pollay&Dewhirst2002).Fromamarketing pointofview,sincethehealthharmsoftobaccobecamewidelyknown,explicitclaimsthatone cigarettebrandwashealthier,saferorlessharmfulthananotherriskedbeingrejectedbyconsumers asnotbeingbelievable.Furthermore,explicitclaimshadtheundesirableconsequenceforthe tobaccoindustryofremindingsmokersthattheywereengaginginabehaviorthatwasinherently harmfultotheirhealth.Instead,thetobaccoindustryturnedtoimplicitmarketingmessagesthrough theuseofbranddescriptors,slogans,andrichadvertisingimagery,toofferhealthreassurance (Pollay&Dewhirst2002).Theseimplicitmessagespromotedattributessuchastaste,flavor,sensory experience,satisfactionandenjoyment. Inareviewoftobaccoindustrydocumentsandadvertising,SuttonandRobinson(2004)identified extensiveuseoffourtypesofmessagesinmentholmarketing:healthy/medicinalclaims,taste sensation(e.g.,fresh,refreshing,cool,clean,crisp),youthfulness,andethnicawareness.Thefirsttwo categoriesarethefocusofonesectionbecausethesethemesareinextricablylinkedinmarketing messagesandinthemindsofconsumers(seelatersectionsonconsumerperceptions). Healthy/medicinalclaimsandtastesensation Untilthemid1950s,marketingmessagespositionedmentholcigarettesforoccasionaluseasa remedyformyriadailments(Gardiner,2004;Sutton&Robinson,2004).Forexample,Samjiand Jackler(2008)archivedandreviewedseveralthousandsofcigaretteadsthatweresampledfrom popularmagazinesandscholarlyjournalsbetween1920and1954.Onlyadsthatdepictedthethroat orathroatdoctorwereselectedforfurtherdescriptionandtheiranalysiswasnotspecifictomenthol advertising.BrandslogansforSpud,thefirstmentholcigarette(AshtonFisherTobaccoCo.),andfor Kool,promotedtheseproductsasremediesfornoseandthroatirritationandforcongestion.A1937 adfeaturedaprescriptionfromDr.Kool,acartoonpenguin:TellhimtoswitchtoKoolsandhellbe allright.DoctorsagreethatKoolsaresoothingtoyourthroat.Theresearchersremarkedthatthe introductionofmentholplayedacentralroleinpositioningtobaccoproductsasatreatmentrather thananirritant. Intheiroverviewofresearchreviewsofqualitativetobaccoindustrydocumentsthatwereprepared forFDA,LeeandGlantz(inpress)alsonotedthatexplicithealthclaimscharacterizedmenthol cigarettesasahealthier,lessharshalternativeforsmokerswhorequiredtemporaryrelieffrom symptoms.Toillustratetheextenttowhichhealthclaimswerewidelyaccepted,theauthorscited anexampleofa1951casereportfromtheJournalofAmericanMedicalAssociationthatreferredto mentholcigarettesasmedicatedcigaretteswithananestheticandcoolingeffect(Highstein& Zeligman1951,citedinLee&Glantzinpress). AbriefhistoryoftobaccomarketingfromtheInstituteofMedicine(2003)notedthatexplicithealth claimspersistedinspiteofa1942agreementbetweentheFederalTradeCommissionandBrown& Williamsontoendsuchadvertising.TheIOMreportcitedtwoslogansfrom1946and1949:HEAD STOPPEDUP?GOTTHESNEEZES?SWITCHTOKOOLS...THEFLAVORPLEASES!andGotaCOLD? SmokeKOOLSasyoursteadysmokeforthatclean,KOOLtaste(table31inIOM,2003).Theseand otherexamplesservetoillustratethatearlymarketingmessageslinkedclaimsabouttheperceived healthbenefitsofmentholwithitstastesensation.AftertheFederalTradeCommissioncodifiedthe cigaretteadvertisingguidelinesin1955,marketingmessagesabouttaste,flavor,aroma,and enjoymentreplacedexplicithealthclaims.TheIOMreporthighlightedtheindustrysuseoftasteand sensorydescriptorssuchasmild,lightandsmoothtosuggesttheconceptofproductsafety. Inareviewoftobaccoindustrydocumentsaboutmarketingforlightandlowtarcigarettes, PollayandDewhirst(2002)describedhowtheindustryrepositionedmentholcigarettesfroma healthremedyforoccasionalusetoapositivesmokingexperienceforregularuse.Inresponseto

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growingpublicconcernaboutthehealthimpactsofsmoking,motivationresearchersandtrade analystsadvisedtheindustrytoadoptsubtlertactics,usingvisualimageryandadcopythatimplied healthfulness(Pollay1989,citedinPollay&Dewhirst2000).ABrown&Williamsondocument highlightedtheimportantroleofmentholinassuagingsmokersconcernsabouthealth:Mentholin thefilterformintheSalemadvertisingwasarefreshingtasteexperience.Itcanbeveryreassuring inapersonalconcernclimate.Undoubtedly,themedicinalmentholconnotationcarriedforwardina therapeuticfashionaspositivetastebenefit.(Cunningham&Walsh,1980,citedinPollay&Dewhirst 2002).Theauthorsconcludedtheuseofmentholwasacriticalelementofthetobaccoindustrys effortstoconvinceconsumersthatparticularcigarettebrandsarerelativelyhealthy.Asdescribedby Pollay&Dewhirst,cigaretteadvertisingisnotoriouslyuninformative,withcharacteristicformsusing veiledhealthimplicationsandpicturesofhealthalongwithvaguepromisesoftasteandsatisfaction (2002,p.i28). SuttonandRobinson(2004)observedthatgeneralmarketmagazineandnewspaperadvertisingof the1950sand1960spromotedmentholbrandswithoutdoorscenes,suchaswoodlands,rain forests,rockgardens,andcountrystreams.Theseimageswerepairedwithsensorydescriptors,such ascool,clean,freshtermsthatconnotehealthbenefits.Forexample,advertisingforSalem mentionedperpetualspringtimeandawonderfulworldoffreshness(MSAInc.1978,citedin Gardiner2004)andNewportsintroductionin1957featuredtheslogan:Richtastewithatouchof refreshingmint(Anderson,inpress). Anderson(inpress)examined953tobaccoindustryinternaldocumentsgleanedfromastringof searchtermsaboutmentholmarketingandconsumerperception.Consistentwithotheraccounts, shereportedthatmentholcigaretteswerefirstpopularizedasaremedytotheburn,drynessand throatirritationthataccompanysmoking.Theindustrydocumentsincludedexamplesofearly advertisingslogansformentholcigarettesthatpromisedhealthfuloutcomes,suchasBreatheeasy, smokeclean,(Brown&Williamson1978citedinAnderson,inpress)andThebeneficialhead clearingqualitiesofmenthol(Brown&Williamsonundated,citedinAndersoninpress).When overtlyhealthorientedmessageswereforbidden,marketingmessagesexploitedconsumer perceptionofthecharacterizingflavorasbothatasteandasensation.Inaddition,themessages capitalizedontheperceptionofacoolingsensationashealthful:Whatawonderfuldifferencewhen youswitchtosnowfreshKools.Yourmouthfeelscleanandcool,yourthroatfeelssoothedandfresh. Enjoythemostrefreshingexperiencesmoking(Brown&Williamson,1968,citedinAnderson,in press).Indeed,tobaccocompaniessoughttopreservetheconnotationsofmentholwithhealth.For example,a1978Brown&Williamsondocumentdescribeditsobjectivetoprovideproductsafety reassurancewhileenhanc[ing]thesatisfactionandrefreshmentperceptionoftheappropriateKool styles(Brown&Williamson,1978,citedinAnderson2010).Andersonconcludedthatmarketing messagesservedtoreassuresmokersthatmentholcigaretteswerehealthierthannonmenthol cigarettesandthatthisreassurancecontinuesincontemporarymarketingmessagesthatfeature moreobliquereferencestohealth. AstudybyPaeketal.(2010)highlightedthecontributionsofproductlabelingandvisualimageryto communicateimplicithealthrelatedclaims.Theircontentanalysisexaminedtheprevalenceof implicithealthpromotionmessagesforcigarettesin1,300magazineadsfrom1954to2003.Equal numbersofadsfor10brandsweresampledfromfivetimeperiods.Thesampleincludedadsfor10 brands,includingNewportandKool,buttheanalysisdidnotcomparementholandnonmenthol advertising.Thepresenceofanimplicithealthclaimwascodedwheneververbalcuesusedeither factualterms(e.g.,lowtar,noadditives,filter)orimpressionisticterms(e.g.,mild,natural,gentle calm,soft,smooth)tocharacterizecigarettes.Thepresenceofanimplicithealthclaimwascoded whenevervisualcuesassociatedcigaretteswithhealthfulplacesorobjects,suchasmountains, fields,anocean,oraglassofwater.Verbalhealthclaimsappearedinadvertisingcopyfor49percent oftheadsfromthepostMSAera(19992003)comparedto45percentoftheadsoverall.Visual

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healthclaimswerefoundin50percentofthepostMSAeraads,comparedto42percentoverall.The researchersconcludedthatimplicitclaimsabouthealthareasprevalentincontemporarycigarette advertisingastheyhavebeenpreviously. ThroughoutTPSACmeetings,tobaccoindustryrepresentativesconsistentlypointedtotasteasbeing themaindriverofpreferenceformentholcigarettesamongmentholcigarettesmokers,withcooling sensationbeingconsideredtobepartoftheoverallconsumertasteexperience(July2010).Lorillard indicatedinitssubmissionthattermssuchassmooth,fresh,refreshingandmildareonly intendedtocommunicatetaste,flavorandsatisfaction(Lorillard,July2010),andnottoimplicitly communicatethatmentholcigarettesarelesshazardousthannonmentholcigarettes. Summary.Analysesoftobaccoindustryinternaldocumentsandthemarketingmessagestheindustry producedprovidecorroboratingevidenceofexplicitandunwarrantedclaimsthatsmokingmenthol cigaretteswouldimprovesmokershealth.Overtime,marketingmessagesincreasinglyreliedon sensorydescriptorsandimagerytoimplythatmentholcigarettesaresaferthannonmenthol cigarettes. WHATOTHERMESSAGESWERE/ARECONVEYEDTOPOTENTIALCONSUMERSBYMENTHOL MARKETINGMESSAGES? Marketingmessagesabouthealthclaimsandsensoryappealsderivefromdirectreferencesto menthol,butothermarketingmessagesconveytheproductsappealwithoutreferencetoits characterizingflavor.Ina1982marketingreport,R.J.Reynoldscharacterizedmentholsmokers(the CoolnessSegment)astheyoungest,themosteconomicallydisadvantaged,andthemostlikelyto beinminorityandethnicgroups,whotend,morethanaverage,todesiretheirbrandofcigarettes tosymbolizepersonalqualitiessuchasyouth;modernwomanhood;romance;careerorientation;and success(citedinAnderson,inpress).Previousresearchdescribestwodominantthemesusedto appealtothesetargetaudiencesandtheiraspirations.Onethemeistheexuberanceofyouth,which SuttonandRobinson(2005)labeledasyouthful,silliness,funandAnderson(inpress)characterized asfunloving,sociable,andyouthful.Mentholadvertisingalsoassociatesproductusewithimages ofanidealizedselfandsocialidentityathemethatSuttonandRobinson(2005)labeledasethnic awareness,andAnderson(inpress)characterizedmorebroadlyasidentityoringroupbelonging. Thesethemesarenotmutuallyexclusive;thesameadvertisementmayservetocommunicateboth typesofmessages(seeforexample,Figure3inAndersoninpress). Youthfulnessandsociability NewportintroduceditsAlivewithPleasure!campaignin1972withadvertisingthatportrayed youngpeoplehavingfun,butengagedinactivitiesthatseemedchildishorjuvenile(Suttonand Robinson,2005).AccordingtoKlausners(inpress)reviewoftobaccoindustrydocuments,the Newportcampaignwasbasedontheassumptionthatpeerinfluenceiscriticaltosmokinguptake andtheadvertisingimagerysoughttorecreateandreinforcethatinfluence.Afterthefirstfouryears, NewportwasstilllaggingbehindKoolandSalem,butitsmarketshareincreasedamongyouth. NewportsSOM[shareofmarket]amongsmokers1417yearsoldissignificantlyhigherthan brandsTotalSOM,reflectingstrongappealtoyoung/newsmokers(Esty1976,citedinKlausner,in press).NewportsPleasurecampaign(theAlivewithpartofthesloganwaslaterdropped) continuestothisday.Newporthasbeentheleadingmentholcigarettebrandandthesecondleading cigarettebrandamongyouthsincetheearly1990s. Anderson(inpress)acknowledgedthatimagesofyouthfulnessandsociabilitywerenotuniqueto marketingmessagesformenthol.Indeed,a1981R.J.Reynoldsreportobserved,Thebenefitof smokingwhichhasmostfrequentlyandmostsuccessfullybeenexploitedbybrandfamiliesappearsto

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beSocialInteraction.AfterthisapproachprovedeffectiveforLorillardsNewportbrand,R.J. ReynoldslaunchedasimilarcampaignforSalem.Advertisingmustconvinceyoungeradultsmokers thatSalemissmokedbynatural,unpretentiousbutinterestingpeoplewhoaresocial leaders/catalysts(makethingshappen)whosesenseofhumorandwitmakesthemfunandexciting tobewith(RJReynolds1981,citedinAndersoninpress).Andersonconcludedthatitwasmenthols youngerprofilerelativetoothercigarettesthatmadethethemesofyouthfulnessandsociability particularlyappealingandpersuasive. Twoempiricalstudiesaddressedconsumerperceptionsofyouthfulnessincigarettemarketing messages.Inonestudy,561adultsviewedandratedtheperceivedageandlevelofattractivenessof modelsinmagazineadsformentholandregularcigarettes(Mazisetal.1992).Advertisementsfor mentholbrandswerejudgedtohavesignificantlyyoungermodels(average25.7years)than advertisementsforregularcigarettebrands(average31.9years).Irrespectiveoftheirownage group,peopleratedyoungermodelsintheadvertisementsasbeingmoreattractivethanolder models. Barbeauetal.(1998)asked913sixthtoeighthgradestudentsfromMassachusettstoratemagazine adsforfourcigarettebrands(Newport,Camel,MarlboroandVirginiaSlims)andfournoncigarette products.Alltheadswerefrom1994andfeaturedhumanfiguresoranthropomorphiccharacters. Themajorityofstudentsjudgedeachofthefourcigaretteadstosaythatsmokingwillmakepeople lookcool(72percentto84percent),attractive(53percentto81percent),popular(50percentto80 percent)andhealthy(51percentto71percent).Studentsresponsesindicatedthatthe advertisementscommunicateideasthatwereinviolationoftheTobaccoInstituteVoluntary AdvertisingandPromotionCode.Liketheadultsinthepreviousstudy(Mazisetal.1992),the studentsratedNewportmodelsaslookingyoungerthanthemodelsappearinginadsforother cigarettebrands.Weaknessesofbothstudiesarethattheysurveyedconveniencesamplesandcould notcontrolforobjectivedifferencesbetweenmodelsthatappearedinads.Nonetheless,theresults suggestthatthemessagethatNewportisabrandforyoungerconsumerswasapparenttoboth adultsandadolescents. Identity/Ingroupbelonging Establishingasenseofbelongingisacentraltaskofidentitydevelopmentinadolescence,particularly forracial/ethnicminorities(Castro2004).Imagesoftheselfasasmokerornonsmokercontributeto thisidentity.Asconcludedinchapter7ofNCIsMonograph19(2008),muchtobaccoadvertising createstheperceptionthatsmokingwillsatisfyadolescentpsychologicalneedsrelatingto popularity,peeracceptanceandpositiveselfimage.Furthermore,adolescentswhobelievethat smokingcansatisfytheirpsychologicalneedsorwhosedesiredimageofthemselvesissimilartotheir imageofsmokersaremorelikelytoexperimentwithcigarettes(NCI2008,p280). Severalhistoriesofmentholmarketingcommentedonappealstoracialidentity,whichcoincided withincreasedmarketshareamongAfricanAmericansinthe1960sand1970s(Gardiner2004; Sutton&Robinson2005).Forexample,commentingonKoolbrandadvertisingofthisperiod,Sutton andRobinson(2005)observedadeparturefromthestandardfareofwaterfalls,countrystreamsand romanticcouplesfoundinwhiteorientedmediatodarkerskinnedmodels,slangterms,andmore masculineimageryinAfricanAmericanorientedmedia.Increasingly,marketingmessagesfor mentholcigarettesappropriatedimagesofathletes,entertainers,hairstyles,clothing,musicand otherelementsofAfricanAmericanpopularculture(Gardiner2004;Giovinoetal.2004;Hafez&Ling 2005;Sutton&Robinson2004).Severalresearchersobservedthatthewordcool,andits significancetotheAfricanAmericancommunity,playedacentralroleintheappealoftheKoolbrand aswellastheproductcategory(Gardiner2004;Castro2004).

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Balbachetal.(2003)examinedadsforR.J.Reynoldsbrandsfromthreemagazinesaimedatan AfricanAmericanaudience.Nearlyalloftheadswereformentholbrands.Between1989and1990, everyaddepictedanescapistorfantasythemewhenasettingwasvisible,mostoftheads(74 percent)featuredexpensiveobjectswhenobjectswerevisible,andapproximatelyhalfoftheads(58 percent)portrayednightlifewheneversociallifewasshown.Allthreethemesremainedevidentin adsthatweresampledfromthesamemagazinesadecadelater,althoughfeweroftheadsfeatured expensiveobjects.IncombinationwithevidencegleanedfromtheirreviewofR.J.Reynoldsinternal documents(discussedinthesectionontargeting),theauthorsconcludedthatmarketingmessages associatedmentholcigaretteswithluxuryobjects,aglamorousnightlife,andafantasyworldinorder toappealtotheaspirationsofyoungadultAfricanAmericans. Nightlifesettingswereobservedinmentholmarketingaimedatabroaderaudienceofyoungadults. Belstocketal.(2008)examinedallcigaretteandalcoholadvertisingthatappearedinMaxim,FHM, CosmopolitanandEbonyin2003and2004.Thesemagazineswereselectedbecauseoftheir popularitywithyoungadultreaders(ages1824).Althoughnoneofthe317alcoholadsreferredto cigarettes,32ofthe114cigaretteads(28percent)includedtextorimageryrelatedtoalcohol. Cigaretteandalcoholadvertisementswereequallylikelytoportrayabarorclubsettingthatimplied anighttimeorafterhourssocialgathering.NewportandKoolweretwoofthefourcigarettebrands thatfeaturedalcoholrelatedcontentintheiradvertising.However,theproportionoftotaladsfor mentholandtheproportionofmentholadswithalcoholcontentwerenotreported. Andersonsreviewofindustrydocuments(inpress)notedthatmentholmarketingappealsto multiplegroupidentities,especially,butnotexclusively,toAfricanAmericans.Sheobservedthat mentholmarketingconveysvariedimagesofmentholsmokersbecausethethreelargest,exclusively mentholbrandsdevelopedsuchdifferentidentities.Severalexamplesfromindustrydocuments characterizedKoolashavingamoremasculineimagethanotherbrands,Salemamorefeminine image,andNewportasthebrandwiththeyoungestdemographicsintheindustry.Anderson concludedthatnosingleunifiedimageofamentholsmokeremergesfrommarketingmessages abouttheproduct. Twoempiricalstudiesexaminedconsumerperceptionsofmentholsmokers,andcommentedonthe degreetowhichperceptionsfitthemessagesconveyedinmentholmarketing.AllenandUnger (2007)examinedselectedsocioculturalfactorsassociatedwithmentholsmokinginaconvenience sampleofAfricanAmericansfromLosAngeles.Theyinterviewed432smokersofatleastfive cigarettesperday(296mentholand136nonmenthol)recruitedfromacampusmedicalcenter, shoppingmallsandothercommunitysites.Differencesbetweengroupsofsmokerswerepresented asoddsratios(adjustedforageandemploymentstatus)andwithoutresponsefrequencies.The resultssuggestedthatforbothmalesandfemales,asignificantcorrelateofmentholusewasthe beliefthatmostAfricanAmericanssmokementhols.Amongfemales(butnotmales),anadditional correlatewasalackofbeliefthatmentholsmokingisaBlackthing. Segerstrometal.(1994)randomlyassigned100whiteand94AfricanAmericancommunitycollege anduniversitystudentswithashortwrittendescriptionofatargetsmokerthatvariedbyrace (AfricanAmericanorwhite)andcigarettetype(mentholorregular).Studentsthenratedthesmoker on15attributesusingsemanticdifferentialscales(e.g.,rich/poor,unpopular/popular,weak/strong). Overall,thepatternofratingsaccordingtothesubjectsownraceandsmokingstatuswas inconsistentandnosingleunifiedimageofamentholsmokeremerged.Althoughthesmallsample sizelimitsconclusionsaboutdifferencesinperceptionsbetweengroups,thestudyfindingis consistentwiththeconclusionofAndersonsdocumentreview(inpress).However,thestudydidnot examineperceptionsofthosewhosmokeddifferentbrandsofmentholcigarettes,whichwouldlikely differ.

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Summary.Mentholmarketingfeaturesyouthfulimageryandconsumersperceivedifferences betweenmentholandnonmentholmarketingintermsoftherelativeageofthemodels.Menthol marketingalsousessociallyandculturallyrelevantmessagesaboutingroupidentitytoappealto differentmarketsegments.Differentgroupidentitiesareemphasizedinmarketingfordifferent brandfamilies,whichmayexplainwhyconsumersdonotshareasingularimpressionofamenthol smoker. Thenextsectionconsiderstheroleofyouthfulimageryandothermessagesaboutingroupidentity incultivatingtargetmarketsformentholbrands. WHOARETHETARGETPOPULATIONSFORMENTHOLMARKETING?ISTHEREEVIDENCETOSHOW THATYOUTH,WOMEN,ANDSPECIFICRACIAL/ETHNICGROUPSWERETARGETED? Fewproductsarepromotedtotheentirepopulationinanundifferentiatedmanner.Theplanningof promotionalstrategyrequiresthedefinitionofacleartargetmarket,wherebythepopulationis segmentedintodefinedsubgroups.Thistargetmarketcanincludepeoplewhoarepotentialbuyers, currentusers,thosewhomakethebuyingdecision,orthosewhoinfluenceit.Extensivequalitative andquantitativeresearchisundertakentoidentifythesalientbeliefs,valuesandpreferencesofthe plannedtargetmarket,whichmightbedefinedonthebasisofage,gender,ethnicity,income,and lifestyle,amongotherattributes(NCI2008).Promotionalstrategiesarethendesignedforand directedtothiswelldefinedconsumergroup(orsegment).Typically,manyconsumertestsare undertakentopretestandrefinebrandingelements.Themessageinasegmentedcampaignmay havebroadappeal,butwillbemostsalienttoandresonatewiththespecifictargetedsegment.The NCIreviewconcludedthatthetobaccoindustryhasbecomeincreasinglysophisticatedinapplying marketresearchtopopulationsegmentsinordertodesignproducts,messages,communication channelsandpromotionsmorealignedwiththeneedsandsusceptibilitiesofparticularmarket segments.Thisresearchresultsinmoreefficiency,greaterreach,andincreasedeffectivenessfor marketingactivitiesaimedattargetedpopulations.(NCI2008,p171). Thissectiondrawsonthreetypesofevidenceabouttargetmarketing:(1)analysesoftobacco industrydocumentsthatdescribedthedevelopment,intent,andconsequencesofmarketing mentholbrands,(2)analysesoftheadvertisingenvironmentthatcomparedthequantityofmenthol advertisingeitherbyneighborhoodcharacteristicsorbyaudiencedemographics,and(3) observationalstudiesthatcomparedadvertisingrecallandrecognitionbyaudiencedemographics. Targeting:Youthandyoungadults Inrelationtotobaccouse,brandimageisespeciallyimportantforadolescentsbecausethisistheage duringwhichthevastmajorityofpeopletakeupsmokingandbrandchoicesaremade.Arecent reviewoftobaccomarketinganditseffectsontobaccousepublishedbytheNationalCancer Institute(2008)concludedthatmuchtobaccoadvertisingtargetsthepsychologicalneedsof adolescents,suchaspopularity,peeracceptanceandpositiveselfimage.Advertisingcreatesthe perceptionthatsmokingwillsatisfytheseneeds.(NCI2008,p280). Tobaccocompaniesframetheirmarketingeffortsasbeingsolelyaimedatinfluencingbrand switchingincurrentusers,anddenytheiradvertisingandpromotionalstrategiespromoteyouth smokinguptake.However,thereisanabundanceofempiricalstudiestoshowthatthetobacco industrydoestargetitsmarketingeffortstowardsyouthandyoungadultsandthatyouthare strategicallyimportantforthecustomerbase.AsconcludedbyPollayetal.(1996),thebattleofthe brandsformarketshareiswagedlargelyamongtheyoung,foritisabrandssuccessamongthe

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youngthatleadstogreaterbrandsalesandprofitinthelongterm(p.13).Despiterestrictionson moretraditionalformsoftobaccomarketing,youthnoticeandareinfluencedbytobaccomarketing effortsinwaysthatincreasetheirlikelihoodoftakingupsmoking(NCI2008).TherecentNCIreview examinedresearchstudieslinkingtobaccoadvertisingandpromotionwithsmokingattitudesand behaviour,includingqualitative,crosssectional,experimental,cohortandtimeseriesstudies.The reviewconcludedthatthetotalweightofevidencefrommultipletypesofstudies,conductedby investigatorsfromdifferentdisciplines,usingdatafrommanycountries,demonstratesacausal relationshipbetweentobaccoadvertisingandpromotionandincreasedtobaccouse,asmanifested byincreasedsmokinginitiationandincreasedpercapitatobaccoconsumptioninthepopulation(NCI 2008,p281). Industrydocumentsresearch Ling&Glantz(2002),inareviewoftobaccoindustrydocumentsfromPhilipMorris,RJ.Reynoldsand Lorillard,exploredtobaccoindustrystrategiesformarketingtoyoungadultsaged18to24years. Theyconcludedthattobaccoadvertisingencouragesregularsmokingandincreasedconsumptionby integratingsmokingintosocialactivitiesandplacesthatreflectlifechangesexperiencedbyyoung adults,withmentholbrandssuchasNewportbeingfeaturedinexampledocuments.Kreslakeetal. AJPH(2008),inareviewoftobaccoindustrydocuments,foundevidencethatyoungersmokers preferredmilderbrandswithlowermenthollevels,withR.J.Reynoldsobservingthatthewantfor lessmentholdoesindeedskewyoungeradult(Etzel1993,citedinKreslake2008).Thesuccessof NewportamongyoungerconsumersNewporthaslowermenthollevelsthanKoolandSalem brandswasattributedtothisfeature,andtheauthorsnotedthatfromthe1980s,allothermajor mentholbrandsactivelypursuedalowlevelmentholformulationtoattractthismarket(Kreslakeet al.AJPH2008).InKreslakeNTR(2008),industrydocumentsindicatedaclearacknowledgmentofthis lowmentholformulationbeingmoreattractiveforthoseinitiatingsmoking.Forexample,one Brown&Williamsondocumentoutlinedthatasuccessfulstartercigarettewouldneedtoprovidea lowtobaccotaste,lowimpactandirritation,lowtobaccoaftertaste,andlowmenthol content(Cantrell,1987citedinKreslakeNTR2008).Kreslakeetal.(NTR2008)refertoseveral Lorillarddocumentsthatdetailedstudiesfindinglowersatisfactionratingsamongyoungerpeoplein theirtwentieswhengivencigaretteswithhighermenthollevels.Bycomparison,smokersaged45 andolderhadhighersatisfactionratingsofcigaretteswithhighermenthollevels. Klausner(inpress),inherindustrydocumentreview,concludedthatyouthwereatargetofmenthol marketing.ShenotesPhilipMorriswasconcernedinthelate1970sthatitlackedacompetitive mentholproductatatimewhenmentholcigaretteusewasincreasingamongtheyoung,womenand AfricanAmericans.WeknewthatBlacks,females,andyoungersmokersweremorelikelytosmoke mentholcigarettesthanwhites,malesandoldersmokers.Thesedifferencescouldhaveaprofound effectonthefuturegrowthofthementholshareofthemarket.Weknow,forexample,thatmales, whitesandoldersmokersaremorelikelytoquitsmokingthanfemales,Blacksandyoungersmokers (citedinKlausner,inpress).Andersonstobaccoindustrydocumentreview(inpress)alsonotedthe importanceofyoungpeopleasaprimarytargetgroupformentholcigarettemarketing.For example,shefounddocumentsthatindicatedthatthemarketingstrategyforNewportthrough muchofthe1990swastocontinuetoimproveNewportsappealasthepeerbrandamongyoung adultsmokers(citedinAnderson,inpress).Sheconcludedthatmentholistargetedtoyoungpeople intheU.S.andthatalthoughdifferentmentholbrandsareassociatedwithdifferentbrand identities,mentholingeneralisperceivedtobeforfemales,youngersmokersandlightersmokers. Sheconcludesthatmarketingthatemphasizescoolness,refreshingsensations,mildness,soothing tasteandyouthfunlovingimagerycontributestotheseperceptions(Andersoninpress).As detailedfurtherinalatersectionontargetingtoAfricanAmericans,Hafez&Ling(2005)document howthecompanyusedmusictoappealinitiallytoAfricanAmericanswithitsKoolJazzconcertsand relatedmusicefforts,butinitiallyfailedinitsaimtofindanideaorsymbolthatwastrulypanracial

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(universalracial).Withits2004KoolMixxcampaign,whichpromotedelementsofhiphopculture throughcolorfulcigarettepackagingandrelatedgiveaways,suchasradios,andmusiccompactdisks, thebrandfinallysucceededinreachingbeyonditscoretargetgroupofAfricanAmericanstoyoung adultsingeneral. Empiricalstudies Twoempiricalstudiesaddressedthecontentand/orappealofmentholmarketingtoadolescentsor youngadults.Ungeretal.(1995)had386eighthgradestudentsinsouthernCaliforniarateeachof 20cigaretteandalcoholadsthatappearedinmagazinesorontelevisionduringearly1993.Brand nameinformationwasconcealedoneachad.ForNewportads,63.3percentofstudentscorrectly identifiedthead/sasbeingforcigarettesand31.4percentcorrectlyidentifiedthebrand.ForKool ads,10.5percentcorrectlyidentifiedthead/sasbeingforcigarettesand11.6percentidentifiedthe brand.Thiscomparedwithcorrectidentificationofcigarettead/sforMarlboroads(87.8percent) andcorrectidentificationofthebrand(71.7percent).Stageofsmokinguptake(nonsusceptible nonsmoker;susceptiblenonsmoker;user)wassignificantlyassociatedwithcorrectbrandname recognitionforallsevencigarettebrandsanalyzedtogetherandforNewportspecifically,withusers recognizingtheadssignificantlymorethannonsusceptiblenonsmokers.Smokingsusceptibilitywas positivelyassociatedwithadlikingforthementholbrandsKoolandNewport,andnonmenthol brandsMarlboro,CamelandCapri.Theseresultswerenotedbytheauthorsasconsistentwiththe notionthatcigaretteadvertisingisattractivetosusceptiblenonsmokersaswellandmayinfluence themtoexperimentwiththeproduct. Arnett&Terhanian(1998)showed534sixthtotwelfthgradersoneprintadvertisementforeachof fivecigarettesbrandsMarlboro,Camel,Kool,Benson&HedgesorLuckyStrikeandaftereach viewingtheycompletedquestionsaboutthead.Overall,56percenthadseentheKooladmorethan sixtimes,38percentlikedit,30percentsaiditmadesmokinglookappealingand9percentsaidit madethemwanttosmokethatbrand.ResponsestothesequestionswerehigherforMarlboroand CamelandlowerforBenson&HedgesandLuckyStrike.Asforotherbrands,smokersmore frequentlyindicatedthannonsmokersthattheylikedtheKoolad,andthattheKooladmadethem wanttosmokethebrand. Twostudiesprovideecologicalevidencethatmentholmarketingexpendituresarerelatedto adolescentcigarettebrandpreference.InasurveyreportedbyBarkeretal.(1994)thethreemost commonlypurchasedbrandsamongadolescentsmokersin1993(Marlboro,CamelandNewport) werethethreemostheavilyadvertisedbrandsin1993.ThisisdespitethefactthatCameland Newportrankedseventhandfifth,respectively,inoverallmarketshare.Similarly,theincreasefrom 19891993inadolescentsbrandpreferenceforCamelcigarettesandthedecreaseinpreferencefor Marlborocigarettesduringthatperiodwerenotexplainedbychangesinoverallmarketsharefor thesebrands.Rather,thesechangesmirroredthedirectionofchangesinbrandspecificadvertising expenditures:from19891993,Marlboroadvertisingdecreasedto$75millionfrom$102million, whileCameladvertisingincreasedto$43millionfrom$27million.Incontrast,theincreased preferenceforNewportmentholcigarettesdidnotreflectthedecreaseinNewportmenthol advertisingexpendituresto$35millionfrom$49millionduringthesameperiod.Theauthorssuggest thatregionaldifferencesinbrandpreferenceofadolescentsandchangesinthosepreferencesduring 19891993mightbeexplainedbyfurtheranalysisoftherelationbetweenregionaladvertising expendituresandbrandpreferences. Pollayetal.(1996)modeledtherelationshipbetweenadvertisingexpendituresforninebrands includingNewport,KoolandSalemandyouthandadultcigarettebrandpreferencebetween1974 and1993.BrandpreferencedatawassourcedfrompopulationsurveysofyouthandfromMaxwell Reportmarketsharedataforadults.Usingstandardtechniquestoanalyzemarketshareinvolving

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Koycktypemodels,theyfoundthatbrandchoicesamongteenagerswererelatedtotheextentof brandspecificcigaretteadvertising.Furthermore,therelationshipbetweenbrandchoiceandbrand advertisingwassignificantlystrongeramongteenagersthanamongadults,byafactorofalmost three(Pollayetal.1996).Thesefindingswererobusttodifferentassumptions,includingtheremoval fromthemodelofthemostpopularbrand,Marlboro.Thesefindingssuggestthatadvertisingfor cigarettebrands,includingmentholcigaretteadvertising,hasagreaterimpactonthebrand preferencesofteenagersthanonadults. Summary.Takentogether,thesectiononyouthfulimageryinmentholmarketingandthestudiesof industrydocumentsdescribedinthissectionconfirmthattheindustrydevelopedmentholmarketing toappealtoyouth.ThisisparticularlytrueoftheNewportbrand,butthatstrategywasalsoadopted byothertobaccocompanies.Marketingmessagespositionedmentholcigarettesasanattractive starterproductfornewsmokerswhoareunaccustomedtointensetobaccotasteand/orhighlevels ofmenthol.Empiricalstudiesprovidefurtherevidenceoftargeting:youthpayattentiontoandare attractedtomentholcigaretteadvertising.Cigaretteadvertising,includingmentholadvertising,has agreaterimpactonthebrandchoiceofadolescentsthanitdoesforadultsmokers.Studiesofthe roleofmentholcigarettesinsmokinginitiationarediscussedinchapter6. Targeting:Women ThewhitepaperbyRising&Alexander(2010)pointsoutthatneitheroftworeviewsoftobaccouse amongwomenincludedinformationthatwasmentholspecific.However,fourtobaccoindustry documentreviewsincludedinformationaboutmentholmarketingtowomenandoneempirical studywasfocusedonmentholmarketingtowomen. Carpenteretal.(2005)reviewedtobaccoindustrydocumentstoshowthatextensiveresearchwas conductedbytheindustryonfemalesmokingpatterns,needsandproductpreferences,including mentholbrands.Theindustrytookaccountofwomenssocialandcosmeticconcernsforcleanliness andfreshnessthroughmentholcigaretteproductdesignandmarketing.Lorillard,forexample, experimentedwithalemonflavoredmentholbrandtoaddressfemalesensitivitytounpleasantodor andaftertastewhilecapitalizingontheirgreaterwillingnesstoexperimentwithflavoredcigarettes (Carpenteretal.2005). Intheirreviewofmentholcigarettemarketingwhichincludestobaccoindustrydocuments,Sutton& Robinson(2004)pointoutthatfemalesmokerswerethefirsttargetedpopulationformenthol cigarettes,whena1930sadvertisementforSpudmentholcigarettesproclaimedthattoreadthe advertisementsthesedays,afellowdthinktheprettygirlsdoallthesmoking(USDHHS,citedin Sutton&Robinson2004).Theseauthorsalsonotedthatadvertisementsformentholcigarettesfrom the1950sonwardhadadistinctlyfeminineaura,featuringimagesofromance,floweringfieldsand springtime. Klausnersdocumentreview(inpress),mentionedabove,describedexamplesofmarketingefforts directedatyoungfemales.Forexamplein1976,R.J.ReynoldsdescribedLorillardsmarketingeffort asfollows:Newportisplacingincreasedemphasisonbothyoungfemaleandyoungmale publicationsreducingolderfemalepublications[magazines].Trendistowardyoungerreadersand moremenalthoughoverallfemaleskewcontinues(documentcitedinKlausner,inpress). Andersonsdocumentreview(inpress)foundthatthethreelargeststandalonementholbrandshad differentbrandidentitiesinthemindofbothmanufacturersandconsumers.R.J.Reynolds documentsportrayedSalemasabrandforsmokerswhoarepassive,feminine,describingitsSalem SlimLightsvarianttobepositionedforconsumerswhodesirearefreshing,lowtarcigarettewith(a) stylish,unpretentiousfeminineimage(citedinAnderson,inpress).Althoughthementholsegment skewsfemale(documentscitedinAnderson,inpress),theKoolbrandhasamoremasculineimage,

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describedbyLorillardasastrongtasting,toughguycigarette(documentscitedinAnderson,in press). Fernandezetal(2005)conductedadescriptiveanalysisofmentholadvertisinginwomens magazinescomparedtoonemensmagazinefrom1988to2002.Theyfoundthattheproportionof mentholadsoutofallcigaretteadsineachissueofmagazinesforwhitewomendidnotdifferfrom thoseforwhitemen.However,asdiscussedmorefullyinthenextsectiononethnicity,therewasa higherprevalenceinmagazinesforHispanicwomen. Summary.Somementholbrandsappeartobemoretargetedtowomenthanmen,whileothers havemoremasculinebranding.However,thereismoreevidencethatmentholmarketingeffortsare directedtoyouthandyoungadultsingeneral,andtoracial/ethnicsubgroupsofwomen(seealso nextsection). Targeting:AfricanAmericans Alargebodyofresearchhasdocumentedadisproportionatevolumeofcigaretteadvertisingaimed atAfricanAmericans(cf.Primacketal.2007).Onlythesubsetofstudiesthatcategorizedor quantifiedadvertisingformentholcigaretteswereexaminedforthissection. Industrydocumentsresearch ThetobaccoindustrysinternaldocumentsillustratesustainedeffortstotargetAfricanAmericans throughthedevelopmentandadvertisingofmentholproductsandthroughcorporateinvolvement incommunitybasedorganizations. Balbachetal.(2003)reviewed21,000industrydocumentsfromasearchstringoftermsrelatedto R.J.ReynoldslaunchofUptown,afullflavorcigarettewithlowerlevelsofmentholthanSalem,that wasdesignedtoappealtoyoungAfricanAmericanmen.Ina1988speech,aseniormarketingofficial notedthatthecompanyhadbeenusingtargetedmarketingprogramsfordecades:Reynolds tobaccohasmadeaspecialefforttoreachBlackSmokerssincetheearly1960salmost70percentof Blacksmokerschooseamentholbrand.ThatswhyspecialadvertisingandpromotionsforSalem cigarettesmakealotofsenseinBlackmediaandBlackcommunities(Winebrenner1988,citedin Balbachetal.2003).TheobjectiveofR.J.ReynoldsBlackInitiativeProgramwastoregainitsshareof theAfricanAmericanmarketwithaplanthatfeaturedtargetedBlackprintmedia(Jet,Essence, Ebony,keynewspapers)andaheavyoutdoorpresence(R.J.Reynolds1990,citedinBalbachetal. 2003).SpecialpackagingforUptownreflectedthecompanysbeliefsthatAfricanAmericansmokers openedcigarettesfromthebottomandthatapackcontainingonly10cigaretteswouldaddressthe pricesensitivityofthetargetaudience.Asaresultofintensepublicpressurethatfollowed R.J.Reynoldspressrelease,thecompanycanceledthetestmarketinginPhiladelphiaandit abandonedtheUptownbrand.A1990PhilipMorrismemorandumattributedthisfailuretoits competitorsmiscalculation:marketingcigarettestominoritieswasnotnew,sayingsowas. (PhilipMorris1990,citedinBalbachetal.,2003)R.J.Reynoldscontinuedeffortstobuildbrandshare intheAfricanAmericanmarketwereinformedbytheideathatahighlyvisiblecommitmentto socialresponsibilityisfundamentaltosuccessfulethnicmarketing(R.J.Reynolds1994,citedin Balbachetal.2003).Theauthorsnotedthatthecompanysstrategyrepresentedacombinationof marketingexistingmentholbrandsandbuildingcommunityrelationshipsthroughsupportoflocal eventsandprograms. HafezandLing(2005)examined210industrydocumentsrelatedtomusicsponsorshipandtheKool brand.Usingmusicastheunifyingelementofanintegratedmarketingcampaignaimedatyoung AfricanAmericansmokerswasaprovenformulaforBrown&Williamson.Beginningwiththefirst KoolJazzconcertin1975,musicpromotionswereusedtomaintainandaugmentmarketshareinthe

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AfricanAmericancommunity.Forexample,a1981marketingdocumentsuggestedthatKoolsmusic campaignwasoriginallydevelopedonastrategyofmoreeffectivelyreachingamajorsegmentof ourtargetaudience,providingsomekindofrewardforthissamegroupintheformofshowsat bargainprices,andusingtheeventstooffsetBlackmediaavailabilitydeficiencies.(Broecker1981, citedinHafez&Ling2005).Vansequippedwithloudspeakers,suchastheKoolMobileMusicTour, wereusedtodistributefreeKoolcigarettesamplesininnercityneighborhoods.Similarpromotional techniqueswerethefoundationofa1981KoolMarketDevelopmentProgram,whichalso encouragedtheinvolvementofBrown&Williamsonssalesrepresentativesandmanagersinretail andcommunityorganizationsthatwillassistinfosteringpositiverelationsintheBlackcommunity. (Brown&Williamson,1982,citedinHafez&Ling,2005). Yergeretal.(2007)examineddocumentsfromthefourcompanies(Brown&Williamson,Lorillard, PhilipMorris,andR.J.Reynolds)whosementholbrandswerethemostheavilymarketedinAfrican Americanneighborhoods,usingsearchtermsrelatedtoAfricanAmerican,innercity,andurban.The analysishighlightedfourstrategiesthatwerecommontotheindustrysmarketingprogramsinthe innercitiesfrom1980tothelate1990s:collectingpsychographicandotherdataaboutAfrican Americanconsumers,usingmobilevanstomaximizethedistributionoffreecigarettes,developing specializedpromotionsforinnercityretailers,andengagingwithlocalorganizationstoimprove corporateimageintheAfricanAmericancommunity.Forexample,PhilipMorrissoughttoresolve problemswithproductavailabilityandvisibilityinitsBlackaccounts,whichweresmallerliquor, grocery,andconveniencestoresininnercities(PhilipMorris1984,citedinYergeretal.2007).The companyredesignedproductdisplaysandpaidretailersincentivestoexpandinventoriesand maintainvisuallyprominentdisplays.FirsttestedinDetroit,theprogramwaslaterexpanded nationwidetopromoteonlymentholextensionsofthecompanysmostpopularbrands.Similarly, Brown&WilliamsonsKoolInnerCityFamilyProgramtargetedthetop20AfricanAmerican marketswithfreegiftsforretailersanddistributors,instoreadvertisingwithAfricanAmerican models,andavarietyofconsumeroffers(Lagreca1987,citedinYergeretal.2007).R.J.Reynolds conductedinterviewsininnercityzipcodeswithatleast50percentAfricanAmericanresidentsand yearlyhouseholdincomesunder$20,000inordertodeterminetheboundariesoftarget neighborhoodsforaBYAS(BlackYoungAdultSmoker)Initiativetoincreasemarketshareforits Salembrand(Hawkinsetal.1989,citedinYergeretal.2007).Additionally,thevalueofthetarget audienceforincreasingbrandsharewasdescribedinthecompanysmarketingreport:Thedaring, flamboyantaspectofYA[youngadult]Blacksmokerspersonalitiesareevidentinthemanytrends theystart.Andthefactthatthesetrendsoftenspreadtothegeneralpopulationspeakstothe unrecognizedpowerandinfluencethissubgroupyieldsonsociety[emphasesinoriginal]. (LefermanAssociates1989,citedinYergeretal.2007).Theauthorsconcludedthatgeographically specific,aggressive,andintentionallydisproportionatelevelsofmarketingcontributedtothe tobaccorelatedhealthdisparitiesthatareevidentamongAfricanAmericans. Intheirreviewof144industrydocuments,Johnsonetal.(2008)identifiedsimilartargeting strategies,includingindustrysponsoredstudiesofAfricanAmericanculture,geographictargetingof urbanareas,andinvestmentsincommunity,ethnic,andculturaleventstoenhancetheindustrys imageintheAfricanAmericancommunity.Forexample,a1976marketingplanforBrown& Williamsonreported:KoolistodevelopprogramswhichingratiatethemselveswiththeBlack community.TheseprogramsaretoshowthemakersofKoolasacommunitycitizen,bebackfire proofandpavethewayforsupportingthebrand.(Brown&Williamson1976,citedinJohnsonetal. 2008). Cruzetal.(2010)combineddatafrominterviewswithaformerBrown&Williamsonexecutivewith analysesoftobaccoindustrydocumentstoexaminehowamixofmarketingstrategieswasusedto promotegrowthinmentholbrandshareamongnewandexistingAfricanAmericansmokersinurban areas.Accordingtotheexecutive,Brown&Williamsonusedthetermfocustoreferto communitiesorstoresinpredominatelylowincome,AfricanAmericanareasthatwereidentifiedas

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beingcriticaltoincreasingmarketshare.Forexample,a2002businessplanstated:Koolisdelivering apremiummessagetoitsanticipatedaudienceandconcentratingin22trendsettingurbancities wherethemajorityofthisaudiencelives.Thesecitieshousethe102focusassignmentsthatKoolhas identifiedtobekeytothegrowthofthebrand(KoolUSA2002,citedinCruzetal.2010).The companyplacedagreaterquantityofinteriorandexteriorsignsinfocusstores,andinstalledpack displaysthatfeaturedmoreshelfspaceformentholthanfornonmentholbrands.Inaddition,a 2002marketingreportdocumentedthatamultipackdiscountofferedin1,600storesresultedina largermarketshareformentholthanwasobservedinstoresthatdidnotreceivethepromotion.The authorsconcludedthatmentholisthelynchpininatightlyintegratedseriesofcampaignsaimedat theurbanpoor,especiallyAfricanAmericans. Andersons(inpress)analysisoftobaccoindustrydocumentshighlightedtheroleofmarketinginthe growingpopularityofmentholcigarettesamongAfricanAmericansmokers.Accordingtoahistoryof mentholbrandswrittenbyanR.J.Reynoldsmarketingofficial,Koolledthistrendbyadvertisingto AfricanAmericansbeforeitscompetitorsdid:KooladswereinEbonyconsistentlyfromatleast 1962,whenourrecordsstart.Koolbecamecooland,bytheearly1970s,hada56percentshare amongyoungeradultBlacksitwastheBlackMarlboro(Burrows1984,citedinAndersoninpress). Thissentimentwasechoedina1968documentfromPhilipMorris,whichobservedthatmenthol cigaretteswereespeciallysuitedtotheneeds,desiresandtastesofNegroconsumers.(PhilipMorris 1968,citedinAndersoninpress).InaBlackOpportunityAnalysisconductedbyR.J.Reynoldsin 1985,thecompanysresearchobservedthatanunderclassofAfricanAmericansmokerswould remainreliablecustomersinspiteofgrowinghealthconcerns:Blackssimplyhavemorepressing concernsthansmokingissues.(R.J.Reynolds1985,citedinAndersoninpress).A1983industry studyoflowincomeAfricanAmericansmokersobservedthatrecallofadvertisingforspecific mentholbrandshadimprovedsince1979andtheuseofmentholcigarettesamongthe1834lower incomeBlacksegmentisalmostuniversal(Lorillardestimated1983,citedinAndersoninpress).The authorconcludedthatheavytargetingoflargelyAfricanAmericanurbanpopulationsisreflectedin thenearlyexclusivepreferencesformentholbrandsamongthesesmokers.Indeed,surveydata describedinchapter4confirmsthatalthoughmorementholsmokersarenonHispanicwhitethan AfricanAmerican,AfricanAmericansdisproportionatelyfavormentholbrands. Alltypesofresearchmethodsaresubjecttolimitations,includingqualitativedocumentsresearch.A separatepeerreviewedpaperbyAndersonetal.(inpress)identifiedseverallimitationsthatpertain tothestudiesreviewedinthissectionandelsewhereinthischapter.Thesheervolumeofdocuments available(morethan60millionpages)makesitimpossibleforresearcherstodeterminethatall relevantdatawereincludedforeachtopicexamined.Althoughresearchersaimtoidentifythemost importantdocumentsamongsimilarresultsforcombinationsofrelatedsearchterms,this saturationwasnotachievedinallstudies.Theprevalenceofacronymsandevidenceofcodewords formentholsuggeststhatresearchersunderstandingofthedocumentsmaybehamperedifthe contextisunknown.Inaddition,evidencethattheindustrytriedtoconcealitsfindingsandto destroydocumentsincreasesthechancethatrelevantdocumentscouldbemissingandthata researchersunderstandingofatopicmightbeincomplete.Despitetheselimitations,thestudies reviewedherearenoteworthyforaconsistencyofevidenceaboutthetobaccoindustryssystematic effortstopromotementholcigarettestoAfricanAmericans. Advertisingenvironment ThewhitepaperbyRising(2010)identifiedsixrelevantpeerreviewedarticles.Inaddition,this sectionincludedonepeerreviewedstudythatwaspublishedafterthewhitepaper(Seidenbergetal. 2010).Thestudiesareorganizedbythetypeofadvertisingexaminedandthenreviewedin chronologicalorder.

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Magazines Threestudiesdocumentedthatadvertisementsformentholcigaretteswereoverrepresentedin magazinesthatarepopularwithAfricanAmericanreaders.Cummingsetal.(1987)comparedads thatappearedinthreemagazineswithalargelyAfricanAmericanreadership(Jet,Ebony,Essence) andfourmagazineswithalargelynonHispanicwhitereadership(Newsweek,Time,Peopleand Mademoiselle).FullpageadsappearingbetweenJune1984andMay1985wereclassifiedaccording toproduct,andbrand(menthol,nonmenthol,orboth).Comparedtotheothermagazines,those targetingAfricanAmericanscontainedalargerproportionofcigaretteads(12.0percentversus9.9 percent)andlargerproportionformentholcigarettes(65.9percentvs.15.4percent).Both comparisonswerestatisticallysignificant. InformedbyhypothesesfromananalysisoftobaccoindustrydocumentsaboutR.J.Reynolds Uptownbrand,onestudycomparedcigaretteadsforR.J.Reynoldsbrandsthatappearedinthesame threemagazinestargetedatAfricanAmericanreaders(Jet,Ebony,andEssence)withthosethat appearedinPeopleWeekly(Balbachetal.2003).Adsweresampledfromtwotimeperiods:the yearssurroundingtheintroductionoftheUptownbrand(19891990)andonedecadelater(1999 2000).ComparedtoPeopleWeekly,themagazinestargetedtoAfricanAmericanscontaineda significantlylargerproportionofR.J.Reynoldsadsformentholbrands100percentvs.31.6percent in198990and97.7percentvs.0percentin19992000. Landrineetal.(2005)examinedcigaretteadsthatappearedinonemagazinetargetedatAfrican Americans(Ebony),oneatLatinos(theSpanishlanguageeditionofPeople)andoneatnonHispanic whites(theEnglishlanguageeditionofPeople).InissuessampledfromJanuary1990throughAugust 2002,theproportionofadsformentholcigaretteswas67.2percentintheAfricanAmerican magazine,35.3percentintheLatinomagazine,and17.3percentintheothermagazine.Unadjusted oddsratiossuggestedthattheAfricanAmericanmagazinewas9.8timesmorelikelytocontaina mentholadthanthewhitemagazine;theLatinomagazinewas2.6timesmorelikelytocontaina mentholad. InasubmissionfromLorillardtoFDA,thecompanystatedthatNewportmarketingexpenditures havenotbeendisproportionatelyweightedtowardAfricanAmericansmokersoranyotherethnic grouporgender(p.44,Lorillard,July2010).Althoughthecompanysadvertisingexpendituresfor generalmarketmagazinesconsistentlyexceededitsexpendituresforAfricanAmericanmagazines (seeFigure11,LorillardJuly2010),thatdifferencedoesnotprecludeapatternoftargetedmarketing thatwasdocumentedinthestudiesofmagazines.Assuminglowerratesarepaidtoadvertisein magazineswithasmallercirculation,itwouldbepossibletoplacealargervolumeofadsinAfrican Americanmagazinesatasubstantiallylowertotalcost.LorillardincreaseditsspendingonAfrican Americanmagazinesrelativetogeneralmarketmagazinesin1993(seeFigure11,LorillardJuly2010), butnostudiesexaminedtherelativeimpactofthatincreaseontheproportionofadsformenthol brands.Contentanalysesofmagazineadvertisingformentholandnonmentholbrandsafter2002 werenotfound. Outdoorandretailadvertising Allfourstudiesonthistopicfoundthatmentholcigarettesweremarketeddisproportionatelyin areaswithmoreAfricanAmericanresidents.Altmanetal.(1991)comparedbillboardadvertisingby theracial/ethnicdemographicsofcensustractsinSanFrancisco,California.Eachofthe901 billboardsinthecitywasphotographedbetween1985and1987.Censustractswerecategorizedby thepredominantracial/ethnicgroupandwithoutregardtotheproportionofnonHispanicwhite residents.Thus,AfricanAmericanneighborhoodsreferredtocensustractswhere30percentofthe residentswereAfricanAmericanandtheywerethedominantethnic/racialminoritygroup,evenifa

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largerproportionofresidentswerenonHispanicwhite.Theproportionofallbillboardsthat advertisedmentholcigaretteswas22percentinAfricanAmericanneighborhoods,17percentin Hispanic,11percentinwhiteand10percentinAsianneighborhoods.AfricanAmerican neighborhoodsweresignificantlymorelikelytocontainbillboardsadvertisingmentholcigarettes. Puccietal.(1998)describedoutdooradvertisingforcigarettesinsixBostonneighborhoodstwo withthehighestmedianhouseholdincome,twowiththelowest,andtwointhemiddlerange.Inthe twooftheneighborhoods,89.2percentand62.3percentoftheresidentswereAfricanAmerican.All outdooradsfortobacco,includingbillboards,placards,posters,stickers,banners,neonand freestandingsigns,werecountedandcategorizedbybrand.Adsforexclusivelymentholbrands, Newport,Kool,andSalem,madeup49percentoftheoutdooradvertisingforcigarettesinthetwo AfricanAmericanneighborhoods,comparedto38percentintheLatinoneighborhoods,and22 percentinthenonHispanicwhiteneighborhoods.Theproportionofalladsformenthol,regardless ofbrand,wasnotcoded. Lawsetal.(2002)visitedallstoresin10demographicallycontrastingareasofBoston,Massachusetts andcomparedtheproportionofallcigaretteadsformentholbrands.Toidentifypredominantly LatinoandAfricanAmericanneighborhoods,theresearchersselectedcensustractsofsimilarper capitaincomebutdifferentethniccompositions.Thecomparisonareaswerepredominantlynon Hispanicwhiteandmoreaffluent.Fieldobservationswereconductedinall128storesthatsold cigarettesin1999.StoresintheareawiththehighestproportionofAfricanAmericanresidents containedthehighestconcentrationofcigaretteadsformentholbrands32percentinthatarea comparedto13percentoverall.Thedifferencebetweentheproportionofadsformentholin predominantlyminorityareas(29percent)andnonminorityareas(12percent)wasstatistically significant. Similarly,Seidenbergetal.(2010)comparedtheproportionofallcigaretteadsformentholon storefrontsintwoBostonneighborhoods,onewithpredominantlyAfricanAmericanresidents(50.1 percent)andonewithfewAfricanAmericanresidents(2.7percent).Toeliminatethelarge discrepancyinthenumberofretailersthatsoldtobaccointhetwoareas,theresearchersvisitedall 59storesthatsoldcigarettesinonezipcodeintheAfricanAmericanneighborhoodwithall43stores thatsoldtobaccointhecomparisoncommunity.Theproportionofcigaretteadsformentholbrands wassignificantlygreaterintheAfricanAmericanneighborhood(53.9percentvs.17.9percent). Adjustingforothercharacteristicsoftheads(includingsize,proximitytoschool,andthepresenceof aprice),theoddsoffindinganadformentholcigaretteswasfivetimesgreateronstorefrontsinthe AfricanAmericanneighborhood. Oneweaknessofthestudiesaboutoutdoorandretailadvertisingisthattheywerelimitedtosmall geographicareas.Inaddition,someoftheanalysesdidnotcontrolforneighborhoodincome, makingitdifficulttodiscernwhetherneighborhoodsweretargetedbecausetheywere predominantlylowincome,AfricanAmerican,orboth. Summary.Allofthetobaccoindustrydocumentreviewsprovideevidencethatthetobaccoindustry developedspecializedbrandsandtailoredmarketingstrategiestopromotementholcigarettesto AfricanAmericans.Studiesoftheadvertisingenvironmentthathavecomparedmentholandnon mentholadvertisingprovidecorroboratingevidenceofthetargetmarketingstrategiesthatwere identifiedintheindustrydocumentsresearch.Inallthreeempiricalstudiesonthesubject,menthol cigaretteswereadvertiseddisproportionatelymorethannonmentholcigarettesinmagazinesaimed atAfricanAmericanreaders,comparedtomagazineswithlowAfricanAmericanreadership.Both studiesofoutdooradvertisingandbothstudiesofretailstoreadvertisingshowedahigher proportionofmentholadsoutofallcigaretteads,inneighborhoodswithmoreAfricanAmerican residentsthanneighborhoodswithlowerproportionsofAfricanAmericanresidents.

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Targeting:OtherRace/Ethnicity AlthoughtherearemanystudiesthatconfirmAfricanAmericanstobeaparticulartargetaudience formentholmarketingefforts,therearefewerindustrydocumentreviewsandempiricalstudiesthat pointtotheuseofmentholadvertisingtargetedtowardsparticularethnicgroups,suchasHispanics, AsianAmericansandHawaiian/PacificIslanders.Nonetheless,availablestudiesgenerallyshow purposefultargetingtowardstheseethnicgroups. Industrydocumentreviews AreviewoftobaccoindustrydocumentsontargetingofAsianAmericansandPacificIslanders describedmanytobaccomarketingcampaignstoreachthesepopulationsubgroups,butmarketing strategiesformentholcigaretteswerenotspecificallymentioned(Mugglietal.2002).Atobacco industrydocumentreviewbyAnderson(inpress)identifiedmentholmarketingcampaigns specificallyaimedtowardsAsiansandHawaiians/PacificIslanders.Forexample,astudyofanR.J. ReynoldsKoolcigarettemarketingcampaigntargetingHawaiiansin1988remarkedthattheuseof ethnicmodelscouldprovideanopportunityforKooltocapitalizeonbeingthefirsttoemployethnic advertisinginHawaiianddisplaywhatislanderscallthealohaspirit(Andersoninpress). Anderson(inpress)alsodocumentedthatPhilipMorrisMarlboropromotionplanin1992included specialprogramstomentholHispanicandAsiansmokerstoincreaseitsmarketshareamongyoung adultsmokers. Empiricalstudies Altmanetal.(1991)conductedadescriptiveanalysisofbillboardsbycensusneighborhood demographiccharacteristicsduring19851987inSanFrancisco.Overall,19percentofbillboards featuredadsfortobacco(and13percentformentholcigarettes).Mentholcigarettebillboardswere morelikelyinAfricanAmerican(22percent)andHispanic(17percent)neighborhoodsthaninAsian (10percent)andwhite(11percent)neighborhoods.Althoughnostatisticalanalysiswasundertaken, theratesappeareddisproportionatelylowerfornonmentholcigarettebillboardsinAfrican American(2percent)neighborhoods,whilebeingaroundhalftherateinHispanic(8percent),Asian (4percent)andwhite(6percent)neighborhoods. Twostudiesfocusedonmagazineadvertisingwerelocated.Landrineetal.(2005),inthesamestudy describedaboveinthesectionontargetingAfricanAmericans,Landrineetal.(2005)examined tobaccoadvertisinginissuesofEbony,PeoplemagazineandPeopleinSpanishbetween1988and 2002.Inthisstudy,adsformentholbrandsweresignificantlymorelikelyintheSpanishlanguage editionofPeople(35percentofcigaretteads),comparedto17percentofadsintheEnglish languageversionofPeoplemagazine.Amorerecentlypublishedstudyreportedonadescriptive analysisofcigaretteadsintheEnglishandSpanishlanguageversionsofCosmopolitanandGlamour magazinesfrom1988to2002(Fernandezetal.2005).Despitethesemagazineshavingthesame publisher,content,lengthandadvertisingpolicies,thereweresignificantlymoreadsformenthol brandsinthemagazinesforSpanishspeakingwomen(51.1percentofcigaretteads)thaninthe versionsforEnglishspeakingwomen(28.3percentofcigaretteads).Infact,magazinestargeting Spanishspeakerswere2.64timesmorelikelythantheEnglishlanguagemagazinestocontainadsfor mentholcigarettes.SixtypercentofthecigaretteadsintheHispanicversionswereforKooland Newport,comparedtoonly26percentofthecigaretteadsinthewhitemagazineversions.Although thisstudywaslookedatjusttwowomensmagazines,itfocusedonpopulartitles.Thesestudies bothprovideevidenceoftargetingofHispanicsthroughmentholmagazineadvertising.

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ThepointofsaleadvertisingstudybyLawsetal.(2002),describedinaprevioussection,audited storesinBostonneighborhoodsfortobaccoadvertising.Theyfound32.3percentofallinteriorand exterioradvertisementsformentholbrandswereinneighborhoodswiththehighestpercentagesof minority(AfricanAmericanandHispanic)residentswhile10percentofallmentholcigaretteads wereinneighborhoodswiththelowestminoritypopulationsastatisticallysignificantdifference. AnotherretailfocusedstudybyGlanzetal.(2006)reportedonanauditoftobaccoadvertisingin184 tobaccoretailoutletsinHawaiiinlate2002.Overall,advertisementsforKoolmentholcigarettes werethemostcommonofalltobaccoadsidentified,irrespectiveofwhetheradswereastraight countorwereweightedbysize.Koolalsohadthemostoutdooradsusingbothoutcomes.Ithadthe largestnumberofindooradswhenastraightcountwasused,andwassecondtoMarlborowhen adjustedforsizeofad.ThisretailadvertisingforKoolwasthoughttoreflectthepreferenceamong Hawaiianyouthformentholcigarettes(especiallyKool),whichdiffersfromyouthpreferencesfor Marlboroonthemainland(Appleyardetal.2006;USDHHSUSSGreport2004). Summary.Comparativelyfewerreviewsandempiricalstudiesexaminedwhethermenthol marketinghasbeentargetedtoracial/ethnicgroupsotherthanAfricanAmericans.Althoughno tobaccoindustrydocumentreviewswereavailableonthetopic,allfourempiricalstudiesexamining mentholandnonmentholadvertisingfoundahigherproportionofmentholadsoutofallcigarette adsinHispanicneighborhoods(2studies)/magazines(2studies),thaninnonHispanicwhite neighborhoods/magazines.AtobaccoindustrydocumentreviewprovidedevidencethatAsian AmericansandHawaiian/PacificIslandersweretargetedinmentholmarketing.Oneempiricalstudy showedahighprevalenceofretailadvertisementsforKoolcigarettesinHawaii. Doesmentholmarketinginfluenceperceivedtasteand/orsensoryexperienceofmenthol cigarettes? ThroughoutTPSACmeetings,tobaccoindustryrepresentativesconsistentlypointedtotasteasbeing themaindriverofpreferenceformentholcigarettesamongmentholcigarettesmokers(July2010). However,tasteisacomplexperception,sinceitistheproductofbothflavorandothersensory attributes.Consumerscanalsobequiteunclearastowhattheymeanbytaste,oftensimplyechoing descriptionsgiventothembytobaccobranding,labelingandadvertising(Pollay&Dewhirst2002). Furthermore,thereisevidencethatconsumersuseelementsoftastetoinferthehealthinessand otherattributesofproducts.Thisislikelytobeanaturalhumantendency,withsomeevolutionary advantages.Forexample,akeyelementofunpleasanttasteistheperceptionofbitterness,thought likelytohaveevolvedinanimalstohelpthemavoideatingplantsandotherfoodscontainingtoxins andotherharmfulchemicals. Thissectionisorganizedintotwoparts.First,itsummarizesconsumerresearchfromotherdomains relatedtotasteperceptiontodocumenthowbrandingandlabelingcaninfluenceconsumertaste perceptionandsensoryevaluation.Subsequently,thissectionsummarizesstudiesspecifically pertainingtomessagesaboutcigarettesingeneralandmentholcigarettesinparticular. Itshouldbenotedthatadditionalliteratureonthesensoryexperienceofsmokingmentholcigarettes comparedtononmentholcigarettesissummarizedinchapters3and6. Roleofbrandingandlabelingintasteperceptionandsensoryevaluation Consumershavegenerallypoorabilitytodiscriminatebetweentastes,dueinparttoourtastebuds abilitytodetectonlysweet,sour,bitter,saltyandumamitastes.Multipleothersensesareinvolved intasteperception,includingsmell,sound(whenbittenorchewed)andtouch(textureinthemouth andtemperature)(Elder&Krishna2009).Visualcuesalsocontributetothesenseoftasteby generatingexpectationsaboutflavor.Evidencefromtheconsumerscienceliteratureaboutthe

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degreetowhichbrandingandlabelinginfluenceperceptionsofthetasteoffoodanddrinks illustratesthattasteperceptionissubjectiveandeasilymanipulated(Deliza&MacFie1996).Useof branding,includinguseofcoloranddescriptivenames,resultsinanexpectationorsensoryhalo effect,wherebytheexpectationhaloinfluenceshowapersonthinksaproductmighttasteaswellas tasteperceptionsandlikingwhentheproductisconsumed. Thereareseveralwaysinwhichexpectationsmightinfluencethesensoryexperienceofproductsand theirlikingoftheproduct(Deliza&MacFie1996;Cardello2007).Onemodelpredictstheexistence ofacontrasteffect(orboomerangeffect),whichmayoccuriftheconsumerholdsexpectationsthat arevastlydifferentfromtheeventualproductperformance.Underthesecircumstances,consumers whohaveverylow(orveryhigh)expectationsaboutaproductmightbepleasantlysurprised(orvery disappointed)bythecontrastwhentheproductisactuallyconsumed.However,contrasteffects haverarelybeenobservedintheliterature,evenwhendisconfirmationofexpectationisarguably quitelarge(Cardello2007).Anothermodel,knownastheassimilationmodel,predictsthat evaluationoftheproductwillchangeinthedirectionofexpectations.Inotherwords,an expectationcanbeadriverofsensoryexperienceandliking.Instudieswherefoodandbeverages havebeenusedastestproducts,thevastmajorityofobservedeffectshavebeenassimilationeffects (Deliza&MacFie1996;Cardello2007). Forexample,bittercoffeewasappraisedaftersamplingastastinglessbitteronlyamongthose consumerswhowereexposedbeforehandtothreeadvertisementsassertingthatthecoffeewasnot bitter(Olson&Dover1978).Anearlystudyfoundthatasliceofturkeywasratedmorepositively aftertastingifconsumersthoughtitwasapopularbrandratherthananunknownbrand(Makens 1965).Inamorerecentstudy,peoplewhoweregivenanenergybarsupposedlycontainingsoy proteinweremorelikelytorateitasgrainyandtasteless,comparedwithidenticalbarsthat containednomentionofthewordsoy(Wansink&Park2002).Infact,neitherbarcontainedsoy. InanotherstudyinIllinois,evocativedescriptivenamesofcafeteriameals(suchasSucculentItalian SeafoodFilet)ledtomealsbeingratedafterconsumptionasmoreappealing,tastierandcaloric,and elicitingmorepositivecomments,thanexactlythesamemealswithlessdescriptivenames(suchas SeafoodFilet)(Wansinketal.2005).Colorandlabelinginfluencedperceptionsofotherwise identicalM&Mcandies:brownM&Mswereratedasmorechocolateythanallothercolors,and thoselabeledasdarkchocolatewereratedasmorechocolateythanthoselabeledmilkchocolate (Shankaretal.2009).Evenchildrenexpresstheeffectsofbrandingontasteperception:astudyof threetofiveyearoldsinCaliforniafoundthatidenticalfoodproductswereappraisedastasting betterwhentheywerebrandedwithMcDonaldsthanwhentheywereunbranded(Robinsonetal 2007). Thereisvariabilityintheextenttowhichbrandandlabelinformationinfluenceevaluationof differenttypesofproducts.Forexample,inanothercontrolledcafeteriastudy,dietandhealthlabels (e.g.,chocolatepuddingvs.healthychocolatepudding;pineapplesoymuffinsvs.dietpineapplesoy muffins)improvedtheratedtasteofdessertsbutnottheratedtasteofentrees(Wansinketal. 2004).Ininterpretingthesefindings,theinvestigatorssuggestedthatpeoplemightexpectadessert labeledashealthyordietrelatedtonottasteverygood.Whenittastesbetterthanexpected,it promptsanoverevaluationoftasteratings.Bycontrast,healthlabelshadlessabilitytoinfluence evaluationoftheentreesoffered,sincetheywerealreadyrelativelyhealthy.Thisstudysuggeststhat forproductsthatarelesshealthy,descriptivelabelslikelyhavegreatercapacitytopromotepositive tasteevaluations. Inrecentyears,muchprogresshasbeenmadeinunderstandingtheneuralbasisofcognitiveeffects ontasteandothersensoryexperiences.Thisresearchhasusedfunctionalmagneticresonance imaging(fMRI)technologythatmeasuresbloodflowinvariousregionsofthebraininresponseto productconsumptionundervaryingconditionsofexpectation.Insummary,thesestudies

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demonstratethatexpectanciescanchangeboththesubjectiveevaluationoftheproductandthe neuralresponsetotheseproducts(Cardello2007;Cardello&Wise2008).Forexample,McClureet al.(2004)foundthatCokewasratedhigherinasubjectivetastetestwhenconsumedfromacup bearingtheCokelogothanfromanunmarkedcup.Consistentwiththesesubjectiveratings,the studyalsofoundthattheimageofaCokecanpresentedpriortoCoketastingresultedingreater brainactivityinthedorsolateralprefrontalcortex(DLPFC),hippocampusandmidbrain,comparedto unbrandedCokedelivery(McClureetal2004).Thisfindingisimportantbecausethehippocampus andDLPFChavebothbeenpreviouslyimplicatedinprocessingemotionandaffectasitrelatesto behaviorchange.Theinvestigatorssuggestedthatbrandinginformationbiasespreferencedecisions throughtheDLPFC,withthehippocampusengagedtorecalltheassociatedinformation(McClureet al2004).Inamorerecentstudy,Nitschkeetal.(2006)foundthatwhenpeopletastedahighly aversive(bitter)fluid,thelevelofactivationinthebilateraltastecortexinthebrainwasreduced whentheyweretolditwouldbeonlymildlyaversive,comparedtowhentheyweretoldthatitwould behighlyaversive.Thismisleadinginformationalsoledtopeopleratingthebitterfluidasless aversivethanthatsamefluidwhenitwastastedfollowingthetruthfulcue.Together,thesestudies implythatbrandingandlabelingcanleadpeopletoholdmorefavorableexpectationsabouta product,andtheseexpectationsinfluencebrainfunctionsinwaysthatresultinanenhancedsensory experience. Theinfluenceofbrandingonsensedexperiencewhenproductsareconsumedisautomatic,inthat consumersarelargelyunawareoftheseprocesses.Inpart,thisislikelytobebecausewhen consumingaproduct,consumershavelimitedtimetomaketheirevaluationandtendtorelyon shortcutseasilyavailableinformationwhichisprocessedquicklyandefficientlytoassisttheir decisionmakingandguidetheirevaluation(alsoknownasheuristicprocessing).Mostconsumersdo notthinkthatbrandingorlabelingpriortotastingwouldchangetheirsensedexperienceofproducts andare,infact,unabletocorrectlypredicttheresultsoftastetestsinwhichexpectanciesare manipulatedinthewaysdescribed(e.g.,Leeetal.2006). Itisimportanttonotethatbrandingandlabelingarenottheonlyinformationavailabletoform consumerexpectations:thesharedexperiencesandrecommendationsofothersandonesown experiencewiththeclassofproducttobetastedwillalsoinfluenceexpectationsandthereforeones subjectiveperceptionsoftaste.Individualswhohavelessexperiencewiththeclassofproductstobe tastedandlowinvolvementwiththeproducttendtorelymoreonbrandingandlabelinginformation (Deliza&McFie1996;Cardello2007). Overall,thisbodyofconsumersensoryresearchsuggeststhataproductthatpeoplemayfind unremarkableorevenaversive,orthattheyknowmaybeunhealthy,canbemanipulatedtobe experiencedasmorepleasantbystrengtheningconsumersexpectationsthattheproductwilloffera positiveexperience.Brandingandlabelingthereforehaveacriticalroletoplayinraisingconsumer expectationsaboutaproduct.AssuggestedbyCardello(2007),theopportunityexiststoimprove theacceptanceofaproductanditsmarketsharethroughcreativemarketingthatestablishesa positiveimageandexpectationforaproduct.Hereliestheheartofalladvertisingstrategiesaimed atimprovingproductimage(Cardello2007,p.230).Thosewhohavelessexperiencewithaclassof products,includingyoungpeople,maybeespeciallyvulnerabletotheeffectsofmarketingon productlikingandsensoryexperience,andtherefore,onitsconsequentinfluenceuponproduct acceptanceanduse. Brandingandlabelingeffectsonsubjectiveexperienceofcigarettes Thereisgoodevidencetoshowthatbrandingandlabelingmodifythesubjectiveperceptionof tobaccowhenitisconsumed.Mostofthisresearchhasbeenundertakenusingcigarettepackaging asthemediumforbranding.Inareviewofinternaltobaccoindustrydocumentsontobacco packagingmadepublicthroughlitigationfiledagainstmajorU.S.cigarettemanufacturers,Wakefield

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etal.(2002)foundthattobaccocompaniesemployedtheconceptofexpectancymanipulationor sensationtransfertoassistthemtodesigncigarettepackaging.Intheindustrydocuments,the termsensationtransferisusedtorefertothephenomenonwherebybrandelementsonpackaging createexpectationsofwhatthecigarettewillbelikewhensmokedalsoreferredtoasthehalo effectofbranding.Numeroustobaccoindustrystudieswerefoundwherebyexactlythesame cigarettespresentedindifferentpacksledconsumerstoevaluatethemdifferentlywhentheywere smoked.Tobaccocompaniesdiscoveredthatlightercolorsonthepackpromotedperceptionsof lowercigarettestrength.Forexample,identicalcigarettespresentedinbluepacksweredescribed afterbeingsmokedastoomild,noteasydrawing,andburntoofast,whereaswhenpresentedin aredpack,theyweredescribedastoostrongandharsher(Wakefieldetal.2002). Apublishedempiricalstudyrandomlyassigned200maleandfemalesmokerstosmokeidentical cigarettesthatwerebrandedeitherAprilorFrontiersman(Friedman&Dipple1978).Female smokerswhosmokedthecigaretteswithafemininebrandnameratedallaspectsoftasteand enjoymentmorefavorablythanthefemalesmokerswhotriedtheidenticalcigaretteswitha masculinename.Similarly,malesmokersfavoredthemasculinebrand,buttheeffectwasless pronounced.Intheirindustrydocumentreviewonmarketingimagery,Pollay&Dewhirst(2002)find thatmarketresearchersforthetobaccoindustryanditsadvertisingagencieswerenotconfident consumersknewwhattheyweretalkingaboutwhenreferringtotasteofacigarette.Asone documentfrom1975detailed,[I]tisalmostimpossibletoknowifthetastesmokerstalkaboutis somethingwhichthey,themselves,attributetoacigaretteorjustaplaybackofsomeadvertising messages.(Marketing&ResearchCounselorsInc.,citedinPollay&Dewhirst2002). DiFranzaetal.(2002)suggestthattheprocessbywhichpackdesigncommunicateswhatconsumers mightexpectfromthecigarettesissubconscious.AnR.J.Reynoldsmarketingdepartmentdocument indicatedthatonthefirstlevelapackageservestoreinforcethebrandsadvertisinginestablishinga certainbrandimageorsetofconnotations,andindoingsoitoperatesonasubconsciouslevel.That is,thefactthatitdoesthisisnotreadilyapparenttotheconsumer(MarketingResearchDepartment 1969,citedinDiFranzaetal.2002).DiFranzaetal.alsonotethattheinfluenceofpackdesignonthe subjectivelyexperiencedqualitiesofthecigaretteisofsuchamagnitudethatwhenpurelyobjective ratingsofthecigarettequalitiesaredesired,thetestcigarettesarenotbranded(DiFranzaetal. 2002).AttheJuly15,2010TPSACmeeting,tobaccoindustryrepresentativesacknowledgedthatthe presenceofbrandinginformationdoesinfluenceconsumerevaluationsofcigaretteswhentheyare smoked(transcriptp.183185.)Thus,consumersperceivedtasteandsensoryevaluationof cigarettesareinfluencednotonlybytheproductitself,butbyrelatedbrandinginformation, includingcolor,packdesign,andlabeling. Inareviewoftobaccoindustrydocuments,Wakefieldetal.(2002)foundthatgreencolorsin mentholpackagingwerepredominantlyusedtoinfluenceexpectationsofmentholtasteandsensory experience.Forexample,aftersmokingidenticalmentholcigarettesinaPhilipMorristest,panelists consistentlyascribedmorementholcoolnesstothosepresentedinthedarkeroftwoshadesof green,comparedwiththestandardwhitepapercigarettes.Therewasnodiscernabledifference betweenthelightershadeofgreenandwhite(Martin1969,citedinWakefield2002).AnotherPhilip MorristestfoundthatthementholbrandSaratogawasperceivedashavingmorementholwhenthe cigaretteitselfwaswrappedwithgreenpaperthaneitherproductionSaratoga,whichhadthesame menthollevelbutwasinawhitewrapper,ortheMorebrand,whichhadahighermenthollevelbut wasinabrownwrapperindicatingthatthegreenpaperhadaneffectontheamountofmenthol perceived(Howes1976,citedinWakefield2002).AsimilarreviewoftobaccopackagingbyDiFranza etal.(2002)alsocommentedonthesesensationtransfertests,givinganexampleofanR.J.Reynolds packtestinwhichmenstronglypreferredthecigarettesmokedwhentakenfromanicepackovera cigarettesmokedwhentakenfromagreenpack,eventhoughthecigaretteswereidenticalin composition.Thetestconcludedthecigaretterelatedtotheicepackseemstobeperceivedasbeing

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amildercigarettebytherespondents.Theiceontheicepackconnotesacool/refreshingcigaretteto therespondents(Magnus1969,citedinDiFranzaetal.2002).Thus,manipulatingelementsof packagedesignissufficienttochangesmokersexpectationsandevaluationsofmentholcigarettes whentheyaresmokedregardlessofhowmuchmentholtheycontain. Consumertestingofcigarettepackswasalsoundertakentoensurethatexpectationsofmenthol contentremainedstablewhenlowertarandnicotinebrandextensionswereintroduced.DiFranzaet al.(2002)pointtoaconsumerstudybyR.J.Reynoldsin1975forthreepackdesignoptionsforSalem mentholcigarettes.Overall,thereportconcludedthattheGreenLinedesignwasthemost effectiveinconnotinglowertarandnicotine,especiallyamongSalemsmokersandfemalesmokers. Thispackagewasalsotheleastlikelyofthethreealternativestoconnotelessmenthol(Daniel1975, citedinDiFranzaetal2002). Summary.Thereisstrongevidencefromthegeneralmarketingliteraturethatbrandingandlabeling influenceconsumerexpectationsaboutaproductandthesubjectiveexperienceofproduct consumption.Tobaccocompanyresearchandempiricalstudiesdemonstratethatelementsof packagingsuchasbranding,coloranduseofdescriptivelabelsinfluenceconsumerbeliefsabout cigarettes,aswellasthesensoryexperiencewhentheproductissmoked.Therehavebeennopeer reviewedexperimentalstudiesspecificallyontheeffectsofmentholbrandingonconsumertasteand sensoryevaluation.However,consumertestingconductedbytobaccocompaniesdemonstratesthat manipulationofelementsofmentholcigarettepackaginginfluencesconsumersensoryexperiences ofperceivedcoolness,amountofmenthol,mildness,andoverallpreference.Thus,menthol packagingreflectsthetobaccoindustrysknowledgeabouthowcolor,labelingandotherelementsof brandingwillimprovetheconsumerexperienceoftheproductscharacterizingflavor. DOCONSUMERSPERCEIVEMENTHOLCIGARETTESASSAFERORLESSHARMFULTHANNON MENTHOLCIGARETTES? AsindicatedinthesectiononPackaging,forbothmentholandnonmentholcigarettes,different shadesofthesamecolorandtheproportionofwhitespacearecommonlyusedtodistinguish betweenvariantsofthesamebrandfamily.Twostudiesillustratethatcolorandotherbranding featuresinfluencedadultsandadolescents(ages1217)expectationsaboutperceivedhealthrisk (Hammond&Parkinson2009);Hammond,Dockrell,Arnott,Lee&McNeill2009).Usingapaired comparisonstudydesignwithoneelementofpackagingmanipulated,adultsmokersratedcigarette packsthatfeaturedlightercolors,sensorydescriptors(smooth,light,mild),andpicturesoffiltersas deliveringsmoothertaste,lesstarandreducedhealthrisks(Hammond&Parkinson2009).In addition,beliefsabouttastewerepositivelycorrelatedwithbeliefsabouttardeliveryandhealthrisk. Thesestudiesdidnotincludementholpacks,buttheyillustratetheextenttowhichbranding elementsabouttasteandsensoryexperiencemaycontributetobeliefsthatsomecigarettesareless harmfulthanothers.Thissectionexaminesevidencefromqualitativeanalysesoftobaccoindustry documents,qualitativefocusgroupresearch,andsurveyresearchthatexaminedconsumer perceptionsaboutthehealthbenefitsandrelativerisksofmentholcigarettes. Industrydocumentreviews Reviewsoftobaccoindustryinternaldocumentsmadepublicasaresultoflegalproceedingsagainst tobaccocompaniesprovideawealthofinformationaboutconsumerperceptionsofmenthol cigarettes.Thelimitationsofindustrydocumentreviewshavebeenoutlinedinaprevioussection. Giovinoandcolleagues(2004)identifiedtobaccoindustrydocumentsinthelate1960sand1970s whichsuggestedthatmentholsmokers,includingAfricanAmericans,perceivedmentholcigarettesto

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belesshazardousthannonmentholcigarettes.Giovinoetal.refertoastudyfromR.J.Reynolds calledProjectYwherementholsmokerswereclassifiedasmoreconcernedthansmokersofnon mentholcigarettes.TheypointtoaPhilipMorrisreportonfocusgroupdiscussionsundertakento assesstheattitudesofAfricanAmericansmokersaboutmentholcigarettes,whichstates,Thereare indicationsthatmentholstendtobeconsideredgenerallybetterforoneshealth.Thatimpression refersnotonlytothehealthoftherespiratorytract,butthewholeorganism.Themajorityviewis thatmentholsarelessstrongthanregularcigarettes,andthatacigarettewhichislessstrongis betterforapersonshealth(TiborKoeves,citedinGiovinoetal.2004).Itwasuncommonfor consumerstoopenlyassertthatmentholcigarettesconferredanexplicithealthadvantage;rather, thatperceptionwasmoreimplicitanddescribedindirectlybytheuseoftermssuchasstrength, cooling,lowerintar,andlessirritating.Consistentwiththepromisesofearlymentholmarketing campaignsdiscussedinapriorsection,tobaccoindustrydocumentsindicatedthatindividual samplingofmentholcigarettesoftenoccurredbecauseofacoldorsorethroat,andduringthe wintermonths(TiborKoeves,citedinGiovinoetal.2004),reflectingthehigherseasonalratesof acuterespiratoryinfectionduringthistime.AnotherR.J.ReynoldsdocumentreportedthatAfrican Americansweremorelikelythanwhitestobelievementholcigaretteswerebetterwhenyouhavea cold,lesslikelytomakeyoucough,andlessirritatingtothethroat(R.J.Reynolds,citedin Giovinoetal.2004). Intheirtobaccoindustrydocumentreview,Kreslakeetal.NTR(2008)summarizesomeofthe tobaccoindustrysextensiveresearchtoassesshowproductdesigninfluencesconsumerratingsof attributesofinterest.Theyfindthatthewayinwhichconsumersdescribeproductattributesdiffers betweenmentholandnonmentholsmokers.Forexample,cigarettestrengthformentholsmokersis definedbymentholintensity,mintyflavorandtobaccoflavor,whereasfornonmentholsmokers,it isdefinedbythroatimpactandthroatscratch.Harshnessisdefinedbyamountoftobaccoflavorfor mentholsmokers,butbythroatimpact,presenceofaburntortarryflavor,andabsenceofadded flavorfornonmentholsmokers(Swaim,citedinKreslakeetal.NTR2008).Therewasevidencein tobaccoindustryconsumerresearchthatconsumersusedmentholcigarettesaspartofapurposive efforttochangetheirsmokingbehaviorinwaysconsistentwithtryingtoreducetheirexposureto thehealthharms.Kreslakeetal.(NTR2008)describequalitativeresearchwithconsumers undertakenbytobaccocompaniesbetween1972and1994.Thesestudiessuggestthatsome mentholsmokersswitchedfromnonmentholsinanefforttomaintaintheirsmokingwithoutthe negativephysicalsymptomstheyattributetononmenthols.Thesestudiesalsodescribeconsumers useofmentholsduringarespiratoryproblemsuchasacold,sorethroatorbronchitis.Switchingto mentholstotrytocutdownontheamountsmokedwasreportedinqualitativeinterviews.Menthol cigaretteswereperceivedbyconsumersasmilderthanregularcigarettes,butwereseenasdistinct fromlightcigarettesbecausetheywereviewedasnotbeingcompromisedbythehigherfilter ventilation.AreportbyRoper(citedinKreslakeNTR2008)onsmokersoflowtarcigarettes concludedthatmentholseemstocompensateormakeupforbothfewcigarettesandlight cigarettesbyprovidinganextrasomething.Kreslakeetal.(NTR2008)concludethatsmokerswho mayotherwisequitbecauseoftheperceivedharshnessandhealtheffectsofhighertarcigarettes, seekoutmentholcigarettesfortheirsubstitutesensationastheymovetowhattheyperceiveisa lowertarcigarettewithitsassociatedimplicithealthreassurance.Tobaccoindustrydocument reviewsontheroleofmentholcigarettesininfluencingquittingbeliefsandintentionsarediscussed morefullyinchapter6inthesectiononsmokingcessation. Anderson(inpress)alsoanalyzedindustrydocumentsonconsumerperceptionsofmenthol cigarettesuptothemid1990s.ConsistentwithKreslakeetal.NTR(2008)andGiovino(2004), Andersonalsoconcludedthatconsumersviewmentholcigarettesassafer,orlessharmful,thannon mentholorfullflavorcigarettes.Shenotesthatmentholsmokerssometimesidentifythisperception explicitly(directly)andsometimesimplicitly(indirectly),throughtheuseoftermsthatsuggest improvedsafetyorhealthbenefits,suchaslight,mild,coolingorsoothing.Forexample,she

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citesanAmericanTobaccofocusgroupstudy,whichobservedthattherewereindicationsthatthe mentholsmokersubconsciouslyperceivedmentholcigarettesasbeinghealthier.Therewas somewhatofahealthimageassociatedwithmenthol,relatedtoitsmaskingofthetobaccotaste anditsassociationwithmedicine,coldsandsorethroats(AmericanTobacco,citedinAndersonin press).Andersonfoundthatmentholcigaretteshavebeenmarketedas,andareoftenperceivedby consumerstobe,milderandlessirritatingthanregularcigarettesandthereforelessofahealth threat,inthesamewaythatlight/lowtarcigarettesaremistakenlyperceivedtobesafer.She concludesthatmentholcigarettesprovidepsychologicalreassurancetoconsumerswithoutproviding anyrealhealthprotection.ThisisexemplifiedinanR.J.Reynoldsanalysisofpotentialforshare growthofmentholin1997:[t]hehealthconcernwasperhapstheprimarymotiveforswitchingto mentholinthefirstplace.Inthehierarchyofproductbenefits/attributesdesiredbymentholfilter smokers,throatconcernsrankjustbehindgenerictasteandsatisfaction(RJR,citedinAndersonin press). Klausners(inpress)tobaccoindustrydocumentreviewwasconsistentwiththefindingsofthese otherreviewsinconcludingthatsomeyoungpeoplesmokementholcigarettesbecausethey perceivethemtobelessharmfulthannonmentholcigarettes,anotiontheypointoutwas encouragedthroughmentholadvertising.Documentsreferredtoyoungsmokerschoosingmenthol cigarettesbecausetheyfoundthementhollessharmfulormovingawayfromtheproblem[of smokingaharmfulproduct]andaguiltreducingmechanismitmanagesinsomesmallmeasureto subtlydisguisethesin(citedinKlausner,inpress).Klausneralsonotesthatsomeyouthuse mentholsforthefirsttimewhentheyhaveasorethroatoracoldbecausetheyperceivethemtobe lessirritatingthannonmenthols.Forexample,aBritishAmericanTobaccostudyfrom1982found somesmokersascrib[e]medicinalpropertiestothementholationandbelievethatmentholsare somehowlessintrusiveorevenlessharmfulthanregularcigarettes. Empiricalandqualitativestudies TheWhitePaperbyRising&Alexander(2010)foundnopublishedempiricalstudiesofyouthbeliefs aboutofmentholcigarettes.Studiesofadultsbeliefsaboutofmentholcigarettesarediscussed below.Afterfirstconsideringcontextualandmethodologicalinterpretationissues,thissection presentsstudiesgroupedbypopulationsurveys,clinicsurveys,andfocusgroupstudies. Surveysthatcomparedmentholandnonmentholsmokersbeliefsabouttheoverallharmof smokingordiseaserisksofsmoking(referredtoinLorillardssubmission,July2010)werenot reviewedinthischapter.Thesesurveysassessedtheperceivedharmorriskfromsmokingcigarettes, butnotmentholcigarettesinparticular.Overtheyears,agrowingproportionofsmokersagreethat cigarettesmokingisharmful(e.g.,NSDUHsurveys),asmightbeexpectedfromtheconsiderable investmentinmediacampaignsaboutthisimportantpublichealthconcern.Mentholsmokersdiffer fromnonmentholsmokersonmanydemographicandpsychosocialtraitsthatwouldinfluencetheir beliefsabouttheharmsofsmoking.Comparingthebeliefsaboutsmokingformentholandnon mentholsmokersdoesnotinformtheresearchquestionabouttheperceivedharmofmenthol cigarettesinrelationtononmentholcigarettes. Researchabouttherelativeharmofmentholcigarettesmustbeinterpretedwithinthecontextof increasedmassmediaeducationabouttherisksofsmoking.Duringthe1990s,severalstates implementedtobaccoeducationcampaignsandaftertheMSAmanymorestatefundedcampaigns publicizedtheserioushealthharmsofsmokingandencouragedsmokerstoquit(NCI2008).Overthe pastdecade,anationalmediacampaignfromtheAmericanLegacyFoundation(Legacy)also broadcastmessagesaboutthemisleadinganddeceptivepracticesoftobaccocompanies.Another Legacymediacampaignemphasizedthedifficultyofquittingsmokingandencouragedsmokersto seekhelp.Mediacoverageaboutthedeceptivemarketingoflightandlowtarcigarettesisalso

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relevant.Afederalcourtorderin2006prohibitedthedefendanttobaccocompaniesfromstatingor implyinganyhealthbenefitsofabrandofcigarettesthroughtheuseofmisleadingtermssuchas light,mild,andlowtar.TheFDAimplementedabanonthesetermsinthemarketingandsale ofcigarettesinJune2010.Duringthepastdecade,thepublichasbeenexposedtoongoingnews coverageandmediaeducationthatrefutestobaccomarketingclaimsthatsomecigarettesareless harmfulthanothers. Againstthisbackdropitisincreasinglyunlikelythatconsumerswouldidentifyanycigarettesas offeringexplicithealthbenefits.Inaddition,questionsthataskrespondentsaboutcomparativerisks arelikelytoelicitresponsesthatdifferenttypesofcigarettesaresimilarlyrisky.However,evenina populationacutelyawareoftheharmsofsmoking,somestudiesrevealconsumerperceptionsthat somecigarettesaresaferthanothers(Hammond&Parkinson2009;Hammondetal.2010).When sociallydesirablerespondingislikely,studiesthatrequireconsumerstochoosebetweentwoor moreproductsthatdifferonspecificdimensionsofinterestaremoresensitiveindicatorsof consumerbeliefs.Suchstudiestypicallycomparetwoormoreproductswithoneelement manipulated,oraskrespondentstorankorderproductsalongparticulardimensions.Thesekindsof comparativeassessmentsareroutinelyusedinconsumerresearch,includingintobaccocompany consumerproducttesting,andinthecigarettepacktestingstudiesbyHammondandcolleagues (Hammond&Parkinson2009;Hammondetal.2010).Todate,nopublishedstudieshaveusedthese methodstocompareconsumerperceptionsofmentholandnonmentholcigarettes.However, reportsfromqualitativemethodsthatpermitmoreindepthandindirectassessmentsofconsumer beliefsaboutmentholcigarettesareincludedinthisreview.Assessmentofimplicithealthbenefits areparticularlyrevealing,includingaspectsoftasteandsensoryexperience,suchascooling, soothing,smoothness,mildness,lownicotine,lowerstrength,easinguncomfortablephysical symptoms,orattributessuchnaturalness.Asindicatedearlier,smokersinterpretthesekindsof attributestoimplyreducedharm(Pollay&Dewhirst2002;Wakefieldetal.2002;DiFranzaetal. 2002;Hammond&Parkinson2009;Paeketal.2010). Populationbasedsurveys Twosecondaryanalysesexaminedadultsperceptionsoftheexplicitbenefitsorharms/risksof mentholcigarettes.Davisetal.(2010)examinedresponsesof4,556adultstoquestionsabout mentholcigarettesfromtheHealthStylessurveythatwasmailedtoanationalconsumerpanelin 2009.ThesurveyaskedrespondentsDoyoubelievementholcigarettes,suchasNewport,Kool, MarlboroMenthol,CamelMentholhavebeneficialhealtheffects?Excluding250respondentswho didnotknowwhatmentholcigaretteswereorprovidednoanswer,76.8percentofrespondents (and81.2percentofsmokers)believedmentholcigaretteshadnohealthbenefits,18.9percent(14.7 percentofsmokers)didnotknowwhethertheydidornot,and4.3percent(4.2percentofsmokers) thoughttheydidhavehealthbenefits.AfricanAmericans(9.0percent),thosewithuptohighschool education(8.6percent)andthosewithannualincomeslessthan$25,000(8.0percent)weremore likelytobelievethatmentholcigaretteshadhealthbenefits.However,therewerenodifferencesby agegroup. TheHealthStylessurveyalsoaskedwhethermentholcigarettessuchasNewport,Kool,Marlboro Menthol,CamelMentholare:moreharmfultomyhealththannonmenthol/regularcigarettes;just asharmfultomyhealthasnonmenthol/regularcigarettes;lessharmfultomyhealththannon mentholcigarettesor;Idontknow.The248respondentswhodidnotknowwhatmenthol cigaretteswereorgavenoanswerwereexcluded.Oftheremainingrespondents,45.8percent perceivedmentholtobejustasharmfulasnonmentholcigarettestotheirhealth,40.9percentdid notknowifmentholcigarettesweremoreorlessharmful,12.6percentthoughtmentholcigarettes weremoreharmfuland0.6percent,lessharmful.Formersmokersweremorelikelythannever smokerstostatethatmentholcigarettesweremoreharmful(15.9percentvs.10.3percent),butthe

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comparisonforcurrentsmokers(14.9percent)wasnotsignificant.AfricanAmericansweremore likelythanwhitestostatethattheydidnotknowwhethermentholcigarettesaremoreorless harmfulthannonmentholcigarettes,butnointeractionswithsmokingstatusweretested. Differencesbyagegroupwerenotreportedasbeingsignificant.Althoughthesurveyachieveda65 percentresponserate,whichisacceptableforamailedquestionnaire,thestudywaslimitedbythe factthatthesamplingframewasapreexistingnationalpanelthatmaynotberepresentativeofthe nationalpopulation.Also,noinformationwasavailableaboutrespondentspastorcurrentuseof mentholcigarettes.Oddsratiosthatcomparedbeliefsbydemographicswereunadjusted,sothe associationscouldbeconfounded. Around13percentrespondedthatmentholcigarettesweremoreharmfultohealth,butitwas difficulttoknowifaperceptionofmoreharmtohealthmightbeduetomentholcigarettesbeing perceivedtobemoreaddictiveorhardertoquit.Thesurveydidaskthesetwoadditionalquestions, andwhileagainamajority(55percent)respondedthatitwasequallyeasytogethookedonmenthol andnonmentholcigarettes,orthattheydidntknow,24.2percentthoughtmentholcigaretteswere moreaddictive.Similarly,while82percentthoughtbothtypesofcigaretteswereequallyhardto quit,12.1percentthoughtmentholswerehardertoquitthannonmenthols.However,thestudy didnotexploretherelationshipsbetweenperceivedharmandthesevariables. Wackowskietal.(2010)examineddatafroma2005telephonesurveyofNewJerseyadults,ofwhom 17.4percentweresmokersand40.4percentofsmokerswerementholcigarettesmokers (Wackowskietal.2010).Smokerswereaskedcomparedtoregularcigarettes,howriskydoyou thinkthefollowingproductsare?Somewhatless,aboutthesame,orsomewhatmorerisky? Mentholcigaretteswereincludedonalistofeighttobaccoproducts(e.g.,cigars,kreteks,bidisand light,herbalandflavoredcigarettes).Questionorderwasrotated.Overall,70.1percentof respondentsreportedmentholcigarettesposedthesameriskasnonmentholcigarettes,25.9 percent(and30.2percentofmentholsmokers)reportedthatmentholcigarettesposedsomewhat morerisk,and4percentreportedthatmentholcigarettesposedsomewhatlessrisk.Among mentholsmokersspecifically,35.2percentofAfricanAmericansand46.3percentofyoungadults (ages18to24)believedmentholcigarettesposedsomewhatmoreriskthannonmentholcigarettes. Independentofotherdemographics,youngadultsmokersweresignificantlymorelikelythanthe referentgroupofoldersmokers(age65orolder)tobelievethatmentholcigarettesweresomewhat moreriskythanregularcigarettes.Amongmentholsmokers,46.3percentof1824yearolds indicatedmentholcigarettesweresomewhatmoreriskythanregularcigarettes,butthecomparable responsesforoldermentholsmokerswerenotreported. Alimitationofthisstudywasthattheresponseratewas20.7percentandthesamplewassourced fromonlyoneUSstate.Thestudycontainedonlyoneitemaboutexplicithealthbenefitsofmenthol cigarettes,andtheauthorspointedoutthatitisunknownhowrespondentsinterpretedthemeaning ofsomewhatlessriskyandsomewhatmoreriskythanregularcigarettes.Theauthors speculatedthattheperceivedeaseofinhalationpermittedbymentholmayleadsmokerstoinhale moredeeplyandalthoughthisisinterpretedasabenefit,itmayalsopartlyexplainwhymenthols areperceivedtobemorerisky.Inaddition,asfortheDavisetal.(2010)survey,analternative interpretationofmoreriskycouldbethatmentholcigaretteswereperceivedasbeingmore addictiveand/ordifficulttoquit. Giventheaforementionedcontextualfactors,itisunsurprisingthatthevastmajorityofrespondents attributednoexplicithealthbenefitstomentholcigarettesandasmallminoritythoughtthat mentholcigarettesweredifferentthannonmentholcigarettesinexplicitharmstohealth. Twostudiesexamineddatafromthesamesurveyaboutperceptionsofmentholcigarettesamong AfricanAmericansmokers.Allenetal.(2010)developedaquestionnairebasedonfocusgroupswith

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AfricanAmericans.ItemswerealsoinformedbytheCastro(2004)literaturereviewofbiological, social,andculturalinfluencesontheuseofmentholcigarettesamongAfricanAmericansand Hispanics.Shecitedexamplesofculturallyrelevantbeliefsaboutthemedicinalpropertiesof menthol,includingingestingamentholproduct(VicksVapoRub)totreatcongestionandcolds. CastroconcludedthathealthrelatedbeliefsaboutmentholsharedbylowerincomeAfrican AmericansandHispanicsareconsistentwithaviewofmentholcigarettesaslesstoxicandaddictive thanregularcigarettes.ThequestionnairedevelopedandusedintheAllenetal.studycontained fivemultiitemscales,twoofwhichassessedmedicinalbenefitsandrelativeharm.TheMedicinal Effectsscaleincludedstatementsthatmentholsarebetterthannonmentholsforasorethroat,help toloosenupastuffedupnose,helptocoolafever,andeaseasthmaproblems;theLessHarmful scaleincludedstatementsthatmentholcigarettescontainfewerchemicaladditives,lessnicotine,are lessharmfulandmorenaturalthannonmenthols.Inotherwords,theLessHarmfulscalewas mostlycomprisedofitemsthatassessedimplicitharm.Anotherscalemeasuredpositiveevaluations aboutthetaste,coolingsensationandsmellofmenthols(Taste/Sensation).Theremainingtwo scalesmeasuredtheextenttowhichrespondentsendorsedbeliefsthatmentholcigarettespresent anAfricanAmericanorstylishimage(Image)andbeliefsaboutmentholbeingfrequentlysmokedby AfricanAmericansnowandinthepast(Tradition). Allenetal(2010)surveyed720smokersinLosAngelesCountywhowererecruitedviastreet interceptmethodsfromregionswithhighpercentagesofAfricanAmericansandinterviewed betweenlate2006andearly2007.Respondentswerecategorizedasexclusivelymentholsmokers (57percent),exclusivelynonmentholsmokers(15percent),orsmokersofbothcigarettetypes(28 percent).Scalescoreswerederivedfromitemresponsestoa4pointscalewithhighernumbers indicatingstrongeragreement.Analysescomparedscalescoresforthethreegroupsofsmokers, adjustingforage,gender,education,andcigarettesperday.Thethreegroupsofsmokerswere equallylikelytoendorsetheImageandTraditionscales.OntheTaste/Sensationscale,mentholonly smokersscoredhigherthansmokersofbothtypes,whoscoredhigherthannonmentholsmokers.It wasnoteworthythatthescalescoresforTaste/Sensationwerepositivelycorrelatedwithscoresfor MedicinalEffectsandLessHarmful.Thisfindingisconsistentwithconsumerresearchundertakenby tobaccocompanies,andwiththefindingsofHammond&Parkinson(2009),indicatingthatthe conceptsoftaste,sensoryexperienceandharmarerelatedinthemindsofconsumers. Comparedtothosewhosmokedexclusivelynonmenthols,mentholonlysmokersandthosewho smokedbothcigarettetypeshadsignificantlyhigherscoresontheMedicinalEffectsandLess Harmfulscales.Olderparticipantsandthosewithlesseducationwerealsomorelikelytoholdthese beliefs.Comparedtothosewhosmokedexclusivelynonmenthols,smokersofbothcigarettetypes hadhigherscoresontheMedicinalEffectsbutnotontheLessHarmfulscale.Thepatternofresults suggeststhatmentholsmokersweremorelikelythannonmentholsmokerstoperceivethat mentholcigarettesprovidemedicinalbenefitsandreducedimplicithealthharms.Smokersages40 andolderandlesseducatedsmokersweremorelikelytoendorsethesebeliefs. Ungerandcolleagues(2010)undertookamoredetailedanalysisofthesedata,includingalargerset ofcovariates,suchasperceiveddiscrimination,depressivesymptoms,anxietysymptoms,sensation seeking,stressandreportedfrequencyofexposuretomentholmarketing.Thisancillaryanalysis foundTaste/Sensationtoaccountforjustoverhalfthevariancebetweenmentholandnonmenthol smokersubgroups.Whenexcludedinordertoevaluatetheinfluenceofothervariables,itwasfound thatcomparedwithnonmentholsmokersandadjustingformanycovariates,thosewhosmokedany mentholcigarettesweremorelikelytoperceivemedicinalbenefitsthanothers.Additionalsubgroup analysisshowedthatthiswasparticularlythecaseamongmalesages40andolder,althoughit shouldbenotedthatthissubgroupanalysishadlowpowertodetecteffects,withanapproximate samplesizeofonly25peoplewhowereregularsmokersineachage/gendersubgroup.

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Surveysofsmokersseekingcessationtreatment Hymowitzetal.(1995)administeredaquestionnairetomentholcigarettesmokersattendinga smokingcessationprograminNewJersey.Of213mentholsmokers,97percentindicatedmenthol cigarettestastebetter,61percentthoughttheyweremoresoothingtomythroatthannon mentholcigarettes,and51percentindicatedthatIcaninhalementholcigarettesmoreeasilythan regularcigarettes.Althoughmentholsmokersendorsedtheseimplicithealthbenefits,fewofthem (8percent)reportedthatmentholcigarettesarebetterforyouthanregularnonmenthol cigarettes.TherewerefewsignificantdifferencesbetweenAfricanAmericansandwhites,andthe smallsamplesizelimitedthesesubgroupcomparisons.Anotherlimitationisthataconvenience sampleofsmokerswhoaresufficientlymotivatedtoquittoseekformalsmokingcessation treatmentlikelydiffersfromthegeneralpopulationofsmokers.Despitethestudylimitations,itis notablethatitsfindingsareconsistentwithconclusionsfromreviewsoftobaccocompanyinternal documentsthatconsumersholdbeliefsthatmentholcigarettesofferaformofimplicitorapparent healthprotection.Thisespeciallyappliestomentholsthroatsoothingqualitieswheninhaledin tobaccosmoke,andthereductionofsensorybarrierstoinhalingthesmoke.Bycomparison,few mentholsmokersendorsedthestatementthatmentholcigaretteswereexplicitlyhealthier/safer thannonmenthols. Bansaletal.(2004)assessedsmokersbeliefsaboutmentholcigarettesaspartofaneducational interventionaboutcigaretteproducts.Ofthe982smokerswhoagreedtoenrollinacessationtrial, 34.2percentsmokedmentholcigarettesandthesamplewaspredominantlynonHispanicwhite (72.8percent).Priortorandomizationtodifferenteducationalconditions,participantsratedtheir agreementwithsixstatementsaboutmentholcigarettes:giveyoulesstarthanregularcigarettes; arecleanerthanregularcigarettes;aresaferthanregularcigarettes;areeasiertoquitsmoking thanregularcigarettes;aresmootheronyourthroatthanregularcigarettesandfeeleasieron yourchestthanregularcigarettes.Respondentswhoagreedordisagreedalsoindicatedthe strengthoftheirbelief(somewhatorstrongly).Respondentswhowereuncertainwereassigneda valueof2onascalethatrangedfrom0to4.Higherscoresreflectedgreaterdisagreementwith beliefsthatmentholcigarettesarelessharmfulthanregularcigarettes.Ameanof3.28outof4 (standarddeviationwasnotreported)suggeststhatonaverage,smokersenrolledinacessationtrial disagreedthatmentholcigaretteswerelessharmfulthanregularcigarettes.Thehighlevelof internalconsistencyofthescalesuggeststhatratingsaboutsensoryexperience(smootherandeasier onthechest)werepositivelycorrelatedwithotheritemsaboutrelativeharm.Inaddition,lower scoreswereobservedforthetwoitemsaboutsensoryexperience,indicatingmoreagreementwith theseitemsthanothers.Inthisrespect,thepatternoffindingswasconsistentwithotherstudies (Allenetal.2010;Hymowitzetal.1994).However,differencesbetweenitemresponseswerenot testedandseparatescoresformentholandnonmentholsmokerswerenotreported.Asnoted previously,aconveniencesampleofsmokersseekingcessationtreatmentlikelyholdsdifferent perceptionsofmentholcigarettesthanthelargerpopulationofsmokers. Focusgroups Richterandhercolleaguesundertooktwostudiesofhealthriskperceptionsofmentholcigarettes.In 2002,Richteretal.(2006)conducted16focusgroupsinDallasandChattanoogawithyoungadult smokers(ages1822years)whohadtriedorcurrentlyusednontraditionaltobaccoproducts(NTPs), suchasbidis,shisha,andherbalcigarettes.Allparticipantsratedlight,regularandmenthol cigarettesagainsteachotherandagainsteachoftheNTPsonasixpointscalefrommuchsaferto muchmoreharmful.NonHispanicwhites(thelargestparticipantgroup),perceivedmenthol cigarettesaslessharmfulthanregularcigarettesandmoreharmfulthanlightcigarettes.Among Hispanics,lightcigaretteswereconsistentlyratedassaferthanregularcigarettes,buttherewas inconsistencyincomparativementholratings.AmongAfricanAmericans,lightcigaretteswererated

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aseitherthesameorsaferthanregularandmentholcigarettes,whereasmentholandregular cigaretteswereperceivedtoposethesamerisk.Astrengthofthisstudywasrepeateduseofthe ratingexerciseinallgroups.Alimitationwasthatresultswerenotpresentedoverall,butratherby race/ethnicityandcollege/noncollegeattendance,whichlimitedthestabilityofestimates.Itwas noteworthythatthegroupwiththelargestsamplesize(nonHispanicwhites)moreclearlyrated mentholcigarettesasbeinginbetweenlightandregularcigarettesontheharmfulnessscale. In2005,Richteretal.(2008)conductedsixfocusgroupswithAfricanAmericanmentholsmokers aged45to64yearsoldinAtlanta.Amongthemaindiscussionthemeswasabeliefthatsmoking mentholcigarettesleadstofewernegativehealtheffects.Tastewasdescribedasaprimereasonfor smokingmentholcigarettes,althoughthisappearedtobecloselylinkedtoperceptionsofharm. Mentholcigaretteswerecommonlydescribedasbeingrefreshing,soothingorsmooth,while nonmentholswerestrongorharsh.Asoneparticipantexplained:Aregularcigaretteistoo strong.IfIsmokethat,Imean,Ijuststartcoughingbecauseitstoostrong.Mentholislighter. Someparticipantsdescribedunpleasantreactionstosmokingnonmentholcigarettesincomparison withmentholcigarettes.IcantsmokenonmentholcigarettesbecauseIwindupwithaheadache andadrymouth.Itdriesmytongueout.Andamentholcigarettedoesnt.Icanenjoyit,especially afterIeat,onesaid.Anotherpersoncommented:Itllhurtyourheadandhurtyourchestifyoutry tosmokeanonmenthol.Participantsinagroupaskedtorankbrandsfrommosttoleastdangerous placedfullflavormentholbrandsinanintermediatepositionbetweenbrandsdescribedaslightor slim,whichwereperceivedtobeleastdangerous,andfullflavornonmentholbrands,perceivedto bemostdangerous.Twoadditionalthemesthatwererelatedtoeachotherwerethatnonmenthol smokerswereconsideredtobehardcoresmokerswithlessinterestinquitting,andthatswitchingto nonmentholcigaretteswasperceivedasastrategythatmentholsmokersusedtotrytoquit smoking.Participantspreferenceformentholcigaretteswerestrongandnonmentholcigarettes wereviewedasacessationaid.Somedescribedswitchingtononmentholsasastrategytohelp themquit,whereasothersindicatedthatswitchingtomentholdelayedquitting.ThereasonI startedsmokingmentholwasbecausetheregularsweresostrongandinsteadofmequitting,Iwas tryingtofindsomemeanstogetaroundthat,soIwenttomenthol,oneparticipantsaid. Limitationsoffocusgroupsarethatindividualsmaybeinfluencedbyothergroupparticipants,and skilledgroupmoderationisrequiredtoensurethatdominantviewsdonotskewresponsesofother participants.Focusgroupsareunlikelytoberepresentativeofthepopulationfromwhich participantsaredrawn,butaredesignedtocapturearangeofviewsandpermitindepthdiscussion ofconcepts,whichrequiressynthesisusingcarefulqualitativeanalysis.Conductingfocusgroupsin multiplecitiesisastrengthoftheresearchreportedhere.Inaddition,theresultsfromthe comparativerankingtaskandthequalitativefindingsareconsistentwithtobaccoindustryconsumer researchonperceptionsofmentholcigarettes. Summary.Takingthetobaccoindustrysdocumentresearchandempiricalstudiesintoaccount,the evidencesuggeststhatconsumersperceivethatmentholcigarettesoffersomeformofimplicit healthprotectionormedicinalbenefitthatnonmentholcigarettesdonotprovide.Thiswas reportedinallfourindustrydocumentreviews.Thesereviewsalsopointedtoconsumerbeliefs aboutexplicithealthbenefitsofmentholcigarettes,reflectingearlyadvertisingmessagesthatmore explicitlypromotedthehealthbenefitsofmentholcigarettes(seemessagingsection).Evidencefrom focusgroupsandseveralsurveysalsosuggestedthatconsumersperceiveimplicithealthbenefitsof mentholcigarettes(Hymowitzetal.1994;Richteretal.2006;Richteretal.2008;Allenetal.2010; Ungeretal.2010).Twostudiesthatusedmultiitemscales(Allenetal.2010;Bansaletal.2004)also foundpositivecorrelationsbetweenbeliefsabouttaste/sensation,medicinalbenefits,andrelative harm,aswasfoundorsuggestedinotherstudies(Pollay&Dewhirst2002;Wakefieldetal.2002; DiFranzaetal.2002;Hammond&Parkinson2009).

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Instudiesthataddressedbothimplicitandexplicithealthbenefits,smokersweremorelikelyto endorsetheformerthanthelatter(Hymowitzetal.1994;Bansaletal.2004).Indeed,fewsmokers endorsedanystatementthatmentholcigarettesareexplicitlysaferorlessharmfulthannon mentholcigarettes(Bansaletal.2004;Davisetal.2010;Hymowitzetal.1994;Wackowskietal. 2010).Inthelargepopulationbasedsurveys,somesmokersreportedthatmentholcigaretteswere moreharmful/riskythannonmentholcigarettes(Davisetal.2010;Wackowskietal.2010),butthe meaningofthisresponseisdifficulttointerpret. Notably,muchofthisresearchfocusedpredominantlyorexclusivelyonAfricanAmericansmokers (Allenetal.2010;Ungeretal.2010;Richteretal.2008,Hymowitz1994),whichraisesthequestionof whethertheseconsumersaresubstantiallymorelikelythanotherstoendorseimplicithealth benefitsofmentholcigarettes.ThetwosurveystudiesofAfricanAmericans(Allenetal.2010;Unger etal.2010),togetherwiththefocusgroupstudyofolderAfricanAmericans(Richteretal.2008),and theearlierclinicpopulationsurveyofHymowitzetal.(1994)whichincludedalargeproportionof AfricanAmericans,allfoundtherespondentstoholdbeliefsaboutthemedicinalbenefitsofmenthol cigarettesandotherimplicithealthbenefitspertainingtomentholcigarettestrength,constituents, smoothnessandeaseofinhalation.Thesestudiesaskedaboutimplicithealthbenefitsinadditionto explicithealthharmsorrisks,andemployedresearchmethodsthatentailedthecompletionofmulti itemscales,requiredrespondentstomakecomparativeratherthanabsolutejudgmentsabout products,orusedqualitativetechniques.Thestudiesthatincludedsamplesizeslargeenoughto compareAfricanAmericanswithotherracial/ethnicgroupsdidnotusethesemethods. EVIDENCESYNTHESIS Chapter5setouttoanswersixquestionsrelatingtothemarketingandconsumerperceptionof mentholcigarettes.Theresponsestothosequestionsareprovidedbelow.Theseanswersassisted TPSACinaddressingthenineoverarchingquestionslistedanddiscussedinchapter1thatarethe subjectofthisreport.Specifically,theseresponsesaddressTPSACspopulationbasedquestions: Doestobaccocompanymarketingofmentholcigarettesincreasetheprevalenceofsmokingbeyond theanticipatedprevalenceifsuchcigaretteswerenotavailable?Insubgroupswithinthepopulation? TPSACconsideredthisinformation,alongwiththeotherevidencegathered,reviewedand synthesizedinthisreport,toassesstheoverallpublichealthimpactofmentholcigarettesandto makeitsrecommendationstotheFDA. Howismentholmarketingdifferentfromandsimilartononmentholmarketing,intermsof product,place,price,promotionandpackaging? Theevidenceissufficienttoconcludethatmentholcigarettesaremarketedinsimilarwaystonon mentholcigarettes,inthatthesamegeneralmarketingprinciplesareemployed. However,theremaybeanimportantdifferenceinpracticeinrelationtoretailmarketingandpricing. Overall,mentholcigarettesareslightlymoreexpensivethannonmentholcigarettes,althougha largerproportionofretailsalesformentholthannonmentholcigarettesarepromoted.More mentholsmokersthannonmentholsmokerstakeadvantageofsuchpromotionsandthisdifference wasgreaterforAfricanAmericansmokers.Therewaslimitedinformationavailableonpricingand promotionsbyneighborhooddemographics,inrelationtotobaccotaxincreases,andinrelationto brands.Thisprecludedamoredetailedunderstandingofhowthetobaccoindustryandconsumers usepricepromotionsofmentholvsnonmentholbrandstounderminethepotentialbenefitsof tobaccotaxincreasesandothertobaccocontrolpoliciesonquitting,particularlyamongkey populationsubgroups.Whiletheprevalenceofsmokinghasdeclinedinthepastseveralyears,the proportionofsmokerswhoprefermentholcigaretteshasincreased.Thus,therateofdeclinein smokingprevalenceisslowerformentholthanfornonmentholsmokers.Thisphenomenonhas

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coincidedwithasubstantiallyincreasedemphasisontobaccomarketingandpricepromotionsatthe pointofsale.Existingevidenceisinsufficienttoconcludethatretailmarketingpracticesmaybe responsibleforrecentincreasesintheproportionofsmokerswhosmokementholcigarettes. Researchisneededtoexaminetherelationshipbetweenthemovetowardsretailbasedmarketing, especiallypricepromotions,andtheincreaseintheproportionofsmokerswhosmokementhol cigarettes. Whathealthreassurancemessageswere/areusedinmentholmarketingmessages? Theevidenceissufficienttoconcludethatmentholcigaretteshavebeenandcontinuetobe marketedwithasetofassociatedbrandingelementsandlabelsthatconnotehealthbenefits.These originallyincludedclaimsofexplicitmedicinalbenefitssuchassoothingasorethroatorclearinga blockednose,butmovedovertimetowardsmoreimpliedhealthbenefits,withtheuseofpowerful imagesofcoolnessandrefreshment,theuseofphrasesandlabelsstressingsensoryexperiencesuch asrefreshingandsmooth,andtheuseofthecolorgreenwhichisassociatedwithnatureand healthiness.Whilecontemporarytobaccomarketingeffortshavebeenconstrainedbylegislation thatrestrictsadvertisingintraditionalmedia,thepowerfuladvertisingmessagesusedinthepastare reinforcedandcontinuedbytheongoinguseofmentholbrandnamesandmentholmarketing messagessuchassmoothandfreshthatareimplicitlylinkedtohealthbenefits. Whatothermessageswere/areconveyedtopotentialconsumersbymentholmarketing messages? Theevidenceissufficienttoconcludethatothermentholmarketingmessagesfeatureyouthful imageryandthemestoappealtoyouthfulaudiences,aswellassociallyandculturallyrelevant messagesaboutingroupidentitytoappealtodifferentmarketsegments.Differentingroup identitiesareemphasizedinmarketingfordifferentbrandfamilies,sothereisnosinglebrandimage thatsignifiesamentholsmoker. Whoarethetargetpopulationsformentholmarketing?Isthereevidencetoshowthatyouth, women,andspecificracial/ethnicgroupsweretargeted? Identificationofprimarytargetgroupsformarketingisbasicmarketingpractice.NCIsMonograph 19providesabundantevidenceoftargetingofyouth,youngadults,racial/ethnicgroups,womenand otherpopulationsubgroupsincigarettemarketing(NCI2008). EvidencepresentedinthisChapterandchapters4and6indicatesthatmentholsmokingishigher amongyouthandyoungadults,comparedwitholderadults.Thereissufficientevidencetoconclude thatmentholcigarettesaremarketeddisproportionatelytoyoungersmokers.Thereisevidence fromtobaccoindustrydocumentsthatthetobaccoindustrydesignedmentholcigaretteswithlower mentholyields,withanawarenessthat,attheselowermenthollevels,thesensoryeffectsof mentholreducetheharshnessofcigarettesfornewsmokers.Inadditiontomessagesthatimplied healthreassurance,mentholcigarettemarketinghaspromotedamoreyouthfulbrandimagethan fornonmentholcigarettes,andhasemphasizedtheroleofmentholcigarettesinpeergroup acceptance. Chapter4demonstratesthatmentholuseishigheramongwomenthanmen.Whilethereis evidencefromindustrydocumentreviewsandempiricalstudiesthatwomenhavebeentargetsof tailoredmentholmarketingefforts,thereisinsufficientevidencethatmentholmarketingwas targetedproportionatelymoretowomenpersethannonmentholmarketing.

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Theevidenceissufficienttoconcludethatmentholcigarettesaredisproportionatelymarketedper capitatoAfricanAmericans.AfricanAmericanshavebeenthesubjectsofspecificallytailored mentholmarketingstrategiesandmessages.Billboardadvertisingandpointofsaleadvertisingfor mentholcigaretteshasbeenoverrepresentedinneighborhoodswithahighpercentageofAfrican AmericansandinmagazineswithhighAfricanAmericanreadership,andmoresothannonmenthol cigaretteadvertising.Consistentwiththesetargetedmarketingefforts,mentholcigarettesare disproportionatelysmokedbyAfricanAmericansmokers.Theevidenceissufficienttoconcludethat itisatleastaslikelyasnotthatmentholcigaretteshavealsobeendisproportionatelymarketedto Hispanics.MentholsmokingishigherinHispanicsthaninnonHispanicwhites.AlthoughAsian Americans,Hawaiian/PacificIslandersandfemaleshavebeenthesubjectsoftailoredmenthol marketingmessagesandmentholsmokingishigherinallthesepopulationsubgroups,thereis insufficientevidencetoconcludethattheyhavebeenproportionatelymoretargetedbymenthol thannonmentholadvertising. Doesmentholmarketinginfluenceperceivedtasteand/orsensoryexperienceofmenthol cigarettes? Theevidenceissufficienttoconcludethatmentholbrandingandmessaginginfluencestheperceived sensoryexperienceofmentholcigarettes,contributingtoconsumersoverallsubjectiveevaluation andlikingoftheproduct. Doconsumersperceivementholcigarettesassaferorlessharmfulthannonmentholcigarettes? Theevidenceissufficienttoconcludethat,consistentwithmarketingclaims,consumersholdbeliefs aboutthemedicinalbenefitsofmentholandbeliefsaboutotherimplicithealthbenefits,andthat thisisespeciallythecaseamongAfricanAmericans.However,inthecontextofwidespreadpublic educationaboutthehealthharmsoftobaccouse,itisuncommontostateanexplicitbeliefthat mentholcigarettesaresaferorlessharmfulthannonmentholcigarettes.

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