• Richard J O'Connor, Andrew Hyland, Gary A Giovino, Geoffrey T Fong, and K Michael Cummings.
• Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York 14263, USA. richard.oconnor@roswell park.org
• Am J Prev Med. 2005 Aug 1; 29 (2): 859085-90.

BackgroundCigarette manufacturers in the United States have begun marketing cigarette brands claiming to reduce smokers' exposure to selected toxins in tobacco smoke. Little data exist on smokers' awareness, use, and beliefs about these products.MethodsData from the U.S. arm of the International Tobacco Control Policy Four-Country Survey (ITC-4), a telephone survey of 2028 adult current cigarette smokers in the United States conducted between May and September 2003, were analyzed. Respondents were asked to report their awareness, beliefs, and use of products marketed as less harmful than traditional cigarettes and of smokeless tobacco (SLT) products.ResultsClose to 39% of smokers were aware of "less-harmful" cigarettes, but only 27% of them could name a specific brand of such cigarettes. The brand named most often was Quest (25.7%), followed by Eclipse (7.6%), Winston (5.7%), herbal cigarettes (3.3%), "smoke-free" cigarettes (2.9%), Marlboro Blend #27 (1.9%), and Omni (1.9%). Of those who named a brand, 25% believed such products were less harmful than "ordinary cigarettes." In contrast, 82% of cigarette smokers were aware of SLT products, but only 10.7% of these believed that SLTs were less harmful than ordinary cigarettes.ConclusionsSmokers hold beliefs about the relative safety of supposedly less-harmful tobacco products that are opposite to existing scientific evidence. These results highlight the need to educate smokers about the risks of alternatives to conventional cigarettes, and the need to regulate the advertising and promotion of such alternatives.

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