Smokers’ Awareness of Filter Ventilation, and How They Believe it Affects Them: Findings from the ITC Four Country Survey

Abstract

Background: Filter ventilation creates impressions of ‘lightness’ and controls machine-tested yields of tar and nicotine. Virtually all factory made cigarettes now have filter ventilation in Australia, Canada, the UK and the US. Previous research, conducted before ‘light’ and ‘mild’ labelling was banned, found low awareness of filter ventilation. This study explores current levels of awareness and understandings. Methods: We used data from the 2018 wave of the ITC Four Country Smoking and Vaping Survey with samples from USA, England, Canada and Australia. Analyses were conducted initially on a weighted sample of 11,844, and subsequently on 7,541 daily factory made cigarette (FMC) smokers. Findings: Only 38.5% of all respondents reported being aware of filter ventilation. Among daily FMC smokers, only 9.4% believed their cigarettes had filter ventilation. Respondents who believed their usual cigarettes had filter ventilation were more likely to believe their usual cigarettes were both less harmful (18.2% vs 8.8%, p<.001) and smoother (11.8% vs 7.3%, p<.001), when compared with other daily FMC smokers. Interpretation: Awareness of filter ventilation remains low in all four countries and few smokers realize their cigarettes almost certainly have it. Smokers who believed their cigarettes have filter ventilation were more likely to believe their cigarettes were both smoother and less harmful, so if anything exacerbates rather than attenuates the intuition that smoother cigarettes are less harmful. Filter ventilation is inherently misleading to smokers. Funding: National Health and Medical Research Council of Australia (APP1106451), US National Cancer Institute (P01CA200512), and Canadian Institutes of Health Research (FDN-148477). Ethical Approval: The survey was approved by Institutional Review Board, Medical University of South Carolina; Research Ethics Office, King’s College London, UK; Office of Research Ethics, University of Waterloo, Canada; and Human Research Ethics, Cancer Council Victoria, Australia. All participants provided consent to participate. Declaration of Interest: GTF has served as an expert witness on behalf of governments in litigation involving the tobacco industry. KMC has been a consultant and received grant funding from the Pfizer Inc. in the past 5 years. K.M.C has also been a paid expert witness in litigation against the tobacco industry. All other authors have no conflicts of interest to declare.