Comments about cigarette additives arose without probing in 10 of 13 groups (3/4 HA, 3/4 LA, 1/2 HW, 3/3 LW). Specific examples included chemicals (e.g., “rat poison,” “ammonia,” “fiberglass,” and “formaldehyde, like the embalming fluid”) and biological contaminants (e.g., such as “rat turds” and “cow urine”).
In addition to specific examples, three broad themes emerged: (1) navigating the conceptual link between smoking and genetics, (2) providing an alternative mechanism of addiction, and (3) providing an alternative mechanism by which cigarette smoking exacerbates physical harm. The themes, described in detail below, did not seem to differ in content by education or race. Additive comments occurred at different times in each focus group.
Nearly all additives discussions were characterized by a pervasive and persistent tone of mistrust. Mistrust was expressed in several ways, including direct expressions such as “you can’t trust people these days,” expressions of uncertainty such as “you don’t know what they’re putting into the cigarettes,” and through the use of words heavily laden with negative affect such as “nasty” and “disgusting.” The speakers’ tones of voice, which manifested frustration, outrage, and indignation, also conveyed mistrust.
Navigating conceptual link
In five groups (2 HA, 1 LA, 1 HW, 1 LW), additive discussions seemed to serve as a mechanism for navigating and understanding the conceptual link between smoking and genetics. Quotations related to this theme also demonstrate the tone of mistrust that was interwoven throughout the spontaneous discussions of additives.
One discussion began before the video was shown, in response to the moderator asking participants about their understanding of genetic risk and its relation to smoking:
[HA-Group2] Man 3: “Well, I feel like the tobacco companies, we don’t know what they put in cigarettes, you know, you really don’t. So they could put something in there to make a risk to the genetics.”
After watching the news story, that participant and another group member continued to process the novel genetic information by directly linking genetic risk to additives inserted into cigarettes by tobacco companies:
[HA-Group2] Man 3: “That’s what I was saying earlier about the tobacco companies… If there is a problem with the genetics and…the cigarettes created it…the tobacco companies caused [it].”
Woman 2: “Because you don’t know what they’ve – could have put in it.”
Other participants contextualized the smoking-genetic link through additives in the environment and other consumer products. The following exchange occurred in response to a moderator’s question about whether participants believed the video’s report describing the genetic link to smoking.
[HA-Group1] Woman 1: “[E]verything is coming up with genetics, now. And it’s too much coming up… Even your food and things. So it just makes you wonder sometimes.”
Moderator: “So could that apply to smoking?”
Man 1 responds: “Yes! If it has to do with…the DNA or the biology of things, if you mix something in with something that’s there, then it alters it.”
These comments illustrate that participants did not consider a genetic risk related to cigarette smoking to be part of a smoker’s biology. They instead considered it to be a mutation spurred by the substances that tobacco companies, who participants mistrusted greatly, add to cigarettes. According to this view, in the absence of additives, there would be no genetic link to nicotine addiction.
Additives cause addiction
Participants in four groups (1 HA, 2 LA, 0 HW, 1 LW) blamed additives for addiction. These discussions were also steeped in mistrust:
[LW-Group2] Woman 1: “You never know what they’re puttin’ in [cigarettes] now…you don’t know what it is actually causing the addiction.”
[HA-Group1] Man 1: “Even with cigarettes…tobacco companies are putting everything into the tobacco…to make it more addictive.”
One group extended this idea, asserting that tobacco companies add substances for the express purpose of preventing people from quitting:
[LA-Group4] Woman 6: “I think they got something in there to make people keep – to keep their addiction…”
Woman 3: “There’s something in that cigarette, I can tell you.”
Woman 6: “It’s something in that cigarette.”
Not all participants who attributed addiction to additives mentioned nicotine by name. It is unclear whether they were unaware of the link between nicotine and addiction, or simply did not feel the need to name it, but the use of general terms such as “everything” and “something” in the quotations above suggests a lack of awareness. Nevertheless, a participant in one group used his beliefs about the addictive nature of additives to reject the news video’s assertion of a genetic link to nicotine addiction:
[LA-Group2] Man 2: “… [I]f you’re gonna serve tobacco then you serve tobacco. Do not extract [and reintroduce altered levels of] nicotine, do not put [in]…all them extra products…[T]he products they put in cigarettes, I believe, is the addiction. Not just the tobacco itself, which means that it’s not genetic…I think if they took all the products that they put in the cigarettes out, there would not be as many smokers as there is now.”
Additives exacerbate physical harm
Participants in seven groups (2 HA, 2 LA, 1 HW, 2 LW) partially attributed specific negative health consequences of smoking to additives, rather than to tobacco itself. The tone of mistrust was less pronounced here than in other themes:
[LW-Group1] Man 6: “Well, with all the chemicals that they put in cigarettes nowadays it is – smoking is dangerous [emphasis in original].”
[HW-Group2] Man 1: “I think there probably are additives to cigarettes that make it worse you know.”
Some participants followed the idea that additives (rather than tobacco) are harmful with a proposal that “natural” or additive-free cigarettes would be less harmful and therefore have less negative impact on health:
[HW-Group2] Woman 2: “I wonder how harmful additives are as compared to the tobacco itself…I wonder if…that might motivate people to – I don’t know – grow their own instead. Because if you are going to [smoke], I mean maybe there are ways that we could make it healthier or not as harmful.”
[LA-Group2] Woman 1: “I don’t think it’s the tobacco that’s killin’ me, it’s the – it’s the chemicals and stuff they put to it.”
These quotes demonstrate that most additive comments were grounded in the idea that additives and tobacco manufacturers – rather than tobacco itself – are the main culprits of intensifying the harms associated with cigarettes.