Research paper
CC-BY-NC 4.0

Misperceptions about “light” cigarettes among smokers in Zambia: Findings from the International Tobacco Control (ITC) Zambia Survey

Susan C Kaai 1  ,  
Geoffrey T Fong 1, 2,  
Fastone Goma 3,  
Gang Meng 1,  
Anne CK Quah 1,  
Ron Borland 4,  
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
Ontario Institute for Cancer Research, Toronto, Ontario, Canada
School of Medicine, University of Zambia, Lusaka, Zambia
Cancer Council Victoria, Melbourne, Victoria, Australia
Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada
Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
Tob. Prev. Cessation 2016;2(September):70
Publish date: 2016-09-01
Little is known about beliefs about “light” cigarettes (“lights”) in African countries where both tobacco industry activity and tobacco control efforts are intensifying. This study in Zambia is the first to examine the prevalence and beliefs about “lights” among smokers in Africa.

Data are from 1,214 smokers participating in the International Tobacco Control (ITC) Zambia Wave 1 Survey (2012), a multi-stage clustered sampling design, face-to-face nationally representative probability sample of tobacco users and non-users aged 15 years and older.

17.0% of respondents’ usual brand of cigarettes was “lights”. 36.5% of smokers believed that “lights” are less harmful; beliefs differed by brand type (42.1% “lights” vs. 38.2% “non-lights”). 42.0% of smokers believed that “lights” are smoother on the throat and chest than regular cigarettes with beliefs differing by brand type. Among smokers who believed that “lights” are smoother, 81.0% believed that these cigarettes are less harmful, much higher than the 4.1% of smokers who did not believe that “lights” are smoother. Smoothness beliefs about “lights” was the strongest predictor of the belief that “lights” are less harmful (p<0.001, OR=131.13, 95% CI 59.4 to 289.5).

Zambian smokers incorrectly believe that “lights” are less harmful. The highly strong association between the belief that “lights” are smoother and the belief that “lights” are less harmful suggests that tobacco control policies need to use a multi-pronged approach including product regulation, banning misleading descriptors and menthol, and implementing sustained long-term public education campaigns to combat sensory beliefs and misperceptions about “lights”.

Susan C Kaai   
Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada, 200 University Avenue West, N2L 3G1 Waterloo, Ontario, Canada
1. Borland R, Fong GT, Yong HH, Cummings KM, Hammond D, King B, et al. What happened to smokers' beliefs about light cigarettes when "light/mild" brand descriptors were banned in the UK? Findings from the International Tobacco Control (ITC) Four Country Survey. Tob Control 2008;17:256-62. doi:10.1136/tc.2007.023812.
2. Elton-Marshall T, Fong GT, Zanna MP, Jiang Y, Hammond D, O'Connor RJ,et al. Beliefs about the relative harm of "light" and "low tar" cigarettes: findings from the International Tobacco Control (ITC) China Survey. Tob Control 2010;19(Suppl 2):i54-62. doi:10.1136/tc.2008.029025.
3. King B, Yong HH, Borland R, Omar M, Ahmad AA, Sirirassamee B, et al. Malaysian and Thai smokers' beliefs about the harmfulness of 'light' and menthol cigarettes. Tob Control 2010;19(6):444-50. doi:10.1136/tc.2009.034256.
4. Kropp RY, Halpern-Felsher BL. Adolescents’ beliefs about the risks involved in smoking “light” cigarettes. Pediatrics 2004;114(4):e445-e451. doi:10.1542/peds.2004-0893.
5. Yong HH, Borland R, Cummings KM, Hammond D, O'Connor RJ, Hastings G, et al. Impact of the removal of misleading terms on cigarette pack on smokers' beliefs about Light/Mild cigarettes: Cross-country comparisons. Addiction 2011;106(12):2204-221. doi:10.1111/j.1360-0443.2011.03533.x.
6. Pollay RW, Dewhirst T.The dark side of marketing seemingly “light” cigarettes: Successful images and failed fact. Tob Control 2002;11(Suppl 1):i18-i31. doi:10.1136/tc.11.suppl_1.i18.
7. Djordjevic MV, Stellman SD, Zang E. Doses of nicotine and lung carcinogens delivered to cigarette smokers. J Natl Cancer I 2000;92:106-111. doi:10.1093/jnci/92.2.106.
8. Kozlowski LT, Mehta NY, Sweeney CT, Schwartz SS, Vogler GP, Jarvis MJ, et al. Filter ventilation and nicotine content of tobacco in cigarettes from Canada, the United Kingdom, and the United States. Tob Control 1998;7(4):369-375. doi: 10.1136/tc.7.4.369.
9. O'Connor RJ, Hammond D, McNeill A, King B, Kozlowski LT, Giovino GA, et al. How do different cigarette design features influence the standard tar yields of popular cigarette brands sold in different countries? Tob Control 2008;17(Suppl I):i1-i5. doi:10.1136/tc.2006.019166.
10. Kozlowski LT, O'Connor RJ. Cigarette filter ventilation is a defective design because of misleading taste, bigger puffs, and blocked vents. Tob Control 2002;11(Suppl I):i40-i50. doi: 10.1136/tc.11.suppl_1.i40
11. Maron DJ, Fortmann SP. Nicotine yield and measures of cigarette smoke exposure in a large population: Are lower-yield cigarettes safer? Am J Public Health 1987;77:546-549. doi:10.2105/AJPH.77.5.546.
12. Hammond D, Collishaw NE, Callard C. Secret science: Tobacco industry research on smoking behaviour and cigarette toxicity. Lancet 2006;367:781-787. doi:10.1016/S0140-6736(06)68077-X.
13. Harris JE, Thun MJ, Mondul AM, Calle EE. Cigarette tar yields in relation to mortality from lung cancer in the cancer prevention study II prospective cohort, 1982-8. BMJ 2004;328(7431):72-78. doi:10.1136/bmj.37936.585382.44.
14. Hecht SS, Murphy SE, Carmella SG, Li S, Jensen, J, Le C, et al. Similar uptake of lung carcinogens by smokers of regular, light, and ultralight cigarettes. Cancer Epidem Biomar 2005;14(3):693-698. doi:10.1158/1055-9965.EPI-04-0542.
15. Thun MJ, Burns DM. Health impact of “reduced yield” cigarettes: A critical assessment of the epidemiological evidence. Tob Control 2001;10(Suppl 1):10i4-i11. doi:10.1136/tc.10.suppl_1.i4.
16. Υang G, Wang Y, Wu Y, Yang J, Wan X. The road to effective tobacco control in China. Lancet 2015;385:1019-1028. doi: 10.1016/S0140-6736(15)60174-X.
17. World Health Organization. Global progress report on implementation of the WHO Framework Convention on Tobacco Control. Geneva. Switzerland. WHO, 2012.
18. World Health Organization. The WHO Framework Convention on Tobacco Control:10 Years of implementation in the African Region. WHO, 2015. Available from: (accessed February 2016).
19. World Health Organization. Policies for tobacco control in the African Region.Brazzaville:WHO Regional Office for Africa. WHO, 2013.
20. Blecher EH, Ross H. Tobacco use in Africa: Tobacco control through prevention. Atlanta, GA: American Cancer Society. 2013.
21. Central Statistical Office (CSO) [Zambia], Ministry of Health (MOH) [Zambia], and ICF International. Zambia Demographic and Health Survey 2013-14. Rockville. Maryland, USA: Central Statistical Office, Ministry of Health, and ICF International. 2014.
22. Salloum RG, Goma F, Chelwa G, Cheng X, Zulu R, Kaai SC, et al. Cigarette price and other factors associated with brand choice and brand loyalty in Zambia: findings from the ITC Zambia Survey. Tob Control. 2015;24(Suppl 3):iii33-iii40. doi:10.1136/tobaccocontrol-2014-051878.
23. World Health Organization. Parties to the WHO Framework Convention on Tobacco Control. WHO, 2016. Available from: March 2016).
24. ITC Project. ITC Zambia National Report. Findings from the Wave 1 (2012) Survey. Waterloo: ITC, 2014a. Available from: (accessed January, 2016).
25. Elton-Marshall T, Fong GT, Yong HH, Borland R, Xu SS, Quah AC, et al. Smokers' sensory beliefs mediate the relation between smoking a 'light/low tar' cigarette and perceptions of harm. Tob Control 2014;0:1-7. doi:10.1136/tobaccocontrol-2014-051977.
26. Fong GT, Cummings KM, Borland R, Hastings G, Hyland A, Giovino GA, et al. The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project. Tob Control 2006;15(Suppl 3):iii3-11. doi:10.1136/tc.2005.015438.
27. ITC Project.Wave 1 (2012) ITC Zambia Technical Report. Waterloo:ITC, 2014b. Available from: (accessed January 2016).
28. Chaiton MO, Cohen JE, McDonald PW, Bondy SJ, et al. The Heaviness of Smoking Index as a predictor of smoking cessation in Canada. Addict Behav 2007;32:1031-1042. doi:10.1016/j.addbeh.2006.07.008.
29. Kozlowski LT, Porter CQ, Orleans CT, Pope MA, Heatherton T. Predicting smoking cessation with selfreported measures of nicotine dependence: FTQ, FTND, and HSI. Drug Alcohol Depen 1994;34(3):211−216. doi: 10.1016/0376-8716(94)90158-9.
30. Hammond D, Dockrell M, Arnott D, Lee A, McNeill A. Cigarette pack design and perceptions of risk among UK adults and youth. Eur J Public Health 2009;19(6):631-637. doi:10.1093/eurpub/ckp122.
31. Pollay RW. The role of packaging seen through industry documents. Expert Report prepared for: JTI-Macdonald, Imperial Tobacco Canada Ltd and Rothmans, Benson & Hedges Inc. v. Attorney General of Canada and Canadian Cancer Society (intervenor). Supreme Court, Province of Quebec, District of Montreal. Defense Exhibit D-116. 2001.
32. Siahpush M, McNeill A, Hammond D, Fong GT. Socioeconomic and country variations in knowledge of health risks of tobacco smoking and toxic constituents of smoke: results from the 2002 International Tobacco Control (ITC) Four Country Survey. Int. J. Environ. Res. Public Health 2006:8(6), 2170–2180.
33. Fotuhi O, Fong GT, Zanna MP, Borland R, Yong HH, Cummings KM. Patterns of cognitive dissonance-reducing beliefs among smokers: a longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey. Tob. Control 2013:22,52-58. doi:10.1136/tobaccocontrol-2011-050139.
34. Shiffman S, Pillitteri JL, Burton SL, Rohay JM, Gitchell JG. Smokers' beliefs about "Light" and "Ultra Light" cigarettes. Tob. Control 2001;10:i17-i23. doi: 10.1136/tc.10.suppl_1.i17.
35. Bansal-Travers M, O’Connor R, Fix BV, Cummings KM. What do cigarette pack colors communicate to smokers in the U.S.? Am J Prev Med 2011;40(6):683-689. doi:10.1016/j.amepre.2011.01.019.
36. Wakefield M, Morley C, Horan JK, Cummings KM.The cigarette pack as image: New evidence from tobacco industry documents. Tob Control 2002;11:i73-i80. doi:10.1136/tc.11.suppl_1.i73.
37. Kotnowski K, Hammond D. The impact of cigarette pack shape, size and opening: Evidence from tobacco company documents. Addiction 2013;108:1658-1668. doi:10.1111/add.12183.
38. O'Connor RJ, Caruso RV, Borland R., Cummings KM, Bansal-Travers M, Fix BV. Relationship of cigarette-related perceptions to cigarette design features: findings from the 2009 ITC U.S. Survey. Nicotine Tob Res 2013;15(11): 1943-1947. doi:10.1093/ntr/ntt075.
39. Tobacco Products Scientific Advisory Committee (TPSAC) (2011). Menthol cigarettes and public health: Review of the scientific evidence and recommendation. Available from (accessed February 2016).