Rachel A. Grana

University of California, San Francisco, San Francisco, California, United States

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Publications (17)65.38 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective: Describe the evolution of strategies used by tobacco companies to minimize concerns about nicotine addiction and to promote medicinal and hedonic benefits of nicotine. Methods: Qualitative analysis of previously secret tobacco industry documents from the Legacy Tobacco Documents Library (legacy.library.ucsf.edu), triangulated with data from national newspapers, trade press, and the Internet from the 1970s through the present. Results: The industry has worked for decades to promote the benefits of nicotine and downplay its addictiveness. Strategies included promoting comparisons between nicotine addiction and addiction to socially acceptable substances such as caffeine and chocolate. These comparisons appeared in highly-publicized scientific meetings and in numerous scientific publications, and in interviews with the press. In addition, tobacco companies have funded and published scientific studies of the benefits of nicotine on cognition and other areas of performance and mood regulation, promoting the benefits of nicotine on performance using examples accessible to the public such as driving a car or flying a plane, and, finally, funding and publishing scientific studies of the medicinal benefits of nicotine for neurological disorders such as Alzheimer’s and Parkinson’s diseases. Discussion: The tobacco industry has implemented strategies to promote the benefits of nicotine to scientific and lay audiences, and to minimize concerns about nicotine addiction. These strategies complement the recent introduction of novel nicotine containing tobacco products and electronic cigarettes. These efforts may normalize nicotine use, encourage uptake of nicotine containing products, or continued long term use of nicotine.
    142nd APHA Annual Meeting and Exposition 2014; 11/2014
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    ABSTRACT: The goal of this study was to summarise the websites of electronic cigarette (e-cigarette) manufacturers in China and describe how they market their products.
    Tobacco control. 10/2014;
  • Circulation 05/2014; 129(19):e490-2. · 15.20 Impact Factor
  • Source
    Circulation 05/2014; 129(19):1972-86. · 15.20 Impact Factor
  • Rachel A Grana, Pamela M Ling
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    ABSTRACT: Electronic cigarettes (e-cigarettes) have been increasingly available and marketed in the U.S. since 2007. As patterns of product adoption are frequently driven and reinforced by marketing, it is important to understand the marketing claims encountered by consumers. To describe the main advertising claims made on branded e-cigarette retail websites. Websites were retrieved from two major search engines in 2011 using iterative searches with the following terms: electronic cigarette, e-cigarette, e-cig, and personal vaporizer. Fifty-nine websites met inclusion criteria, and 13 marketing claims were coded for main marketing messages in 2012. Ninety-five percent of the websites made explicit or implicit health-related claims, 64% had a smoking cessation-related claim, 22% featured doctors, and 76% claimed that the product does not produce secondhand smoke. Comparisons to cigarettes included claims that e-cigarettes were cleaner (95%) and cheaper (93%). Eighty-eight percent stated that the product could be smoked anywhere and 71% mentioned using the product to circumvent clean air policies. Candy, fruit, and coffee flavors were offered on most sites. Youthful appeals included images or claims of modernity (73%); increased social status (44%); enhanced social activity (32%); romance (31%); and use by celebrities (22%). Health claims and smoking-cessation messages that are unsupported by current scientific evidence are frequently used to sell e-cigarettes. Implied and overt health claims, the presence of doctors on websites, celebrity endorsements, and the use of characterizing flavors should be prohibited.
    American journal of preventive medicine 04/2014; 46(4):395-403. · 4.24 Impact Factor
  • Rachel A Grana, Lucy Popova, Pamela M Ling
    JAMA Internal Medicine 03/2014; · 13.25 Impact Factor
  • Sungkyu Lee, Rachel A Grana, Stanton A Glantz
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    ABSTRACT: As elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes. Data from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13-18 years were analyzed with logistic regression. A total of 9.4% (8.0% ever-dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever-e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39-1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09-.12). Some Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking.
    Journal of Adolescent Health 11/2013; · 2.97 Impact Factor
  • Sara Kalkhoran, Rachel A. Grana, Pamela Ling
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    ABSTRACT: Background: Dual use of cigarettes and smokeless tobacco products (particularly snus) and of cigarettes and e-cigarettes is increasing in the U.S. These products are often promoted as safer and for use in smoke-free environments. E-cigarettes are also marketed as beneficial in quitting smoking. Methods: 1412 current smokers completed online cross-sectional surveys in November 2011. Univariate and multivariate logistic regression models evaluated associations between perceived harm of tobacco products, willingness to try smokeless tobacco, quitting behaviors and (a) dual use of cigarettes and smokeless tobacco products, or (b) dual use of cigarettes and e-cigarettes. Results: 1210 smokers were cigarette only users, 76 were dual users with smokeless tobacco, and 124 were dual users with e-cigarettes. In multivariate models, dual use with smokeless tobacco was associated with younger age, male gender, and having attempted to quit smoking by switching to smokeless products (OR=15.38 95%CI [7.99, 29.59]). Dual use with e-cigarettes was associated with ever using nicotine replacement therapy (OR=1.99 [1.32,3.01]) and having made an attempt to quit smoking in the past year (OR=1.60 [1.06,2.43]. Willingness to try smokeless tobacco when one is unable to smoke was associated with both smokeless tobacco product dual use (OR=1.29 [1.13,1.47]) and e-cigarette dual use (OR=1.14 [1.04,1.24]). Conclusions: Compared to cigarette-only smokers, dual users may perceive and use non-cigarette products as they are marketed - for when they cannot smoke and with utility for smoking cessation. E-cigarette use by a cigarette smoker may signal interest in quitting.
    141st APHA Annual Meeting and Exposition 2013; 11/2013
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    ABSTRACT: BACKGROUND: The Tea Party, which gained prominence in the USA in 2009, advocates limited government and low taxes. Tea Party organisations, particularly Americans for Prosperity and FreedomWorks, oppose smoke-free laws and tobacco taxes. METHODS: We used the Legacy Tobacco Documents Library, the Wayback Machine, Google, LexisNexis, the Center for Media and Democracy and the Center for Responsive Politics (opensecrets.org) to examine the tobacco companies' connections to the Tea Party. RESULTS: Starting in the 1980s, tobacco companies worked to create the appearance of broad opposition to tobacco control policies by attempting to create a grassroots smokers' rights movement. Simultaneously, they funded and worked through third-party groups, such as Citizens for a Sound Economy, the predecessor of AFP and FreedomWorks, to accomplish their economic and political agenda. There has been continuity of some key players, strategies and messages from these groups to Tea Party organisations. As of 2012, the Tea Party was beginning to spread internationally. CONCLUSIONS: Rather than being a purely grassroots movement that spontaneously developed in 2009, the Tea Party has developed over time, in part through decades of work by the tobacco industry and other corporate interests. It is important for tobacco control advocates in the USA and internationally, to anticipate and counter Tea Party opposition to tobacco control policies and ensure that policymakers, the media and the public understand the longstanding connection between the tobacco industry, the Tea Party and its associated organisations.
    Tobacco control 02/2013; · 3.85 Impact Factor
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    Rachel A Grana
    Journal of Adolescent Health 02/2013; 52(2):135-136. · 2.97 Impact Factor
  • Rachel A. Grana, Pamela Ling
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    ABSTRACT: Background: Electronic cigarettes (or e-cigarettes) are novel nicotine delivery products advertised widely and aggressively on the internet. The products and their marketing are currently unregulated. This study identified the marketing messages and selling features on e-cigarette retail websites. Methods: One-hundred websites were identified using anonymized iterative searches, using terms such as electronic cigarette, e-cigarette, and e-cig. The top 50 results of each search were examined to identify the top 100 unique retail Web sites. Sites were content analyzed by four independent coders. Results: Six main messages were identified:1) using e-cigarettes has health benefits compared to using tobacco cigarettes, 2) e-cigarettes can be used to circumvent clean indoor air laws, 3) e-cigarette vapor is less harmful than secondhand smoke, 4) e-cigarettes can be used to quit smoking tobacco cigarettes 5) e-cigarettes are the new and modern way to smoke and 6) using e-cigarettes is cheaper than smoking tobacco cigarettes. Novel features of websites included instructional how-to videos, testimonial videos, celebrity endorsements, holiday promotions, and affiliate programs recruiting consumers to become e-cigarette sellers. Discussion: E-cigarette marketing websites frequently include health and cessation claims and features with youth appeal that could have negative effects on public health if they deter or undermine cessation or recruit novices to start using nicotine. Health claims should be supported by objective data (not produced or funded by e-cigarette manufacturers) and youth appeals should be eliminated.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Rachel A. Grana, Pamela Ling
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    ABSTRACT: Background: Smokeless tobacco products and electronic cigarettes (e-cigarettes) have been promoted to smokers to use in smoke-free environments. Some studies have found that smokers who also use other tobacco products are less motivated to quit than cigarette-only smokers. Methods: Random time-location samples of young adults attending bars and nightclubs in San Diego, CA completed cross sectional surveys in 2011. Current (past 30-day) smokers' data (n=619) were analyzed to examine the relationship between use of traditional smokeless tobacco, snus, hookah, little cigars and e-cigarettes and reporting having made a quit attempt in the past year. Results: Forty-three percent of participants were female, mean age was 24 years, and 72.8% were in college/ had graduated college. Participants reflected California's race/ethnic representation with 34% Hispanic, 46% white and 20% other races/ethnicities. Past 30 day use of smokeless tobacco was 6.6%, snus 5.5%, hookah 24.9%, little cigars 12.9% and e-cigarettes 9.9%. Past 30-day use of an e-cigarette was statistically significantly associated with having made a quit attempt in the past year (χ2 = 4.049, df=1, p=0.04). Use of any other tobacco product was not statistically significantly associated with having made a past year quit attempt. Having used snus was associated with reporting expecting to be smoking in the next year (χ2 = 6.56, df=2, p=0.04). Discussion: Young adult smokers in this sample tried other tobacco products at disproportionately high rates. Although e-cigarettes have not been approved for smoking cessation, young adult smokers who have tried to quit may be more likely to try them.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
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    ABSTRACT: Background: Public Service Announcements (PSAs) encouraging tobacco cessation or avoidance may produce unintended outcomes, including reactance---resistance to the message and attempts to re-establish control, and boomerang effects---unintended attitudes or behaviors against the message. Though frustration at smoking or tobacco companies may be persuasive, reactance and boomerang effects are not. Methods: Seventy-five current and former adult smokers evaluated anti-tobacco message concepts in 8 online focus groups in summer 2011. Qualitative grounded theory analysis was used to identify the main types of reactions to the message concepts. Results: Reactions to anti-smoking message concepts comprised five main themes 1) anger at being stigmatized, 2) disagreement with government control over individual freedom or tobacco companies 3) desire to quit but feeling unable to quit, coupled with resistance to labeling oneself addicted 4) expressions of support and pride for participants who discussed their own quit attempts 5) frustration at tobacco companies for being dishonest. For example, in response to an anti-tobacco ad concept containing tobacco warning labels, participants frequently complained about governmental interference in their lives. A message including this is your brain on nicotine evoked anger, contrasts with street drugs, and claims that smoking was a habit, not an addiction. Conclusion: Focus group participants expressed conflicted attitudes about their smoking status and desire or ability to quit. The social stigma of smoking is a strong factor in smokers' attitudes towards smoking, quitting, cigarette alternatives and regulation. Identifying thematic and linguistic mechanisms leading to reactance and boomerang effects can improve campaign messaging.
    140st APHA Annual Meeting and Exposition 2012; 10/2012
  • Youn Ok Lee, Arnab Mukherjea, Rachel Grana
    Tobacco control 08/2012; · 3.85 Impact Factor
  • Rachel A. Grana, Jeff Jordan, Pamela Ling
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    ABSTRACT: Introduction: Quitting smoking before age 30 reduces risk from smoking-related morbidity and mortality by 90%. Young adults attending bars have high smoking rates; this pilot study explored the feasibility of smoking cessation groups in bars. Methods: Participants were young adult smokers interested in quitting and identified as social leaders by key informants in the local bar scene in San Diego. Participants attended weekly social support based meetings for 10-12 weeks (two groups, total N=27). Meetings occurred in a local bar and included a smoking cessation counselor to provide evidence-based advice/information and monetary incentives. Each meeting, participants reported smoking status, which was validated with expired carbon monoxide (CO) readings. Results: At baseline, participants smoked an average of 11.2 cigarettes per day, and 17 participants had made about 2.5 prior quit attempts. Fifty-five percent of participants had perfect attendance and 17% missed ≤2 sessions. At the end of the intervention, participants had reduced their average number of cigarettes per day, from 11.2 to 6.8, and 74% of participants reported having tried to quit during the intervention. In addition, 37% (n=10) of the sample had quit (reported currently attempting to quit, time since last cigarette ≥ 1 day, and CO levels of ≤6ppm). CO monitoring, cash incentives, cessation counselor, and social support were rated as the most helpful aspects of the intervention. Discussion: Conducting a smoking cessation intervention for young adults in the bar setting is feasible, well-received by the participants and has positive effects on smoking cessation, reduction and quit attempts.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
  • Rachel A. Grana, Pamela Ling
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    ABSTRACT: Introduction: Electronic cigarettes (or e-cigarettes) occupy a novel place in the nicotine/tobacco use market as they face unique legal challenges and are primarily sold over the Internet. However, little is known about these products and no published studies investigate their marketing. This study examines the main marketing messages and strategies to sell e-cigarettes and compares them to smokeless tobacco advertising. Methods: Content analysis of fifteen popular websites (found among first retrievals in repeated Google searches of the terms electronic cigarette, e-cigarette, and e-cig). We also included the electronic cigarette companies facing legal challenge or regulatory warnings from the FDA in the sample. Results: We found four main messages communicated through Web-based e-cigarette advertising: 1) they are a safer alternative to continuing to smoke tobacco cigarettes, 2) they are the new and modern way to smoke, 3) they can be used to quit smoking tobacco cigarettes, and 4) they can be used to circumvent clean indoor air laws. The sites often include unique Web-based marketing tools, such as instructional how-to videos and testimonial flash-based videos (embedded or linked from their sites to YouTube). Discussion: Marketing messages used to sell e-cigarettes overlap with new smokeless tobacco product advertising themes (e.g., for use when you can't smoke"). The aggressive marketing of e-cigarettes, their potential appeal to current smokers wanting to quit, and the use of claims that are not supported by scientific evidence warrants public health surveillance and action.
    139st APHA Annual Meeting and Exposition 2011; 11/2011
  • Source
    Rachel A Grana, Stanton A Glantz, Pamela M Ling
    Tobacco control 06/2011; 20(6):425-6. · 3.85 Impact Factor

Publication Stats

74 Citations
65.38 Total Impact Points

Institutions

  • 2011–2014
    • University of California, San Francisco
      • • Division of General Internal Medicine
      • • Division of Hospital Medicine
      San Francisco, California, United States