Opposition to banning cigarette filters and the belief that removing filters makes cigarettes much more harmful among adults who smoke: Findings from the 2022 International Tobacco Control Four Country Smoking and Vaping Survey.

Introduction: In line with historical tobacco industry marketing claims, many consumers perceive cigarettes with filters as less harmful than cigarette without filters. However, scientific evidence indicates that cigarette filters do not reduce the risks associated with smoking. We examined opposition to banning the sale of cigarettes with filters, beliefs about whether removing filters makes cigarettes much more harmful, and whether this belief is associated with opposition to banning filters among adults who smoke cigarettes from four high-income countries.

Methods: Data are from 2,980 adults who smoke cigarettes and participated in the 2022 ITC Smoking and Vaping Survey in Australia, Canada, England, and the United States (US). Weighted descriptives estimated opposition to a cigarette filter ban and the belief that removing filters makes cigarettes 'much more', 'a little more', 'not more' harmful, or 'don't know'. Adjusted regression analyses examined the association between opposition to banning filters (vs. support/don't know) and the belief that removing filters would make cigarettes much more harmful (vs. otherwise).

Results: Across all counties, 69.3% opposed banning filters, 11.5% of respondents supported banning filters, and 19.1% did not know (main effect for country differences: p=0.001). Country differences remained significant after adjusting for covariates (p=0.047), with adults who smoke in Australia and the US being significantly more likely to oppose a filter ban than those in England. Canada did not differ significantly from any of the countries. Nearly half (45.9%) believe that removing filters would make cigarettes much more harmful, 28.6% reported a little more harmful, 15.3% were unsure, and 10.2% reported not more harmful (country differences: p=0.002). Country differences were no longer significant after adjustment (p=0.18). Believing that removing filters makes cigarettes much more harmful was strongly associated with opposing a filter ban (78.5%) (vs. otherwise: 62.1%, p<0.001).

Conclusions: Across all four countries, three-quarters of adults who smoke erroneously believe that removing filters would make cigarettes more harmful, and believing that doing so would make cigarettes much more harmful was the strongest predictor of opposing a filter ban.

Implications: More than 90% of manufactured cigarettes worldwide contain filters. Contrary to marketing claims by the tobacco industry, cigarette filters do not offer any health protection from cigarette smoke; however, three-quarters of adults who smoke erroneously believe that cigarettes with filters are much less harmful than cigarettes without filters. To protect public health and the environment, the World Health Organization has recommended that policymakers consider banning cigarette filters as they are unnecessary single use plastics.