The impact of cigarillo text warning presence and size on young adults' cigarillo risk beliefs, knowledge, appeal and use intentions.

Introduction: Cigar warning labels can serve as health communication tools; yet current cigar warnings in the United States can be small or absent, and efforts to standardize them have met industry resistance, partly due to limited research.

Methods: In 2021, we conducted an online 3x2x2 factorial experiment with 1352 young adult (aged 18-34) past 12-month cigar users. Participants viewed a cigarillo pack image that varied by: text-only warning size (none; small 15%-of-pack label; larger 30%-of-pack label); warning color (white; black); and brand (Swisher Sweets; White Owl). We compared group means on risk perceptions, knowledge and intentions.

Results: Packs with any warning label (vs. none) elicited higher endorsement that the packs made participants think about health risks of smoking cigarillos (p<.001), as did packs with larger 30%-of-pack versus 15%-of-pack warnings (p<.001). Packs with a warning label (vs. without) elicited greater absolute perceptions of cigarillo harm (p<.001), as did 30%-of-pack versus 15%-of-pack warnings (p<.001). Risks referenced in the stimuli warning (mouth and throat cancer) were more frequently mentioned in an open-ended knowledge item by participants in conditions with a warning label versus the no-warning condition (p<.05). Packs with 30%-of-pack warnings were also rated as less attractive and elicited lower use intentions than packs without a warning or with the 15%-of-pack warning (p<.05).

Conclusions: Results provide evidence that cigar text-only warning labels, particularly larger ones, can facilitate some cigar risk knowledge and beliefs, reduce pack appeal and discourage product interest, supporting policy efforts to strengthen cigar warning requirements.

Implications: Our results suggest that use of the small text warnings on cigarillo packs (~15% of pack size), as currently still found in the United States based on existing Federal Trade Commission agreement guidelines, is better than having no warnings at all, but that larger warnings sized at 30% of pack (as proposed by the US Food and Drug Administration and voluntarily used by some brands/manufacturers) could have significant benefits across a range of outcomes. Study findings lend support for the cigar warning requirements proposed by the US Food and Drug Administration through the Deeming Rule.