Over 4 million US adults regularly smoke cigars, which causes multiple cancers, including
oral, esophageal, pancreatic, laryngeal, and lung cancer. Even smoking 1-2 cigars per day
is associated with elevated cancer risk. Though cigarette consumption decreased 39% from
2000 to 2015, cigar consumption increased 85%. Of the three major types of cigars-large
cigars, little cigars, and cigarillos-little cigars and cigarillos (LCC) are the most
commonly used in the US. LCC use among adults has increased in part because LCCs are
taxed at a lower rate than cigarettes, are subject to fewer regulations and marketing
restrictions, can be purchased in small pack sizes, and are exempt from flavor bans that
apply to cigarettes.
In May 2016, the Food and Drug Administration (FDA) required text-only warnings on LCC
packs, rotating among six statements. Research on cigarettes suggests warnings on packs
should have multiple rotating sets, contain images illustrating the negative health
effects associated with LCC use, and be large. However, the evidence for cigarette
warning labels cannot adequately inform implementation of improved LCC warnings for four
reasons: 1) The currently mandated cigar warnings differ from existing cigarette
warnings; 2) there is no evidence on the effectiveness of the currently mandated cigar
warnings (i.e., behavioral intentions or outcomes) or evidence on efforts that might
improve LCC warnings (i.e., images, larger warning size, removal of LCC flavor
descriptors on packaging); 3) Courts have ruled that one type of effective tobacco
warning (i.e., for cigarettes) cannot be used to justify other types of tobacco warnings,
such as those for LCCs and 4) LCC users have different demographic and consumption
profiles than cigarette users (i.e., LCC users include a higher proportion of young
adults African Americans, and LCCs are used on fewer days per month, which should be
taken into account when developing improved warnings.
Gaps exist in understanding how LCC policies, such as the removal of flavor descriptors
on packaging, influence the impact of LCC warnings. This eye tracking and
psychophysiology project will provide new data to fill these evidence gaps and advance
general scientific knowledge about elements of tobacco warnings research.
During the study, Participants will see 12 LCC pack stimuli images presented in random
order. 3 packs will feature pictorial LCC warnings and a "Sweet" flavor descriptor, and
the same 3 warnings will be presented on packs without a flavor. The remaining 6 LCC
packs will have 3 text-only warnings, with 3 images containing the "Sweet" flavor and 3
images without a flavor. We will measure attention to the warnings and attention to the
flavor descriptors as well as electrodermal activity and affective responses for each of
the 12 stimuli.
