Substance Use
Relative effectiveness of cigarillo warning themes in text and pictorial formats: An experimental study among a nationally representative sample of US young adults Rime Jebai* Rime Jebai Erin L. Sutfin Alexandra R. Zizzi Beth A. Reboussin Jennifer Cornacchione Ross
Significance: Health warning labels (HWLs) are an effective tool to communicate the health risks of cigar use and can decrease use when applied on cigar packages. This study aims to assess the relative effectiveness of the themes of the six FDA-proposed cigarillo warnings in text and pictorial format by cigarillo smoking status.
Methods: A nationally representative sample of cigarillo users and susceptible nonusers ages 18-29 were randomized to a text or study-developed pictorial warning condition. Within each condition, participants viewed all six of the FDA-proposed HWLs in random order. The warning themes were lung cancer and heart disease; cancers of the mouth and throat; nicotine/addiction; not a safe alternative; harm to baby; and secondhand smoke. We assessed negative affect, cognitive elaboration, and perceived message effectiveness (PME) for each warning. ANOVA for repeated measures followed by Bonferroni adjustment for multiple comparisons were used to test the equality of outcome means between the HWLs themes within text and pictorial format for current (past 30 day) cigarillo users and susceptible nonusers.
Results: Of the 348 participants, 62.0% were current users, and 37.9% were susceptible nonusers. The sample was 46.5% female; mean age 23.9. There were significant differences between the 6 pictorial HWLs’ themes for negative affect (F=2.35;p=0.04). Among current users, the pictorial HWL cancers of the mouth and throat (M±SD=2.98±1.13) elicited the lowest negative affect compared to the nicotine/addiction (3.35±1.27;d=0.29), harm to baby (3.31±1.26;0.25), and not a safe alternative pictorial HWLs (3.30±1.24;0.26). The nicotine/addiction pictorial HWL (3.35±1.27) evoked higher negative affect than lung cancer and heart disease (3.04±1.25;0.27). No significant differences were found among pictorial HWL themes for susceptible nonusers. No differences were observed among the text HWL themes for current or susceptible nonusers.
Conclusions: Differences among the 6 HWL themes emerged within the pictorial format. Except for cancers of the mouth and throat and lung cancer and heart disease, the pictorial HWLs depicted people, displaying the full face or the entire person. Pictorial HWLs depicting people to represent health effects may be more effective than images of diseased organs or body parts. The FDA should consider adding such images to the text warnings on cigarillo packages to better convey the health risks of cigarillo smoking and reduce its rates among young people.