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Randomized Controlled Trial
. 2023 Mar;32(2):211-217.
doi: 10.1136/tobaccocontrol-2020-056288. Epub 2021 Jul 30.

Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults

Jennifer Cornacchione Ross  1 , Allison J Lazard  2   3 , Jessica L King  4 , Seth M Noar  2   3 , Beth A Reboussin  5 , Desmond Jenson  6 , Erin L Sutfin  5
Affiliations
Randomized Controlled Trial

Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults

Jennifer Cornacchione Ross et al. Tob Control. 2023 Mar.

Abstract

Background: The US Food and Drug Administration requires six text-only warnings for cigar products, including cigarillos. Research has demonstrated the superiority of pictorial over text-only cigarette warnings, yet the relative effectiveness of pictorial warnings for cigarillos has not been examined. We examined the impact of pictorial cigarillo warnings compared with text-only warnings.

Methods: Data were collected from a nationally representative sample of US young adult (18-29) cigarillo users and susceptible non-users. Participants were randomised to one of three experimental conditions: text-only or one of two pictorial conditions (combined for analyses). For each warning, we assessed negative emotional reactions, cognitive elaboration (ie, thinking about cigarillo risks) and perceived message effectiveness (PME).

Results: Participants (N=661) were 46.5% female, 64.7% white and 21.9% Hispanic; 34.1% reported past 30-day cigarillo use; 41.4% were lifetime users (excluding past 30-day use); and 24.4% were susceptible non-users. Pictorial warnings elicited more negative emotional reactions and higher PME than text-only warnings (p values<0.01), with interactions showing the largest effects for past 30-day users (emotional reactions: d=0.99, PME: d=0.63). For cognitive elaboration, there was no main effect of warning type, but an interaction revealed effects for past 30-day users (p<0.05, d=0.46).

Conclusions: Pictorial cigarillo warnings elicited greater negative emotional reactions and PME compared with text-only warnings. These effects and the effects on cognitive elaboration were strongest for past 30-day users. Our findings extend research on cigarette warnings to cigarillos, demonstrating that pictorial warnings are superior to text-only warnings for cigarillos in eliciting beneficial responses.

Keywords: non-cigarette tobacco products; packaging and labelling; public policy.

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Conflict of interest statement

Competing interests: SMN has served as a paid expert witness in government litigation against tobacco companies. There are no additional competing interests.

Figures

Figure 1
Figure 1
Text and pictorial cigarillo warnings example study stimuli.
Figure 2
Figure 2
Least squares mean differences and 95% CIs between pictorial and text-only warnings.
See this image and copyright information in PMC

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