Perceived Effectiveness of Cigar Warnings Among Young People in the U.S.

INTRODUCTION: The effectiveness of warning size and format on cigar packaging in influencing youth and young adult smoking behaviors is not well understood. This study tested these cigar warning characteristics among youth and young adults who use or are susceptible to using little cigars or cigarillos. METHODS: The study recruited 506 U.S. youth and young adults, aged 15-20 years, between April and June 2023. Participants reported ever or past 30-day use of little cigars or cigarillos or were susceptible to using little cigars or cigarillos. A 2 × 2 between-subjects online experiment was conducted where youth and young adults were randomized to 1 of 4 conditions, with manipulations for cigar warning size (30% or 50% of the package) and format (U.S. Food and Drug Administration-proposed text-only or pictorial). Youth and young adults viewed 6 warnings on a mock cigarillo package. The primary outcome was perceived message effectiveness. A mixed-effects regression model was fit to examine the effects of warning size and format on outcomes in September 2023. RESULTS: Most participants were female (50.0%), White (59.3%), and heterosexual (67.8%). Nearly half were susceptible to little cigars or cigarillos (47.4%), followed by past 30-day use (32%) and ever use (20.6%). Pictorial warnings significantly increased perceived message effectiveness compared with text-only warnings. Similar effects were found for risk perceptions, cognitive and emotional reactions, and recognition. Warning size had no statistically significant effect on outcomes. CONCLUSIONS: Pictorial cigar warnings outperformed U.S. Food and Drug Administration-proposed text-only warnings on perceived message effectiveness and secondary outcomes among youth and young adults who use or are susceptible to little cigars or cigarillos. These results suggest that a pictorial format will enhance the effectiveness of cigar warnings, as has been found for cigarettes.