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Original research
Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults
  1. Jennifer Cornacchione Ross1,
  2. Allison J Lazard2,3,
  3. Jessica L King4,
  4. Seth M Noar2,3,
  5. Beth A Reboussin1,
  6. Desmond Jenson5,
  7. Erin L Sutfin1
  1. 1 Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2 Hussman School of Journalism and Media, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  3. 3 Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
  4. 4 Department of Health & Kinesiology, University of Utah, Salt Lake City, Utah, USA
  5. 5 Public Health Law Center, Mitchell Hamline School of Law, Saint Paul, Minnesota, USA
  1. Correspondence to Dr Jennifer Cornacchione Ross, Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA; jcornacc{at}wakehealth.edu

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.

  • packaging and labelling
  • non-cigarette tobacco products
  • public policy

Data availability statement

No data are available. Additional data are currently being analysed.

https://doi.org/10.1136/tobaccocontrol-2020-056288

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    Data availability statement

    No data are available. Additional data are currently being analysed.

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    Footnotes

    • Twitter @jencornacc, @AllisonLazard, @jess4817, @SethNoar, @desmondjenson, @erinsutfin

    • Contributors JCR led the study design; AJL developed study stimuli; and BAR performed the statistical analyses. All authors contributed to the implementation of the study, writing and revision of the manuscript, and approval of the final version of the manuscript.

    • Funding Research reported in this article was supported by the National Cancer Institute and Food and Drug Administration (FDA) Center for Tobacco Products (award number R03CA206487). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the FDA.

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

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.