Comparing Graphic to Text-Only Warning Labels to Discourage Cigarillo Smoking by Young Adults

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Project Summary Although cigarette smoking has declined, use of other tobacco products has increased, particularly among young adults. The second most common tobacco product used is cigar products. Use of cigarillos is of particular concern because they have many negative health effects, contain toxic chemicals, and are associated with using other tobacco products, such as cigarettes. Additionally, some young adults believe them to be less harmful and less addictive than cigarettes, encouraging uptake and continued use. Cigarillos are currently not included in federal regulation under the Tobacco Control Act, but will fall under the authority of the Food and Drug Administration (FDA) once the proposed Deeming Rule is finalized. This will give the FDA the task of communicating the risks of cigarillos to the public, using (among other means) required warning labels. However, significant knowledge gaps exist in our understanding of how to effectively communicate the risks of cigarillo smoking. This R03 application will address these gaps by testing a specific way that the FDA can communicate the risks of cigarillo smoking: warning labels. Thus, the specific aims of the proposed study are to: (1) develop graphic cigarillo warnings to most effectively communicate the risks of cigarillo smoking, by pairing existing images with the 5 text warnings proposed in the Deeming Rule; and (2) compare the relative effectiveness of text-only versus graphic cigarillo warning labels to discourage cigarillo smoking by young adult cigarillo users and at-risk nonusers. The 5 text warnings proposed in the Deeming Rule will be tested in this study. In Year 1, we will convene focus groups of young adults (18-29) who are current users or at-risk of using cigarillos to develop the graphic warnings by choosing images that represent the 5 text warnings in the proposed Deeming Rule. Subsequently, we will conduct an experiment using a nationally-representative panel of young adult cigarillo users and at-risk nonusers to assess differences between the relative effectiveness of text-only versus graphic warnings to discourage them from cigarillo smoking. The ultimate goal of this research is to better understand how warning labels might discourage cigarillo use among young adults. The results of this timely project could inform the FDA's policymaking and educational efforts on cigarillo warning labels and messaging, and thereby ultimately reduce tobacco-related morbidity and mortality. This R03 application from a New Investigator is directly responsive to 3 of the 10 FDA Center for Tobacco Products interest areas, and is submitted in response to RFA-OD-15-004.