Little Cigar and Cigarillo Warnings to Reduce Tobacco-Related Cancers and Disease

摘要 超过400万美国成年人经常抽雪茄，这会导致多种癌症，包括口腔癌， 食管癌、胰腺癌、喉癌和肺癌。小雪茄和小雪茄（LCC）的使用， 由于税收的不平等， 在香烟和雪茄之间，LCC包装尺寸使雪茄产品负担得起， 法规，如香料禁令，存在于香烟中，而不是雪茄。研究很少 检查了目前强制性的小雪茄和小雪茄（LCC）警告的有效性。 对香烟警告的研究表明，有效的LCC警告应该 使用说明与使用相关的负面健康影响的图像和一个大警告 标签突出显示在包装上，删除风味描述符可能会改善 注意警告信息。然而，针对香烟的研究不能充分地 由于产品特性、用户 人口统计学和烟草警告的高法律的门槛。没有研究表明 这些变化对当前LCC用户使用LCC的影响。我们建议的研究将填补 通过了解LCC警告特征（即，内容、格式、大小） 是最有影响力的减少LCC的使用，以及如何一个额外的LCC政策，删除 包装上的风味描述符，影响LCC警告的影响。在目标1中，我们将使用 现有的研究和专家审查，以开发新的文字和图片LCC警告，并测试 新的警告使用在线实验，以确定警告，成人LCC用户认为， 最有效。我们将在目标2中进行一项全国性的、基于网络的随机对照试验，以检查 Aim 1中最有效的警告图像增加了成年LCC的戒烟意愿 用户，与当前强制的警告和控制条件相比。虽然我们的目标2 研究将评估改进的警告如何影响LCC行为意图，我们的目标3将 评估LCC包装上的风味描述符是否分散了警告， 冲击在目标3中，我们将在成人LCC用户中进行一项面对面的实验室研究， 注意力（眼动追踪）、情感（面部肌电图）和唤醒的客观测量 （皮肤电活动），以确定风味描述符如何影响 与当前强制性警告相比，改进了警告。该研究将填补 关键差距在于哪些特征使LCC警告标签最有效， 提供LCC警告如何影响LCC行为意图的必要证据。我们 总体目标是制定有效的LCC警告，减少癌症和其他健康风险。

ABSTRACT Over 4 million US adults regularly smoke cigars, which causes multiple cancers, including oral, esophageal, pancreatic, laryngeal, and lung cancer. Little cigar and cigarillo (LCC) use among adults has dramatically increased over the last decade because of disparities in taxation between cigarettes and cigars, LCC pack sizes that make cigar products affordable, and regulations, such as flavor bans, that exist for cigarettes but not for cigars. Little research has examined the effectiveness of currently mandated little cigar and cigarillo (LCC) warnings. Research from studies of cigarette warnings suggests that effective LCC warnings should employ images that illustrate negative health effects associated with use and a large warning label prominently displayed on the pack, and that removal of flavor descriptors may improve attention to warning messages. However, research specific to cigarettes cannot adequately inform LCC warning development due to the differences in product characteristics, user demographics and high legal bar for tobacco warnings. No research exists on the potential impact of such changes on LCC use among current LCC users. Our proposed study will fill the existing gaps by understanding which LCC warning characteristics (i.e., content, format, size) are most influential in reducing LCC use, and how an additional LCC policy, the removal of flavor descriptors on packaging, influences the impact of LCC warnings. In Aim 1, we will use existing research and expert review to develop new text and pictorial LCC warnings and test the new warnings using online experiments to identify warnings that adult LCC users perceive as most effective. We will conduct a national, web-based RCT in Aim 2 to examine whether the most effective warnings with images from Aim 1 increase quit intentions among adult LCC users, compared to the currently mandated warnings and a control condition. While our Aim 2 study will assess how improved warnings influence LCC behavioral intentions, our Aim 3 will assess whether flavor descriptors on LCC packages distract from warnings, reducing their impact. In Aim 3, we will conduct an in-person laboratory study among adult LCC users using objective measures of attention (eye tracking), affect (facial electromyography), and arousal (electrodermal activity) to determine how flavor descriptors influence the effectiveness of improved warnings compared to currently mandated warnings. The proposed study will fill critical gaps regarding which characteristics make LCC warning labels most effective and provide needed evidence on how LCC warnings influence LCC behavioral intentions. Our overarching goal is to develop effective LCC warnings that reduce cancer and other health risks.