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

摘要 超过 400 万美国成年人经常吸雪茄，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 由于税收差异，成年人在过去十年中急剧增加 介于香烟和雪茄之间，LCC 包装尺寸使雪茄产品价格实惠，以及 诸如香料禁令之类的法规适用于卷烟，但不适用于雪茄。很少有研究 检查了目前强制执行的小雪茄和小雪茄 (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大警告 标签显着地显示在包装上，并且去除风味描述符可能会改善 注意警告消息。然而，专门针对香烟的研究并不能充分 由于产品特性、用户的差异，告知LCC警告开发 人口统计数据和烟草警告的严格法律门槛。尚无关于潜力的研究 这些变化对当前 LCC 用户中 LCC 使用的影响。我们提出的研究将填补 通过了解哪些 LCC 警告特征（即内容、格式、大小）来了解现有差距 对减少 LCC 使用影响最大，以及如何实施额外的 LCC 政策、取消 包装上的风味描述符会影响 LCC 警告的效果。在目标 1 中，我们将使用 现有研究和专家审查，以开发新的文字和图片 LCC 警告并测试 新警告使用在线实验来识别成人 LCC 用户认为的警告 最有效。我们将在目标 2 中开展一项全国性的、基于网络的随机对照试验，以检验是否 来自 Aim 1 的图像最有效的警告可增加成人 LCC 的戒烟意愿 与当前强制的警告和控制条件相比。而我们的目标 2 研究将评估改进的警告如何影响 LCC 的行为意图，我们的目标 3 将 评估 LCC 包装上的风味描述是否会分散人们对警告的注意力，从而减少警告的影响 影响。在目标 3 中，我们将使用以下方法对成人 LCC 用户进行现场实验室研究： 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功效 与当前强制警告相比，改进了警告。拟议的研究将填补 关于哪些特征使 LCC 警告标签最有效和最有效的关键差距 提供有关 LCC 警告如何影响 LCC 行为意图的必要证据。我们的 总体目标是制定有效的 LCC 警告，以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.