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， 食道癌、胰腺癌、喉癌和肺癌。少量雪茄和雪茄(LCC)在 在过去的十年里，由于税收的不平等，成年人的数量急剧增加。 在香烟和雪茄之间，使雪茄产品负担得起的LCC包装尺寸，以及 对香烟有规定，但对雪茄没有规定的规定，如香料禁令。几乎没有研究表明 审查了当前强制规定的小雪茄和雪茄(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 使用图片说明与使用相关的负面健康影响和较大的警告 显著地显示在包装上标签，且去除风味描述符可以改进 注意警告信息。然而，专门针对香烟的研究不足以 根据产品特性、用户的不同，通知LCC警告开发 人口结构和烟草警告的较高法律门槛。目前还没有关于这一潜力的研究 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 通过了解哪些LCC警告特征(即内容、格式、大小)存在差距 在减少LCC使用方面影响最大，以及额外的LCC政策如何消除 包装上的风味描述符，影响LCC警示的影响。在目标1中，我们将使用 现有研究和专家评审，以开发新的文本和图片LCC警告并测试 使用在线实验识别成年LCC用户认为的新警告 最有效的。我们将在目标2中进行一次基于网络的全国性RCT，以检查 来自Aim 1的图像最有效的警告增加了成人LCC的戒烟意向 用户，与当前强制警告和控制条件进行比较。而我们的目标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会分散对警告的注意力，从而减少其 冲击力。在目标3中，我们将在成年LCC用户中进行一项面对面的实验室研究，使用 注意力(眼球跟踪)、情感(面部肌电)和觉醒的客观测量 (皮肤电活动)，以确定风味描述符如何影响 与当前强制要求的警告相比，改进了警告。拟议的研究将填补 关于哪些特征使LCC警告标签最有效以及 就LCC警告如何影响LCC行为意图提供所需的证据。我们的 首要目标是开发有效的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.