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.
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