||1R01CA240732-01 Interpret this number
||Univ Of North Carolina Chapel Hill
||Little Cigar and Cigarillo Warnings to Reduce Tobacco-Related Cancers and Disease
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.
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