Designing More Effective Cigar Warnings: An Experiment Among Adult Cigar Smokers

Abstract

Introduction: Little systematic evidence exists about the effectiveness of cigar warnings. This study examined the perceived message effectiveness (PME) of warning statements about different health consequences caused by cigars. PME is a validated self-report scale of how effectively a health message discourages smoking.

Aims and methods: We conducted an online study from April to May 2020 with adults in the United States who used cigars in the past 30 days (n = 777). Participants were randomly assigned to view and rate PME (three items, range 1-5) for seven out of 37 text warning statements about different health consequences from cigar use. Linear mixed effects models evaluated the most effective warning characteristics (eg, type of health consequence), controlling for repeated measures and participant demographics.

Results: Analyses showed that health consequences about the cardiovascular system (B = 0.38), mouth (B = 0.40), other digestive (B = 0.45), respiratory system (B = 0.36), and early death (B = 0.36) were associated with higher PME scores than reproductive health consequences (all p values <.001). Similar results were found for these health consequences compared with addiction (all p values p < .001). We also observed that awareness of the health consequence was associated with higher PME scores (B = 0.19, p < .001) and length of the warning message (number of characters) was associated with lower PME scores (B = -0.007, p = .03). No differences were observed between cancer and noncancer health consequences (p = .27) or health consequences that used plain language versus medical jargon (p = .94).

Conclusions: Our study provides new evidence about the perceived effectiveness of different cigar health warning statements and identifies features that may strengthen statements.

Implications: Our study with cigar smokers from across the United States provides much-needed evidence concerning the perceived effectiveness of different cigar health warning statements and features that may strengthen such statements. Mandated cigar warnings in the United States could be strengthened by including health consequences that were perceived as more effective in our study (eg, early death), using health consequences that participants were aware of, and using short warning statements.