Wackowski Olivia A, Gratale Stefanie K, Jeong Michelle, Schroth Kevin R J, Mercincavage Melissa, Strasser Andrew A, Delnevo Cristine D
Rutgers Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, NJ, USA.
Department of Psychiatry and Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA.
Nicotine Tob Res. 2025 Aug 22;27(9):1607-1615. doi: 10.1093/ntr/ntaf074.
Cigar warning labels can serve as health communication tools; yet current cigar warnings in the United States can be small or absent, and efforts to standardize them have met industry resistance, partly because of limited research.
In 2021, we conducted an online 3 × 2 × 2 factorial experiment with 1352 young adults (aged 18-34) past 12-month cigar users. Participants viewed a cigarillo pack image that varied by: text-only warning size (none; small 15%-of-pack label; larger 30%-of-pack label); warning color (White; Black); and brand (Swisher Sweets; White Owl). We compared group means on risk perceptions, knowledge, and intentions.
Packs with any warning label (vs. none) elicited higher endorsement that the packs made participants think about the health risks of smoking cigarillos (p < .001), as did packs with larger 30%-of-pack versus 15%-of-pack warnings (p < .001). Packs with a warning label (vs. without) elicited greater absolute perceptions of cigarillo harm (p < .001), as did 30%-of-pack versus 15%-of-pack warnings (p < .001). Risks referenced in the stimuli warning (mouth and throat cancer) were more frequently mentioned in an open-ended knowledge item by participants in conditions with a warning label versus the no-warning condition (p < .05). Packs with 30%-of-pack warnings were also rated as less attractive and elicited lower use intentions than packs without a warning or with the 15%-of-pack warning (p < .05).
Results provide evidence that cigar text-only warning labels, particularly larger ones, can facilitate some cigar risk knowledge and beliefs, reduce pack appeal, and discourage product interest, supporting policy efforts to strengthen cigar warning requirements.
Our results suggest that the use of the small text warnings on cigarillo packs (~15% of pack size), as currently still found in the United States based on existing Federal Trade Commission agreement guidelines, is better than having no warnings at all, but that larger warnings sized at 30% of the pack (as proposed by the U.S. Food and Drug Administration (FDA) and voluntarily used by some brands/manufacturers) could have significant benefits across a range of outcomes. Study findings lend support for the cigar warning requirements proposed by the U.S. FDA through the Deeming Rule.
雪茄警示标签可作为健康传播工具；然而，美国目前的雪茄警示可能很小或根本没有，而且标准化这些警示的努力遭到了行业抵制，部分原因是研究有限。
2021年，我们对1352名过去12个月内使用过雪茄的18至34岁年轻人进行了一项在线3×2×2析因实验。参与者观看了不同的小雪茄包装图片，这些图片的变化因素包括：仅文字的警示大小（无；占包装15%的小标签；占包装30%的大标签）、警示颜色（白色；黑色）以及品牌（Swisher Sweets；White Owl）。我们比较了各组在风险认知、知识和意图方面的均值。
带有任何警示标签的包装（与无警示标签的包装相比）更能让参与者认可该包装会使他们思考吸小雪茄的健康风险（p <.001），占包装30%的警示标签的包装与占包装15%的警示标签的包装相比也是如此（p <.001）。带有警示标签的包装（与无警示标签的包装相比）能引发对小雪茄危害更强的绝对认知（p <.001），占包装30%的警示标签与占包装15%的警示标签相比也是如此（p <.001）。在有警示标签的条件下，参与者在开放式知识项中更频繁地提及刺激警示中提到的风险（口腔和咽喉癌），而在无警示条件下则不然（p <.05）。与无警示或有占包装15%警示标签的包装相比，占包装30%警示标签的包装吸引力更低，使用意图也更低（p <.05）。
结果表明，仅文字的雪茄警示标签，尤其是较大的标签，能够促进对一些雪茄风险的认知和信念，降低包装吸引力，并抑制对产品的兴趣，支持加强雪茄警示要求的政策努力。
我们的结果表明，根据现有的联邦贸易委员会协议指南，美国目前在小雪茄包装上使用的小文字警示（约占包装大小的15%）比完全没有警示要好，但占包装30%的更大警示标签（如美国食品药品监督管理局（FDA）提议并被一些品牌/制造商自愿采用）在一系列结果方面可能会带来显著益处。研究结果支持了美国FDA通过《认定规则》提出的雪茄警示要求。
