Experts' Perceptions of and Suggestions for Cigar Warning Label Messages and Pictorials

Introduction: Warning labels can be effective tools to inform the public about tobacco risks. However, tobacco warning research has been largely cigarette-centric. This formative study explores potential directions for improving the current warnings for cigars. Aims and Methods: Between June and August 2019, we conducted interviews with 10 experts about the current cigar warning statements and requirements, the inclusion of pictorials in cigar warnings, and legal issues. Additionally, experts viewed and discussed concept images to pair with existing warning statements, including realistic photographic images and symbolic images (eg, icons, caution symbols). Results: Experts agreed that cigar warnings should be strengthened (eg, by increasing their size and use of pictorials) to better leverage their potential impact and maintain warning parity with cigarettes. However, perceived challenges exist given the wide variety of cigar products, product terminology, and use patterns. Experts agreed that photographic pictorials of health effects are likely to be more salient, informative, and effective for behavior change than symbolic ones, but may be vulnerable to legal challenges. Symbolic images used in warnings may obtain attention in a less controversial way, but may be considered less serious and factually accurate, increasing legal risks. Experts indicate that cigar educational campaigns can complement warnings and address additional themes, especially aimed at youth, including exposure to chemicals and flavorings and misperceptions that cigars are naturals. Conclusions: Additional consumer research is needed to examine the potential public health impact of improving cigar warnings and to support regulatory efforts.

Automated summary

This study explores potential directions for improving cigar warnings, with experts agreeing that warnings should be strengthened by increasing size and incorporating images. Challenges exist due to the wide variety of cigar products. Experts believe photographic pictorials of health effects are more effective, but may face legal challenges. Cigar educational campaigns can complement warnings and address additional themes.