Cigar Warning Noticing and Demographic and Usage Correlates: Analysis from the United States Population Assessment of Tobacco and Health Study, Wave 5.

Stefanie K Gratale,Andrew A Strasser,Olivia A Wackowski,Arjun Teotia,Cristine D Delnevo,Julia Chen-Sankey,Ollie Ganz

doi:10.3390/ijerph19063221

Abstract

Although cigars pose health risks similar to cigarettes, their packaging/marketing is not subject to commensurate regulation in the US. In a 2000 agreement with the Federal Trade Commission, seven major manufacturers agreed to use some form of cigar warning. In 2016, the Food and Drug Administration passed a rule requiring larger standardized warnings, but the requirement was successfully challenged in court. Here, we examined U.S. population-level trends in noticing existing cigarillo, traditional and filtered cigar warnings. We analyzed Wave 5 Population Assessment of Tobacco and Health adult data to assess prevalence of past-30 day warning noticing and associations with socio-demographic and tobacco use variables. Noticing was higher among current users of cigarillos (27%), filtered (34%) and traditional cigars (21%), than non-users (8% for each product, p < 0.0001), and among every-day vs. some-day users, established vs. experimental users, and past-30 day users vs. those without past-30 day use. Results varied by product, but generally indicated lower noticing among non-Hispanic Whites and dual cigarette users, but higher noticing among those purchasing cigars by the box/pack (vs. not purchasing for themselves). Low overall noticing but higher prevalence among frequent users underscores a need for a stronger, uniform cigar warning label policy in the US.

Highlights

As combustible tobacco products, cigars pose similar health risks to those of cigarettes, including respiratory and cardiovascular disease as well as high levels of exposure to carcinogenic compounds [1,2]
Our findings further indicate that Non-Hispanic Black and/or Non-Hispanic Other respondents are more likely to notice cigarillo and traditional cigar warnings, respectively, than Non-Hispanic White respondents, which may be related to differences in use of these products [4], as well as other potential factors such as differences in exposure to pro-tobacco marketing
Our findings indicate that dual cigar/cigarette users are less likely to notice cigar warnings; while this could result from such users having become accustomed or even desensitized to tobacco warnings in general, our data do not allow us to confirm the reason for this finding

Summary

Introduction

Cigars pose similar health risks to those of cigarettes, including respiratory and cardiovascular disease as well as high levels of exposure to carcinogenic compounds [1,2]. In the United States (U.S.), cigar products are available in three primary types—large cigars, cigarillos, and filtered (little) cigars—and vary in features including size, weight, flavors, and quantity sold per package [3]. Of special concern is that cigar smoking is prevalent in potentially vulnerable populations in the U.S. including young adults and minority groups (e.g., non-Hispanic Black and Hispanic) [4,5], with young adults representing the majority of cigarillo smokers [6]. Given the health risks of tobacco use, tobacco warning labels are one tool used by policy makers and regulators to inform consumers and discourage product use. Cigarette packaging has been required to carry a warning label in the U.S since the 1965

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