{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:32:37Z","timestamp":1760146357027,"version":"build-2065373602"},"reference-count":32,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T00:00:00Z","timestamp":1730246400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Institute on Drug Abuse of the National Institutes of Health","award":["5R01DA048529-03"],"award-info":[{"award-number":["5R01DA048529-03"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Limited research has examined attention to these cigar-specific health warnings and their perceived effectiveness among young people. The objective of our study was to evaluate the attention to and perceptions of a set of cigar-specific health warnings among young adult tobacco users and non-users. Methods: Young adults ages 18\u201324 in Columbus, Ohio, were recruited into an eye-tracking experiment examining cigarillo packaging between May 2022 and February 2023. Participants (n = 124) were shown 12 unique, branded cigarillo packages featuring a rotation of four of the Food and Drug Administration\u2019s mandated health warnings: (1) Cigar smoking can cause lung cancer and heart disease (\u201cdisease\u201d); (2) tobacco smoke increases the risk of lung cancer and heart disease, even in nonsmokers (\u201cnonsmokers\u201d); (3) cigar smoking can cause cancers of the mouth and throat, even if you do not inhale (\u201cinhale\u201d); and (4) cigars are not a safe alternative to cigarettes (\u201calternative\u201d). Software captured visual attention to each product package, including the health warning. Participants also ranked the most effective message to motivate people to quit; one week later, the participants (n = 118) self-reported unaided recall of the experiment. Results: Study participants were an average of 21.2 years old, 54.2% were female, 73.7% were White, 65.3% had some college education, and 26.3% reported tobacco use in the previous month. The health warning, \u201cCigar smoking can cause cancers of the mouth and throat, even if you do not inhale\u201d was ranked the most effective cigar warning (41.5%) and drew the greatest proportion of visual attention (26.1%). More than half (52.5%) recalled details regarding the health warning messages one week following the experiment, with few recalling (17.7%) specific warning message themes. Conclusions: Understanding the best performing health warnings is a crucial strategy to share accurate information on the risks of tobacco use. Our findings suggest that the warning on cancer risk even without inhaling drew the greatest visual attention and highest rating of perceived effectiveness among this sample of young adult cigarillo users and non-users.<\/jats:p>","DOI":"10.3390\/ijerph21111442","type":"journal-article","created":{"date-parts":[[2024,10,30]],"date-time":"2024-10-30T09:10:44Z","timestamp":1730279444000},"page":"1442","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Cigar-Specific Health Warnings: Attention, Recall, and Perceived Effectiveness Among Young Adult Users and Non-Users"],"prefix":"10.3390","volume":"21","author":[{"given":"Elizabeth G.","family":"Klein","sequence":"first","affiliation":[{"name":"College of Public Health, Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anne E.","family":"Driscoll","sequence":"additional","affiliation":[{"name":"College of Public Health, Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abigail B.","family":"Shoben","sequence":"additional","affiliation":[{"name":"College of Public Health, Ohio State University, Columbus, OH 43210, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joseph M.","family":"Macisco","sequence":"additional","affiliation":[{"name":"Department of Population and Public Health Sciences, Boonshoft School of Medicine, Wright State University, Dayton, OH 45435, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6301-9185","authenticated-orcid":false,"given":"Stephanie","family":"Pike Moore","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanda J.","family":"Quisenberry","sequence":"additional","affiliation":[{"name":"Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-8505","authenticated-orcid":false,"given":"Erika S.","family":"Trapl","sequence":"additional","affiliation":[{"name":"Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,30]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1136\/tc.2010.037630","article-title":"Health warning messages on tobacco products: A review","volume":"20","author":"Hammond","year":"2011","journal-title":"Tob. Control."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1136\/tobaccocontrol-2014-051978","article-title":"Pictorial cigarette pack warnings: A meta-analysis of experimental studies","volume":"25","author":"Noar","year":"2016","journal-title":"Tob. Control."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"8","DOI":"10.18001\/TRS.3.2(Suppl1).2","article-title":"Changes in the mass-merchandise cigar market since the Tobacco Control Act","volume":"3","author":"Delnevo","year":"2017","journal-title":"Tob. Regul. Sci."},{"unstructured":"Public Health Law Center (2023). Cigar Association v. FDA: Undercutting the FDA\u2019s Ability to Regulate Tobacco Products, Public Health Law Center.","key":"ref_4"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"606","DOI":"10.1093\/ntr\/ntab238","article-title":"Trends in cigar sales and prices, by product and flavor type\u2014The United States, 2016\u20132020","volume":"24","author":"Wang","year":"2022","journal-title":"Nicotine Tob. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1457","DOI":"10.1093\/ntr\/ntx209","article-title":"US adult cigar smoking patterns, purchasing behaviors, and reasons for use according to cigar type: Findings from the Population Assessment of Tobacco and Health (PATH) Study, 2013\u20132014","volume":"20","author":"Corey","year":"2017","journal-title":"Nicotine Tob. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"818","DOI":"10.1080\/10810730.2016.1177141","article-title":"Adolescent and Young Adult Perceptions of Hookah and Little Cigars\/Cigarillos: Implications for Risk Messages","volume":"21","author":"Cornacchione","year":"2016","journal-title":"J. Health Commun."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"827","DOI":"10.1093\/ntr\/ntv151","article-title":"The Most Natural Tobacco Used: A Qualitative Investigation of Young Adult Smokers\u2019 Risk Perceptions of Flavored Little Cigars and Cigarillos","volume":"18","author":"Sterling","year":"2015","journal-title":"Nicotine Tob. Res."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"17","DOI":"10.18001\/TRS.3.2(Suppl1).3","article-title":"Flavored cigar misperceptions and uncertainty: Identifying at-risk smokers","volume":"3","author":"Sterling","year":"2017","journal-title":"Tob. Regul. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e20181505","DOI":"10.1542\/peds.2018-1505","article-title":"Tobacco product harm perceptions and new use","volume":"142","author":"Parker","year":"2018","journal-title":"Pediatrics"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"965","DOI":"10.1037\/adb0000819","article-title":"Do smokers\u2019 harm perceptions of cigarillos differ by modified use of the tobacco product? Findings from waves 3 and 4 of the PATH study","volume":"36","author":"Timberlake","year":"2022","journal-title":"Psychol. Addict. Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1136\/tc.2008.028043","article-title":"Impact of graphic and text warnings on cigarette packs: Findings from four countries over five years","volume":"18","author":"Borland","year":"2009","journal-title":"Tob. Control"},{"doi-asserted-by":"crossref","unstructured":"Alonso, F., and Cohen, J.E. (2024). Rotation of tobacco health warnings and messages: Challenges and recommendations for implementation. Tob. Control.","key":"ref_13","DOI":"10.1136\/tc-2024-058640"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"102236","DOI":"10.1016\/j.pmedr.2023.102236","article-title":"Perceived message effectiveness of cigar warning themes among adults in the United States","volume":"34","author":"Ross","year":"2023","journal-title":"Prev. Med. Rep."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1136\/tobaccocontrol-2020-056288","article-title":"Responses to pictorial versus text-only cigarillo warnings among a nationally representative sample of US young adults","volume":"32","author":"Ross","year":"2021","journal-title":"Tob. Control"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1093\/ntr\/ntab207","article-title":"Designing More Effective Cigar Warnings: An Experiment Among Adult Cigar Smokers","volume":"24","author":"Kowitt","year":"2021","journal-title":"Nicotine Tob. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1382","DOI":"10.1093\/ntr\/ntab012","article-title":"Experts\u2019 Perceptions of and Suggestions for Cigar Warning Label Messages and Pictorials","volume":"23","author":"Wackowski","year":"2021","journal-title":"Nicotine Tob. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.amepre.2021.01.028","article-title":"Youth exposure to warnings on cigar, e-cigarette, and waterpipe tobacco packages","volume":"61","author":"Kowitt","year":"2021","journal-title":"Am. J. Prev. Med."},{"doi-asserted-by":"crossref","unstructured":"Vargees, C., Stroup, A.M., Niznik, T., Dunn, D., Wyatt, R., Hoetger, C., Taleb, Z.B., Cohn, A.M., Cobb, C.O., and Fetterman, J.L. (2023). Patterns of use; perceptions, and cardiopulmonary health risks of cigar products: A systematic review. BMC Public Health, 23.","key":"ref_19","DOI":"10.1186\/s12889-023-17216-z"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1016\/j.addbeh.2018.05.024","article-title":"Little cigars and cigarillos: Affect and perceived relative harm among US adults, 2015","volume":"85","author":"Majeed","year":"2018","journal-title":"Addict. Behav."},{"unstructured":"Moore, S.P., Ennis, A.C., Kirihara, S., Gomez, E.C., Reyes-Klein, M., Sharp, H., Macisco, J., Trapl, E., Quisenberry, A., and Klein, E.G. Visual attention and recall of flavored cigarillo package elements among young adults: A randomized control trial, PLoS Global Public Health, under review.","key":"ref_21"},{"unstructured":"Smart Eye SB (2024, January 11). Aurora Smart Eye\u2019s Smallest Compact Remote Eye Tracker. Available online: https:\/\/www.smarteye.se\/.","key":"ref_22"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1093\/ntr\/ntx021","article-title":"Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving","volume":"19","author":"Klein","year":"2017","journal-title":"Nicotine Tob. Res."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"175","DOI":"10.18001\/TRS.1.2.7","article-title":"Does Size Impact Attention and Recall of Graphic Health Warnings?","volume":"1","author":"Klein","year":"2015","journal-title":"Tob. Regul. Sci."},{"unstructured":"U.S. Food and Drug Administration (2024). Cigar Labeling and Warning Statement Requirements, U.S. Food and Drug Administration.","key":"ref_25"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1037\/0278-6133.15.5.355","article-title":"Validation of susceptibility as a predictor of which adolescents take up smoking in the United States","volume":"15","author":"Pierce","year":"1996","journal-title":"Health Psychol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"272","DOI":"10.1136\/tobaccocontrol-2021-056560","article-title":"\u201dTobacco package health warnings: A global success story","volume":"31","author":"Cunningham","year":"2022","journal-title":"Tob. Control"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.socscimed.2016.06.011","article-title":"The impact of strengthening cigarette pack warnings: Systematic review of longitudinal observational studies","volume":"164","author":"Noar","year":"2016","journal-title":"Soc. Sci. Med."},{"key":"ref_29","first-page":"416","article-title":"Effects of Strengthening Cigarette Pack Warnings on Attention and Message Processing: A Systematic Review","volume":"94","author":"Noar","year":"2016","journal-title":"J. Mass Commun. Q."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1146\/annurev-publhealth-060922-042254","article-title":"Warning Labels as a Public Health Intervention: Effects and Challenges for Tobacco, Cannabis, and Opioid Medications","volume":"45","author":"Popova","year":"2024","journal-title":"Annu. Rev. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"107958","DOI":"10.1016\/j.addbeh.2024.107958","article-title":"Does noticing cigar warnings associate with cigar harm perceptions and smoking behaviors? Analysis from Wave 5 of the population assessment of tobacco and health study","volume":"152","author":"Gratale","year":"2024","journal-title":"Addict. Behav."},{"doi-asserted-by":"crossref","unstructured":"Noar, S.M., Jang, Y., Zarndt, A.N., Zhao, X., Ross, J.C., and Cappella, J.N. (2024). Achieving Public Health Impact: Health Communication Research to Inform Tobacco Regulatory Science. Health Commun., 1\u20138.","key":"ref_32","DOI":"10.1080\/10410236.2024.2326250"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/11\/1442\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T16:24:06Z","timestamp":1760113446000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/11\/1442"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,30]]},"references-count":32,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,11]]}},"alternative-id":["ijerph21111442"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21111442","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2024,10,30]]}}}