Young adults’ cigarillo risk perceptions, attention to warning labels and perceptions of proposed pictorial warnings: a focus group study

OBJECTIVE: Although cigars pose similar health risks to cigarettes, they are not uniformly required to carry a warning label on their packaging in the USA. The US Food and Drug Administration’s 2016 deeming rule established a cigar warning requirement, but it was challenged in federal court for failing to document warning effects on prevention/cessation, thus necessitating an evidentiary base for such requirements. We sought to explore young adult users’ understanding of cigarillo risks and addictiveness, as well as their perceptions of current (voluntary) and proposed cigar warning labels. DESIGN: In December 2020–January 2021, we conducted eight focus groups with young adult cigarillo smokers. We asked participants their first associations of cigarillos and beliefs about product harms/addictiveness, and then discussed existing warning labels and examples of potential pictorial warnings. SETTING: Focus groups were conducted remotely via the Adobe Connect platform, with participants from 20 US states. PARTICIPANTS: Participants included 42 young adults (ages 18–29; 50% male), who were recent cigarillo users (ie, past 30 days) or less frequent users (ie, past 12 months). RESULTS: Participants frequently used cigarillos as blunts and often conveyed uncertainty about cigarillo risks and addictiveness, in general and relative to cigarettes. Participants typically paid little attention to current text warnings, but many expressed that pictorial warnings would more effectively promote knowledge of product risks and discourage use among prospective users. CONCLUSIONS: US young adult cigarillo users may lack knowledge about product risks and addictiveness. Standardised warning requirements, particularly pictorial labels, may help address this knowledge gap and deter use.