Are Some of the Cigar Warnings Mandated in the U.S. More Believable Than Others?

Background: Text warnings are mandated on cigars sold in the United States (U.S.), however little published research has examined effectiveness of cigar warnings. This is the first study examining the believability of cigar warnings among adults in the U.S. Methods: Adults in the U.S. (n = 5014) were randomized in a phone survey to receive one of three cigar-specific mandated warning messages ("Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale", "Cigar smoking can cause lung cancer and heart disease", and "Cigars are not a safe alternative to cigarettes") with one of four warning sources (no source, Surgeon General, CDC (Centers for Disease Control and Prevention), FDA (Food and Drug Administration)). Results: Most adults found the cigar warnings very believable (66.9%). Weighted logistic regression results indicate that the message "Cigar smoking can cause lung cancer and heart disease" was associated with higher odds of being very believable (AOR: 2.05, 95% CI: 1.55, 2.70) and the message "Cigars are not a safe alternative to cigarettes" was associated with lower odds of being very believable (AOR: 0.71, 95% CI: 0.55, 0.92) compared to the message "Cigar smoking can cause cancers of the mouth and throat, even if you do not inhale". Warning source had no impact on believability. Conclusions: We tested three of the currently mandated cigar warnings in the U.S. and found significant differences in believability between them. Further research on cigar warnings may improve communication to the public on cigar health risks, ultimately preventing uptake of cigars and promoting cessation among cigar users.