Eight graphic health warnings2 were shown to premium cigar and cigarillo / little cigar smokers. Relevance and credibility of health messages for both premium cigar and cigarillo / little cigar smokers is influenced by whether or not they directly inhale the cigar smoke. Premium cigar smokers, in particular, have a great deal of difficulty in accepting messages about health consequences which are based on the smoke being inhaled. As they do not perceive that smoke enters the lungs, it is not seen to be absorbed into the body as much and therefore to result in the same health consequences as tobacco smoke that is inhaled.

Three of the health warnings were perceived as relevant, credible and understandable for both premium cigar and cigarillo / little cigar smokers. All elements of the three messages, including warning message, image and explanatory message (copy), are credible and relevant in their current format and do not need to be refined further prior to use. These are:

  • ‘throat cancer’;
  • ‘mouth cancer’; and
  • ‘damage to teeth and gums’.

Graphic health messages for ‘Throat cancer,’ ‘Mouth cancer’ and ‘Damages, teeth and gums’

C. Cigar smoking causes throat cancer
Image C: Image of effects of throat cancer.

E. Cigar smoking causes mouth cancer
Image E: Image of effects of mouth cancer.

G. Cigar smoking damages your teeth and gums
Image G: Image of effects of cigar smoking on teeth and gums.
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These messages were all seen as comparatively relevant and credible to premium cigar smokers as the smoke from cigars touches the mouth, gums and teeth when it is held in the mouth and tasted. While some rejected throat cancer, as they don’t inhale, the image was seen as somewhat typical of the age of a cigar smoker, and therefore a possibility. Further, the throat was seen as in reasonable proximity to the mouth where cigar smoke is held and tasted, therefore the possibility of the throat being affected was accepted overall.

Two further messages may be effective for use with cigarillo / little cigar smokers, although may require some refinement. These were:
  • ‘heart disease’ – with refinement to copy required if there was a need to use on premium cigar packaging; and
  • ‘not a safe alternative’ - with revised image and copy.

Graphic health messages for ‘Heart Disease’ and ‘Not a safe alternative’

Cigar smoking increases your risk of heart disease
Image: Image of healty heart beside damaged heart.

B. Cigar smoking is not a safe alternative
Image B: Image of foot with toe tag.

Premium cigar smokers are less likely to find these messages relevant, although they will accept these as credible. Most premium cigar smokers were relatively educated about various causes of heart disease, through having greater general awareness of lifestyle related diseases due to their age or being from higher socio-economic groups. They were reluctant to accept that their smoking behaviour could increase their risk of heart disease more than other activities that they were likely to engage in, for example, eating a rich diet or drinking alcohol. This perception was increased by the fact that they were likely to engage in premium cigar smoking relatively infrequently compared to these other activities. The message had greater credibility and relevance with cigarillo / little cigar smokers, particularly those that also smoked cigarettes. Familiarity with the messages from cigarette packs created a sense of acceptance that the potential consequences must be the same for other tobacco products.

The ‘Not a safe alternative’ health warning was particularly relevant to many cigarillo / little cigar smokers, as the perception that cigarillo / little smoking is a safer alternative than cigarettes is their primary motivation for smoking that particular product. It was relevant and credible to infrequent premium cigar smokers but not relevant or credible to the more frequent premium cigar smokers, with premium cigars their only choice of tobacco product, not an alternative.

This warning message could be strengthened by use of an alternative image as the relationship between the image of a dead person and headline was not immediately apparent. An image that more immediately represents danger, such as a skull and cross bones may be more effective. Changes to the copy of this message would improve its relevance. Phrases such as ’the risk just gets higher if you inhale’ and ‘even if you don’t inhale’ minimise relevance rather than increase it. A more effective means of making the warning relevant to both those who do inhale and those who don’t would be to state ‘if you inhale or not’.
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Graphic health messages for ‘Lung cancer’ and ‘Don’t let others breathe cigar smoke’

Image H: Image of man breathing through tube.Image D: Image of healthy lung beside unhealth lung.
Image F: Image of child with breathing apparatus.
If necessary, and following revisions to both copy and image, ‘lung cancer’ could be used on cigarillo / little cigar packs. It is unlikely that this message will be credible for premium cigar smokers, in particular the more frequent or connoisseur smokers. This is because they do not feel they inhale any of the cigar smoke. However, it would benefit those cigarillo and little cigar smokers who do consciously inhale. In order to maximise credibility some significant changes would be necessary to the image to prompt a more emotional reaction among smokers. Changes to the copy, such as those mentioned for ‘not a safe alternative’ above, would be necessary to minimise self–exclusion when discussing inhaling across all audiences.

‘Don’t let others breathe cigar smoke’ is not recommended as one of the health warnings that could be used. It does provoke a strong emotional response, and smokers find the idea of their smoking affecting other people’s health uncomfortable. However, they do not find the message relevant for themselves. Many did not have children and those that did claim they do not smoke around their or other people’s children. As such the message was rationalised away as irrelevant for themselves.

2 Some images may be the subject of copyright. Many have been kindly provided by overseas governments, non-government organisations, medical practitioners and individuals. Where required, acknowledgements for particular images may be found at Appendix C.
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