Adolescent and Young Adult Perceptions on Cigar Packaging: A Qualitative Study

Abstract

Objective

To identify the appealing components of cigar packaging among youth.

Methods

We conducted 8 focus groups among cigar users, separated by sex and age group (ie, adolescents, young adults) in Connecticut between February and July, 2016. Participants were shown cigar packages and instructed to circle aspects of the images on the packages that appealed to them independently and a group discussion followed.

Results

The appealing components identified were flavors (46.8%), price promotions (28.8%), branding (21.2%), marketing claims (17.2%, eg, “natural”), product features (15.2%, eg, the word “cigarillo”), number of cigars (8.0%), color (4.4%), re-sealable features (2.8%), and other (6.0%; eg “limited offer,” geographic region). Relative to female participants, male participants were more likely to find flavors and price promotions appealing, and less likely to find colors as appealing (ps < .05). Relative to young adults, adolescents were more likely to find price promotions, branding, marketing claims and number of cigars appealing, and less likely to find colors as appealing (ps < .05).

Conclusions

In order to reduce the appeal of cigars to youth, regulatory agencies should consider prohibiting flavors, appealing colors, price promotions, misleading marketing claims, and logos/trademarks on cigar packaging.

INTRODUCTION

Cigars (defined as cigarillos, little cigars, or big cigars) are more toxic than cigarettes and are known to cause cancers of the lung and upper aerodigestive tract (which includes the respiratory tract and the upper part of the digestive tract).¹ Despite these adverse health effects, the sale of cigars has risen drastically.² From 2000 to 2011, cigar consumption increased by 123% while cigarette consumption has continued to decline.² Furthermore, cigars are popular among adolescents and young adults; the majority (72%) of adult cigar users are between 18 and 29 years old,³ and 1.4 million (8.6%) adolescents are past-30-day cigar users.⁴ Lifetime use of cigars is high at 30.5% among high school students and 8.9% among middle school students.⁵

The increased popularity of cigars among youth may be attributed to the widespread availability of cigars in recent years; 80% of tobacco retailors sell cigar products.⁶ Point-of-sale marketing also is effective in attracting youth,^7,8 and a key aspect of point-of-sale marketing is the packaging. Tobacco packages serve as an important vehicle for tobacco manufactures to attract attention from consumers, as well as non-consumers to describe the product and communicate the brand image.⁹ A robust body of literature on cigarette packaging indicates that bright colors, pictures, logos, brand-specific font types and sizes, and unique designs are enticing to youth,^7,10–12 and tobacco companies continue to use tobacco packaging as a primary source of marketing and are constantly developing novel packaging to increase the appeal of their product.^13–15

However, unlike cigarette companies that face restrictions on packaging, cigar marketing and packaging were not regulated until recently. On August 8, 2016, the Food and Drug Administration (FDA) extended their regulatory authority to include cigar products.¹⁶ These measures restrict youth access to cigars by prohibiting the sale of cigars to minors younger than 18 years old, requiring ID checks for individuals younger than 27 years old who try to purchase cigars, banning free samples of cigars, prohibiting the sale of cigars in vending machines unless they are in adult-only facilities, and mandating health warning labels on cigar packages. In addition, the FDA can also regulate the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of cigars and other related components, such as rolling papers and filters. The FDA needs scientific evidence to inform these various areas of regulation. In particular, a central research priority of the FDA’s Center for Tobacco Products is to understand tobacco marketing to youth.¹⁷

Consistent with this research priority, the current study conducted focus groups with adolescents and young adults to examine the appealing components of cigar packaging, which is an area that the FDA can regulate. The attractiveness of cigar packaging may alter an individual’s attitudes and perceptions toward that product, which can then further shape an individual’s behavioral intentions to use that product and subsequent use behaviors.¹⁸ For instance, perceptions of attractiveness of certain cigarette packs predicted interest in trying those cigarettes among adolescents.¹⁹ Thus it is important to understand what components of cigar packaging are appealing to youth. This information can help the FDA set standards and restrictions on cigar packaging to reduce youth appeal.

Certain characteristics, such as flavors, price promotions, a variety of colors, marketing claims, and brand names/logos, have been shown to be appealing. For instance, flavored cigars are more popular among adolescents and young adults relative to older adults.²⁰ Cigars are also available in a variety of flavors, including fruit, candy, and alcohol (eg, wine) and these flavors are marketed heavily on cigar packaging; thus, it is important to understand youth perceptions on flavors on cigar packaging. If youth find the flavors on cigar packaging appealing, then regulations could prohibit flavor marketing on packaging to reduce youth appeal.

In addition to the appealing flavors, low cost is particularly effective in enticing youth to use tobacco products.²¹ Indeed, tobacco company documents reveal that tobacco companies have developed and used various pricing strategies as a key marketing strategy to attract youth.²² Currently, cigars are cheaper than cigarettes because they are taxed at a lower rate.²³ In states with high cigarette tax, a pack of 20 little cigars may cost half as much as a pack of 20 cigarettes.²⁴ However, unlike cigarettes, direct advertisements of price promotions are allowed on cigar packaging. Given the previous finding that youth are 2 to 3 times more responsive to tobacco price change than adults,²¹ youth may find price promotions used on cigar packaging attractive.

Other appealing components of cigar packaging may be the package design, which includes sizes, shapes, and color. The package design can alter perceptions regarding the product, such as lowering harm perceptions through the use of lighter colors on packaging.^12,25 For instance, light colors on cigarette packs are perceived as “healthier.”^9,26,27 Additionally, cigarette packaging has been used to promote perceptions of low health risks through the use of marketing claims, such as “light,” “mild,” and “low tar,”^12,26,28,29 as well as through the use of brand imagery and color.⁹ The colors are also used to attract specific subpopulations, such as women.²⁶

Branding on packaging may be also appealing. Research has shown that adolescents and young adults not only purchase tobacco to satisfy a physiological need for nicotine, but the brand names, images, and logos play an important role in creating a social identity.³⁰ Related research on cigarette products finds that packs are often considered a “badge product” because the brand signifies a social identity.⁹ Furthermore, neuroimaging studies have shown that familiar food brand logos (eg, McDonald’s) activated neural systems of reward among children, indicating that branding has a powerful effect even on children.³¹

In sum, the majority of the existing literature examining the appeal of tobacco packaging has been on cigarette packaging, and research on the appeal of cigar packaging is non-existent to the best of our knowledge. As stated above, with the passage of the deeming rule, the FDA now has the opportunity to regulate cigar packaging and needs information on the appeal of cigar packaging to youth. In this study, we assessed the appeal, among adolescents and young adults, of various aspects of cigar packaging, including flavors (eg, images depicting flavors, flavor names), marketing claims (eg, “natural,”) brand names/logos, color, and product/packaging features. We also examined sex and age group differences in the appeal of cigar packaging.

METHODS

Participants

A total of eight focus groups (N =47 total participants) were conducted among ever users of cigars, separated by sex and age group (ie, 2 male adolescent, 2 female adolescent, 2 male young adult, and 2 female young adult groups) in New Haven County, CT, February–July 2016. We made a concerted effort to recruit a racially/ethnically diverse sample because of the evidence that point-of-sale advertising of cigars is widespread and cigars are more readily available and cheaper in predominantly Black, urban neighborhoods.⁶ Table 1 displays the demographic characteristics of the participants.

Table 1.

Demographic Characteristics of Focus Group Participants

	Adolescents (N = 25)		Young Adults (N = 22)
	Males (N = 16)	Females (N = 9)	Males (N = 11)	Females (N = 11)
Age, M (SD)	16.5 (0.7)	16.1 (1.2)	20.9 (1.5)	20.9 (1.6)
Race/Ethnicity, N (%)
White	8 (50.0%)	3 (33.3%)	4 (36.4%)	7 (63.6%)
Black	6 (37.5%)	5 (55.6%)	5 (45.4%)	5 (45.4%)
Hispanic	5 (31.2%)	4 (44.4%)	3 (27.2%)	1 (14.2%)
Number of cigars smoked per day in the past 30 days, M (SD)	3.2 (7.3)	1.9 (1.7)	1.8 (1.9)	4.3 (1.8)

Note: Participants could select more than one race/ethnicity so total values may exceed 100%.

Procedure

Adolescent cigar users were recruited from two local high schools through flyers sent to homerooms and in-person recruitment sessions during lunch periods. Young adult participants (ages 18–25) were recruited from the community using flyers and Facebook and Craigslist advertisements. Phone screening determined eligibility; participants had to have used a cigar product in their lifetime and had to be willing to participate in a focus group to discuss cigar use behaviors and perceptions.

In high schools, we obtained passive parental consent. Specifically, we sent a parent information letter to all high school participants prior to conducting focus groups to inform them that their child may participate in a focus group study that will ask them to discuss their perceptions about cigars. Parents were instructed to contact the research staff if they did not want their child to participate; no parents objected to their child’s participation. Participants and parents were told that we would not disclose participant’s cigar use status to anyone outside of the research team, including parents and school staff. All participants provided verbal assent (if younger than 18 years old) and consent (if 18 years and older) prior to participating. All participants were informed of the limits of confidentiality and were told that if they had any concerns they should not participate; specifically, we informed them that while we would not be sharing any research data or their cigar use status with their teachers or peers, other focus group members would know that they were a cigar user due to their participation in the focus group, and school staff (for high school students) could also find out that they participated in a focus group about cigar perceptions.

At the end of the focus group, participants completed a short, anonymous survey that included questions on demographics and tobacco use behaviors (eg, number of cigars smoked per day in the past 30 days). Participants were provided with snacks and remunerated with $25 for their participation.

After the focus group, a debriefing session took place to inform participants that our research goal was to better understand cigar use and perceptions in youth, that we did not support the use of tobacco products due to known health risks, and that our research was funded by the NIH and not by the tobacco companies.

This study was part of a larger focus group study designed to understand cigar perceptions and use behaviors among youth to inform the regulation of this product. Focus group discussions lasted about 60 minutes in duration and two moderators led each group and a note taker took active notes. The groups were audio recorded and later transcribed verbatim by an independent professional transcriptionist and secondary transcriptionists reviewed all audio recordings and transcripts and made modifications, if needed.

This paper presents results from the portion of the focus group that addressed the appeal of cigar packaging through the use of photo elicitation method³² and a focus group discussion that followed. First, each participant was shown 5 sets of images, with each set representing different cigar brands. Each set contained 3 images of the same brand. The brands were chosen based on the popular brands used by adolescents as reported in the literature: Black and Mild, Swisher Sweets, Dutch Masters, White Owl, Philies Blunt.^33–35 All sets of cigar packaging had flavors, price promotions, brand names/logos, surgeon general warnings, a variety of colors, and marketing claims. However, there were some differences. For instance, the package shape and the package type differed; some were boxed packages and some were pouches, and some had a translucent cover that showed cigar products through packaging and some had opaque packaging that did not show the product. We selected images with different brands and features of packaging in order to enhance the ecological validity of the images and provide preliminary information on the appeal of different aspects of cigar packaging. See Figure 1 for the sets of packaging images shown. Participants were asked to circle appealing aspects of each image set independently (eg, “Circle the part of the image that you find most attractive.”). Following this exercise, the moderators asked the participants to share the aspects of the packaging that were appealing for each set of images (eg, “What is attractive about the cigar packaging?” “Please share what you circled and why you found that part attractive.”). Not all participants verbally discussed each set of images, but all participants in each group had an opportunity to share.

Figure 1.

Cigar Packaging Images Shown to Focus Group Participants

Data Analysis

All qualitative analyses were conducted on Atlas.ti7 (Version 7.1.8). Our qualitative framework for data analysis involved deductive and inductive approaches in a two-stage process. The deductive approach stemmed from the photo elicitation method that used images of cigar packaging to identify appealing themes. Major themes regarding packaging appeal were derived from the circled images (eg, flavors, color, cost). We then took an inductive approach to identify new themes (and modify existing ones) and derive reasons underlying the appeal of each component or theme from the focus group discussion that followed the photo elicitation method.

Pattern-level analysis identified emergent themes.³⁶ Themes were identified in multiple ways including: 1) declaration of a particular theme, 2) frequency with which a theme was mentioned, 3) omission of certain themes in the discussion, 4) congruence or support for themes, 5) co-occurrence of ideas (two ideas discussed together; e.g., color of packaging elicits thoughts of flavor), and 6) sequence, suggesting a temporal pattern in data. This iterative process was used to create the final codebook.

To identify the appealing themes based on the circled components of cigar packaging images, two independent coders identified the themes of the circled images and any discrepancies were resolved by a discussion with a third reviewer. Then the frequency of circled components (e.g., flavors, brand logo, brand name) of each image was entered in SPSS (Version 21). We conducted descriptive statistics to characterize the frequency of cigar packaging themes that were circled, as well as chi-square tests to examine if these circled images (yes/no) differed by sex (male/female) and age group (adolescents/young adults).

To assess the themes derived from the focus group discussion following the photo elicitation process, a first coder independently coded all the transcripts, categorizing relevant statements in the transcripts under the codebook theme, and then a second coder independently coded half of the transcripts to confirm the coding themes and make amendments as necessary. Any discrepancies in coding between the coders were discussed and amended, and a third independent member of the research team also reviewed these discrepant cases, if needed.

RESULTS

Themes

The appealing components of cigar packaging that emerged from the focus groups were flavors (ie, flavor name [eg, strawberry, pineapple], flavor images), price promotions, branding (ie, logo, name), marketing claims (eg, “natural,” “fresh,” “premium”), product features (ie, image/word for cigarillos, image/word for leaf wrappers), color, package features (eg, re-sealable), and “other” (ie, geographic location, claims of “limited offer,” health warning label).

Results below discusses each appealing component of cigar packaging in the order of the frequency it was circled. See Table 2 for example quotations for each of these themes and Figure 2 for the percentage of times each theme was circled separated by sex and age group.

Table 2.

Qualitative Evidence of Features of Cigar Packaging Appealing to Adolescents and Young Adults

Main themes	Subthemes	Example quotations	Sex/age group
Flavors	Flavor images	“This pineapple. If I see a pineapple I might want to taste a pineapple and that’s enough for me to buy it”	Male young adult
	Flavor words	“The word, strawberry. If I see ‘strawberry’ then I know it’s sweet and that’s what I want.”	Male young adult
	New Flavors	“Huh, um, let’s see. The wine grapes I never heard of that. So like any new flavor I would like to try it.” “I picked the peach one because personally I haven’t seen a peach Dutch yet. So I figured I’d want to try it.”	Male adolescent Female young adult
Price Promotion	Good deal/low cost	“I circled the three for two. That’s a good deal and they’re Dutch Masters.” “Buy two get three that’s always a nice feeling. I could see that.”	Female young adult Male young adult
	High cost	“The regular price of dutches. Two for 99 cents. If I’m paying two for $1.69, you are buggin’”	Male adolescent
Marketing Claims		“I also circled the thing of the Swisher Sweet that says ‘smooth, sweet and satisfying.’ Like that could catch your attention.”	Male young adult
Branding	Brand logo preference	“The owl is pretty dope, to be honest.” [Re: White Owl]	Male adolescent
		“That shield is awesome!” [Re: Swisher Sweets]	Male adolescent
		“Because you have these wise men on the cover. It’s basically promoting that smart people smoke.” [re: images of men on Dutch]	Female young adult
	Brand preference	“I circled the whole page because I love them [Black & Mild]”	Female young adult
	Never heard of the brand	“None of these are the brands that we smoke.”	Male adolescent
Product features	Cigar image/word	“I also just like the design of it [the actual cigar]. Like, kind of like brown. The actual cigarette, like you can see the actual cigarette [cigarette is referring to Black & Mild]”	Female young adult
	Novel cigar feature	“Yeah, this packaging for Black and Mild is what I circled because you don’t see ‘em like that. Black and Mild’s always have the tip and come in a box. Then that actual cigarillos kind of, like I would want to try that.”	Male young adult
	Leaf wrapper image/word	“On the last page, the whole sweet, green, natural leaf wrapper…natural really appeals to me”	Female adolescent
Quantity without mentioning cost		“The fact that you get three”	Male adolescent
Color	Liking	“It gives like, it adds embellishment to the package. Like other ones are boring. I only circled this because of the colors together are pretty but the rest of them are ugly.” “You don’t really want to buy them if they come in a black wrapper. So these brighter colors are more popular at least to me.”	Female adolescent Male young adult
	Disliking	“I think they [colors] look kind of tacky”	Female young adult
	Color cueing flavor	“I did the strawberry because it was pink.”	Female young adult
Other	Package design	“I picked the last one because it looks more classic than the rest of them.”	Female young adult
	Geographic region	“Because the sweet ones are Connecticut grown”	Female young adult
	Package type	“I guess it’s kind of cool because they come in a box.” “A pouch, it’s not a cardboard or uh the paper.”	Female young adult Male young adult
Re-sealable pouch		“Because if you don’t want to use them both you can reseal it and then it stay fresh for later.”	Female young adult

Figure 2. Appealing Cigar Packaging Features by Sex and Age Group (Total Images, N = 250).

Note: More than one response could be selected so the percentages do not add to 100%. Marketing claims on packaging include “guaranteed fresh,” “smooth, “satisfying,” “Soft n’ Fresh,” “premium,” “certified to burn slow,” and “natural.” The “other” category included the overall perception of the design of packaging (eg, “classic”), the package type (eg, “box” “pouch”), the word “Connecticut,” promotional offers, such as “limited offer.”

Flavors

Flavors were most frequently circled as appealing (identified 46.8% of all the images). Of the overarching flavor theme, 83.8% were words that named the flavors and 12% were images that represented the flavors without the word, and 4.2% were both images and words. Relative to female participants, male participants more frequently identified flavors as appealing, Χ² (1, 239) = 6.41, p = .011. The frequency of selecting flavors did not differ between adolescents and young adults. Participants reported that the words describing the flavors (including the word “sweet”) and flavor images caught their attention, increased their curiosity regarding the product, and were a reason to buy the product. Most participants reported that novel flavors piqued their interest in trying the product; however, a few reported disliking some of the flavors presented.

Price Promotion

Price Promotion was the second most frequently circled cigar packaging feature (28.8%). There were two types of price promotions identified: 1) getting a certain number of cigars for a specific price (ie, “two for 99¢”) and 2) implying price promotion without directly mentioning the word “price” or a specific dollar amount (ie, “buy 2 get 3”). Male participants were more likely to circle price promotions on packaging than female participants (Χ² (1, 239) = 4.65, p = .031), and adolescents were more likely than young adults to circle this component (Χ² (1, 239) = 7.34, p = .007). However, adolescents also expressed that some of the prices listed on the example packaging were too high.

Branding

Branding was circled in 21.2% of all images, and this rate did not differ by sex but differed by age group, with more adolescents reporting the appeal of branding than young adults, Χ² (1, 239) = 8.82, p = .003. The brand logos and the brand names were two features on packaging that relayed branding. The perceptions of brand logos (ie, owl from White Owl, Shield from Swisher Sweets, Dutch Masters [images of men]) were positive. The cartoon image of an owl on the White Owl packaging was most commonly identified as attractive (eg, “dope,” “cool,” “cute,”). In terms of the brand names, some selected a specific brand name as an attractive feature of packaging because it was their preferred brand. The overall liking of brand names did not differ across brands. Focus group discussions revealed that many participants were less familiar with the brands presented and reported that they primarily used Games, Backwoods, Black and Milds (assessed in this study), and Entourage. The focus group participants mentioned that these brands are appealing because they were endorsed by hip-hop stars (eg, “Games and Backwood right now is like more popular. Because all the artists that you hear, and all of them talk Backwoods.” male adolescent).

Marketing claims

Marketing claims on packaging, such as “guaranteed fresh,” “smooth, “satisfying,” “Soft n’ Fresh,” “premium,” “certified to burn slow,” and “natural” were circled 17.2% of the time. Participants preferred claims of guaranteed freshness because they disliked stale and dry cigars and “natural” was seen as having low harm. The number of times marketing claims were circled did not differ by sex but adolescents were more likely than young adults to circle this feature, Χ² (1, 239) = 7.08, p = .008.

Product features

Product features include the images and/or words “cigarillos” and “cigars,” as well as the mention of the images and/or words of the leaf wrappers. Product features were circled in 15.2% of all images. There were no sex and age group differences. Some circled the words “cigarillos” on packaging and some circled the actual image of the cigar that could be seen through the translucent packaging. Focus group discussion identified that the ability to see the cigar product through packaging and the novel features of cigars were attractive. For example, one male adolescent participant reported that he is familiar with a Black and Mild with a tip but the image of this brand cigarillo without a tip made him want to try it. Some participants chose the word and the image describing the leaf wrapper.

Quantity

Quantity without mentioning the cost or implying price promotion (eg, “2 cigarillos”) was circled for 8% of the image features. This frequency did not differ by sex but differed by age group; adolescents were more likely than young adults to report the appeal of the number of cigars on packaging, Χ² (1, 239) = 6.23, p = .013.

Other

Other components included aspects of packaging that were too few in numbers to warrant their own categories (6%). There were no differences by sex and age group in the circling of “other” category. Responses in the “other” category included the overall perception of the design of packaging (eg, “classic”), the package type (eg, “box” “pouch”), the word “Connecticut,” and promotional offers, such as “limited offer.” One participant chose the Surgeon General Warning on the packaging.

Color

Color was circled in 4.4% of all images. Female participants (Χ² (1, 239) = 7.32, p = .007) and young adults (Χ² (1, 239) = 5.74, p = .017) were more likely to identify color as an attractive component. Of those who discussed color, most of the remarks related to the appeal of bright colors compared to the dark, “drab” colors that make the product less appealing. Some participants also indicated that certain colors reminded them of a specific flavor (as discussed above), such as pink for strawberry and green for mint. However, a few reported disliking some colors and described them as “tacky.”

Re-sealable package

Re-sealable package was circled in 2.8% of all images, with no differences by sex and age group. Participants reported that the re-sealable package feature was attractive because of its ability to keep cigars fresh (dry and stale cigars were unappealing) and the ability to use the package to hold leftover cigars.

Discussion

To the best of our knowledge, this qualitative focus group study is the first to examine perceptions on cigar packaging among adolescents and young adults who have tried a cigar. Adolescents and young adults identified various aspects of cigar packaging as attractive: flavors, price promotions, brand names/logos, marketing claims, product features (eg, image and word describing cigars, wrapper), number of cigars, package features (eg, re-sealable), and color. Flavors and price promotions were the top two appealing components of cigar packaging.

In terms of flavors, adolescents and young adults found the written description of flavors and the pictorial depiction of flavors (eg, image of fruits, wine) on packaging appealing. The focus group discussion revealed that both familiar and novel flavors were attractive. Flavors were most frequently mentioned as a reason for purchasing the cigar product or evoking interest in purchasing the product. Interestingly, we observed that color of packaging also elicited thoughts about flavors. For example, the pink color elicited interest in using the product because it signified strawberry cigar flavor. This is known as “sensation transference,” in which the sensations derived from the packaging are attributed to the product itself, a common marketing strategy used by the tobacco companies to manipulate sensory perceptions.³⁷ The current findings indicate that words and images that depict flavors, as well as colors associated with flavors on cigar packaging are appealing. These findings are consistent with the literature indicating that flavored tobacco use among adolescents is high; 42.4% of adolescent tobacco users reported using flavored cigars.³⁸ Among cigar using adolescents, the use of flavored tobacco product in the past 30 days was 71.7%.³⁹ Flavors in tobacco are problematic because flavors can mask the natural harshness of the tobacco product; therefore, making them easier to use.²⁰

The second most attractive feature on cigar packaging was price promotions. The majority of participants’ comments referred to the low cost as being attractive, while some adolescents reported disliking some of the prices listed on packaging because they were too high (eg, $1.69) and reported that they would not pay that price to purchase cigars. This suggests that youth like obtaining cigars at a very low cost and increasing the cost might dissuade them from cigar use. We also observed that participants found the number of cigars on packaging without the mention of price as attractive (eg, “2 cigarillos”). Thus, comprehensive cigar regulations should not only address the low cost of cigars but also limit the “deals” that couple quantity with low cost on packaging. Some legislations have already started to set restrictions on price promotion of cigars. For example, Boston implemented a city-wide law in 2012 that set restrictions on cigar packages; cigar packages must have at least 4 cigars unless the retail price meets the following minimum pricing requirements: 1) a single cigar must be higher than $2.50, 2) a package of two must be higher than $5.00, 3) and a package of three must be higher than $7.50.³⁵ The impact of these changes on appeal and use of cigars by youth should be examined.

The third highest attractive feature was branding. It is important to note that many adolescents were less familiar with the brands presented even though these brands were identified as popular cigar brands used by youth in previous studies.^33–35 Our focus group participants reported using other brands, such as Game, Entourage, and Backwoods, which were not included as images in this study. Thus, there is a possibility that different responses could have been obtained had we used alternative brand images. The reasons for the popularity of these brands among adolescents and young adults are unclear, but our focus group participants mentioned that these brands are appealing because they were endorsed by hip-hop stars. Future studies should identify marketing strategies of cigar brands used by youth to better understand the appeal of these brands. Future studies should also assess whether different cigar brands are marketed in different geographic regions and whether the brands that are identified by our focus group participants are popular only in Connecticut or whether they are also popular in other regions. Interestingly, some participants marked “Connecticut” on the wrapper, indicating the preference for locally produced cigars.

Even though the cigar packaging images shown to the participants did not represent the cigar products they used, the participants still identified branding features that appealed to them. For instance, we observed that many adolescents described the logo of White Owl, which is a cartoon image of the owl, as “dope,” “cool,” “cute” and the shield on Swisher Sweets as “awesome.” Although the use of cartoon characters on cigarette advertisement has been banned because of the evidence that this is particularly appealing to youth,^40,41 similar types of cartoon images are being used on cigar packaging and need to be regulated.

The fourth highest attractive feature was marketing claims. Tobacco companies have used words on tobacco packaging to suggest low health risks.²⁸ We observed that cigar packaging used words such as “natural” and “smooth,” which were interpreted to mean “low harm.” Furthermore, our participants were also attracted to marketing claims like “satisfying” and “fresh.” We also observed that adolescents were more likely than young adults to report that they were attracted to manufacturer marketing claims on packaging. This finding is particularly concerning because it suggests that adolescents may be more vulnerable to marketing claims. Indeed, previous focus group findings showed that cigars are viewed as more “natural,” “fresh,” less addictive, and less harmful than cigarettes.^42,43 Many of these positive perceptions correspond to the cigar manufacturer claims on packaging. Future research should identify whether eliminating marketing claims on packaging influences harm perceptions and reduces cigar use among youth.

Another method used by the tobacco industry to communicate low health risk is to use lighter colors on packaging.^26,29 However, our study findings did not allude to this perception. Rather, the participants discussed the preference for brighter colors and dislike of dull colors. The appeal of bright colors was identified as attractive more frequently by adolescents than young adults. Focus group discussion revealed that female participants, relative to male participants, preferred the pink color. This finding is consistent with previous studies that observed that pink coloring on cigarette packaging was especially appealing to women.⁴⁴ As noted above, colors on packaging also cued flavors.

In line with previous studies that identified that cigarette packaging features are important to both adult and adolescent consumers,^12,15,25 we have also identified that a variety of cigar packaging features that appealed to adolescents and young adults. For instance, claims of “limited offer,” novel features of packaging (eg, the ability to see the product through a translucent cover, claims such as “new”), and the re-sealable feature of the package that allowed users to keep remaining cigars fresh were attractive. It is important to note that we provided participants with images of cigar packaging rather than actual cigar packaging. Participants may have different responses if they were able to see and touch the packages. Some appealing components of packages, such as the shape and the size of packages are difficult to evaluate in a printed image. We also asked participants to circle the part of packaging that most appealed to them, so subtler components, such as the color of packaging, may have been underestimated. Given the various appealing components of cigar packaging design, studies should investigate whether plain packaging would lower youth cigar appeal based on the studies on cigarette packaging that showed that plain packaging is viewed least appealing by adolescents.^27,29,45,46

Interestingly, but not surprisingly, only one participant identified the health warning label on packaging as attractive. The finding that almost all participants did not circle or mention health warning labels suggests that other features of the packaging are more attractive to youth. Future studies should identify whether other appealing components of the packaging are detracting youth from paying attention to health warning labels. Identifying more effective methods to communicate health warning labels could improve the current FDA’s mandate to include health warning labels on cigar packaging. Strategies could include increasing the size of the warning label, using graphic health warnings, and standardizing the pack size to affect the prominence of the health warning labels, as studied with cigarette packaging.^29,47,48

In addition to the limitations already listed above, other limitations of the study should be noted. First, participant responses may have been subject to social desirability bias within the focus group setting. This concern is somewhat mitigated by the fact that we instructed participants to circle the appealing components of packaging independently before discussing their responses. However, there is still a possibility that previous discussions in the earlier part of the focus group regarding general cigar perceptions may have influenced participant responses. Second, although the packaging examples presented in each set contained similar components (eg, flavor, price promotion, branding), there were some differences. For instance, not all cigar packaging images were the same type of package (ie, box versus pouch), so we may have underestimated the appeal of certain features. We chose cigar images that were commercially available. While this maximized ecological validity, future studies should pilot test cigar packaging components to strengthen internal validity. Third, the cigar packaging images presented are the most common commercially available cigar products; however, the identification of sweet flavors in this study may have been an overestimate because many of the images we used had flavors on packaging. However, it is important to note that the Nielson data on the overall sales of pipes and cigars in 2015 showed that flavored and sweet cigars represented 41.1% of the overall market share relative to 3.7% non-flavored cigars unflavored cigars,⁴⁹ suggesting that consumers are exposed to more flavored cigar products. Furthermore, a strong body of literature shows that youth are using flavored tobacco products^38,39

In addition, we cannot draw conclusive statements about preference for specific flavor types because we did not assess all available cigar flavors and some flavors were presented more than once (eg, wine). Future studies should examine non-sweet flavors as well as a full range of flavors to draw conclusions about perceptions of flavors on cigar packaging. Fourth, we also did not systematically randomize or counterbalance the presentation of the images. Although it is unlikely that this could have affected the responses because each set contained similar components (eg, flavor, color, cost), future studies should systematically randomize the presentation of order to reduce any potential bias. Fifth, we cannot ascertain whether appeal of the features of cigar packaging is influential of their actual use behaviors. Future experimental studies are needed to better understand this association. Finally, although a strength of this study is examining perceptions of cigar packaging among cigar users in the focus groups, research is needed to assess the appeal of cigar packaging among non-users, particularly among those susceptible to initiation, to inform youth prevention efforts.

Despite these limitations, this study has several strengths. This is the first study to observe that adolescents and young adults who have tried a cigar find various aspects of cigar packaging appealing, with flavors and price promotions being the most frequently identified features. The current methods are strengthened by the use of qualitative focus groups, which allowed for in-depth discussion and elaboration on themes that could not be captured on surveys. The information obtained in this study could be used to inform future experimental and population survey studies. For example, experimental and population survey studies could identify whether limiting the most appealing components of packaging or implementing plain packaging that restricts all appealing components impacts youth cigar perceptions or use.

Although the FDA now has the authority to regulate cigar packaging, cigar packaging remains largely unregulated, with the exception of mandatory health warning labels. Cigar packaging continues to be a marketing tool used by the tobacco companies to draw attention to the product and communicate to potential consumers about their product. We identified various appealing features on the cigar packaging, such as flavors, price promotions, branding, marketing claims, and product features (eg, an image of the product on packaging). However, whether the FDA can impose regulations on all these features is unclear. Implementing regulations on cigarette packaging has been difficult in the USA. Currently, cigarette packages are only required to include a warning label and are prohibited from making modified risk claims,⁵⁰ however, cigarette companies can still use size and color on packaging to relay messages of low harm.^29,48 The FDA is currently in the midst of an ongoing litigation regarding requiring more prominent health warnings on cigarette packaging.⁵¹ Efforts to regulate cigar packages may face similar challenges. However, despite these challenges, mounting evidence indicates that the FDA should eliminate flavors and unsupported marketing claims from cigar packaging.

IMPLICATIONS FOR TOBACCO REGULATION.

As of August, 2016, the FDA can regulate the manufacture, import, packaging, labeling, advertising, promotion, sale, and distribution of cigars. As the FDA considers policies for regulating cigar packaging under its new regulatory authority, research is critically needed to understand cigar packaging features that appeal to youth. Our study findings showed that adolescents and young adults identified many features of cigar packaging as attractive, such as flavors, price promotion, branding, and marketing claims. These qualitative results should be further explored using quantitative data to determine whether causal associations exist in order to inform future cigar packaging regulation.