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Cohn AM, Chen S. Age groups differences in the prevalence and popularity of individual tobacco product use in young adult and adult marijuana and tobacco co-users and tobacco-only users: Findings from Wave 4 of the population assessment of tobacco and health study. Drug Alcohol Depend 2022; 233:109278. [PMID: 35151023 PMCID: PMC9028208 DOI: 10.1016/j.drugalcdep.2022.109278] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 11/29/2021] [Accepted: 12/09/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Tobacco use is high among marijuana and tobacco users, compared to tobacco-only users. This study examined the relative ranking (based on prevalence) of past 30-day tobacco product use separately across young adult and older adult past 30-day marijuana and tobacco co-users and tobacco-only users. METHOD Prevalence and relative ranking of past 30-day use of eight different tobacco products and blunts were examined in young adult (ages 18-24) and adults (ages 25 +) tobacco users who did and did not report past 30-day marijuana use (unweighted n = 33,644) from Wave 4 of the Population Assessment of Tobacco and Health study. Multiple logistic regressions examined increased odds of using each product in the past 30-days by marijuana and tobacco co-use. RESULTS Nearly half (47.9%) of past 30-day young adult tobacco users reported past 30-day marijuana use (e.g., co-use); 27.7% of adult tobacco users reported past 30-day co-use. Cigarettes were the most popular product used in the past 30-days across tobacco-only and co-users of both age groups. Rankings of all other tobacco products differed between the age groups. Among young adult co-users, blunts were ranked the second most popular product used in the past 30-days, followed by e-cigarettes, and then cigarillos/filtered cigars. Among adult co-users, blunts were ranked the fourth most popular product used in the past 30-days. Adult co-users reported significantly higher prevalence of past 30-day use of all combustible products compared to tobacco only users. CONCLUSIONS Co-users may be at increased risk of health consequences given high rates of combustible tobacco use.
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Affiliation(s)
- Amy M Cohn
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, 1200 Children's Avenue, Suite 14000, Oklahoma City, OK 73104, USA; TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK, 73104, USA.
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 800 N.E. 13th Street, Oklahoma City, OK 73104, USA.
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Cohn AM, Johnson AL, Fryer CS, Villanti AC. Marijuana use predicts onset of current little cigar use in a national sample of US young adults. Drug Alcohol Depend 2018; 190:235-241. [PMID: 30064060 DOI: 10.1016/j.drugalcdep.2018.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 01/23/2018] [Accepted: 01/23/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND This study examined whether young adult marijuana use increases risk of subsequent large cigar (LC) and little cigar/cigarillo (LCC) use among naïve users. METHODS Data were from 8 waves of the Truth Initiative Young Adult Cohort, a national sample of US young adults aged 18-34 assessed every 6 months. Discrete-time survival analyses examined whether baseline ever marijuana use among never cigar users predicted onset of past 30-day LC and LCC use and whether baseline ever LC and LCC use among never marijuana users predicted onset of past 30-day marijuana use. Models adjusted for demographics, past 30-day alcohol use, past 30-day tobacco product use, and menthol tobacco use. RESULTS In adjusted models, baseline ever marijuana use predicted onset of past 30-day LCC but not LC use. Cumulative risk ratios showed that 23% of ever marijuana users at baseline reported past 30-day use of LCCs by the end of wave 8 compared to just 3% of baseline never marijuana users. Race and past 30-day use of specific tobacco products also predicted onset of past 30-day LC and LCC use. Past 30-day use of alcohol uniquely predicted onset of past 30-day LCC use but not LC use. Baseline ever LC and LCC use did not predict onset of past 30-day marijuana use in models that adjusted for demographics, alcohol, and specific tobacco product use. CONCLUSIONS Ever marijuana use among US young adults may be an important predictor of onset of regular LCC use. Findings suggest different pathways linking marijuana to different cigar sub-types.
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Affiliation(s)
- Amy M Cohn
- Battelle Memorial Institute, 2111 Wilson Blvd #1000, Arlington, VA, USA; Department of Oncology, Georgetown University Medical Center, 3800 Reservoir Rd. NW, Washington DC, 20057, USA.
| | - Amanda L Johnson
- Schroeder Institute, Truth Initiative, 900 G St. NW, Washington DC, 20001, USA
| | - Craig S Fryer
- Department of Behavioral and Community Health, University of Maryland School of Public Health, 4200 Valley Dr. #2242, College Park, MD, 20742, USA
| | - Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, 1 S Prospect St., MS 482, Burlington, VT, 05401, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School, of Public Health, 624 N Broadway, Baltimore, MD, 21205, USA
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Antognoli E, Koopman Gonzalez S, Trapl E, Cavallo D, Lavanty B, Lim R, Flocke S. Cigarettes, Little Cigars, and Cigarillos: Initiation, Motivation, and Decision-Making. Nicotine Tob Res 2018; 20:S5-S11. [PMID: 30125020 PMCID: PMC6093420 DOI: 10.1093/ntr/nty099] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 05/14/2018] [Indexed: 01/06/2023]
Abstract
Introduction Cigarettes and little cigars and cigarillos (LCCs) are the most prevalent dual-use tobacco combination; one-third of cigarette smokers use LCCs. Risk factors for multiple tobacco product use have been reported; however, there is little understanding of why some individuals transition to and maintain multiple product use. In this study, we examine narratives of tobacco product initiation and decision-making among LCC-only and LCC-cigarette smokers. Methods We audio-recorded in-depth interviews with 60 individuals, aged 14-28, who reported smoking more than or equal to 1 cigarillo per week; half also smoked cigarettes. Transcribed interviews were coded using a phenomenological approach to examine themes about smoking initiation, motivation, and product decision-making. Results Among dual users, 60% began smoking LCCs before or at the same time as cigarettes, and 40% began smoking cigarettes first. Reasons for smoking cigarettes in addition to LCCs included easier access when experiencing craving and less time to smoke the product. Cigarette smokers reported first smoking LCCs in social contexts when sharing LCCs with other smokers, or when they could afford a single LCC but not a pack of cigarettes. LCC-only smokers reported not smoking cigarettes because of their expense, unpleasant taste and/or smell, and fear of becoming addicted. Conclusions In this sample of current LCC users, half also used cigarettes. Product initiation order was almost evenly split, but reasons for initiating the second product differed, with immediacy of reducing cravings as a key reason for LCC users to smoke a cigarette and social and financial reasons for cigarette users to smoke an LCC. Implications Understanding how and why dual use is initiated and sustained can inform policies to help prevent increased nicotine dependence and initiation of additional tobacco products. This study demonstrates that the beliefs, perceptions, and practices of LCC-only and dual users inform their product selection. Our findings point to the need to apply the strategies that have been effective at decreasing cigarette consumption to LCCs.
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Affiliation(s)
- Elizabeth Antognoli
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH
| | - Sarah Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland, OH
| | - Brittany Lavanty
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH
| | - Rock Lim
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH
| | - Susan Flocke
- Center for Community Health Integration, Case Western Reserve University, Cleveland, OH
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
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Sterling KL, Majeed BA, Nyman A, Eriksen M. Risk Perceptions of Little Cigar and Cigarillo Smoking Among Adult Current Cigarette Smokers. Nicotine Tob Res 2017; 19:1351-1358. [PMID: 27659275 DOI: 10.1093/ntr/ntw244] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/21/2016] [Indexed: 11/15/2022]
Abstract
Introduction Few studies have examined the perceptions of risk of little cigar and cigarillo (LCC) smoking among cigarette smokers, which is important for expanding regulatory policies and developing prevention programs. We examined current cigarette smokers' perceived harm of LCC smoking, and determined whether these perceptions were associated with susceptibility and intention to continue smoking LCCs. Methods Data were from the 2014 Tobacco Products and Risk Perceptions Survey of a probability sample of 5717 US adults. Data were analyzed for a subsample of 1191 current cigarette smokers who were stratified into three groups: (1) dual current cigarette smokers who had ever used LCCs, (2) current smokers susceptible to LCC smoking, and (3) current smokers who were not susceptible to LCC smoking. Results Overall, 47.2% of participants were dual smokers, 12.7% were susceptible to LCC smoking, and 40.1% were not susceptible. Perceptions of risk of LCCs varied across the groups. Dual smokers were more likely to perceive that daily LCC smoking is "very risky" (OR = 1.64, 95% CI = 1.08, 2.41) while occasional LCC smoking is only "somewhat risky" (OR = 1.71, 95% CI = 1.02, 2.87). Of the dual smokers, 20.7% intended to continue smoking LCCs in the future. Perceptions of addiction and risk of daily LCC smoking significantly predicted intention to continue LCC smoking. Addiction perceptions also significantly predicted susceptibility to initiate LCC smoking. Conclusions Perceptions about harms from and addiction to LCCs could predict future LCC smoking. Health communication campaigns need to address the harms of LCCs. Implications Our data suggest that perceptions of risk about the addictiveness of LCCs and frequency of use are important determinants of the LCC smoking susceptibility among some cigarette smokers and intended continued use among cigarette smokers with a history of LCC use. Health communication campaigns should address misperceptions related to LCCs.
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Affiliation(s)
- Kymberle L Sterling
- School of Public Health, Georgia State University, Atlanta, GA.,Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Ban A Majeed
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Amy Nyman
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
| | - Michael Eriksen
- Tobacco Center of Regulatory Science (TCORS), School of Public Health, Georgia State University, Atlanta, GA
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Andreotti G, Freedman ND, Silverman DT, Lerro CC, Koutros S, Hartge P, Alavanja MC, Sandler DP, Freeman LB. Tobacco Use and Cancer Risk in the Agricultural Health Study. Cancer Epidemiol Biomarkers Prev 2016; 26:769-778. [PMID: 28035020 DOI: 10.1158/1055-9965.epi-16-0748] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/14/2016] [Accepted: 12/19/2016] [Indexed: 01/28/2023] Open
Abstract
Background: Cigarettes are well known to cause cancer, but less is known about the risks of other tobacco products and use of more than one product.Methods: We examined cancer incidence in relation to exclusive use of six tobacco products [cigarettes, other combustibles (pipe, cigar, cigarillo), and smokeless tobacco (chewing tobacco, snuff)] in the Agricultural Health Study. We also examined the added cancer risks associated with use of cigarettes and other tobacco products.Results: In our study population of 84,015, ever use of smokeless tobacco was higher than the general United States population, whereas cigarette use was lower and other combustible product use was about the same. The strongest associations for exclusive ever use were for lung cancer [cigarettes HR = 15.48; 95% confidence interval (CI), 11.95-20.06; other combustible tobacco HR = 3.44; 95% CI, 1.53-7.71; smokeless tobacco HR = 2.21; 95% CI, 1.11-4.42]. Compared with exclusive cigarette smokers, cigarette smokers who additionally ever-used another combustible product had higher risks of smoking-related cancers (HR = 1.16; 95% CI, 1.04-1.30), especially among those who smoked cigarettes for more than 15 years.Conclusions and Impact: Cigarette smokers who additionally ever used smokeless tobacco had cancer risks similar to exclusive cigarette smokers. Users of cigarettes and other combustible tobacco may have higher risks of certain cancers than exclusive cigarette users. Cancer Epidemiol Biomarkers Prev; 26(5); 769-78. ©2016 AACR.
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Affiliation(s)
- Gabriella Andreotti
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland.
| | - Neal D Freedman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
| | - Debra T Silverman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
| | - Catherine C Lerro
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
| | - Stella Koutros
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
| | - Patricia Hartge
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
| | - Michael C Alavanja
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Department of Health and Human Services, Research Triangle Park, North Carolina
| | - Laura Beane Freeman
- Division of Cancer Epidemiology and Genetics, Department of Health and Human Services, NCI, NIH, Bethesda, Maryland
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Dela Cruz CS, Tanoue LT, Matthay RA. Lung cancer: epidemiology, etiology, and prevention. Clin Chest Med 2011. [PMID: 22054876 DOI: 10.1016/j.ccm.2011.09.001.lung] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Lung cancer is the leading cause of cancer death in the United States and around the world. A vast majority of lung cancer deaths are attributable to cigarette smoking, and curbing the rates of cigarette smoking is imperative. Understanding the epidemiology and causal factors of lung cancer can provide additional foundation for disease prevention. This article focuses on modifiable risk factors, including tobacco smoking, occupational carcinogens, diet, and ionizing radiation. It also discusses briefly the molecular and genetic aspects of lung carcinogenesis.
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Affiliation(s)
- Charles S Dela Cruz
- Pulmonary and Critical Care Medicine Section, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S441-C, New Haven, CT 06519, USA.
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Abstract
Lung cancer is the leading cause of cancer death in the United States and around the world. A vast majority of lung cancer deaths are attributable to cigarette smoking, and curbing the rates of cigarette smoking is imperative. Understanding the epidemiology and causal factors of lung cancer can provide additional foundation for disease prevention. This article focuses on modifiable risk factors, including tobacco smoking, occupational carcinogens, diet, and ionizing radiation. It also discusses briefly the molecular and genetic aspects of lung carcinogenesis.
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Affiliation(s)
- Charles S Dela Cruz
- Pulmonary and Critical Care Medicine Section, Department of Internal Medicine, Yale University School of Medicine, 300 Cedar Street, TAC S441-C, New Haven, CT 06519, USA.
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Strasser AA, Orom H, Tang KZ, Dumont RL, Cappella JN, Kozlowski LT. Graphic-enhanced information improves perceived risks of cigar smoking. Addict Behav 2011; 36:865-9. [PMID: 21481542 PMCID: PMC3094503 DOI: 10.1016/j.addbeh.2011.03.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/15/2011] [Accepted: 03/21/2011] [Indexed: 11/29/2022]
Abstract
The Internet is a major source of health information and several notable health web sites contain information on the risks associated with cigar smoking. Previous research indicates that Internet pages containing health information on cigars have high reading levels and are restricted to text material, which can decrease understanding. We examined the effects of existing text-only (from the United States National Cancer Institute website) versus novel graphic-enhanced information on smokers' perceptions of health risks associated with cigar smoking. The study was a laboratory-based single session of current cigarette smokers (n=102) who viewed cigar smoking risk information on a computer monitor then completed cigar risk questionnaire items. Participants were randomized to view either text-only or graphic-enhanced cigar information. The graphic version contained additional risk information about cigarillos and little cigars. Text-only participants were more likely to underestimate perceived health risks associated with cigar smoking compared to graphic-enhanced participants (47.1% versus 17.7%, p=.001); and, graphic-enhanced participants were more likely to report that they would share the cigar health risk information with friends compared to those viewing text-only, 47.0% versus 27.4%, p=.005. Employing graphics to convey health risks associated with cigar smoking increases understanding and likeliness to share information. Integrating information about little cigar and cigarillo risk in conjunction with large cigar risk information is an effective public health strategy to provide more comprehensive risk information. Utilizing graphics on health information internet pages can increase knowledge and perceived risks of cigar smoking.
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Affiliation(s)
- Andrew A Strasser
- Center for Interdisciplinary Research on Nicotine Addiction, University of Pennsylvania, 3535 Market Street, Philadelphia, PA 19104, USA.
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