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Mantey DS, Montgomery L, Chen B, Omega-Njemnobi O, Harrell MB. Blunt smoking during emerging adulthood: Characterizing transitions in cannabis and cigar co-use among a diverse cohort in Texas. Addict Behav 2024; 156:108062. [PMID: 38805771 DOI: 10.1016/j.addbeh.2024.108062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 04/30/2024] [Accepted: 05/11/2024] [Indexed: 05/30/2024]
Abstract
OBJECTIVE To characterize and compare transitions in blunt smoking behaviors among a diverse cohort of youth and young adults observed between Spring 2019 and Fall 2021. METHODS We analyzed n = 14,152 observations (i.e., completed surveys) provided by n = 2,610 youth and young adults over six (6) waves from Spring 2019 to Fall 2021 via the Texas Adolescent Tobacco and Marketing Surveillance (TATAMS) system. Participants were recruited in age-cohorts, reflecting 16.5 years (0.5), 18.5 years (0.6), and 20.1 years (0.8) of age at baseline. We applied a three-state Markov model to estimate blunt initiation (never → ever), onset (never → current), continuation (ever → current), and discontinuation (current → ever). First, we compared transitions in blunt smoking by race/ethnicity, with non-Hispanic (NH) Whites as the referent. Second, we stratified the Markov models by race/ethnicity to identify common and unique predictors of blunt transitions, including sex, age, alcohol use, depression, anxiety, and tobacco cigar smoking. RESULTS At baseline, 73% of participants had never smoked blunts, 15.3% had ever smoked blunts s, and 11.7% currently smoked blunts. NHB (HR: 2.15; 95% CI: 1.21-3.84) and Hispanic (HR: 1.72; 95% CI: 1.08-2.72) participants had significantly greater risk of blunt smoking initiation, relative to NHWs. Similarly, NHBs had great risk for continuation (HR: 1.65; 95% CI: 1.16-2.34) and lower risk of discontinuation (HR: 0.57; 95% CI: 0.42-0.77), relative to NHWs. Alcohol use predicted greater risk for onset among NHW (HR: 5.22; 95% CI: 1.40-19.45), NHB (HR: 3.14; 95% CI: 1.32-7.46), and Hispanic (HR: 2.99; 95% CI: 1.80-4.97) participants. CONCLUSIONS Blunt smoking initiation was most common among NHB and Hispanic youth and young adults while risk for sustained blunt smoking was higher in NHB youth and young adults. Research and interventions should investigate the link between alcohol use and elevated blunt smoking among young people.
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Affiliation(s)
- Dale S Mantey
- UTHealth, University of Texas School of Public Health, Department of Health Promotion and Behavioral Science, USA; UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA; Michael and Susan Dell Center for Healthy Living, USA.
| | - LaTrice Montgomery
- University of Cincinnati College of Medicine, Addiction Sciences Division, Department of Psychiatry & Behavioral Neuroscience, USA
| | - Baojiang Chen
- Michael and Susan Dell Center for Healthy Living, USA; UTHealth, University of Texas School of Public Health, Department of Biostatics and Data Science, USA
| | - Onyinye Omega-Njemnobi
- UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA
| | - Melissa B Harrell
- UTHealth, University of Texas School of Public Health, Department of Epidemiology, Human Genetics & Environmental Sciences, USA; Michael and Susan Dell Center for Healthy Living, USA
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Mays D, Johnson AC, Jeong M, Ganz O, Audrain-McGovern J, Strasser AA, Delnevo CD. Tobacco minimum packaging policy to reduce cigarillo use among young people: results of an experimental study. Tob Control 2024; 33:164-170. [PMID: 35840318 PMCID: PMC9840711 DOI: 10.1136/tc-2022-057304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/06/2022] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The Food and Drug Administration has the authority to set a minimum for cigar pack size, a product feature linked to price. This study examined the effects of cigarillo package size and price on young adults' smoking and purchase intentions. DESIGN Young adults (n=1032) 18-30 years old who smoked cigarillos in the past 12 months completed an online 3×2 within-subjects experiment testing the effects of cigarillo pack size (1, 2, 5) and price (actual price, standardised price per stick) on intentions to purchase and smoke cigarillos. We modelled the main effects and interactions of pack size and price on intentions to buy and smoke cigarillos overall and by cigarillo use frequency. RESULTS Intentions to buy and smoke were strongest for lower priced singles and two packs compared with higher priced five packs. Under standardised price conditions, participants preferred larger packs, but under actual pricing conditions smaller packs, especially two packs, were preferred. Participants who smoked cigarillos less than monthly were more likely to buy and smoke the least expensive products (buy: singles actual price adjusted OR (aOR)=4.51, 95% CI 3.76 to 5.42; two packs actual price aOR=9.76, 95% CI 8.11 to 11.75; five packs standardised price aOR=3.17, 95% CI 2.89 to 3.48) with the strongest preference for two packs and singles. CONCLUSIONS Young adult cigarillo smokers prefer smaller packs in conditions where pricing incentivises smaller packs. Minimum pack size policies may reduce the appeal of cigarillos among young adults, especially less frequent cigarillo smokers. Pack size policy should take into consideration price, and ideally these two factors should be addressed together.
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Affiliation(s)
- Darren Mays
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Deparment of Internal Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Andrea C Johnson
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Michelle Jeong
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew A Strasser
- Department of Psychiatry and Tobacco Center of Regulatory Science, Perelman School of Medicine and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco studies, Rutgers Biomedical Health Sciences, Rutgers University and Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, USA
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Jensen JK, Stoddard GJ, Delnevo CD, Merten JW, Azagba S. Longitudinal analysis of cigar use patterns among US youth and adults, 2013-2019. BMC Public Health 2023; 23:1580. [PMID: 37596633 PMCID: PMC10439534 DOI: 10.1186/s12889-023-16253-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cigars are available in a range of pack quantities, which contrasts regulations requiring cigarettes to be sold in packs of 20 or greater. Smaller packages may be associated with increases in initiation while larger packs may lead consumers to smoke more. The purpose of this study was to inform pack quantity regulations by examining whether usual cigar pack quantity purchased was associated with use, initiation, and discontinuation among youth and adults for four cigar types: premium cigars, large cigars, cigarillos, and filtered cigars. METHODS We analyzed waves 1-5 (2013-2019) of the adult and waves 2-5 (2014-2019) of the youth Population Assessment of Tobacco and Health (PATH) Study. Samples included those responding to the item on pack quantity and providing data at all waves (adults: premium cigars [N = 536], large cigars [N = 1,272], cigarillos [N = 3,504], filtered cigars [N = 1,281]; youth: premium cigars [N = 55], large cigars [N = 217], cigarillos [N = 1514], filtered cigars [N = 266]). Generalized estimating equation models examined the population-averaged effects of pack quantity on cigar use, initiation, and discontinuation. RESULTS Adult pack quantity was positively associated with the days used per month for premium cigars (b: 0.23, 95% CI: 0.11, 0.34), large cigars (b: 0.17, 95% CI: 0.08, 0.25), cigarillos (b: 0.12, 95% CI: 0.003, 0.24), and filtered cigars (b: 0.07, 95% CI: 0.04, 0.10), and positively associated with amount smoked per day for all cigar types. Youth pack quantity was positively associated with days used per month for premium cigars (b: 0.88, 95% CI: 0.33, 1.43), large cigars (b: 0.79, 95% CI: 0.43, 1.15), and cigarillos (b: 0.17, 95% CI: 0.01, 0.34). Adult initiation was associated with pack quantity for filtered cigars (b: -2.22, 95% CI: -4.29, -0.13), as those who initiated purchased smaller pack quantities compared to those who did not initiate that wave. Pack quantity was not associated with discontinuation for adults or youth. CONCLUSIONS Cigar use increased as usual pack quantity purchased increased across cigar types for youth and adults. Small increases in pack quantity (e.g., one additional cigar) are likely to result in consuming less than one additional day per month, though larger increases (e.g., 10 additional cigars per pack) may result in greater use.
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Affiliation(s)
- Jessica King Jensen
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, New Brunswick, NJ, 08901, USA.
- Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, 303 George St, New Brunswick, NJ, 08901, USA.
| | - Gregory J Stoddard
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, New Brunswick, NJ, 08901, USA
| | - Julie W Merten
- Brooks College of Health, University of North Florida, 1 UNF Dr Building 39, Jacksonville, FL, 32224, USA
| | - Sunday Azagba
- Ross and Carol Nese College of Nursing, Penn State University, Nursing Sciences Building, University Park, PA, 16802, USA
- Social Science Research Institute, Penn State University, 114 Building, Henderson Drive, University Park, PA, 16802, USA
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King Jensen JL, Cornacchione Ross J, Rebentisch K, Delnevo CD, Azagba S. Examining Cigar Pack Quantity Purchases by Cigar Type in the United States Between 2014 and 2017. Nicotine Tob Res 2023; 25:S50-S58. [PMID: 37506242 PMCID: PMC10380179 DOI: 10.1093/ntr/ntac285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/16/2022] [Accepted: 02/09/2023] [Indexed: 07/30/2023]
Abstract
INTRODUCTION We examined whether the proportion of cigar pack quantity usually purchased differed between 2014 and 2017 in the United States. METHODS Data are from waves 1 and 4 of the Population Assessment of Tobacco and Health Study. The proportions of pack quantity purchases between waves for premium cigars, large cigars, cigarillos, and filtered cigars for 10-pack quantities (singles, 2-packs, 3-packs, 4-packs, 5-packs, 6-9-packs, 10-packs, 11--19-packs, 20-packs, ≥21 packs) were compared using Z-tests. We used multivariable linear regressions to examine factors associated with pack quantity. RESULTS For premium cigars, most adults purchased singles, with 84.4% in 2014 and 88.7% in 2017. For large cigars, single purchases increased from 46.2% to 62.7% (p < .00001). Two-packs also increased, 3.1% to 10.2% (p < .00001), while 5-packs, 6-9 packs, 10-19-packs, and 20-packs decreased. For cigarillos, singles purchases increased from 51.9% to 57.5% (p = .0002). Two-packs also increased, 8.8% to 19.6% (p < .00001), while 3-packs, 4-packs, 5-packs, and 20-packs decreased. For filtered cigars, the most prevalent pack quantity shifted from 20-packs in 2014 (62.6%) to singles in 2017 (36.7%). Singles, 2-packs, 3-4-packs, and 5-packs increased while 11-19-packs, 20-packs, and ≥21 packs decreased. Days used were positively associated with pack quantity purchase for all cigar types in 2017, while the price was positively associated with premium cigar purchase. CONCLUSIONS Between 2014 and 2017, the proportion of consumers who purchased singles remained at over 80% for premium cigars and increased for other cigars. Continued monitoring of use behaviors, including pack quantities by cigar type, is needed as the market and policy landscapes continue shifting. IMPLICATIONS Single cigar purchases are prominent across cigar types. Five-packs and 20-packs were the second most common pack quantities across cigar types, with relatively low proportions for other pack quantities. These findings suggest adults consuming premium cigars consistently prefer singles, a pattern that was found across cigar types. However, when considering purchases made online, premium cigars are widely purchased in larger pack quantities. Age and race were associated with purchase for some cigar types at some years, days used were associated with the purchase quantity in 2017 for all cigar types, and price was positively associated across time periods for only premium cigar purchases. Thus, the factors associated with cigar pack quantity purchase remain unclear. As the cigar policy landscape shifts, continued monitoring of the purchase behaviors by cigar type will be important to better inform future cigar policies.
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Affiliation(s)
- Jessica L King Jensen
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Jennifer Cornacchione Ross
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, MA 02118
| | - Kayla Rebentisch
- Department of Health and Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
| | - Sunday Azagba
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA, USA
- Consortium for Substance Use and Addiction, Pennsylvania State University, University Park, PA, USA
- Social Science Research Institute, The Pennsylvania State University, University Park, PA, USA
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Jensen JK, Ko H, Kim J, Delnevo CD, Azagba S. The impact of cigar pack size and pricing policies on youth and adult cigar use in the US. Drug Alcohol Depend 2023; 248:109897. [PMID: 37163866 PMCID: PMC10330501 DOI: 10.1016/j.drugalcdep.2023.109897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 04/21/2023] [Accepted: 04/23/2023] [Indexed: 05/12/2023]
Abstract
BACKGROUND Over 250 US localities have adopted cigar pack quantity and price policies. No empirical studies exist on their impact on tobacco use. METHODS A quasi-experimental design was used to assess the impact of cigar policies on cigar and cigarette use among (1) Minnesota youth (n=569,528, triennially 2007-2019); (2) New York youth (n=111,236, annually 2000-2020), (3) New York adults (n=62,295, annually 2003-2019), and (4) District of Columbia (DC) adults (n=5027, annually 2015-2019). We estimated the county-level policy coverage for 15 local policies in Minnesota. Differences-in-differences approach was used to compare the policy in NYC with the rest of the state (no policy). We examined changes in DC use before and after policy implementation. Analyses adjust for sociodemographic characteristics. RESULTS In Minnesota, youth in counties with a greater proportion of the population covered by a policy had lower odds of cigar use (AOR: 0.51; 95% CI: 0.38-0.69). Similarly, adult cigar use in DC declined following policy enactment (AOR: 0.65; 95% CI: 0.46-0.93). Cigarette use also decreased in both Minnesota and DC following policy enactment. However, in New York, the NYC policy did not have a significant impact on cigar use among youth (AOR: 0.95; 95% CI: 0.47-1.93) or adults (AOR: 1.98; 95% CI: 0.85-1.37) in NYC compared to the rest of the state. The only significant effect in NYC was reduced odds for adult cigarette use (AOR: 0.79; 95% CI: 0.68-0.92). CONCLUSIONS Findings suggest regulating cigar packaging could decrease cigar consumption without increasing cigarette consumption, but effects may differ across jurisdictions.
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Affiliation(s)
- Jessica King Jensen
- Rutgers Center for Tobacco Studies, 303 George Street, New Brunswick, NJ08901, USA; Rutgers Robert Wood Johnson School of Medicine Department of Family Medicine and Community Health, 303 George Street, New Brunswick, NJ08901, USA.
| | - Hyunkyu Ko
- Department of Orthopeadics, Orthopaedic Center, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA
| | - Jaewhan Kim
- Department of Physical Therapy & Athletic Training, University of Utah, 520 Wakara Way, Salt Lake City, UT 84108, USA
| | - Cristine D Delnevo
- Ross and Carol Nese College of Nursing, Penn State University, Nursing Sciences Building, University Park, PA16802, USA
| | - Sunday Azagba
- Ross and Carol Nese College of Nursing, Penn State University, Nursing Sciences Building, University Park, PA16802, USA; Social Science Research Institute, Penn State University, 114 Building, Henderson Drive, University Park, PA16802, USA
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Giovenco DP, Spillane TE, Talbot E, Wackowski OA, Audrain-McGovern J, Ganz O, Delnevo CD. Packaging Characteristics of Top-Selling Cigars in the United States, 2018. Nicotine Tob Res 2022; 24:1678-1683. [PMID: 35287167 PMCID: PMC9575977 DOI: 10.1093/ntr/ntac070] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 03/11/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Tobacco product packaging is an influential industry marketing tool, but research on cigar packaging characteristics is limited. This study leveraged a pack archive of the top-selling, mass-market cigar products in the US and their corresponding sales data to assess the prevalence of common pack features in the marketplace. METHODS The 50 cigar products with the highest national unit sales in 2018 were identified using Nielsen's Scantrack data. A content analysis captured common packaging features within four domains: physical, textual, graphical, and promotional elements. Descriptive statistics, weighted by each pack's 2018 unit sales, documented the market share of pack characteristics overall and by brand. RESULTS Products in the sample constituted 62% of all convenience store cigar sales in 2018. Black & Mild, the most popular brand, did not display warning labels on its single stick, cellophane-wrapped products, which constituted nearly all of its sales (96.3%). Resealable foil pouches were the most common packaging style across other brands, and were most often sold in predominantly red, green, or silver packaging. Common flavor categories included concept (eg, "Jazz", 32.4%), fruit (15.7%), and sweet (14.5%). Prepricing (eg, "2 for 99 cents") was a popular promotional strategy, appearing on 74% of all packs sold. CONCLUSIONS Cigar packaging features such as small pack sizes, innovative materials, flavor names, bright colors, and cost-saving promotions are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help reduce appeal and potentially curb cigar use. IMPLICATIONS Sales of mass-market cigars in the US have remained strong over the past decade, propelled by lax product regulations. This study demonstrated that cigar packaging features that may enhance consumer appeal, such as small pack sizes, flavor names, sensory descriptors, bright colors, and cost-saving promotions, are prevalent among the top-selling products. Stronger packaging-focused policies at the federal and local levels may help curb cigar use, reduce youth appeal, and potentially minimize existing disparities in cigar use.
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Affiliation(s)
- Daniel P Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Torra E Spillane
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Eugene Talbot
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ, USA.,Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ, USA
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Simuzingili M, Hoetger C, Garner W, Everhart RS, Hood KB, Nana-Sinkam P, Cobb CO, Barnes AJ. What influences demand for cigars among African American adult cigar smokers? Results from a hypothetical purchase task. Exp Clin Psychopharmacol 2022; 30:479-485. [PMID: 34110888 PMCID: PMC8660958 DOI: 10.1037/pha0000491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
African Americans (AA) have historically been targeted by the tobacco industry and have the highest rates of current cigar use among racial/ethnic groups in the U.S. Yet, there is limited evidence on other factors influencing cigar use. Amongst a sample of 78 AA current cigar (any type) smokers, log-linear regression models examined correlates of cigar demand obtained from a validated behavioral economic purchase task. Mean intensity, or cigar demand when free, was 6.68 cigars (standard deviation [SD]: 8.17), while mean breakpoint, or the highest price a participant was willing to pay, was $4.62 (SD: 3.88). Mean maximum daily expenditure, Omax was $15.20 (SD: 25.73) and Pmax, the price at Omax was $5.25 (SD: 3.95). Participants aged 21 to 30 years compared to those aged 18 to 20 years, those with higher levels of dependence, and females compared to males, had a significantly higher intensity. Participants with cannabis use above the sample median in the last 30 days (4 + days) had significantly higher intensity and Omax than those below the median. Further, participants with a high school education or more had a significantly lower intensity, breakpoint, and Omax than those with less than high school education. Individuals with income below the federal poverty line (FPL) also had a significantly lower breakpoint and Omax than those above. Finally, tobacco harm perceptions were inversely associated with Pmax. Stricter policies on cigar products, such as higher taxes and product-specific harm messaging, may have an immediate and sustained impact on health disparities related to cigar use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Psychology, Virginia Commonwealth University
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas
| | | | | | | | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Psychology, Virginia Commonwealth University
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University
- Center for the Study of Tobacco Products, Virginia Commonwealth University
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King Jensen JL, Delnevo CD, Merten JW, Torton B, Azagba S. A synthesis of local cigar pack policies in the US. Prev Med Rep 2022; 28:101865. [PMID: 35774854 PMCID: PMC9237935 DOI: 10.1016/j.pmedr.2022.101865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/14/2022] [Accepted: 06/22/2022] [Indexed: 11/26/2022] Open
Abstract
Communities have adopted cigar pack policies to eliminate inexpensive, small packs from being sold and reduce youth use. Still, it is unclear how widespread these policies are and whether they differ based on specific policy components. This study identified and measured local cigar pack size and price policies in the US. We used a systematic 14-step process to identify, obtain, and code local cigar pack policies, including pack size and pricing. Between January and July 2021, we identified 299 local cigar pack policies in the US. Policies were (1) identified through municipal code review and requests to state tobacco control representatives, (2) obtained online or from municipality representatives, and (3) double-coded for minimum pack size, minimum price, adopted/effective/enforcement dates, cigar definitions, differences in pack size/price by cigar type, price adjustments, whether the price is before discounts, policy exclusions, and enforcement. We identified 259 municipalities with cigar pack policies, 40 of which amended the pack size or price requirements after initial adoption, resulting in 299 policies. Policies specified eight different pack size requirements ranging from 2 to 25; most prevalent were minimums of 2 (n = 116, 39.2%) and 4 (n = 67, 22.6%). Minimum prices ranged from $0.35 to $10.00 per cigar. Exclusions included cigars priced above a specified amount (n = 225, 76.0%; $2.01-$10.00) and cigars sold at adult-only or tobacco retailers (n = 45, 15.2%). This is the first comprehensive synthesis of cigar pack size and price policies within the US. Policies vary widely both between and within states.
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Affiliation(s)
- Jessica L King Jensen
- Department of Health & Kinesiology, University of Utah, Salt Lake City, UT 84112, USA
- Corresponding author at: 250 S 1850 E, Rm 255, Salt Lake City UT 84112, USA.
| | - Cristine D Delnevo
- Rutgers Center for Tobacco Studies, Rutgers University, New Brunswick, NJ 08901, USA
| | - Julie W Merten
- Brooks College of Health, University of North Florida, Jacksonville, FL 32224, USA
| | - Brooke Torton
- Legal Resource Center for Public Health Policy, University of Maryland Francis King Carey School of Law, Baltimore, MD 21201, USA
| | - Sunday Azagba
- Penn State Ross and Carol Nese College of Nursing, University Park, PA 16802, USA
- Penn State Social Science Research Institute, University Park, PA 16802, USA
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Azagba S, King JL, Shan L. Characteristics differ based on usual cigar-type use among U.S. adults: Analysis from the tobacco use supplement to the current population survey. Prev Med Rep 2022; 24:101560. [PMID: 34976627 PMCID: PMC8683945 DOI: 10.1016/j.pmedr.2021.101560] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/08/2021] [Accepted: 09/12/2021] [Indexed: 12/15/2022] Open
Abstract
Significant demographic heterogeneity was found based on usual cigar type. Males were more likely to use all types of cigars relative to non-use. Males were less likely to use cigarillos and filtered cigars relative to large cigars. Black adults had greater odds for using all types of cigars relative to non-use. Education, income, and other tobacco use also varied according to cigar type.
The tobacco products landscape is continually shifting, and there are concerns about the increased popularity of non-cigarette tobacco products, including cigars. This study examines characteristics associated with usual cigar-type use. Data are from the 2018–19 Tobacco Use Supplement to the Current Population Survey. Multinomial logistic regression was used to assess the association between sociodemographic characteristics and cigar-type use (i.e., large cigars, cigarillos, and little filtered cigars). Analyses also examined factors relative to large cigar use and further stratified by sex. Of 137,221 adults included in the study, 1467 used large cigars most often, 513 used cigarillos most often, 446 used little filtered cigars most often, and the remaining 134,795 did not use cigars. In adjusted models, males had greater odds for using all types of cigars relative to non-use. In contrast, males were less likely to use cigarillos (AOR 0.28, 95% CI 0.20–0.41) and filtered cigars (AOR 0.20, 95% CI 0.14–0.28) relative to large cigars. Black adults had greater odds of using all types of cigars relative to non-use, and cigarillos (AOR 3.55, 95% CI 2.47–5.08) and filtered cigars (AOR 2.50, 95% CI 1.70–3.68) relative to large cigars. Education, income, and other tobacco use also varied according to cigar type. Characteristics of those who usually use large cigars differed significantly from those who usually use cigarillos, little filtered cigars, or reported no cigar use.
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Affiliation(s)
- Sunday Azagba
- Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA 16802, USA
- Corresponding author at: Ross and Carol Nese College of Nursing, The Pennsylvania State University, University Park, PA 16802, USA.
| | - Jessica L. King
- Department of Health & Kinesiology, University of Utah, Salt Lake City, UT, USA
| | - Lingpeng Shan
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA
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King JL, Bilic A, Merten JW. Reasons for Pack Size Purchase among US Adults Who Purchase Cigars. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157790. [PMID: 34360081 PMCID: PMC8345579 DOI: 10.3390/ijerph18157790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
With municipalities across the US establishing minimum cigar pack size regulations, it is critical to understand what drives pack size preference. The purpose of this exploratory study was to identify reasons for cigar pack size purchase. We used Amazon’s Mechanical Turk to survey adults who had purchased cigars and reported past 30 day use. Participants responded to an open-ended item asking their reasons for purchasing their usual pack size. Responses were double-coded and categorized. Of 152 respondents, 61 used traditional cigars, 85 used cigarillos, and 36 used filtered cigars. Across all cigar types, most participants (73.7%) purchased boxes rather than singles; 5–9-packs were the most popular pack size category (19.7%), followed by 20+-packs (18.4%). We identified 16 reasons for pack size purchase across seven categories: price, consumption, social aspect, convenience, product characteristics, availability, and general preferences. Reasons varied according to whether the consumer purchased larger or smaller pack sizes. In this exploratory study to identify reasons for cigar pack size purchases, findings were consistent with those identified through tobacco industry documents and in the cigarette literature. Future research should examine the prevalence of these reasons, including as a function of demographic and use characteristics, to help inform the understanding of potential minimum cigar pack regulations.
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Affiliation(s)
- Jessica L. King
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, UT 84112, USA;
- Correspondence:
| | - Anna Bilic
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, UT 84112, USA;
| | - Julie W. Merten
- Department of Public Health, Brooks College of Health, University of North Florida, 1 S UNF Dr Building 39, Jacksonville, FL 32224, USA;
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Associations between Black and Mild Cigar Pack Size and Demographics and Tobacco Use Behaviors among US Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126628. [PMID: 34202992 PMCID: PMC8296399 DOI: 10.3390/ijerph18126628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/04/2021] [Accepted: 06/10/2021] [Indexed: 11/17/2022]
Abstract
Pack size is an important pricing strategy for the tobacco industry, but there is limited data on how users differ based on preferred pack size for cigar products. Using data from Wave 4 of the Population Assessment of Tobacco and Health Study, this study identified differences in adult cigar user characteristics based on pack size purchasing behavior among users of a top cigar brand, Black and Mild. Weighted chi-square tests were used to examine the associations between Black and Mild pack size and sociodemographic, cigar and other substance use characteristics. Overall, our study found that users of Black and Mild cigars differ by demographic, cigar and other tobacco use characteristics based on preferred pack size, with smaller packs appealing to younger, female, less-experienced and less-established smokers, and larger packs appealing to older, male, more experienced, and more dependent cigar smokers. Dual use of cigarettes and cigars was also higher among users of smaller packs. While this study is cross-sectional, findings suggest that minimum packaging laws for cigars may impact younger adults who are purchasing smaller pack sizes and likely experimenting with new cigar products and styles.
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Azagba S, King J, Shan L. Associations between e-cigarette pack size and vaping frequency among U.S. adults. Prev Med 2021; 143:106332. [PMID: 33221268 PMCID: PMC8054984 DOI: 10.1016/j.ypmed.2020.106332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 02/02/2023]
Abstract
Little research exists on the association between e-cigarette pack quantity and use. We examined whether using e-cigarettes every day or somedays was associated with purchasing e-cigarettes by the box/pack or as singles. Data are from the 2018-2019 Tobacco Use Supplement to the Current Population Survey, analyzed in 2020. The sample included adults who reported current e-cigarette use (N=2,413). We conducted multivariable logistic regression models to examine the association between purchasing e-cigarettes by the box/pack or as singles and using e-cigarettes every day or somedays. Models controlled for demographic characteristics, flavored e-cigarette use, and other tobacco use, and were stratified by sex and device type. Of the 2,413 respondents, 63.1% reported purchasing e-cigarettes as singles, while 36.9% reported buying by the box or pack. Among those who purchased by the box and singles, approximately 56% and 50% used e-cigarettes every day, respectively. Those who reported purchasing by the box/pack had greater odds of every day e-cigarette use compared to some day use (Adjusted Odds Ratio: 1.36, 95% CI: 1.09, 1.68). This finding held for both males, females, and all device types. These findings present a first step in determining the relationship between e-cigarette pack size and use behavior.
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Affiliation(s)
- Sunday Azagba
- Department of Family and Preventive Medicine, University of Utah School of Medicine, United States.
| | - Jessica King
- Department of Health & Kinesiology, University of Utah, United States
| | - Lingpeng Shan
- Department of Family and Preventive Medicine, University of Utah School of Medicine, United States
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Association between purchasing behaviors and cigar use: A longitudinal analysis of Waves 1-3 of the Population Assessment of Tobacco and Health (PATH) Study. PLoS One 2020; 15:e0235496. [PMID: 32598379 PMCID: PMC7323953 DOI: 10.1371/journal.pone.0235496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Over 120 US jurisdictions have implemented policies mandating minimum cigar pack quantities, yet little empirical research exists on the relationship between pack quantity and use. We examined whether cigar use was associated with purchasing cigars by the box/pack or as singles, purchase quantity, and price paid per cigar. Methods Data are from Waves 1–3 (2013–2016) of the Population Assessment of Tobacco and Health (PATH) Study, analyzed in 2019. The sample included adults who reported current use of any type of cigars (cigarillos [N = 3,051], traditional cigars [N = 2,586], and filtered cigars [N = 1,295], including with marijuana) at Wave 1. For each cigar type, a generalized estimating equation model was used to examine the population-averaged effects of purchasing behavior on cigar use. Results Cigar users of each type who purchased by the box or pack smoked more per day than users who purchased singles (cigarillos: β = 1.02, p<0.0001; traditional cigars: β = 1.40, p<0.0001; filtered cigars: β = 2.55, p<0.01). Cigar users who purchased larger quantities smoked more per day (cigarillos: β = 0.16, p<0.0001; traditional cigars: β = 0.04, p<0.0001; filtered cigars: β = 0.24, p<0.0001). Higher price per cigar was significantly associated with smoking fewer traditional cigars (β = -0.12, p<0.01) and filtered cigars (β = -0.86, p = 0.02), but not cigarillos (β = 0.08, p = 0.62). Conclusions Smaller pack quantities and higher price per cigar were associated with smoking fewer cigars per day. Given the authority of the Food and Drug Administration and local jurisdictions over cigar pack quantity, this study provides data pertinent to potential minimum and maximum package quantity regulations and policies.
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