Dissonance in Young Adult Cigarillo Users' Categorization of Concept Flavored and Unflavored Products

Electronic Nicotine Delivery Devices Function as a Complement for Cigarillos in Sexual and Gender Minority Young Adult Women

INTRODUCTION

Cigarillos are the second most used tobacco product among younger populations. The highest prevalence of the use of cigars is among sexual and gender minority (SGM) women. Policy interventions like flavor bans and the availability of alternative tobacco products may have a disparate effect.

AIMS AND METHODS

The current study utilized an online store analog, The experimental tobacco marketplace, to investigate the effects of cigarillo and electronic nicotine delivery devices (ENDS) flavor bans on tobacco product purchasing. SGM (n = 72) and cisgender heterosexual (CisHet; n = 46) women viewed conditions in which cigarillo flavors were available or unavailable and ENDS flavors available or unavailable and the interaction between the two. Mixed models were conducted on each dependent variable with condition, price, and SGM identity as predictors and nicotine dependence, annual income, and race/ethnicity as covariates. Simple linear regressions were performed to determine the substitution profile for each tobacco product. Condition showed no effect.

RESULTS

We found a main effect of price on cigarillo purchasing and a main effect of SGM identity in which SGM women purchased more ENDS than CisHet women. A complementary association between cigarillos and ENDS in which ENDS purchasing decreased as cigarillo purchasing decreased was found. This association was irrespective of flavor ban conditions and among SGM women only.

CONCLUSIONS

These results suggest that flavor availability of cigarillos and ENDS may not influence women who use cigarillos to move to another tobacco product and that women SGM cigarillo users are not likely to substitute their cigarillo smoking behavior with ENDS.

IMPLICATIONS

The results of this study suggest that SGM women are not likely to quit using cigarillos if flavors are removed from the market and instead will use unflavored products. Substituting their cigarillo use with ENDS does not appear likely given the complementary relation found between cigarillos and ENDS. The substitution patterns found for cigarettes and ENDS are not found for cigarillos and ENDS among young adult women who use cigarillos, further demonstrating the need for research on the conditions in which people who use cigarillos will decrease consumption or switch to a potentially less harmful product.

Visual attention and recall of flavored cigarillo package elements among young adults: A randomized control trial

INTRODUCTION

Flavoring in cigarillos contributes to greater product initiation and abuse liability particularly among young adults. Few studies have examined how packaging elements, including flavor, may draw visual attention from potential consumers as well as impact product recall. This study aimed to test the difference in visual attention to flavor names and other packaging elements on cigarillo products as well as recall of these packaging elements.

MATERIALS AND METHODS

Young adults aged 16-28 years were recruited to participate in a randomized control trial (Clinictrials.org ID: NCT04358705) in June through December 2022 (N = 89). Participants were randomized to two conditions viewing 12 flavored or unflavored cigarillo package images. Eye tracking software captured participants viewing (dwell) time on package features: flavor, brand, health warning, price, and other package imagery. Participants were asked about their recall of the images viewed. The proportion of dwell time on each package elements were used to examine differences between experimental conditions.

RESULTS

Across conditions, participants spent the greatest proportion of dwell time looking at the health warning. Participants in the flavored condition spent a significantly greater proportion of dwell time looking at flavor name (mean: 10.66%; SD: 3.56) compared to those in the unflavored condition (mean:7.03%; SD 2.81). Following the experiment, 45.8% of those in the flavored condition recalled having seen flavors or flavor names, which was greater than recall of all other elements and was significantly greater than flavor recall in the unflavored condition (12.2%).

CONCLUSIONS

Flavored cigarillos attract greater visual attention and were the most memorable element of cigarillo packaging among young adults sampled. Changes to cigarillo packaging, including limiting flavor descriptors, imagery, and/or color on packaging and advertisements may be an effective way to reduce young adults' attention to the products and thus their appeal.

Flavored Tobacco Product Use Among California Adolescents Before and Immediately After a Statewide Flavor Ban

INTRODUCTION

In December 2022, a California law banned the retail sale of most flavored tobacco products (including e-cigarettes). This investigation evaluates adolescents' use of flavored tobacco before and after enactment.

METHODS

The Teens Nicotine and Tobacco Project included online surveys of California adolescents (age 12-17) in 2022 (N=5127) and 2023 (N=5015) that assessed past 30-day use of various tobacco products, flavored product use, and perceived access to flavored e-cigarettes. Eight focus groups conducted in 2023 and 2024 (total N=35) queried flavored tobacco experiences and perceptions.

RESULTS

Among participants who used specific products, the prevalence of flavored product use declined for cigarettes (2022: 72.0%; 2023: 57.2%), cigars (2022: 87.2%; 2023: 67.4%), and smokeless tobacco (2022: 93.1%; 2023: 83.1%) but not for e-cigarettes (2022: 91.0%; 2023: 90.7%) or hookah (2022: 88.1%; 2023: 85.6%; the flavor law exempted some hookah sales). In 2023, 10.2% of all participants used any flavored tobacco product (2022: 10.0%), primarily flavored e-cigarettes (2022: 8.6%; 2023: 8.8%). In 2023, 22.0% of all participants were aware of the statewide flavor ban, including 44.1% of participants who reported tobacco use. Few focus group participants were aware of the statewide law or perceived difficulties accessing flavored e-cigarettes.

CONCLUSIONS

Shortly following a statewide flavor ban, adolescent use of flavored cigarettes, cigars, and smokeless tobacco declined, but flavored e-cigarette use was unchanged. More time for implementation and enforcement may be needed to see full policy impact.

IMPLICATIONS

These finds suggest that a statewide flavored tobacco policy in California was followed shortly by declines in adolescent use of some flavored tobacco products. Additional time for implementation and enforcement, along with potential further actions, such as greater restrictions on online sales, could be necessary to curb youth access to flavored e-cigarettes.

What Is (Un)Flavored? A Scoping Review of the Conceptualization of Flavored Cigarillos

INTRODUCTION

To identify how flavor is conceptualized with respect to cigarillos to illuminate areas of concordance and discordance and provide a pathway for the harmonization of tobacco flavor measurement.

AIMS AND METHODS

Three methods were used to identify research measuring flavors respective to cigarillo products including: (1) querying research databases using key words "cigarillo," "tobacco" and "flavor"/'flavour,' (2) sub-sampling of the eligible literature with backward and forward reference searching, and (3) a bibliographic search of key experts. Two reviewers independently screened titles, abstracts, and full texts. Inclusion criteria required manuscripts to be available in English, published prior to 3/1/2022, be original and peer-reviewed, and include a measure of flavor pertaining to cigarillo products. A total of 163 manuscripts met these criteria and were subsequently evaluated.

RESULTS

Cigarillo flavor determinations were made based on the presence of flavoring agents, sensory characteristics, marketing or package characteristics, pre-defined lists, the absence of any of these, and/or were undefined. Individual flavors and their related classifications were not altogether mutually exclusive due to differences in conceptualization which has evolved over time.

CONCLUSIONS

Flavor measures continue to evolve, likely in response to both tobacco control policies and industry shifts. There is a lack of standardization in flavor conceptualization that can be ameliorated through intentional integration of multiple forms of research such as identifying patterns of flavoring agents and/or marketing strategies that elicit a specific flavor profile. By doing this, we may more comprehensively evaluate the impact of flavors, their constituents, and related marketing strategies on broader population health.

IMPLICATIONS

There are discrepancies in the conceptualization of flavor in tobacco and nicotine products. The lack of standardized, definitive language limits our ability to comprehensively evaluate the population-level health impact of flavors in addition to our ability to effectively inform, implement, and enforce policies restricting flavors in tobacco and nicotine products.

Flavour loyalty may predict cessation or substitution following a cigarillo flavour ban among young adults in the USA

SIGNIFICANCE

The purpose of this research was to measure flavour loyalty and identify how current cigarillo users may respond to a hypothetical flavour ban in the USA.

METHODS

Cigarillo users aged 21-28 (n=531) were recruited between October 2020 and April 2021 to participate in an online survey. Respondents categorised their preferred, usual and current cigarillo flavours. Individuals who preferred tobacco flavours were compared with individuals who preferred any other flavours. Strength of preferences, or flavour loyalty, was defined when an individual's preferred flavour matched what they use both usually and currently creating a spectrum of individuals with a strong tobacco preference (n=34), weak tobacco preference (n=20), weak flavour preference (n=162) and strong flavour preference (n=315). Those preferring tobacco were aggregated into any tobacco preference (n=54).

RESULTS

Individuals who preferred any flavour scored higher on a scale of nicotine dependence. There was a dose-response relationship in those who said they would discontinue cigarillos if flavoured options were not available: 11.4% of individuals with any tobacco flavour preference, 27.8% of those with a weak flavour preference and 38.1% of those with a strong flavour preference. A similar trend was noted among those who would switch to another product: 19.2% of those with tobacco flavour preference, 34.3% of those with a weak flavour preference and 43.2% of those with a strong flavour preference.

CONCLUSION

Individuals who display strong flavour preferences were more likely to say they would discontinue use or seek out alternative flavoured products following a ban on flavoured cigarillos.