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Ntansah CA, Hackworth EE, Henderson KC, Reynolds RM, Yang B, Ashley DL, Duong HT, Thrasher JF, Popova L. Reactions to Messages About a Nicotine Reduction Policy: A Focus Group Study Among People Who Use Little Cigars and Cigarillos. Nicotine Tob Res 2024; 26:87-93. [PMID: 37596965 PMCID: PMC10734388 DOI: 10.1093/ntr/ntad155] [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: 04/06/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/21/2023]
Abstract
INTRODUCTION The U.S. Food and Drug Administration (FDA) has proposed rulemaking to reduce the nicotine content in cigarettes and other combusted tobacco products to non-addictive levels. This qualitative study documents reactions to messages communicating this policy among people who use little cigars and cigarillos (LCCs). AIMS AND METHODS We conducted eight focus groups with participants from four populations with the highest prevalence of cigar use (African American males and females, white males and females). Participants described their reactions to eight messages about the policy: Three messages about the equal risk of LCCs with regular and low nicotine levels; three quit efficacy messages about low nicotine LCCs being easier to quit; one "compensation" message to correct misperceptions about the policy causing people to smoke more to get desired nicotine; and one message about using alternative nicotine sources (eg, e-cigarettes). RESULTS Participants perceived risk messages as the most motivating to quit, whereas efficacy messages made some participants feel that the policy would cause former users of LCCs to relapse. Many participants expressed favorable responses to the compensation message. The message about using alternative nicotine sources sparked intense responses, with many participants expressing outrage and mistrust of the message. Participants' beliefs that they were not addicted to LCCs dampened their perceptions of the effectiveness of the policy. CONCLUSIONS Perceptions of the addictiveness and relative harms of LCCS influenced responses to policy messages. The FDA should consider using different messages to communicate with people who use LCCs because they perceive LCCs as different from cigarettes. IMPLICATIONS This is the first study to document affective and cognitive responses to the FDA's reduced nicotine policy among people who use LCCs. The false belief that cigar products are less harmful than cigarettes may be influencing people's lack of support for the reduced nicotine policy and difficulty in understanding its potential positive impact. To maximize the public health benefit of the reduced nicotine policy, the FDA should include LCC products in the policy; however, it is crucial that they use educational messaging to clarify misperceptions regarding nicotine and harm as it applies to LCCs.
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Affiliation(s)
- Charity A Ntansah
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Emily E Hackworth
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | | | - Reed M Reynolds
- Communication Department, University of Massachusetts, Boston, MA, USA
| | - Bo Yang
- Department of Communication, University of Arizona, Tucson, AZ, USA
| | - David L Ashley
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Hue Trong Duong
- Department of Communication, Georgia State University, Atlanta, GA, USA
| | - James F Thrasher
- Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, USA
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Vargees C, Stroup AM, Niznik T, Dunn D, Wyatt R, Hoetger C, Taleb ZB, Cohn AM, Cobb CO, Fetterman JL. Patterns of use, perceptions, and cardiopulmonary health risks of cigar products: a systematic review. BMC Public Health 2023; 23:2357. [PMID: 38017396 PMCID: PMC10685631 DOI: 10.1186/s12889-023-17216-z] [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: 08/16/2022] [Accepted: 11/13/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.
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Affiliation(s)
- Comreen Vargees
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, USA
| | | | - Taylor Niznik
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Delaney Dunn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Riley Wyatt
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
- Institute for Integrative Health Care and Health Promotion (IGVF), Witten/Herdecke University, Alfred-Herrhausen-Straße 50, Witten, 58455, Germany
| | - Ziyad Ben Taleb
- Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, USA
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, 806 W Franklin St, Richmond, VA, 23284, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, 100 W Franklin St, Richmond, VA, 23220, USA
| | - Jessica L Fetterman
- Evans Department of Medicine and Whitaker Cardiovascular Institute, Boston University School of Medicine, 600 Albany Street, Boston, MA, 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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Gratale SK, Jeong M, Sidhu A, Safi Z, Strasser AA, Delnevo CD, Wackowski OA. Young adults' cigarillo risk perceptions, attention to warning labels and perceptions of proposed pictorial warnings: a focus group study. BMJ Open 2022; 12:e061064. [PMID: 35768091 PMCID: PMC9240892 DOI: 10.1136/bmjopen-2022-061064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE Although cigars pose similar health risks to cigarettes, they are not uniformly required to carry a warning label on their packaging in the USA. The US Food and Drug Administration's 2016 deeming rule established a cigar warning requirement, but it was challenged in federal court for failing to document warning effects on prevention/cessation, thus necessitating an evidentiary base for such requirements. We sought to explore young adult users' understanding of cigarillo risks and addictiveness, as well as their perceptions of current (voluntary) and proposed cigar warning labels. DESIGN In December 2020-January 2021, we conducted eight focus groups with young adult cigarillo smokers. We asked participants their first associations of cigarillos and beliefs about product harms/addictiveness, and then discussed existing warning labels and examples of potential pictorial warnings. SETTING Focus groups were conducted remotely via the Adobe Connect platform, with participants from 20 US states. PARTICIPANTS Participants included 42 young adults (ages 18-29; 50% male), who were recent cigarillo users (ie, past 30 days) or less frequent users (ie, past 12 months). RESULTS Participants frequently used cigarillos as blunts and often conveyed uncertainty about cigarillo risks and addictiveness, in general and relative to cigarettes. Participants typically paid little attention to current text warnings, but many expressed that pictorial warnings would more effectively promote knowledge of product risks and discourage use among prospective users. CONCLUSIONS US young adult cigarillo users may lack knowledge about product risks and addictiveness. Standardised warning requirements, particularly pictorial labels, may help address this knowledge gap and deter use.
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Affiliation(s)
- Stefanie K Gratale
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Michelle Jeong
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Anupreet Sidhu
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Zeinab Safi
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Andrew A Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers University, New Brunswick, New Jersey, USA
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Flocke SA, Ishler K, Albert E, Cavallo D, Lim R, Trapl E. Measuring nicotine dependence among adolescent and young adult cigarillo users. Nicotine Tob Res 2022; 24:1789-1797. [PMID: 35512368 PMCID: PMC9596997 DOI: 10.1093/ntr/ntac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users. METHODS Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14 to 28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning (DIF) and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption. RESULTS Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the IRT fit criteria. Two PROMIS items had non-ignorable DIF. The pool of 40 items had good score reliability for a range of 2 standard deviations. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p<.001; R 2 = 0.33. CONCLUSIONS This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users. IMPLICATIONS This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.
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Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland OR, USA
| | - Karen Ishler
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland OH,USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland OH, USA
| | - Rock Lim
- Case Western Reserve University, Center for Community Health Integration, Cleveland OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland OH, USA
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Hallett A, Chen SP. Perceptions and Attitudes of University and College Students Towards Cannabis Use. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00777-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Cornacchione Ross J, Reboussin DM, Noar SM, Wiseman KD, Sutfin EL. What Do Adolescents and Young Adults Think a Cigarillo Is? Implications for Health Communication. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3311. [PMID: 33806872 PMCID: PMC8004959 DOI: 10.3390/ijerph18063311] [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: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term "cigarillo" in such efforts. The study goal was to assess adolescent and young adult perceptions of the term "cigarillo". We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13-25). We asked participants "what is a cigarillo?" with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question "what is a cigarillo" was "I don't know" (51% of participants), followed by "a thinner and smaller version of a traditional cigar" (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was "I don't know" (54.9%) followed by "a thinner and smaller version of a traditional cigar" (45.1%). Cigarillo users were more likely to select the "a thinner and smaller version of a traditional cigar" response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term "cigarillo". Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC 27157, USA;
| | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
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Glover-Kudon R, Gammon DG, Rogers T, Coats EM, Loomis B, Johnson L, Welton M, Lavinghouze R. Cigarette and cigar sales in Hawaii before and after implementation of a Tobacco 21 Law. Tob Control 2021; 30:98-102. [PMID: 31932332 DOI: 10.1136/tobaccocontrol-2019-055248] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION On 1 January 2016, Hawaii raised the minimum legal age for tobacco access from 18 to 21 years ('Tobacco 21 (T21)') statewide, with no special population exemptions. We assessed the impact of Hawaii's T21 policy on sales of cigarettes and large cigars/cigarillos in civilian food stores, including menthol/flavoured product sales share. METHODS Cigarette and large cigar/cigarillo sales and menthol/flavoured sales share were assessed in Hawaii, California (implemented T21 in June 2016 with a military exemption), and the US mainland using the only Nielsen data consistently available for each geographical area. Approximate monthly sales data from large-scale food stores with sales greater than US$2 million/year covered June 2012 to February 2017. Segmented regression analyses estimated changes in sales from prepolicy to postpolicy implementation periods. RESULTS Following T21 in Hawaii, average monthly cigarette unit sales dropped significantly (-4.4%, p<0.01) coupled with a significant decrease in menthol market share (-0.8, p<0.01). This combination of effects was not observed in comparison areas. Unit sales of large cigars/cigarillos decreased significantly in each region following T21 implementation. T21 policies in Hawaii and California showed no association with flavoured/menthol cigar sales share, but there was a significant increase in flavoured/menthol cigar sales share in the USA (7.1%, p<0.01) relative to Hawaii's implementation date, suggesting T21 may have attenuated an otherwise upward trend. CONCLUSIONS As part of a comprehensive approach to prevent or delay tobacco use initiation, T21 laws may help to reduce sales of cigarette and large cigar products most preferred by US youth and young adults.
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Affiliation(s)
- Rebecca Glover-Kudon
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Doris G Gammon
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Todd Rogers
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Ellen M Coats
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Brett Loomis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Lila Johnson
- Tobacco Prevention and Education Program, Hawaii State Department of Health, Honolulu, Hawaii, USA
| | - MaryBeth Welton
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - René Lavinghouze
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ishler KJ, Flocke SA, Albert EL, Trapl E, Gunzler D. Cigarillo and multiple tobacco product use and nicotine dependence in adolescents and young adults. Addict Behav 2020; 111:106537. [PMID: 32795846 DOI: 10.1016/j.addbeh.2020.106537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/09/2020] [Accepted: 06/30/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Multiple tobacco product (MTP) use is a growing public health concern, particularly among adolescents and young adults. This study identifies subgroups of MTP use among cigarillo users and examines associations with nicotine dependence (ND). METHODS 1089 youth (ages 14-28) who currently smoke cigarillos completed a web-based survey regarding their current use of cigarillos, little cigars, traditional cigars, cigarettes, e-cigarettes, and waterpipe/hookah. Latent class analysis (LCA) was used to identify patterns of product use by type and amount. The LCA also assessed the relationship between the latent classes and a 38-item measure of ND, controlling for relevant demographics. RESULTS Most participants (88.2%) reported using two or more tobacco products in the past 30 days. The best-fitting LCA solution revealed 7 classes: (1) Mixed-Light tipped cigarillo and light cigarette users, 28.9%; (2) Light tipped cigarillo users, 15.8%; (3) Light untipped cigarillo users, 14.3%; (4) Heavy tipped cigarillo users, 13.4%; (5) E-cigarette and waterpipe users, 11.9%; (6) Heavy users of tipped and untipped cigarillos and light users of cigarettes, 9.8%; and (7) Dabblers who primarily used traditional cigars, but were also likely to use a variety of other products, 6.1%. Classes comprised of those using multiple products-particularly those that included cigarettes-had significantly higher levels of ND than other classes (Tukey's HSD P < .05). CONCLUSIONS Distinct patterns of MTP use are evident among young cigarillo smokers. Smoking multiple products, particularly smoking cigarillos in combination with cigarettes, is associated with higher ND compared to other product use patterns.
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Audrain-McGovern J, Rodriguez D, Alexander E, Pianin S, Sterling KL. Association Between Adolescent Blunt Use and the Uptake of Cigars. JAMA Netw Open 2019; 2:e1917001. [PMID: 31808925 PMCID: PMC6902767 DOI: 10.1001/jamanetworkopen.2019.17001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Almost two-thirds of adolescents who smoke blunts also report using cigars. Although adolescent co-use of blunts and cigars is prevalent, whether adolescent blunt use is associated with progression to current cigar use (past 30-day use) and increased frequency of use is unknown. OBJECTIVE To determine whether adolescent use of blunts is associated with progression to cigar use (past 30-day use) and increased number of days used (in the past 30 days) across the subsequent 24 months compared with adolescents who have never used blunts. DESIGN, SETTING, AND PARTICIPANTS In this prospective cohort study of adolescents from 4 public high schools outside of Philadelphia, Pennsylvania, in-classroom surveys were administered at baseline (fall 2016, beginning of 9th grade) and at 6-month intervals for the following 24 months (fall 2018, beginning of 11th grade). Data analyses were conducted in September and October 2019. EXPOSURES Self-report of lifetime (ever) blunt use at baseline (age 14 years). MAIN OUTCOMES AND MEASURES Progression to current cigar use (use in the past 30 days) and escalation in the frequency of use (number of days used in the past 30 days) across the subsequent 24 months. RESULTS Of 1825 participants, 907 (49.7%) were female, 1330 (72.9%) were white, and 376 (20.6%) were Hispanic; the mean (SD) age at baseline was 14.38 (0.55) years. In all, 257 participants (14.0%) reported ever blunt use. Mixed-effects models revealed that ever blunt use at baseline vs never blunt use was associated with progression to current cigar use (past 30 days use: odds ratio, 22.66; 95% CI, 11.34-45.27) but not escalation in the number of days used across the following 24 months (β = 0.13; 95% CI, -0.17 to 0.43). CONCLUSIONS AND RELEVANCE These findings highlight the risk that blunt use may pose for subsequent cigar use among adolescents. Policies and public health campaigns addressing marijuana as well as cigars will be important to reduce adolescent blunt use and cigar use.
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Affiliation(s)
- Janet Audrain-McGovern
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Daniel Rodriguez
- School of Nursing and Health Sciences, LaSalle University, Philadelphia, Pennsylvania
| | - Emily Alexander
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Stephen Pianin
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia
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Lim R, Ishler K, Trapl E, Flocke S. "Phantom smokers": Young cigarillo users who do not identify as smokers. Drug Alcohol Depend 2019; 204:107551. [PMID: 31541873 PMCID: PMC6949010 DOI: 10.1016/j.drugalcdep.2019.107551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 05/10/2019] [Accepted: 07/13/2019] [Indexed: 01/14/2023]
Abstract
INTRODUCTION Many young consumers of non-cigarette tobacco products, such as cigarillos, do not identify as smokers. These "phantom smokers" tend to underestimate risks to health and feel little urgency to quit. This study examines the prevalence and characteristics of phantom smoker status among young cigarillo users. METHODS An online survey was conducted among 14-28 year olds who smoke at least 2 cigarillos per week. Phantom smoker status was determined by a negative response to "Do you consider yourself a smoker?" Other variables included smoking frequency, group smoking and sharing, and confidence in ability to quit. Associations between smoker identity and these variables were tested using chi square, independent samples t-tests and multivariable logistic regression. RESULTS Of 1089 respondents, 242 (22%) were identified as phantom smokers. Phantoms smoked half as many cigarillos per week as identified smokers (M = 4.75, SD = 5.11 vs. M = 11.33, SD = 0.88, p < .001) and phantoms were more likely to smoke only when sharing (39.7% vs 21.8%, p < .001). While 59.5% of identified smokers also smoked cigarettes, only 33.5% of phantoms did so (p < .001). Most phantom smokers (83.8%) were unconcerned about addiction. Phantoms also expressed greater confidence in their ability to quit (M = 4.40, SD = 0.98) than did identified smokers (M = 3.72, SD = 1.25, p < .001). CONCLUSIONS Despite regular cigarillo use, over 20% of respondents did not identify as smokers. Cigarillo smoking, along with non-daily and shared use, should be routinely assessed among youth. Phantom smokers' lack of concern about addiction and high confidence in their ability to quit may render conventional messages about smoking risk ineffective.
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Affiliation(s)
- Rock Lim
- Center for Community Health Integration, Case Western Reserve University, Suite 402, 11000 Cedar Ave., Cleveland, OH, 44106-7136, USA.
| | - Karen Ishler
- Center for Community Health Integration, Case Western Reserve University, Suite 402, 11000 Cedar Ave., Cleveland, OH, 44106-7136, USA; Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106-7164, USA.
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, 10900 Euclid Ave., Cleveland, OH, 44106-7069, USA.
| | - Susan Flocke
- Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
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Kong G, Creamer MR, Simon P, Cavallo DA, Ross JC, Hinds JT, Fishbein H, Gutierrez K. Systematic review of cigars, cigarillos, and little cigars among adolescents: Setting research agenda to inform tobacco control policy. Addict Behav 2019; 96:192-197. [PMID: 31125939 PMCID: PMC6645397 DOI: 10.1016/j.addbeh.2019.04.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 04/01/2019] [Accepted: 04/28/2019] [Indexed: 01/06/2023]
Abstract
INTRODUCTION We conducted a systematic review of the literature on cigar research on youth to identify potential future research agenda to generate evidence to inform cigar regulations to prevent cigar use among youth. METHODS We searched articles on Medline, EMBASE, and PsycINFO in April 2017 to identify articles relevant to cigars and adolescents. Two independent coders examined 48 articles to determine eligibility: (1) published between 2000-April 2017; (2) published in English; (3) conducted in the United States; (4) published in a peer-review journal; (5) examined cigars, cigarillos, or little cigars; (6) included youth (12-18 years old); and (7) included empirical data. Three independent coders reviewed the included articles (n = 48) to identify whether the studies addressed FDA's Research Priorities. RESULTS The studies addressed FDA's Research Priorities of "behavior" (n = 48), "communications" (n = 4), "marketing influences" (n = 1), and "impact analysis" (n = 1). Studies on "behavior" underscored the need for improvements in measurement, such as using brand names and distinguishing cigar products. The review revealed the need for restrictions on cigar flavors, development of media campaigns and interventions, increasing the cost (via taxation), and evaluating the impact of cigar policies. CONCLUSIONS The studies mostly focused on surveillance of behaviors and use patterns, which revealed cigar specific issues to address in policies to decrease cigar use among youth. The lack of studies addressing other FDA's research priorities highlighted the critical need for future studies that inform prevention of youth cigar use.
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Affiliation(s)
- Grace Kong
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America.
| | - MeLisa R Creamer
- UTHealth The University of Texas Health Science Center at Houston School of Public Health in Austin, Austin, TX 78701, United States of America
| | - Patricia Simon
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America
| | - Dana A Cavallo
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America
| | - Jennifer Cornacchione Ross
- Wake Forest School of Medicine, Department of Social Sciences & Health Policy, Winston Salem, NC 27101, United States of America
| | - Josephine T Hinds
- The University of Texas at Austin, Department of Kinesiology & Health Education, Austin, TX 78712, United States of America
| | | | - Kevin Gutierrez
- Yale School of Medicine, Department of Psychiatry, New Haven, CT 06519, United States of America
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Antognoli E, Cavallo D, Trapl E, Step M, Koopman Gonzalez S, Perez R, Flocke S. Understanding Nicotine Dependence and Addiction Among Young Adults Who Smoke Cigarillos: A Qualitative Study. Nicotine Tob Res 2019; 20:377-382. [PMID: 28184877 DOI: 10.1093/ntr/ntx008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022]
Abstract
Introduction Cigarillo use is increasing, particularly among young adults. Nicotine dependence (ND) is important for understanding smoking behavior and cessation, but the development of measures of ND has focused almost exclusively on cigarette smokers. We examined smoking patterns, preferences, and beliefs of cigarillo users to better understand their experience of addiction and expression of ND symptoms. Methods Using purposive sampling, we conducted in-depth interviews between June 2015 and January 2016 with 30 young adults aged 18-28 who reported smoking ≥1 cigarillo per week. Interviews were based on a semi-structured guide designed to capture participants' smoking levels and patterns as well as their experiences of smoking and addiction. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes. Results Participants had a mean age of 23, with a majority being female (56%) and African American (80%). The median number of cigarillos smoked per week was 20; 70% also smoked cigarettes, and 43% also smoked marijuana blunts. Our analysis highlighted the complexity of measuring cigarillo use due to product manipulation, sharing, and multiple product use. Participants expressed a preference for smoking in a social group where cigarillos were shared, and not smoking an entire cigarillo at once when alone. Most cigarillo users did not consider themselves to be addicted. Conclusions Cigarillo users express unique smoking practices and beliefs that signify the need for a more product-inclusive measure of ND, and can inform the development of tobacco cessation interventions tailored to cigarillo users. Implications The increasing use of cigarillos among young adults has significant public health consequences. Addressing this issue requires accurate measurement and effective treatment of dependence on cigarillo products. The results of this study directly inform the development of a revised measure of ND, and can contribute to the efficacy of cessation interventions for cigarillo users.
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Affiliation(s)
- Elizabeth Antognoli
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland, OH
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
| | - Mary Step
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH
| | - Sarah Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
| | - Rose Perez
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH
| | - Susan Flocke
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH.,Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
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Spears CA, Jones DM, Pechacek TF, Ashley DL. Use of other combustible tobacco products among priority populations of smokers: Implications for U.S. tobacco regulatory policy. Addict Behav 2019; 93:194-197. [PMID: 30735829 DOI: 10.1016/j.addbeh.2019.01.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/26/2022]
Abstract
Certain sub-populations (e.g., those living in poverty, racial/ethnic minorities, sexual minorities, and people with mental health conditions) experience profound tobacco-related health disparities. Ongoing surveillance of use of various combustible tobacco products by priority populations of cigarette smokers is needed, particularly in the changing U.S. tobacco regulatory landscape. In 2018 the FDA announced their consideration of a tobacco product standard that would limit the level of nicotine in combustible cigarettes, and such regulations should consider potential effects on tobacco-related disparities. If certain subgroups of cigarette smokers are also using other combustible products, they may be particularly likely to continue dual use or switch to exclusive use of those products if a nicotine reduction standard only applies to cigarettes. Accordingly, this study provided recent U.S. nationally representative data on use of other combustible tobacco products among current cigarette smokers by sociodemographic characteristics. Data were drawn from current cigarette smokers (n = 2559) in 2016 and 2017 U.S. nationally representative surveys. Associations between sociodemographic variables (poverty status, education, race/ethnicity, sexual orientation, and mental health status) with use of little cigars and cigarillos (LCCs), traditional cigars, and hookah were examined. Among current cigarette smokers, those living in poverty, racial/ethnic minorities, and those with mental health conditions were particularly likely to use LCCs. Racial/ethnic minority smokers were more likely to smoke traditional cigars. Non-heterosexual smokers, Hispanic smokers, and smokers with mental health conditions were particularly likely to use hookah. These findings have important implications for tobacco regulatory policy and other efforts to combat tobacco-related disparities.
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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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Mead EL, Chen JC, Kirchner TR, Butler J, Feldman RH. An Ecological Momentary Assessment of Cigarette and Cigar Dual Use Among African American Young Adults. Nicotine Tob Res 2018; 20:S12-S21. [PMID: 30125017 PMCID: PMC6093372 DOI: 10.1093/ntr/nty061] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 03/28/2018] [Indexed: 11/25/2022]
Abstract
Introduction The dual use of cigarettes and cigars among African American young adults is a significant public health issue. Patterns of and reasons for dual use are difficult to capture using traditional self-report methods. This study used ecological momentary assessment (EMA) to characterize patterns of dual smoking and examine the personal and environmental predictors of cigarette and cigar smoking among African American young adult dual users (ages 18-29) in real-time. Methods For 14 days, 64 participants smoked ad libitum and were prompted four times daily to record their smoking, craving, emotions, social smoking, and environment via text message on their mobile phones. The odds of single product and dual use were examined using adjusted generalized estimating equations. Results Participants smoked an average of 7.9 cigarettes and 4.2 cigars per day. Cigarettes and cigars were smoked as frequently during periods of dual use as they were during periods of single product use. Cigarette craving was positively associated with cigarette-only smoking (OR: 1.07), whereas cigar craving was positively associated with cigar-only smoking (OR: 1.43) and dual use (OR: 1.08). Cigars had the greatest odds of dual use when with others (OR: 4.69) and in others' homes (OR: 4.33). Cigarettes had the greatest odds of being smoked while alone (OR: 1.57). Conclusions EMA was useful for capturing variable smoking patterns and predictors. In this study population, cigarettes and cigars appeared to be smoked additively, and cigars smoked socially. These findings can inform future interventions addressing dual use in this high priority population. Implications This is the first study to use EMA to examine naturalistic patterns and predictors of multiple tobacco use in real-time. African American young adults smoked cigarettes and cigars during periods of dual use as frequently as during periods of single product use. This suggests that most use was additive (one product smoked in addition to another) and less often as substitution (one product smoked instead of another). Social smoking and craving were strongly associated with cigar smoking in single and dual use periods. This study suggests the need for cessation messaging specifically targeted to reduce dual use in this population.
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Affiliation(s)
- Erin L Mead
- University of Connecticut Health, School of Medicine, Farmington, CT
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, Tobacco Center of Regulatory Science, College Park, MD
| | - Julia Cen Chen
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD
| | | | - James Butler
- University of Maryland Center for Health Equity, School of Public Health, Department of Behavioral and Community Health, College Park, MD
| | - Robert H Feldman
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, Tobacco Center of Regulatory Science, College Park, MD
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Trapl ES, Koopman Gonzalez SJ. Attitudes and Risk Perceptions Toward Smoking Among Adolescents Who Modify Cigar Products. Ethn Dis 2018; 28:135-144. [PMID: 30038474 DOI: 10.18865/ed.28.3.135] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective To examine high school youths' perceptions of health risks, and personal and parental attitudes toward cigarette, cigar, and marijuana use among youth who use or modify cigars. Participants The 2013 Cuyahoga County Youth Risk Behavior Survey used a two-stage cluster sample design to randomly sample public high schools and classrooms. Students in selected classrooms were eligible; 16,855 students completed the survey. Main Outcome Measures This study examines the association between risk perceptions of and youths' personal and parental attitudes toward smoking cigarettes, cigars, and marijuana with current use of cigars, cigarillos or little cigars (CCLCs) or modified CCLCs (ie, freaking or blunting). Results 23.5% of youth reported current use of CCLCs in some way; 11.0% reported current freaking and 18.5% reported current blunt use. CCLC users tended to be male and Black. Perceiving all smoking behaviors as risky, wrong, or wrong by parents reduced odds of using CCLCs. After multivariate analysis, Blacks had increased odds of using CCLCs if they perceived smoking cigarettes as harmful, which was not found among other race/ethnicity categories. Having parents who believed that smoking CCLCs is wrong increased the odds of youth freaking or blunting among all CCLC users. Odds of blunting was greater for those who believed CCLCs were more risky among all CCLC users. Conclusions Findings suggest that CCLC users may think cigars are safer than cigarettes, and that modifiers may think their use is safer and more in line with their parents' views than non-modified CCLCs.
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Affiliation(s)
- Erika S Trapl
- Prevention Research Center for Healthy Neighborhoods, Dept of Population and Quantitative Health Sciences, Case Western Reserve University; Cleveland Ohio
| | - Sarah J Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Dept of Population and Quantitative Health Sciences, Case Western Reserve University; Cleveland Ohio
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18
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Giovenco DP, Spillane TE, Mauro CM, Martins SS. Cigarillo sales in legalized marijuana markets in the U.S. Drug Alcohol Depend 2018; 185:347-350. [PMID: 29500953 PMCID: PMC5997459 DOI: 10.1016/j.drugalcdep.2017.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/13/2017] [Accepted: 12/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Nearly half of marijuana users in the United States also smoke cigarillos, with many using the products as marijuana "blunts." The relationship between marijuana legalization and tobacco retail has not yet been examined. This study uses tobacco sales data to compare the cigarillo marketplace in states with legalized recreational marijuana to the overall U.S. marketplace in 2016. METHODS Cigarillo sales data from 2016 were obtained from the Nielsen Research Company in the following market regions: Denver, CO; Seattle, WA; Portland, OR; and the overall U.S. Descriptive statistics highlighted differences in the market share of various product features (e.g., flavors, brand, pack size) across regions. RESULTS Characteristics such as fruit flavors, single sticks, and 2-3 packs were more popular in legal marijuana regions compared to the overall U.S. Black & Mild, a brand not traditionally used for blunts, was the top brand nationally (32.8% market share), but Swisher was the top brand in legal marijuana regions. In Seattle and Portland, for example, over half of cigarillo sales were for Swisher products (59.1% and 52.1%, respectively). Cigarillo wraps (i.e., no tobacco filler) were particularly popular in Denver, constituting 11.4% all cigarillo sales versus 2.8% nationally. CONCLUSIONS Cigarillo product characteristics traditionally associated with blunt use may shape the tobacco market in legal marijuana regions. As more states continue to legalize recreational marijuana, state and local governments should anticipate the potential impact on the tobacco marketplace and implement tobacco control policies (e.g., flavor bans, minimum pack sizes) that discourage product use.
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Affiliation(s)
- Daniel P. Giovenco
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, United States
| | - Torra E. Spillane
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, United States,Corresponding author: Torra E. Spillane, Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, United States, Phone: 212-342-0616,
| | - Christine M. Mauro
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, United States
| | - Silvia S. Martins
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th Street, New York, NY 10032, United States
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Antognoli E, Koopman Gonzalez S, Trapl E, Cavallo D, Lim R, Lavanty B, Flocke S. The Social Context of Adolescent Co-Use of Cigarillos and Marijuana Blunts. Subst Use Misuse 2018; 53:654-661. [PMID: 28933976 PMCID: PMC5820125 DOI: 10.1080/10826084.2017.1355388] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND The use of cigarillos for smoking as a tobacco product and for making marijuana blunts is increasing among adolescents. Previous research has documented the co-use of these products, however little is known about the contextual features that generate and sustain this practice. OBJECTIVE This study aims for a deeper understanding of why and how co-use of cigarillos and marijuana blunts occurs. METHODS Between December 2015 and April 2016, we conducted in-depth interviews with 30 adolescents aged 14-18 who reported smoking ≥1 cigarillo per week. Semi-structured interviews were designed to capture participants' smoking products, practices, and preferences, as well as their beliefs and experiences about smoking. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes. RESULTS All participants reported smoking cigarillos for use as a tobacco product, averaging 13 per week. Twenty-five (83%) also reported using cigarillos to smoke marijuana blunts. A preference for group smoking and product sharing, and the belief that cigarillos extend the high of marijuana were found to promote the co-use of these products. Cigarillos were also found to be used as a substitute for blunts when marijuana was unavailable or when its use was being restricted or monitored. Conclusions/Importance: This analysis of adolescent cigarillo and marijuana co-use demonstrates how marijuana use can initiate, increase, and reinforce tobacco use. These findings can be used to inform public health education campaigns and other programs and policies aimed at reducing cigarillo and marijuana use by youth.
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Affiliation(s)
- Elizabeth Antognoli
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Sarah Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland, OH, USA
| | - Rock Lim
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Brittany Lavanty
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Flocke
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH, USA
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH, USA
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Mincey K, Turner BL, Brown A, Maurice S. Understanding barriers to healthy behaviors in black college men. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2017; 65:567-574. [PMID: 28777707 PMCID: PMC6093620 DOI: 10.1080/07448481.2017.1360305] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Due to the short life expectancy of black men, it is important to understand what impacts health behaviors in this group so that interventions and programs can be developed to improve their health behaviors which may help in increasing the life expectancy of black men. The purpose of this study was to understand what perceived barriers exist for black college men that prevent them from engaging in healthy behaviors. PARTICIPANTS AND METHODS Thirty-five black male students at a southern Historically Black College and University participated in five focus groups and four interviews. A qualitative analysis was used to analyze data for similar themes and codes. RESULTS Perceived barriers to engaging in healthy behaviors appear to be influenced by image, food cost, and education. Cues to action for not engaging in healthy behaviors appear to be related to role models. CONCLUSIONS Black college men are not adequately informed or educated about elements that can impact their health and how they can improve it. College administrators and researchers should develop interventions that include elements of increasing health knowledge and age-appropriate role models to improve health behavior change among this group.
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Affiliation(s)
- Krista Mincey
- Assistant Professor, Department of Public Health Sciences, Xavier University of Louisiana, Campus Box V, 1 Drexel Drive, New Orleans, LA 70125
| | - Brian L. Turner
- Assistant Professor, Department of Psychology, Xavier University of Louisiana, 1 Drexel Drive, Campus Box 115, New Orleans, LA 70125, 504-520-5278
| | - Amber Brown
- Student, Xavier University of Louisiana, Department of Public Health Sciences, New Orleans, LA 70125
| | - Sheldon Maurice
- Graduate, Xavier University of Louisiana, Department of Psychology, New Orleans, LA 70125
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Giovenco DP, Miller Lo EJ, Lewis MJ, Delnevo CD. "They're Pretty Much Made for Blunts": Product Features That Facilitate Marijuana Use Among Young Adult Cigarillo Users in the United States. Nicotine Tob Res 2017; 19:1359-1364. [PMID: 27613943 PMCID: PMC5896518 DOI: 10.1093/ntr/ntw182] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 07/07/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Cigarillo use is prevalent among young adults in the United States. Many young people use cigarillos as "blunts," a term for a cigar emptied of its tobacco and replaced with marijuana. Because cigars in the United States are not subject to the same regulations as cigarettes, they offer a diverse selection of flavors and packaging styles. It is unclear how these and other product attributes facilitate blunt use. METHODS Semi-structured telephone interviews were conducted with a sample of 40 young adult cigar or cigarillo users in the United States to assess patterns of use and perceptions about product features. Quotations from interview transcripts were coded for major themes and summarized across participants. RESULTS Regardless of their preferred brand, participants felt that the brand Black & Mild is primarily smoked for the tobacco. There was a strong perception, however, that other popular cigarillo brands are almost always used to make blunts. Participants believed that cigarillo companies design their products to simplify blunt-making, with features such as perforated lines or wrappings that unroll easily. Resealable foil pouches, a popular packaging style, are often used to hold unused marijuana and mask its smell. CONCLUSIONS Blunt use is pervasive among young adult cigarillo users in the United States, and certain cigar companies have developed products that facilitate blunt-making. Future surveillance measures should capture the extent to which cigarillo users are using these products as blunts. Continued surveillance of cigarillo sales and popular product attributes are needed. IMPLICATIONS Cigarillo use is prevalent among young adults in the United States, many of whom are using the products as blunts. This study found that product features such as brand, flavor, packaging, and price influence the selection of cigarillos used for this purpose. There is also a strong perception among young adult cigarillo users that cigarillo companies design their products and packaging to make the blunt-making process simple and enjoyable. Better surveillance measures are needed to capture the extent to which cigarillos are used as blunts and which product features are driving category growth.
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Affiliation(s)
- Daniel P Giovenco
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Erin J Miller Lo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - M Jane Lewis
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
| | - Cristine D Delnevo
- Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ
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Mead EL, Johnson SL, Siddiqui J, Butler J, Kirchner T, Feldman RH. Beyond blunts: Reasons for cigarette and cigar use among African American young adult dual users. ADDICTION RESEARCH & THEORY 2017; 26:349-360. [PMID: 30344466 PMCID: PMC6191202 DOI: 10.1080/16066359.2017.1366456] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND African American young adults are at high risk for dual use of cigarettes and cigars. Limited work has explored and characterized the reasons for use in this population and their relative importance for initiation and current smoking of these products. METHOD Reasons for cigarette and cigar use were systematically explored and categorized using a mixed methods participatory approach called concept mapping. A series of in-person group sessions were held with 30 African American young adult (ages 18-29) current smokers of both cigarettes and cigars in Prince George's County, MD and Washington, DC. Participants brainstormed, sorted, rated, and interpreted their reasons for initiation and past 30-day use of cigarettes and cigars. A cluster map was generated using multi-dimensional scaling, and t-tests were used to explore differences in ratings by background characteristics. RESULTS Participants generated 64 reasons for smoking cigarettes and cigars, and categorized these reasons into six groups: emotions, urges, access, product characteristics, lifestyle, and outside pressure. Emotions and urges were the most important motivations for initiation and current smoking of both products. Product characteristics were significantly more important for cigar initiation and smoking than for cigarettes, and outside pressure was more important for current smoking of cigars than cigarettes. Ratings differed by gender, socioeconomic status, and smoking characteristics. CONCLUSIONS Cigarette and cigar smoking have several overlapping motivations, but key differences were also found, most notably for product characteristics. The FDA's regulation of cigars and cigarettes should focus on addressing key characteristics appealing to young adults to curb dual use.
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Affiliation(s)
- Erin L Mead
- School of Medicine, University of Connecticut Health, 263 Farmington Avenue, Farmington, CT 06030, US, Tel: (860) 679-2456,
| | - Sarah Lindstrom Johnson
- T. Denny Sanford School of Social and Family Dynamics, Arizona State University, PO Box 873701, Tempe, AZ 85287, US. Tel: (480) 965-9975,
| | - Junaed Siddiqui
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, US,
| | - James Butler
- Department of Behavioral and Community Health, Maryland Center for Healthy Equity, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, US, Tel: (301) 405-0757,
| | - Thomas Kirchner
- College of Global Public Health, New York University, 41 E. 11st Street, New York, NY 10003, US, Tel: (646) 997-0548,
| | - Robert H Feldman
- Department of Behavioral and Community Health, Tobacco Center of Regulatory Science, School of Public Health, University of Maryland, 4200 Valley Drive, College Park, MD 20742, US,
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Dickinson DM, Johnson SE, Coleman BN, Tworek C, Tessman GK, Alexander J. The Language of Cigar Use: Focus Group Findings on Cigar Product Terminology. Nicotine Tob Res 2016; 18:850-6. [PMID: 26826209 PMCID: PMC5698903 DOI: 10.1093/ntr/ntv285] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 12/23/2015] [Indexed: 11/12/2022]
Abstract
INTRODUCTION The consumption of cigar products has increased since 2000. The multiple product types within this category, combined with the varied language with which consumers refer to them, present challenges for accurately assessing the prevalence of cigar product use. Surveillance is also complicated by the fact that these products can be used to smoke marijuana, as "blunts"-cigars in which the tobacco is removed and replaced with marijuana. Few studies exist regarding the language and terminology used to describe these products. METHODS Sixteen focus groups were conducted in five cities in the United States between March and May of 2014. Participants (N = 123) included adults who had used cigars, cigarillos, or little cigars in the past 30 days. A semi-structured moderator guide was used to gather data on the terms used to identify cigar product subtypes and the language used to describe the products and their use. RESULTS Participants used a variety of terms for each product subtype. Brand names were often used, as well as slang terms, including terms describing cigars modified for marijuana use. Some subtypes were less likely than others to be considered "cigars." Participants had mixed opinions about whether users of cigar products are "smokers." CONCLUSIONS Users of cigar products may classify or label products differently from researchers and policy makers, and many refer to their product by brand name or a slang term. These findings have implications for future research, instrument design, and public health messaging about cigar products. IMPLICATIONS This study adds to the body of evidence highlighting the challenges for measurement and surveillance of non-cigarette tobacco products, including cigars. Findings illustrate the myriad terms used by consumers to describe their use of cigar product subtypes, as well as the complexity of distinguishing between use of cigar products as intended, versus as a vehicle for smoking marijuana. Future research aimed to enhance specificity of cigar use measures will enable policy-makers and public health practitioners to more fully characterize prevalence and patterns of use by cigar subtype.
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Affiliation(s)
- Denise M Dickinson
- Public Health Research Division, RTI International, Research Triangle Park, NC;
| | - Sarah E Johnson
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Blair N Coleman
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Cindy Tworek
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Greta K Tessman
- Office of Science, Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD
| | - Jennifer Alexander
- Public Health Research Division, RTI International, Research Triangle Park, NC
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