The association of perceptions of harmfulness and addictiveness on the age of initiation of cigar product use among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017.

Background: Perceptions of cigar products' harmfulness and addictiveness in youth are associated with subsequent cigar product initiation, but their association on the age of initiation of cigar product use is unknown. Methods: The association of perceptions of harmfulness and addictiveness at youth's first wave of PATH participation (waves 1 or 2 in years 2013-2015) on the age of initiation of (i) ever. (ii) past 30-day, and (iii) fairly regular use of any cigar products (cigarillos, filtered cigars, or traditional cigars) during the followed-up in PATH waves 2-4 (2014-2017) was estimated using weighted interval-censored Cox proportional hazards models. Also, the association of the interaction between perceptions of harmfulness and addictiveness and the age of initiation of any cigar use are reported. Hazard ratios (HR) and 95% confidence intervals (CI) are reported. Results: Among youth who had ever heard of cigar products, youth who perceived cigars to be "low-medium harmfulness and low-medium addictiveness" had 60% (HR: 1.60, 95%CI: 1.36-1.89) higher hazard risk to initiate ever cigar product use at an earlier age, and had 46% (HR:1.46, 95%CI: 1.14-1.86) higher hazard risk to initiate past 30-day cigar product use at younger ages than those who perceived cigars to be "high harmfulness and high addictiveness." Moreover, youth who perceived cigars to be "low-medium harmfulness and high addictiveness" had 33% (HR: 1.33, 95%CI: 1.15-1.53) higher hazard risk to initiate ever cigar product use at younger ages than those who perceived cigars to be "high harmfulness and high addictiveness." Youth who reported "high harmfulness and low-medium addictiveness" (HR: 0.24, 95% CI: 0.07-0.83) had 76% lower hazard risk to initiate fairly regular use of cigar products at younger ages compared to youth who reported "high harmfulness and high addictiveness." Conclusions: Prevention and awareness campaigns should reinforce the unique potential for harm and addiction of cigar products to curb cigar product initiation among US youth.

Short communication: Racial/ethnic disparities in cigar and cigarette exclusive, dual, and polyuse among adults.

Background: Despite documented racial/ethnic differences in cigar use, disparities in the context of dual and polyuse with cigarettes are unclear. Methods: Using the Population Assessment of Tobacco and Health Study (2016-18), we examined prevalence and intensity of use patterns among adults (18+) who were Non-Hispanic (NH) Black, NH White, Hispanic, or another race/ethnicity: exclusive cigarillo, filtered cigar, traditional cigar, or cigarette use; dual use of each cigar product with cigarettes; dual or polyuse of cigars without cigarettes; and cigar and cigarette polyuse. We used multinomial logistic regression to compare odds of each pattern of use to non-use of cigars or cigarettes and quantile regression to assess differences in median products used per day. Results: In our sample (n = 33,424), NH Black adults were more likely to exclusively smoke cigarillos (1.8%), cigarillos and cigarettes (1.6%), and multiple cigar products with or without cigarettes than other racial/ethnic groups. In adjusted models, NH Black compared to NH White adults had higher odds of exclusive cigarillo use (aOR 5.24, 95% CI 3.74-7.34), exclusive filtered cigar use (aOR 2.40, 95% CI 1.33-4.35), cigarillo and cigarette dual use (aOR 2.19, 95% CI 1.60-3.00), and dual/polyuse of cigar products (aOR 2.03, 95% CI 1.22-3.38) compared to non-current use. However, NH White adults tended to smoke the most cigarettes and filtered cigars per day. Conclusions: While the prevalence of cigar use was generally highest among NH Black adults, intensity of use was often highest among NH White users. These patterns may further explain racial/ethnic disparities in tobacco-related health outcomes.

Characteristics differ based on usual cigar-type use among U.S. adults: Analysis from the tobacco use supplement to the current population survey.

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.

The Recalled Age of Initiation of Multiple Tobacco Products among 26-34 Year Olds: Findings from the Population Assessment of Tobacco and Health (PATH) Study Wave 1 (2013-2014).

This study examined the recalled age of initiation of seven different tobacco products (TPs) and explored potential influences of sex, race/ethnicity, and cigarette-smoking status on tobacco use initiation among adults 26-34 years old using the PATH study. METHODS: Secondary analyses were conducted in the adult restricted PATH wave 1 (2013-2014) dataset. Weighted statistics are reported using the balanced repeated replication method and Fay's correction to account for PATH's complex study design. Distributions and histograms of the recalled age of initiation of seven different TPs (cigarettes, cigarillos, traditional cigars, filtered cigars, hookah, smokeless tobacco, and e-cigarettes) are reported, as well as the impact of sex and race/ethnicity using Cox proportional hazard models. The impact of cigarette-smoking status on the recalled age of initiation of each tobacco product other than cigarettes was explored. RESULTS: The highest modes of the recalled age of initiation of cigarette use were at 14-15 and 15-16 years old. The distributions of the recalled age of initiation of cigarillos, traditional cigars, filtered cigars, hookah, and smokeless tobacco occurred later, with the highest modes at 15-16 and 17-18 years old. The distribution of the recalled age of initiation of e-cigarettes had a different shape than the other TPs, with the highest mode reported at 27-28 years old. CONCLUSION: Due to the ever-changing tobacco marketplace, understanding when contemporary adults aged 26-34 years recall initiating TP use is important and will inform prevention researchers.

How and Why Consumers View "Little Cigars" as Legally-Defined Cigarettes.

OBJECTIVE: To test if consumers perceive filtered "little cigars" as legally-defined cigarettes and identify features they associate with cigarettes but not little cigars and vice versa. METHODS: 1,030 adults (mean age 31.1 years, 34% male, 25% non-white) were randomized in a 2×2 between-subjects experiment to view images of filtered "little cigars" that varied by package labeling (cigars: yes/no) and the product displayed in front of the packaging (filtered "little cigar" or cigarette). Measures assessed participants' perceptions that the product shown can be used as a substitute for cigarettes and features perceived to be associated with cigarettes vs. little cigars. RESULTS: Participants perceived filtered "little cigars" as substitutes for cigarettes, perceived certain features to be more like little cigars (e.g., no filter/tip, wrapped in tobacco leaf) and others to be more like cigarettes (e.g., filtered, could be inhaled deeply). In analysis of covariance assessing experimental condition effects, participants viewing images of cigarettes had stronger perceptions that filtered "little cigars" could be used as cigarette substitutes and had cigarette characteristics, but the effect was small. CONCLUSIONS: This study provides new evidence that filtered "little cigars" are perceived by consumers as cigarettes under current laws and identifies features distinguishing little cigars from cigarettes.

Impairment of Endothelial Function by Little Cigar Secondhand Smoke.

OBJECTIVES: Little cigars and cigarillos are gaining in popularity as cigarette use wanes, mainly due to relaxed regulatory standards that make them cheaper, easier to buy individually, and available in a variety of flavors not allowed in cigarettes. To address whether they should be regulated as strictly as cigarettes, we investigated whether little cigar secondhand smoke (SHS) decreases vascular endothelial function like that of cigarettes. METHODS: We exposed rats to SHS from little cigars, cigarettes, or chamber air, for 10 minutes and measured the resulting acute impairment of arterial flow-mediated dilation (FMD). RESULTS: SHS from both little cigars and cigarettes impaired FMD. Impairment was greater after exposure to little cigar SHS than by cigarette SHS relative to pre-exposure values, although the post-exposure FMD values were not significantly different from each other. CONCLUSIONS: Exposure to little cigar SHS leads to impairment of FMD that is at least equal to that resulting from similar levels of cigarette SHS. Our findings support the need to prevent even brief exposure to little cigar SHS, and support tobacco control policies that regulate little cigars as strictly as cigarettes.