Little Cigars And Cigarillos Use Research Articles

"I Crave a Blunt, I Don't Crave a Cigarillo": A Focus Group Study on Perceptions of Nicotine and Addiction among US Adults Who Currently Smoke Little Cigars or Cigarillos.

While the US Food and Drug Administration (FDA)'s proposal to reduce the nicotine content in cigarettes is gaining traction, it is still undetermined whether the policy will also include other combustible tobacco products, such as little cigars and cigarillos (LCCs), and how such a policy should be communicated given the patterns of use and perceptions around LCCs. This study examined perceptions of nicotine and addiction related to LCC use and involved data collection from eight semi-structured virtual focus groups conducted in Summer 2021 in the US. Participants were adults who reported past-30-day use of LCCs, consisting of African American males (n = 9), African American females (n = 9), white males (n = 14), and white females (n = 11). Participants discussed their perceptions of nicotine and addiction in general and in relation to LCC use. Inductive thematic analysis of transcripts was conducted. Differences across race and sex groups were examined. Participants did not consider nicotine to be a characterizing feature of LCCs; rather, they generally associated nicotine with cigarettes. Participants' views of nicotine and addiction related to LCCs were discussed along four dimensions: context of use, frequency of use, the presence of cravings, and whether a product is modified (e.g., by adding marijuana). Social and infrequent use, a lack of cravings, and the use of LCCs for marijuana were considered indicative of a lack of addiction and reasons not to be concerned about nicotine in LCCs. Because perceptions of nicotine and addiction related to LCCs differ from those of cigarettes, communications about a reduced nicotine policy that includes LCCs should consider these differences to ensure the policy is understood by people who currently use LCCs and to prevent people who use cigarettes from switching to LCCs.

Themes in TikTok Videos Featuring Little Cigars and Cigarillos: Content Analysis.

Little cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. This study analyzed LCC-related content on TikTok, an audio and video-based platform popular among youth. Publicly available posts (N=811) that contained the LCC-related hashtags #swishersweets or #backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. Among the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5%), followed by music (n=559, 68.9%), youth (n=332, 40.9%), humor (n=263, 32.4%), LCC use (n=242, 29.8%), flavors (n=232, 28.6%), branding (n=182, 22.4%), paraphernalia (n=137, 16.9%), blunt rolling (n=94, 11.6%), and price (n=84, 10.4%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5%), (2) youth (264/811, 32.6%), (3) humor (219/811, 27%), (4) flavors (214/811, 26.4%), and (5) LCC use (207/811, 25.5%). LCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok's community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform.

Changes in Little Cigar and Cigarillo Use during the COVID-19 Pandemic: A Cross-Sectional Analysis of a Nationally Representative Sample of Young Adult Users.

We examined the smoking behaviors of U.S. young adults ages 18–36 regarding little cigars and cigarillos (LCCs) during the COVID-19 pandemic. Survey data were collected from a nationally representative sample of young adults between October and November 2020. Respondents who reported using LCCs with tobacco (CAI) and/or with marijuana (CAB) within the past 6 months prior to the survey (n = 399) were included in the study. Logistic regression analyses assessed the association between their perceived risk of having COVID when smoking LCCs and pandemic-related behavioral changes in CAI and CAB use (e.g., worrying, quit attempts, smoking more, smoking less). Findings showed that users with a higher perceived risk of getting COVID-19 when smoking LCCs were more likely to endorse trying to quit CAI and CAB during the pandemic. Compared to the non-Hispanic White population, the non-Hispanic Black population were less likely to endorse smoking less CAI and trying to quit CAB during the pandemic. Dual users of CAI and CAB and females were more likely to endorse smoking more CAB compared to CAB-only users and males, respectively. Tailored cessation strategies are needed for dual users, non-Hispanic Black young adults, and young women. Raising awareness about the risks of LCC use can be an effective strategy for LCC smoking cessation.

Cigar Harm Beliefs and Associations with Cigar Use among Young Adults

Background: Cigar use, including little cigars and cigarillos (LCCs) and large traditional cigars, continues to harm young adults. Research on harm beliefs about cigars, particularly large cigars, is sparse. The current study examined cigar harm beliefs and associations with cigar use. Methods: Data are from a 2019 survey of a young adult cohort study recruited in fall 2010. Participants were asked questions about their beliefs about the harm of LCC and large cigar use. Those reporting ever use of cigars were asked how frequently they inhale the smoke into their lungs. Results: Participants (N = 1910) were 51.9% female with a mean age of 26.7 (SD = 0.6). Ever cigar use was 44.2% for large cigars and 43% for LCCs. Compared to those who have never used large cigars or LCCs, those reporting ever use of large cigars or LCCs reported lower harm beliefs about inhaling harmful chemicals and becoming addicted (ps <.0001). Those who reported higher harm beliefs also reported inhaling the smoke into their lungs more frequently for large cigars and LCCs (ps<.05). Conclusions: Cigar use harm beliefs were lower among participants reporting ever use of cigars compared to those reporting never use. Contrary to predictions, those reporting greater harm beliefs were more likely to report inhaling smoke more frequently than those with lower harm beliefs.

Impact of Little Cigars and Cigarillos Packaging Features on Product Preference.

Background: We conducted a discrete choice experiment (DCE) among young adult cigarette smokers in the period July–August 2018 to examine their preference for cigarillos in response to various packaging-related attributes, including flavor, flavor description, quality descriptors, pack size, and prices. Methods: A convenience sample of 566 US young adult cigarette smokers aged 18–34, among whom 296 were current little cigar and cigarillo (LCC) smokers, were recruited using Facebook ads and invited to participate in an online (Qualtrics) tobacco survey containing DCE and tobacco use questions. In the experiment, participants chose among two cigarillo products or “neither” (opt-out). Results: We analyzed preferences for LCCs using multinomial, nested, random parameter logit models. Results showed that young adult cigarette smokers preferred grape over menthol, tobacco/regular, and wine flavors; “color only” and “color and text” flavor depictions over text only; “smooth” and “sweet” quality descriptors over “satisfying”; and larger pack sizes and lower prices. Conclusions: Regulating packaging-related features will impact LCC choices among US young adult smokers. FDA regulation over these packaging-related features may impact LCC use among young adult smokers.

Differences in reasons for little cigar/cigarillo use across white and black/African American young adult users

IntroductionThe prevalence of little cigar and cigarillo (LCC) use among young adults is high. Research shows there are racial/ethnic differences in this prevalence, with Black/African American users more likely to report current LCC use. Given these discrepancies in LCC use, the present study aimed to assess potential differences in reasons for LCC use between White and Black/African American young adult ever and past 30-day users. MethodsParticipants were White (n = 2150), and Black/African American (n = 308) young adults (aged 18 to 24) recruited from Amazon Mechanical Turk who completed an online survey of tobacco use (December 2018–January 2019). LCC users were asked eight reasons for using LCCs. ResultsFlavoring was cited as the most popular reason for LCC use among White ever users while affordability was the most popular among Black/African American ever users. Adjusted logistic regressions among ever users revealed that Black/African American respondents (vs White) were more likely to use LCCs because of their affordability, the perception that LCCs are less harmful than cigarettes, and because of LCC advertising appeal. Among past 30-day users, adjusted logistic regression models showed that Black/African American respondents (vs White) were more likely to use LCCs because of their affordability. ConclusionsFindings align with previous studies showing that LLCs are more heavily marketed in predominantly Black/African American communities. Prevention efforts should account for racial differences in reasons for use in message development.

Exposure to cigar Point-of-Sale marketing and use of cigars and cigarettes among young adults

IntroductionFew studies examine the impact of objective exposure to point-of-sale (POS) marketing for cigars including little cigars and cigarillos (LCCs) on tobacco use. The present study aimed to examine the relationship between exposure to LCC marketing at the POS and current and future use of LCCs and cigarettes among young adult college students. MethodData on LCC and cigarette use from 4201 young adult students (mean age = 22.8 [SD = 2.3]; 35.9% non-Hispanic whites) attending 24 Texas colleges was linked to objective assessments of POS marketing at 220 tobacco retail outlets within one mile of the colleges. Multilevel logistic regression analyses examined the impact of LCC marketing at the POS on use of LCCs and cigarettes currently and 6-months later. ResultsParticipants were, on average, exposed to 43 LCC marketing materials per week. Results from cross-sectional analyses indicated that exposure to LCC POS marketing was associated with higher odds of current use of LCCs (AOR = 1.003, 95% CI = 1.0002, 1.0053) and cigarettes (AOR = 1.006, 95% CI = 1.0050, 1.0075). The relationship between LCC POS marketing exposure and LCC use was not significant in longitudinal models; however, exposure to LCC POS marketing at baseline did predict current cigarette use at 6-month follow-up (AOR = 1.004, 95% CI = 1.0021, 1.0052). ConclusionFindings suggest a substantial influence of LCC marketing exposure at the POS. Regulations on LCC marketing at the POS, especially around college campuses, should be considered.

Neighborhood Disparities in the Availability, Advertising, Promotion, and Youth Appeal of Little Cigars and Cigarillos, United States, 2015.

Between 2012 and 2016, sales of cigars increased by 29% in the United States. In small local studies, greater little cigar and cigarillo (LCC) availability and marketing has been documented in neighborhoods with a greater proportion of Hispanic or Latino and black residents, and near schools. This national study of cigarette retailers assesses whether LCC availability and marketing at the point of sale is associated with neighborhood racial, ethnic, income, and percent youth demographics. In 2015, we collected LCC availability and marketing data through retailer audits of a nationally representative sample of 2128 cigarette retailers. Using 2011-2015 American Community Survey census tract estimates, we modeled associations of neighborhood demographics (in quartiles) with availability of LCC-flavored products, and presence of exterior advertisements, youth marketing, and promotions. Nearly 90% of retailers sold LCCs, 83.0% sold flavored LCCs, and 30.9% had youth marketing. Controlling for retailer type and other neighborhood characteristics, neighborhoods with the highest proportion of black residents had significantly higher odds of flavored LCC availability (adjusted odds ratio [AOR] = 2.24, 95% confidence interval [CI] = 1.52, 3.30); exterior advertisements (AOR = 2.84, 95% CI = 1.94, 4.16); price promotions (AOR = 1.62; 95% CI = 1.07-2.45), and youth appeal (AOR = 1.49, 95% CI 1.08-2.08) compared to the lowest. Disparities in flavored LCC availability, exterior advertising, and youth appeal were also present for lower income neighborhoods. Neighborhoods with a greater proportion of black or lower income residents have greater flavored LCCs availability and LCC marketing. Without stronger LCC regulation, residents of these neighborhoods may be at a greater risk of LCC use. LCCs are harmful combustible tobacco products that are less regulated than cigarettes (eg, lower taxation, cheaper outlay due to small package sizes, availability of flavors), which makes them an affordable and appealing product to youth. This study documents greater availability, advertising, and marketing of LCCs in neighborhoods with a higher proportion of black or lower-income residents, potentially putting these populations at a greater risk of using or switching to these products in the face of increasing cigarette regulations. These findings underscore the need for local, state, and federal LCC regulatory action.

Affect Predicts Small Cigar Use in a National Sample of US Young Adults

Affect is an important dimension of risk perceptions, which are proximal determinants of little cigar and cigarillo (LCC) smoking. We examined the association among affect, risk perceptions, and current LCC use and susceptibility in a national probability sample of US young adults, aged 18-29. Structural equation models examined the effect of affect, via risk perceptions, on LCC current use and susceptibility for 772 young adults who took the 2015 Tobacco Products and Risk Perceptions Survey, which asked about affect for images related to LCCs and health risks of daily LCC use. Positive affect toward LCCs was associated with lower perceived risks of daily LCC smoking (p < .001). Lower perceived risks were associated with higher probability of current LCC smoking (p = .008) among young adults who were aware of LCCs and with susceptibility to use among young adult never LCC users (p < .001). A direct effect of positive affect on current LCC use (p < .02) and susceptibility to use LCCs also was found. Future research should investigate how regulatory policy or enforcement actions can be used to regulate LCC components (eg, flavoring, advertising, etc) that influence affect and risk perceptions.

Abstract A05: Does Dual Use of Cigarettes and Little Cigars/Cigarillos Increase the Risk for Nicotine Dependence Among Young Adults?

Abstract Purpose: Tobacco use continues to be the leading cause of cancer deaths in the U.S. In 2016, the Food and Drug Administration (FDA) announced that it would regulate little cigars and cigarillos (LCCs) and expressed concerns about the risks of dual use of combustible tobacco products. Little cigars and cigarillos (LCCs) are growing in popularity among young people and racial/ethnic groups who experience disproportionately higher rates of tobacco-caused cancers. To better understand the relationships between dual use patterns and nicotine dependence, this study investigated the association between dual use of cigarettes with LCCs and time to first cigarette within 5 minutes of waking in the morning. We hypothesized that dual users of cigarettes and LCCs (either with tobacco or marijuana in the LCC casing) would show increased dependence on nicotine. Procedures: An online cross-sectional survey administered in 2015 by the GfK Group (formerly Knowledge Networks) was used to collect data on LCC use behaviors among a national probability sample of African American, Hispanic, and White cigarette smokers, 18-44 years of age (n=1018). GfK conducted the survey by recruiting samples from the KnowledgePanel® and opt-in panel sources. The primary independent variable was tobacco use subtype (cigarette-only = reference; cigarette and other tobacco use excluding LCCs; LCCs with tobacco retained in the casing; LCCs with marijuana in the casing (LCC-blunt); or LCC poly use (LLC-tobacco and LCC-blunt). Associations of tobacco use subtype with the primary outcome, time to first cigarette within 5 minutes of waking were tested in multivariable regression models, which adjusted for demographics (e.g., age, gender, race/ethnicity) and other covariates, including the use of menthol cigarettes, smoking frequency, smoking intensity, self-efficacy to quit, other tobacco use, use of marijuana other than blunts, and alcohol use. Results. In the sample of cigarette smokers, 48.6% were cigarette-only smokers, 13.9% used cigarettes and other form of tobacco not including LCCs, 15.4% used LCC-tobacco, 11.5% used LCC-blunts, and 10.6% were poly users (LCC-tobacco and LCC-blunt users). The majority of African American (57.6%), Hispanic (64.0%), and male (55.2%) cigarette smokers were dual users. In the weighted adjusted regression models, results showed that young adult cigarette smokers who were poly-users were nearly twice as likely to smoke a cigarette within the first 5 minutes of waking compared to cigarette-only users (AOR=1.97, 95% CI=1.03-3.75). Male poly users were more than twice as likely as cigarette-only users to smoke a cigarette within the first 5 minutes of waking (AOR=2.32, 95% CI= 1.04-5.17). Female blunt users were 3 times as likely as cigarette-only users to smoke a cigarette within the first 5 minutes of waking (AOR=3.19, CI=1.45-7.00). African Americans who used LCC-tobacco were less likely than cigarette-only users to smoke a cigarette within the first 5 minutes of waking (AOR=0.17, 95% CI=0.04-0.63). Hispanics who used LCC-tobacco or LCC-blunt were nearly 4 times as likely to smoke a cigarette within the first 5 minutes of waking (AOR=3.99 CI=1.39-11.43; AOR=3.88, CI=1.37-11.01). Among White cigarette smokers, there were no significant differences in time to first cigarette among tobacco use subtypes. Conclusions. Results showed that dual use behavior is common and that there is differential risk of nicotine dependence by tobacco use subgroup type and by racial/ethnic and gender groups. Marijuana in LCCs may increase addiction to cigarettes for males, females, and Hispanics, but not for African Americans. These data are complex, but point to the need to develop tailored health messages for cigarette-only users and dual users. Citation Format: Pebbles Fagan, Pallav Pokhrel, Thaddeus Herzog, Mignonne Guy, Ian Pagano, Kymberle Sterling. Does Dual Use of Cigarettes and Little Cigars/Cigarillos Increase the Risk for Nicotine Dependence Among Young Adults? [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr A05.

Association between menthol-flavoured cigarette smoking and flavoured little cigar and cigarillo use among African-American, Hispanic, and white young and middle-aged adult smokers

ObjectivesFlavour additives in cigarettes and little cigars and cigarillos (LCCs), which influence smokers’ risk perceptions, may reinforce dual flavoured tobacco use. We examined the association among mentholated cigarette use, risk...

‘Sweeter Than a Swisher’: amount and themes of little cigar and cigarillo content on Twitter

ObjectiveDespite recent increases in little cigar and cigarillo (LCC) use—particularly among urban youth, African-Americans and Latinos—research on targeted strategies for marketing these products is sparse. Little is known about the...

Risk Perceptions of Little Cigar and Cigarillo Smoking Among Adult Current Cigarette Smokers.

Few studies have examined the perceptions of risk of little cigar and cigarillo (LCC) smoking among cigarette smokers, which is important for expanding regulatory policies and developing prevention programs. We examined current cigarette smokers' perceived harm of LCC smoking, and determined whether these perceptions were associated with susceptibility and intention to continue smoking LCCs. Data were from the 2014 Tobacco Products and Risk Perceptions Survey of a probability sample of 5717 US adults. Data were analyzed for a subsample of 1191 current cigarette smokers who were stratified into three groups: (1) dual current cigarette smokers who had ever used LCCs, (2) current smokers susceptible to LCC smoking, and (3) current smokers who were not susceptible to LCC smoking. Overall, 47.2% of participants were dual smokers, 12.7% were susceptible to LCC smoking, and 40.1% were not susceptible. Perceptions of risk of LCCs varied across the groups. Dual smokers were more likely to perceive that daily LCC smoking is "very risky" (OR = 1.64, 95% CI = 1.08, 2.41) while occasional LCC smoking is only "somewhat risky" (OR = 1.71, 95% CI = 1.02, 2.87). Of the dual smokers, 20.7% intended to continue smoking LCCs in the future. Perceptions of addiction and risk of daily LCC smoking significantly predicted intention to continue LCC smoking. Addiction perceptions also significantly predicted susceptibility to initiate LCC smoking. Perceptions about harms from and addiction to LCCs could predict future LCC smoking. Health communication campaigns need to address the harms of LCCs. Our data suggest that perceptions of risk about the addictiveness of LCCs and frequency of use are important determinants of the LCC smoking susceptibility among some cigarette smokers and intended continued use among cigarette smokers with a history of LCC use. Health communication campaigns should address misperceptions related to LCCs.

Little Cigars and Cigarillos Use Among Young Adult Cigarette Smokers in the United States: Understanding Risk of Concomitant Use Subtypes.

In 2016, the Food and Drug Administration announced that it would regulate little cigars and cigarillos (LCCs) and expressed concern about the concomitant use of combustible tobacco products. To understand LCC use among socially-disadvantaged cigarette smokers, we assessed (1) the prevalence of concomitant use of subtypes of LCCs: LCC-tobacco, LCC-blunt, and LCC- poly use, which includes use of both LCC-tobacco and LCC-blunt and (2) and its association with sociodemographic factors and substance use behaviors using race/ethnicity and gender stratified models. In 2015, a web-based survey was administered to a national probability sample of black/African American, Hispanic/Latino, and white cigarette smokers aged 18-44 (n = 1018). Weighted estimates were used to assess current LCC-tobacco, LCC-blunt, and LCC-poly use. Multinomial regression models assessed sociodemographic, other tobacco and substance use correlates associated with LCC user subtypes. Of cigarette smokers, 63% did not smoke LCCs; 15.1% were LCC-tobacco users; 11.1% were LCC-blunt users; and 10.5% were LCC-poly users. Black/African American and Hispanic/Latino cigarette smokers had higher odds of LCC-tobacco, LCC-blunt, and LCC-poly use compared to white cigarette smokers. Blacks/African Americans who initiated cigarette smoking before age 18 and smoked other tobacco products had greater odds of LCC-tobacco use than whites. Male cigarette smokers who smoked other tobacco products and females who had early onset of cigarette use also had greater odds of LCC-tobacco use. Over 30% of cigarette smokers concomitantly used LCCs, which may prolong smoking. Accurate estimates of diverse LCC use behaviors may increase our understanding of the potential harms of concomitant use. Aggregate measures of LCC smoking do not distinguish subtypes of use among socially-disadvantaged cigarette smokers (ie, young adults, blacks/African Americans, Hispanics/Latinos), who may engage in these unique smoking behaviors. We document the prevalence of young adult cigarette smokers who dual use LCC-tobacco and LCC-blunts and are poly users of LCC-tobacco + LCC-blunts, and identify sociodemographic groups at risk for use. The Food and Drug Administration is concerned about concomitant behavior, which may increase chronic disease risk and addiction. Accurate estimates of LCC smoking behaviors may increase our understanding of the harms of concomitant use; which can inform prevention programs that specifically target LCC subtypes.

Characteristics and Patterns of Black & Mild Use Among African American Smokers.

Increased consumption of little cigars and cigarillos (LCCs) among late adolescent and young adult African American smokers is an emerging public health concern. Despite a growing body of epidemiological evidence, there is scant research on systematic variations in LCC use among young adult African Americans. This study aimed to disaggregate African American Black & Mild (B&M) smokers and to identify subgroups of cigarillo smokers' behaviors and associated characteristics. Using telephone screening data for a NIH-funded clinical laboratory study of toxicant exposure associated with B&M use, latent class analysis (LCA) was used to classify 331 African American B&M smokers' based on daily use, average daily consumption, preference for flavors, preference for product design tips, and product modification behaviors. Results showed five classes, three of which (Daily-Hypers, Daily-Flavored, and Heavy-Daily-Hypers) reflected daily use and average daily consumption rate ranging between 2.7 and 8.9 B&M cigarillos per day. Non-Daily-Hypers and Non-Daily-Flavored classes represented non-daily use patterns and averaged less than 1.0 B&M cigarillo per day. Both sets of classes defined by daily users and non-daily users included smokers who preferred flavored tobacco and who practiced product modification techniques involving hyping and blunting. Latent class analysis is a useful method to detect subtle differences in B&M product preferences and smoking behaviors among African Americans. Study findings highlight the importance of developing tailored interventions that consider within group differences in order to reduce the prevalence of cigarillo smoking among those with the greatest burden. The current study is the first to identify unique subgroups of African American B&M smokers based on cigarillo use behaviors and associated characteristics. Latent class analyses may prove useful for understanding other subgroups of tobacco users. Current findings concerning patterns of LCC use illustrate how future tobacco cessation and prevention interventions may be tailored for African American smokers.

The Most Natural Tobacco Used: A Qualitative Investigation of Young Adult Smokers' Risk Perceptions of Flavored Little Cigars and Cigarillos.

Flavored little cigar and cigarillo (LCC) smoking prevalence rate is increasing among young adults; little is known about their comprehension of its risks. To inform tobacco control regulatory policy and prevention methods, we explored young adult smokers' risk perceptions of flavored LCC products and its use. Purposive samples (n = 90) of African American, Hispanic, and white young adults who self-identified as dual (smoked ≥ 1 LCC and cigarette in past 30 days) and cigarette-only (≥1 cigarette in past 30 days) smokers participated in 12 audiotaped focus groups and a semi-structured interview conducted in the Southeastern United States. Participants discussed their experiences smoking flavored LCCs and perceived health risks of smoking flavored LCCs. A brief survey was administered to characterize participants. The participants had a mean age of 25.1 years (SD = 4.5), were majority male (53.1%), and were 60.0% African American, 29.5% white, and 17.5% Hispanic. Along with health risks and addiction, three major themes emerged as underlying contributors of risk perceptions: affect, participants' smoking practices (amount smoked and inhalation), and beliefs about the components of LCCs (including flavoring and filters). Participants' reported intention to smoke flavored LCCs with its tobacco or as blunts (filled with marijuana) also influenced perceptions. Flavored LCCs were viewed along a continuum of risks compared to cigarettes and blunt smoking. Our study revealed dimensions that were important for the formation of risk perceptions about flavored LCCs. A multidimensional conceptual model and a measure of risk perceptions that is inclusive of these dimensions should be developed and examined for LCC use patterns.

Little Cigar and Cigarillo Beliefs and Behaviors among African-American Young Adults.

To inform the development of future research and culturally-targeted interventions to address little cigar and cigarillo (LCC) use among an at-risk population: African-American (AA) young adults. Additionally, this project assesses LCC use and perception differences between college- and non-college attending AA young adults who use LCCs. Separate focus groups with college and non-college attending AA young adult LCC users assessed participants' attitudes, norms, and perceived behavioral controls regarding LCC use, which was guided by the Theory of Planned Behavior. A thematic analysis following standard qualitative methods procedures revealed 5 themes. Participants shared overwhelmingly positive attitudes toward LCC use, ubiquitous use in their communities, and limited barriers to use. Additionally, participants had difficulty separating LCC and marijuana use practices because LCCs often served as carriers for marijuana. There were no substantive differences between the college and non-college samples with respect to overall themes. Future research should assess LCC intended versus altered use and create culturally relevant intervention measures.

The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers.

Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. A geographically diverse sample of current cigarette smokers were included in analyses (n = 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics. Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.

Cantrell et al. Respond

We thank Sheehan for her comments. We are aware of the known correlation between racial segregation and neighborhood-level socioeconomic status (SES). However, the high correlation between these two measures can make it challenging to implement the analyses strategies recommended. A strong relationship between the two potential predictors can make their independent effects unidentifiable in regression analyses that include both.1 The ability to detect moderation effects is also limited because sparse data are often found in cross-tabulated categories (i.e., high African American and high SES). These issues are not always adequately addressed in published neighborhood studies. The 2010 American Community Survey census data demonstrated significant correlations between measures of block group-level SES (income, unemployment, education) and percentage of African Americans in the Washington, DC communities where outlets are based. Correlations ranged from 0.6 to 0.9, making it nearly impossible to separately evaluate whether point-of-sale (POS) tobacco marketing strategies were targeted based on SES status or the racial/ethnic composition of communities. Further, Short Form 1 census data, which were the data available for this study, did not include measures of SES at the block group.2 Finally, growing evidence suggests that cigar use is high among African American youths3,4 and adults.5 Accordingly, we focused our analysis on block group racial/ethnic demographic characteristics and did not include highly correlated SES measures. The previous literature on POS marketing has found both neighborhood-level minority composition and low SES to be associated with tobacco advertising.6–9 Yet again, many of these analyses were unable to unpack the separate influence of the two factors. This is a limitation of our study and similar studies in areas where community race/ethnicity and SES are highly correlated. Nonetheless, these patterns clearly indicate higher availability and advertising of little cigars and cigarillos (LCCs) in areas with high concentrations of African Americans, which also tend to be low SES communities. We appreciate Sheehan’s discussion of additional community structural characteristics. As she correctly notes, the lower availability of prevention programs and services found in African American communities may influence tobacco use. However, we obtained data and conducted analyses only on POS tobacco marketing and census demographics; thus, we refrained from making policy recommendations based on data that were not part of the study. We agree that neighborhood-level structural factors are likely critical in understanding LCC initiation, addiction, and cessation.10 We encourage researchers and policymakers to consider these factors when developing interventions and policies related to LCC use.