Traditional Cigars Research Articles

Cigar-Smoking Patterns by Race/Ethnicity and Cigar Type: A Nationally Representative Survey Among U.S. Adults

Racial/ethnic minorities have a higher prevalence of past 30-day cigar smoking than White, non-Hispanics. Little is known, however, about racial/ethnic differences in advanced cigar-smoking patterns by cigar types. This research explores whether cigar-smoking patterns differ by race/ethnicity and cigar types. This study used a nationally representative sample of adults (aged ≥18 years; N=28,148) from the Wave 3 survey (2015-2016) of the Population Assessment of Tobacco and Health Study for analysis. Cigar-smoking patterns included past 30-day use, daily use, established use, past 12-month blunt use, use within 30 minutes of waking, and the number of cigars used per day. Weighted multivariable regressions were conducted in 2019 to examine the associations between race/ethnicity and cigar-smoking patterns by cigar types (traditional cigars, cigarillos, and filtered cigars), controlling for covariates. Compared with White, non-Hispanics, Black, non-Hispanics were more likely to smoke cigars in the past 30 days (AOR=2.27, 95% CI=2.03, 2.54) and daily (AOR=2.65, 95% CI=1.89, 3.70), have established cigar smoking (AOR=1.95, 95% CI=1.66, 2.29), and smoke blunts in the past 12 months (AOR=2.30, 95% CI=1.84, 2.88). This pattern was generally consistent across cigar types and was especially pronounced for cigarillos. Compared with White, non-Hispanics, Hispanics were more likely to smoke cigars within 30 minutes of waking (AOR=1.50, 95% CI=1.10, 2.06). This study finds that Black, non-Hispanics and Hispanics have more advanced patterns of cigar smoking than White, non-Hispanics. Interventions and policies for minimizing cigar smoking may differentially benefit these populations and reduce disparities.

Age of initiation of cigarillos, filtered cigars and/or traditional cigars among youth: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017.

Early age of initiation of tobacco use is associated with sustained tobacco use and lower rates of smoking cessation. Although much is known about age of initiation of cigarette use, much less is known about the age of initiation of cigar product use among youth. Survival analyses of the Population Assessment of Tobacco and Health youth annual datasets (ages 12-17) from 2013 to 2017 were conducted for any cigar product use, cigarillos or filtered cigars, and traditional cigars across four cigar use outcomes, age of initiation of: susceptibility to use, ever use, past 30-day use and "fairly regular" use. An interval censoring survival method was implemented to estimate the probability of each outcome for age of initiation of each cigar product overall. Differences in age of initiation by sex and race/ethnicity were assessed using weighted Cox proportional hazards models for interval-censored data. For each outcome across the three cigar products, striking increases in the probability of initiation begin before 17 years old. For cigarillo or filtered cigars, males had a higher risk of onset of susceptibility to use, initiating ever use, and initiating past 30-day use at earlier ages than females. Compared to Non-Hispanic Whites, Hispanic and Non-Hispanic Other had lower risk of initiating ever use and past 30-day use at earlier ages. Non-Hispanic Black youth had higher risk of initiating past 30-day use and "fairly regular" use than Non-Hispanic White youth at earlier ages. Similar findings are reported for any cigar use and traditional cigar use. Developmentally and culturally appropriate cigar use interventions and communication campaigns should be provided to youth before 17 years of age to prevent the onset and progression of cigar products. Regulatory policies that reduce appeal of all cigar products should be implemented to curb cigar initiation among youth.

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.

Flavor Inconsistencies between Flavored Tobacco Products among US Adults.

Objective: Banning flavors in some tobacco products, while allowing them in others, may shift consumer preferences towards products in which flavors are still allowed. In this study, we examine flavor popularity and inconsistencies in flavor preference across non-cigarette tobacco products among US adults. Methods: We used data from the Population Assessment of Tobacco and Health Study Wave 3 to assess the prevalence of flavor preference for users of non-cigarette tobacco products (N = 9037), as well as flavor inconsistencies between products among polyusers (N = 3183). Results: Most users of flavored tobacco products reported using one flavor category per product. Fruit and tobacco were among the most commonly used flavor categories of ENDS, hookah, traditional cigars, and cigarillo/filtered cigars. Menthol/mint was the most common flavor among snus/smokeless users. Polyusers of ENDS and traditional cigars had the largest inconsistency, where about 68%-76% used different flavors across products. Conversely, polyusers of traditional cigars and cigarillos/filtered cigars had the lowest inconsistency (25%-28%). Conclusions: Flavor preferences differed according to product, suggesting that consumers are not likely to switch across products to maintain a flavor preference. Future research should assess flavor preferences prospectively to improve understanding of the potential benefits of flavor bans.

Cigarillo and multiple tobacco product use and nicotine dependence in adolescents and young adults

IntroductionMultiple 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). Methods1089 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. ResultsMost 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). ConclusionsDistinct 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.

Association between purchasing behaviors and cigar use: A longitudinal analysis of Waves 1-3 of the Population Assessment of Tobacco and Health (PATH) Study.

Over 120 US jurisdictions have implemented policies mandating minimum cigar pack quantities, yet little empirical research exists on the relationship between pack quantity and use. We examined whether cigar use was associated with purchasing cigars by the box/pack or as singles, purchase quantity, and price paid per cigar. Data are from Waves 1-3 (2013-2016) of the Population Assessment of Tobacco and Health (PATH) Study, analyzed in 2019. The sample included adults who reported current use of any type of cigars (cigarillos [N = 3,051], traditional cigars [N = 2,586], and filtered cigars [N = 1,295], including with marijuana) at Wave 1. For each cigar type, a generalized estimating equation model was used to examine the population-averaged effects of purchasing behavior on cigar use. Cigar users of each type who purchased by the box or pack smoked more per day than users who purchased singles (cigarillos: β = 1.02, p<0.0001; traditional cigars: β = 1.40, p<0.0001; filtered cigars: β = 2.55, p<0.01). Cigar users who purchased larger quantities smoked more per day (cigarillos: β = 0.16, p<0.0001; traditional cigars: β = 0.04, p<0.0001; filtered cigars: β = 0.24, p<0.0001). Higher price per cigar was significantly associated with smoking fewer traditional cigars (β = -0.12, p<0.01) and filtered cigars (β = -0.86, p = 0.02), but not cigarillos (β = 0.08, p = 0.62). Smaller pack quantities and higher price per cigar were associated with smoking fewer cigars per day. Given the authority of the Food and Drug Administration and local jurisdictions over cigar pack quantity, this study provides data pertinent to potential minimum and maximum package quantity regulations and policies.

4219 Discrepancies in flavor preferences among adult ever users of various tobacco products in the US – Findings from The Population Assessment of Tobacco and Health Study (2015-2016)

OBJECTIVES/GOALS: Flavorings differ between brands and tobacco products, potentially altering the sensory perceptions. This study aimed to examine discrepancies in flavor preference across various non-cigarette tobacco products among a national representative sample of US adult regular tobacco users. METHODS/STUDY POPULATION: Data from the Population Assessment of Tobacco and Health (PATH) Study Wave 3 (W3) were used. Weighted prevalence of flavor preference for various tobacco products, including electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos/filtered cigars, hookah and snus/smokeless, was presented for 9,037 adult current and new former users of multiple flavored tobacco products. Within-subject flavor discrepancies were assessed using generalized estimating equations (GEE) models considering the complex sampling design of the PATH study. RESULTS/ANTICIPATED RESULTS: Most regular users of a flavored tobacco products reported using one flavor category per product. Fruit flavors, followed by tobacco, were the most common flavor categories among ENDS (32% and 25%, respectively) and hookah users (44% and 36%, respectively). Tobacco flavor was the most common among regular users of traditional cigars (80%), cigarillos/filtered cigars (55%), and smokeless tobacco (79%). Polytobacco users of ENDS and traditional cigars had the largest discrepancy, where about 68-76%% used different flavor categories when switching products. Conversely, polytobacco users of traditional cigars and cigarillos/filtered cigars had the lowest discrepancy (23-25%). DISCUSSION/SIGNIFICANCE OF IMPACT: Many consumers of multiple tobacco products had different flavor preferences when switching between products. In the event of a partial or full flavor ban for ENDS, these findings raise questions about consumer loyalty to a particular tobacco product or a particular flavor category. Conflict of Interest Description: MLG serves as a paid consultant for Johnson &amp; Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare. CONFLICT OF INTEREST DESCRIPTION: MLG serves as a paid consultant for Johnson &amp; Johnson and has received research grant from Pfizer, manufacturers of smoking cessation medications. The other authors have no conflicts to declare.

Adult perceptions of the relative harm of tobacco products and subsequent tobacco product use: Longitudinal findings from waves 1 and 2 of the population assessment of tobacco and health (PATH) study

ObjectivesTo examine: (1) How perceptions of harm for seven non-cigarette tobacco products predict subsequent use; (2) How change in use is associated with changes in perceptions of product harm; (3) Whether sociodemographic variables moderate the association between perceptions and use. MethodsData are from the adult sample (18+) of the Population Assessment of Tobacco and Health (PATH) Study, a nationally representative longitudinal cohort survey conducted September 2013-December 2014 (Wave 1 (W1) n = 32,320) and October 2014-October 2015 (Wave 2 (W2) n = 28,362). ResultsWave 1 users and non-users of e-cigarettes, filtered cigars, cigarillos, and pipes, who perceived these products as less harmful had greater odds of using the product at W2. For the other products, there was an interaction between W1 perceived harm and W1 use status in predicting W2 product use. At W2, a smaller percentage of U.S. adults rated e-cigarettes as less harmful than cigarettes compared to W1 (41.2% W1, 29.0% W2). Believing non-cigarette products to be less harmful than cigarettes was more strongly associated with subsequent product use in the oldest age group (55+ years) while weaker effects were observed in the youngest age group (18–24 years). This moderating effect of age was significant for e-cigarettes, hookah, traditional cigars, and cigarillos. ConclusionsStrategies to prevent initiation and promote cessation of these products may benefit from understanding and addressing perceptions of these products.

Clinical and Economic Outcomes Associated with Concurrent Use of Opioids and Benzodiazepines in the Elderly Medicare Population

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.

Use of other combustible tobacco products among priority populations of smokers: Implications for U.S. tobacco regulatory policy

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.

Disaggregating Asian American and Native Hawaiian and Other Pacific Islander (AANHOPI) Adult Tobacco Use: Findings from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014.

Tobacco studies often combine data for Asian American and Native Hawaiian and Other Pacific Islander (AANHOPI) subgroups, masking subgroup differences. This study describes tobacco use (ever use and past 30-day use) among some disaggregated AANHOPI subgroups. Data are from Wave 1 of the 2013-2014 Population Assessment of Tobacco and Health (PATH) Study, a nationally representative, longitudinal cohort study of civilian non-institutionalized adults and youth in the USA. The dataset contains a sample of 32,320 adults, of which 1623 identified as being of AANHOPI origin. Asian Americans further identified as being Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, or other Asian. Those who identified as Native Hawaiian, Guamanian or Chamarro, Samoan, and Other Pacific Islander were combined into an NHOPI group. Tobacco measures included ever and past 30-day use of cigarettes, e-cigarettes, cigars (traditional cigar, cigarillos, filtered cigar), hookah, and smokeless tobacco including snus pouches, and pipe tobacco. Unadjusted and adjusted estimates for tobacco use are reported by AANHOPI membership and sex. In general, Asian Indians and Chinese had the lowest and NHOPI had the highest tobacco use prevalence compared to other AANHOPI subgroups. Males generally had higher prevalence compared to females. Prevalence varied by AANHOPI membership and tobacco product. Adjusted prevalence estimates were higher compared to unadjusted estimates for many subgroups, attenuating some unadjusted differences found between AANHOPI subgroups. Tobacco use varies by AANHOPI subgroup and product type. Unadjusted and adjusted analyses can be conducted as tobacco use differences in AANHOPI subgroups may be attributed to socio-economic status differences. Treating these distinct subgroups as a monolithic group may contribute to reliance on tobacco prevention and control strategies that may have limited impact on specific subgroups.

Classifying Java plum (Eugenia jambolana) Leaf for Tobacco Cigarette Wrapper using Convolutional Neural Network

With the increasing prices of cigarettes and cigars, more and more smokers are looking for an alternative. One way to smoke without the use of traditional cigarettes, cigars, or electronic cigarettes is to roll tobacco leaves with Java plum leaves. It is difficult to select which leaves are to be used as cigarette covers because there are characteristics to be considered such as their texture, color, dryness and shape. This study aims to help or replace human experts in classifying Java Plum leaves using a Convolutional Neural Network Classifier. Tensorflow Inception V3 is retrained to classify the leaves of the Java plum into three categories, and with 1470 test images, the neural network model managed to achieve a 91.2% accuracy in the classification. The system needs more sample photos to get a higher accuracy rate.

Experts Call For More Action to Thwart Youth Vaping ‘Epidemic’

Experts Call For More Action to Thwart Youth Vaping ‘Epidemic’

Mental Health Problems and Onset of Tobacco Use Among 12- to 24-Year-Olds in the PATH Study

To examine whether mental health problems predict incident use of 12 different tobacco products in a nationally representative sample of youth and young adults. This study analyzed Wave (W) 1 and W2 data from 10,533 12- to 24-year-old W1 never tobacco users in the Population Assessment of Tobacco and Health (PATH) Study. Self-reported lifetime internalizing and externalizing symptoms were assessed at W1. Past 12-month use of cigarettes, electronic nicotine delivery systems (ENDS), traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, other smokeless tobacco, bidis and kreteks (youth only), and dissolvable tobacco was assessed at W2. In multivariable regression analyses, high-severity W1 internalizing (adjusted odds ratio [AOR]= 1.5, 95% CI= 1.3-1.8) and externalizing (AOR= 1.3, 95% CI= 1.1-1.5) problems predicted W2 onset of any tobacco use compared to no/low/moderate severity. High-severity W1 internalizing problems predicted W2 use onset across most tobacco products. High-severity W1 externalizing problems predicted onset of any tobacco (AOR= 1.6, 95% CI= 1.3-1.8), cigarettes (AOR= 1.4, 95% CI= 1.0-2.0), ENDS (AOR= 1.8, 95% CI= 1.5-2.1), and cigarillos (AOR= 1.5, 95% CI= 1.0-2.1) among youth only. Internalizing and externalizing problems predicted onset of any tobacco use. However, findings differed for internalizing and externalizing problems across tobacco products, and by age, gender, and race/ethnicity. In addition to screening for tobacco product use, health care providers should screen for a range of mental health problems as a predictor of tobacco use. Interventions addressing mental health problems may prevent youth from initiating tobacco use.

Longitudinal associations between youth tobacco and substance use in waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study

BackgroundWhile evidence suggests bidirectional associations between cigarette use and substance (alcohol or drug) use, how these associations are reflected across the range of currently available tobacco products is unknown. This study examined whether ever tobacco use predicted subsequent substance use, and ever substance use predicted subsequent tobacco use among 11,996 U.S. youth (12–17 years) from Waves 1 (2013–2014) and 2 (2014–2015) of the Population Assessment of Tobacco and Health (PATH) Study. MethodsEver use of cigarettes, e-cigarettes, traditional cigars, cigarillos, filtered cigars, pipe, hookah, snus pouches, smokeless tobacco excluding snus pouches, dissolvable tobacco, bidis, kreteks, alcohol, marijuana, prescription drugs, and other drugs (cocaine and other stimulants, heroin, inhalants, solvents, and hallucinogens) was assessed at Wave 1 followed by past 12-month use assessments at Wave 2. The analyses included covariates (demographics, mental health, sensation seeking, prior use) to mitigate confounding. ResultsEver tobacco use predicted subsequent substance use. The magnitude of the associations was lowest for alcohol, higher for marijuana, and highest for other drugs. Ever substance use also predicted subsequent tobacco use. Specifically, ever alcohol, marijuana, and non-prescribed Ritalin/Adderall use predicted tobacco-product use. Ever e-cigarette and cigarette use exclusively and concurrently predicted subsequent any drug (including and excluding alcohol) use. E-cigarette and cigarette use associations in the opposite direction were also significant; the strongest associations were observed for exclusive cigarette use. ConclusionTobacco and substance use prevention efforts may benefit from comprehensive screening and interventions across tobacco products, alcohol, and drugs, and targeting risk factors shared across substances.

Self-perceived Mental Health and Population-level Tobacco Use Disparities.

Poor mental health is associated with increased cigarette smoking, yet whether this extends to alternative tobacco product use remains unknown. Wave 1 data from the Population Assessment of Tobacco and Health study assessed relationships between self-perceived mental health (SPMH) and prevalence of and motives for tobacco use among US adults (N = 32,320). Fair/poor SPMH, as compared to good/excellent SPMH, was associated with increased current cigarette (AOR = 2.91, 95% CI = 2.64, 3.20), e-cigarette (AOR = 1.35, 95% CI = 1.20, 1.53), cigarillo (AOR = 1.38, 95% CI = 1.22, 1.56), filtered cigar (AOR = 1.43, 95% CI = 1.21, 1.70), and smokeless tobacco (AOR = 1.17, 95% CI = 1.01, 1.36), but not traditional cigar use (AOR = 1.04, 95% CI = 0.90, 1.20). Whereas most motives for tobacco use were similar across SPMH rating, those with fair/poor SPMH, as compared to good/excellent SPMH, were more likely to report using traditional cigars due to affordability (AOR = 1.56, 95% CI = 1.23, 1.98) and e-cigarettes (AOR = 1.43, 95% CI = 1.15, 1.79) and smokeless tobacco (AOR = 1.84, 95% CI = 1.19, 2.83) due to appealing advertising. Although individuals with poor SPMH are more likely to use alternative tobacco products than those with better SPMH, most motives for use are strikingly similar. These findings highlight the importance of continual monitoring of tobacco use trends among vulnerable populations.

Abstract 5279: Prevalence and correlates of perceived harmfulness and addictiveness to traditional and alternative tobacco products among US adults

Abstract Purpose: Beliefs about addictiveness and harmfulness of tobacco products are associated with intentions to use them. This study aimed to (1) evaluate perceived harmfulness and addictiveness patterns towards multiple tobacco products and (2) examine sociodemographic variables that influence those perceptions. Methods: Weighted multivariate ordinal logistic regression analyses were performed on 5,474 US adults aged ≥18 years who participated in the 2015 and 2017 cycles of the Health Information National Trends Survey-FDA. The two primary outcomes were perceived harmfulness and addictiveness of traditional (cigarette, cigar, and pipe filled with tobacco) vs alternative tobacco (e-cigarette, hookah, and “roll your own” cigarettes). All models were adjusted for age, gender, race/ethnicity, education, household income, census region, and smoking status. Results: Overall, 7.9% of adults in the U.S. perceived alternative tobacco as “not harmful at all” compared to 2.4% for the traditional products. Similarly, 16.2% of adults perceived alternative tobacco as “not addictive at all” compared to 13.6% for the traditional products. Beliefs about the harmfulness and addictiveness of traditional and alternative tobacco products differed by sociodemographic characteristics and smoking status: Those who believed traditional and alternative tobacco products are more harmful were more likely to be female, older (compared with those aged 18-34), Black (compared with White), former or never smokers (compared with current smokers), and adults living in West (compared with Northeast). Similarly, those who believed traditional and alternative tobacco products are more addictive were more likely to be female, older, Black, and adults living in West. However, no association between smoking status and perceived addictiveness was noted. Conclusion: Adults in U.S. perceive tobacco harmfulness and addictiveness differently based on their sociodemographic characteristics and smoking status. These findings are potential areas for targeted behavioral interventions to increase individuals' perceived risk of harm and addiction to all forms of tobacco products in the United States. Citation Format: Kahee A. Mohammed, Martin W. Schoen, Nosayaba Osazuwa-Peters, Ahmad M. Al-Taee, Gebran W. Khneizer, Lauren D. Arnold, Leslie Hinyard, Thomas E. Burroughs. Prevalence and correlates of perceived harmfulness and addictiveness to traditional and alternative tobacco products among US adults [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 5279.

US Adult Cigar Smoking Patterns, Purchasing Behaviors, and Reasons for Use According to Cigar Type: Findings From the Population Assessment of Tobacco and Health (PATH) Study, 2013-2014.

The US cigar market is diverse, yet until recently most research studies and tobacco surveillance systems have not reported behavioral and related outcomes by cigar type. The 2013-2014 Population Assessment of Tobacco and Health Study collected data separately for filtered cigars (FCs), cigarillos, and traditional cigars, which were further distinguished as premium or nonpremium. Descriptive statistics for adult established current smokers of each cigar type and cigarettes were calculated for demographic characteristics, tobacco use patterns, purchasing behaviors and reasons for use. Adjusted prevalence ratios (APRs) using a marginal predictions approach with logistic regression assessed correlates of dual cigar and cigarette smoking. Age, sex, race/ethnicity, education level, and poverty status of smokers varied according to cigar type. Daily cigar smoking prevalence and number of cigars smoked per day were higher for FCs (37.3%; median: 1.6 cigars/day, respectively), than all other cigar types (6.7%-25.3%, all p < .01; 0.1-0.4 cigars/day, all p < .01, respectively); daily smoking and cigars per day were similar for nonpremium cigars and cigarillos (p = .11; p = .33, respectively). Cigarette smoking was twice as common among smokers of nonpremium cigars, cigarillos, and FCs (58.0%-66.0%) than among premium cigars (29.9%). Among current cigar smokers, FC smokers (APR = 1.23, 95% confidence interval [CI] = 1.09-1.39), other tobacco product users (APR = 1.27, 95% CI = 1.15-1.41), and those with a GED/high school diploma or less (APR = 1.20, 95% CI = 1.09-1.33) were more likely to also smoke cigarettes. User characteristics, cigar smoking patterns, and dual smoking with cigarettes varied by cigar type highlighting the importance of adequately describing the cigar type studied and, where appropriate, differentiating results by cigar type. Despite the diversity of the cigar market place, historically many research studies and tobacco surveillance systems have treated cigars as a single product type. This study describes similarities and differences in the user characteristics, tobacco use patterns, and purchasing behaviors of premium, nonpremium, cigarillo, and filtered cigar smokers. To enhance tobacco regulatory science, sufficient descriptions of the cigar type(s) studied and, where appropriate, differentiation of the particular cigar type(s) studied should be undertaken to improve the interpretation of study findings, understanding of cigar use patterns and related behaviors and future approaches to reducing cigar-attributable morbidity and mortality.

Co-occurrence of tobacco product use, substance use, and mental health problems among youth: Findings from wave 1 (2013–2014) of the population assessment of tobacco and health (PATH) study

IntroductionCigarette use is associated with substance use and mental health problems among youth, but associations are unknown for non-cigarette tobacco product use, as well as the increasingly common poly-tobacco use. MethodsThe current study examined co-occurrence of substance use and mental health problems across tobacco products among 13,617 youth aged 12–17years from Wave 1 (2013–2014) of the nationally representative Population Assessment of Tobacco and Health (PATH) Study. Participants self-reported ever cigarette, e-cigarette, smokeless tobacco, traditional cigar, cigarillo, filtered cigar, hookah, and other tobacco product use; alcohol, marijuana, and other drugs; and lifetime substance use, internalizing and externalizing problems. ResultsIn multivariable regression analyses, use of each tobacco product was associated with substance use, particularly cigarillos and marijuana (AOR=18.9, 95% CI: 15.3–23.4). Cigarette (AOR=14.7, 95% CI: 11.8–18.2) and cigarillo (AOR=8.1, 95% CI: 6.3–10.3) use were strongly associated with substance use problems and tobacco users were more likely to report internalizing (AOR=1.6, 95% CI: 1.4–1.8) and externalizing (AOR=1.4, 95% CI: 1.3–1.6) problems. Female tobacco users were more likely to have internalizing problems than male tobacco users. Poly-tobacco users were more likely than exclusive users to use substances (AOR=3.4, 95% CI: 2.7–4.3) and have mental health (AOR=1.2, 95% CI: 1.0–1.5) and substance use (AOR=4.7, 95% CI: 3.4–6.6) problems. ConclusionsRegardless of the tobacco product used, findings reveal high co-occurrence of substance use and mental health problems among youth tobacco users, especially poly-tobacco users. These findings suggest the need to address comorbidities among high risk youth in prevention and treatment settings.

Co-occurrence of tobacco product use, substance use, and mental health problems among adults: Findings from Wave 1 (2013–2014) of the Population Assessment of Tobacco and Health (PATH) Study

BackgroundAlthough non-cigarette tobacco product use is increasing among U.S. adults, their associations with substance use and mental health problems are unclear. This study examined co-occurrence of tobacco use, substance use, and mental health problems, and its moderation by gender, among 32,202U.S. adults from Wave 1 (2013–2014) of the nationally representative longitudinal Population Assessment of Tobacco and Health (PATH) Study. MethodsParticipants self-reported current cigarette, e-cigarette, traditional cigar, cigarillo, filtered cigar, hookah, smokeless tobacco and other tobacco product use; past year alcohol, marijuana, and other drug use; and past year substance use, internalizing and externalizing problems. ResultsCompared to non-current tobacco users, current users were more likely to report alcohol or drug use (adjusted odds ratio (AOR)=2.6; 95% confidence interval (CI): 2.3, 2.9), with the strongest associations observed for cigarillo and hookah users. Across all tobacco product groups, users were more likely to report internalizing (AOR=1.9; 95% CI: 1.7, 2.1), externalizing (AOR=1.6; 95% CI: 1.5, 1.8), and substance use (AOR=3.4; 95% CI: 2.9, 4.1) problems than non-users. Gender moderated many of these associations and, of these, all non-cigarette tobacco product associations were stronger among females. ConclusionsThis nationally representative study of U.S. adults is the first to comprehensively document tobacco use, substance use, and mental health comorbidities across the range of currently available tobacco products, while also demonstrating that female tobacco users are at increased risk for substance use and mental health problems. These findings may point to gender differences in vulnerability and suggest that interventions incorporate gender-specific approaches.