What influences demand for cigars among African American adult cigar smokers? Results from a hypothetical purchase task

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

INTRODUCTION

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

AIMS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS

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

Examining Demand and Substitutability of Usual Brand Little Cigars/Cigarillos and Cigarettes in Young Adults Who Dual Use

INTRODUCTION

Cigarette and little cigar/cigarillo (LCC) dual use is popular among young people and poses a substantial health risk. What remains unclear is the abuse liability of LCCs vs. cigarettes, LCCs' substitutability for cigarettes, and the influence of flavors on the abuse liability and substitutability of LCCs.

METHODS

Sixty-five young adults (18-34 years) who dual use completed hypothetical purchase tasks to measure consumption of usual brand cigarettes and LCCs in 24 hours at increasing prices (demand), and LCC consumption at increasing cigarette prices (substitution). Three demand indices were calculated from raw data: breakpoint (price after which consumption reaches 0), Omax (maximum daily expenditure), and Pmax (price at maximum expenditure). Two indices were estimated using nonlinear mixed-effects modeling: intensity (consumption when free) and price-sensitivity (rate of decline in consumption as price increases). Substitution, and associations of flavored use with demand and substitution, were estimated using linear mixed models.

RESULTS

Results indicated similar abuse liability for LCCs and cigarettes. Intensity was greater for cigarettes, but price-sensitivity was similar. Flavored LCC use was associated with lower price-sensitivity and greater intensity than unflavored. LCCs were significant substitutes for cigarettes, but the effect was small. Flavored use was not associated with substitution.

CONCLUSIONS

Among young adults who dual use, LCCs and cigarettes had similar abuse liability, and those who used flavored had higher demand for their LCCs. A flavored cigar ban, as well as targeted prevention and cessation services for those who smoke flavored LCCs, may be important for reducing dual use in young adults.

IMPLICATIONS

Cigarette and LCC dual use remains high among young adults. Using hypothetical purchase tasks with young adults who dual use, LCCs had abuse liability similar to cigarettes, but were only modest substitutes for cigarettes. Participants who used flavored LCCs reported greater abuse liability than those who used unflavored, but not greater substitution for cigarettes. Prevention and cessation services are needed to target LCCs in young people, particularly those smoking flavored products. A flavored cigar ban may help to reduce their demand.

Validity of a little cigars/cigarillos purchase task in dual users of cigars and cigarettes

INTRODUCTION

Hypothetical purchase tasks have been widely used to assess the reinforcing value of tobacco products. However, a task has not yet been validated for little cigars and cigarillos (LCCs), a popular tobacco product class among vulnerable populations. This study sought to validate the LCC Purchase Task (LCCPT) in a sample of experienced LCC smokers.

METHODS

Data were collected from 65 young adult (18-34 years) LCC and cigarette dual users (78.5% male) in Connecticut (2018-2020). Participants completed the usual-brand LCCPT for consumption in 24 h at increasing prices. We calculated four observed demand indices: intensity (consumption at $0), breakpoint (price after which consumption reaches 0), O_max (maximum daily expenditure), and P_max (price at which daily expenditure was maximized). Two indices were estimated from demand curves: Q₀ (predicted consumption as price approaches $0) and price-sensitivity (sensitivity to price increases). Spearman correlations and multivariable regressions examined the associations between demand indices, self-reported cigar use, and dependence.

RESULTS

Correlations were in expected directions. All indices except breakpoint and P_max were positively correlated with use, and all indices were correlated with multiple measures of dependence. Overall, greater demand and expenditure for LCCs and lower sensitivity to price changes were correlated with greater use and dependence. In regression analyses intensity and price-sensitivity showed the strongest relationships with use and dependence.

CONCLUSIONS

The validity of the LCCPT was supported in a sample of experienced LCC smokers. This instrument can be incorporated into other protocols to assess the abuse liability of LCCs.

Exploring the Experiences and Perceptions of Cigar Craving and Addiction among Young Adult Black Cigar Smokers

Black young adults have the highest prevalence of cigar smoking in the U.S. Little is known about how this population perceives addiction to cigar smoking, which may influence long-term smoking and cessation outcomes. This study used semi-structured in-depth interviews to understand cravings, triggers, and perceived addiction from cigar smoking among a purposive sample of Black young adult cigar smokers (N = 40; 21-29 years). An iterative process was used to develop the codebook, and thematic analysis was used to capture findings based on the products predominantly used: cigarillos, large cigars, or blunts. Results suggest that while participants may share similar types of cravings and triggers (e.g., stress) across the use of these products, predominant blunt smokers reported more unique triggers related to relieving physical discomforts. While most participants reported cigars could be addictive to people in general, only a few perceived that they themselves were addicted. Participants who predominantly smoked cigarillos reported high perceived addiction to cigars, while those who predominantly smoked blunts reported low addiction. Education messages are needed to inform young Black adult cigar smokers about the risks and health symptoms of cigar addiction. These efforts may help increase cigar cessation seeking and reduce cigar addiction-related health consequences and disparities among Black populations.