1
|
Sanchez JI, Fong RS, Hampilos K, Cooper ZD, Middlekauff HR. Blunt Talk on "Blunts": The Increasingly Popular Tobacco Product That Is Potentially Exacerbating Tobacco-Related Health Disparities. J Gen Intern Med 2024:10.1007/s11606-024-08980-8. [PMID: 39313669 DOI: 10.1007/s11606-024-08980-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Accepted: 07/26/2024] [Indexed: 09/25/2024]
Abstract
A "blunt" is a hollowed-out cigar/cigarillo from which much of the loose tobacco has been removed, and the remaining tobacco wrapper filled with cannabis. Although blunts contain significant levels of tobacco/nicotine, they are often treated as if they were exclusive cannabis products and omitted from surveys of tobacco products. Whereas the prevalence of virtually all other tobacco products is on the decline in the USA, available data suggest that the prevalence of blunt smoking is not - and in fact, it may be increasing. Blunts are most frequently used by people who self-identify as Black. As a result of misperceptions and perhaps biases, there is a dearth of scientific investigation, hence knowledge, surrounding the health effects associated with blunt smoking. Co-use of tobacco and cannabis has been reported to have additive and even synergistic adverse health effects. Lack of investigations into the health effects of tobacco products most frequently used by Black people may contribute to tobacco-related health disparities. We argue that the scientific and public health communities must treat blunts as the potentially lethal tobacco product that they are, studying their prevalence and use patterns, and investigating their adverse health effects, both short and long term.
Collapse
Affiliation(s)
- Joshua I Sanchez
- Department of Medicine, Division of Cardiology, and Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Reece S Fong
- Department of Medicine, Division of Cardiology, and Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Katherine Hampilos
- Department of Medicine, Division of Cardiology, and Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Ziva D Cooper
- UCLA Center for Cannabis and Cannabinoids, Jane and Terry Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry and Biobehavioral Sciences, and Department of Anesthesiology and Perioperative Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA, USA
| | - Holly R Middlekauff
- Department of Medicine, Division of Cardiology, and Department of Physiology, UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
| |
Collapse
|
2
|
Kong AY, Westneat SC, Anesetti-Rothermel A, van de Venne JG, Debnam C, Ribisl KM, Cohn AM, Rose SW. Neighborhood Inequities in Tobacco Product Descriptors, Washington, DC, 2018-2019. Nicotine Tob Res 2024; 26:S73-S81. [PMID: 38817025 PMCID: PMC11140226 DOI: 10.1093/ntr/ntad226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 11/02/2023] [Accepted: 11/07/2023] [Indexed: 06/01/2024]
Abstract
BACKGROUND The tobacco industry uses product descriptors to communicate reduced harm and increase appeal. This cross-sectional study assessed store-level racial, ethnic, and socioeconomic inequities in the distribution of retail tobacco product descriptors in a convenience sample of retailers in Washington, DC. METHODS Young adults (n = 146) who did not currently use tobacco reported real-time store visits over 14 days. Trained data collectors took high-resolution photographs of all tobacco (including e-cigarette) marketing in each store (n = 96) participants visited. We coded text descriptors on tobacco product advertisements and displays into descriptor categories (eg, fruit, sweet, concept). We fit multilevel models to examine relationships between store neighborhood census tract-level racial, ethnic, and socioeconomic characteristics and tobacco product descriptors in stores. As a supplementary analysis, we used geospatial methods to model predicted patterns of descriptors at the census tract level. RESULTS Stores located in census tracts with the highest versus lowest percentage of Black residents had a greater count of fruit, sweet or dessert, alcohol, and concept descriptors (p < .05), similar to findings from the geospatial approach. Adjusted models also indicated some inequities in stores in census tracts with higher percentages of Hispanic or Latino residents for fruit, alcohol, and concept descriptors; however, tract-level models showed opposite results for concept flavors. CONCLUSIONS In this convenience sample, fruit, alcohol, sweet/dessert, and concept FTP descriptors were prevalent in stores in neighborhoods with more Black residents demonstrated through two analytic approaches. Surveillance using representative samples of tobacco retailers could improve the ability to track the extent of this inequity. IMPLICATIONS We document inequities in the amount of fruit, sweet or dessert, alcohol, and concept flavor descriptors in stores across neighborhoods in Washington, DC. Federal, state, and local regulatory action is needed to reduce inequities in flavored tobacco product availability and marketing, including for concept flavors.
Collapse
Affiliation(s)
- Amanda Y Kong
- Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Susan C Westneat
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Andrew Anesetti-Rothermel
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | - Judy G van de Venne
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
| | | | - Kurt M Ribisl
- Health Behavior, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy M Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shyanika W Rose
- University of Kentucky, Center for Health Equity Transformation and Behavioral Science College of Medicine, Lexington, KY, USA
- Markey Cancer Center, Lexington, KY, USA
| |
Collapse
|
3
|
Havermans A, Pauwels CGGM, Bakker-'t Hart IME, Fayokun R, van Nierop LE, Hellmich IM, Talhout R. Across the world availability of flavour accessories for tobacco products. Tob Control 2024:tc-2023-058255. [PMID: 38580443 DOI: 10.1136/tc-2023-058255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 01/22/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE This study aimed to provide an inventory of different types of flavour accessories for combustible tobacco products in eight countries varying in their approaches to flavour legislation and cultural aspects, including tobacco use. METHODS A standardised search protocol was developed and shared with local informants to acquire information on the availability and marketing of flavour accessories in web shops accessible from Brazil, India, Italy, Singapore, South Africa, Switzerland, the UK and the USA. Characteristics of the products and web shops were reported, and flavours were categorised in a flavour wheel. RESULTS Flavour accessories were available in all participating countries. Reported types are flavour capsules, cards, filter tips and tubes for make-your-own cigarettes, drops, sprays, rolling paper, aroma markers, a flavour stone and a flavour powder. In total, 118 unique flavours were reported, which were mostly fruity and sweet. Marketing of these products was often associated with (menthol) flavour bans. CONCLUSIONS The wide availability and variety of flavour accessories raise significant public health concerns, as they have attractive flavours, and thus hinder the regulatory aim of flavour bans. Flavour accessories are not tobacco products and thus not regulated as such. Therefore, it is recommended that policymakers include these products in comprehensive flavour bans, to close this loophole in existing tobacco control measures.
Collapse
Affiliation(s)
- Anne Havermans
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Charlotte G G M Pauwels
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ingrid M E Bakker-'t Hart
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ranti Fayokun
- No Tobacco Unit, World Health Organization, Geneva, Switzerland
| | - Lotte E van Nierop
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Ina M Hellmich
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Division of Human Nutrition and Health, Wageningen University, Wageningen, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| |
Collapse
|
4
|
Diaz MC, Yoon SN, Donovan E, Akbar M, Schillo BA. The Effect of State and Local Flavored Cigar Sales Restrictions, on Retail Sales of Large Cigars, Cigarillos, and Little Cigars in Massachusetts, California, Illinois, and New York. Nicotine Tob Res 2024; 26:169-176. [PMID: 37453140 DOI: 10.1093/ntr/ntad121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 05/10/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION In 2009, the Family Smoking Prevention and Tobacco Control Act prohibited flavored cigarettes but allowed for flavored cigars. Since, there has been a 34% increase in youth cigar use and widened racial disparities. State and local jurisdictions have increasingly enacted flavored tobacco product sales restrictions. As more jurisdictions consider implementing flavor restrictions, it is important to understand their effect on tobacco markets that have high flavor proliferation, including the cigar market. AIMS AND METHODS This study uses data from Truth Initiative's flavor policy database and NielsenIQ retailer scanners for California, Illinois, Massachusetts, and New York. We use a three-way fixed-effect model to assess the impact of the percentage of the population covered by a flavored cigar sales restriction on per capita unit sales of cigars. RESULTS We find that population coverage by cigar sales restrictions was significantly associated with decreases in per capita cigar sales. More specifically, a 25% increase in the percentage of the population covered by a flavored cigar sales restriction was associated with a decrease in per capita all cigar sales of 15%-19%, 4%-10% for large cigars, 17%-21% for cigarillos, and 2%-41% for little cigars. CONCLUSION Flavored cigar sales restrictions are an effective policy to reduce per capita cigar sales. The Food and Drug Administration (FDA)'s proposed product standards would increase population covered by a flavored cigar sales restriction to 100%, leading to potential significant reductions in cigar sales, especially little cigar, and cigarillo sales. This may also substantially reduce youth cigar use and racial disparities in cigar use. IMPLICATIONS In April 2022, the U.S. FDA published a proposed rule to prohibit characterizing flavors in all cigars and menthol cigarettes. Besides this proposed rule, there has been little federal action to date to reduce sales of flavored cigars. However, as of March 31, 2022, Massachusetts and 333 localities across 10 states have enacted policies that restrict the sale of flavored cigars and other tobacco products. We find that population coverage by cigar sales restrictions is significantly associated with decreases in per capita cigar sales.
Collapse
Affiliation(s)
- Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Emily Donovan
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Maham Akbar
- Public Policy, Truth Initiative, Washington, DC, USA
| | | |
Collapse
|
5
|
Phan L, Seyl C, Chen-Sankey J, Niederdeppe J, Guy MC, Sterling KL, Choi K. Exploring Young Adults' Beliefs About Cigar Smoking by Susceptibility: A Belief Elicitation Study. Nicotine Tob Res 2023; 25:1648-1658. [PMID: 37294098 PMCID: PMC10445255 DOI: 10.1093/ntr/ntad088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 06/03/2023] [Accepted: 06/08/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Young adults are at risk for cigar smoking, which is associated with cancers and pulmonary and cardiovascular diseases. Little is known about young adults' beliefs about smoking cigarillos, little filtered cigars, and large cigars, and how these beliefs may vary across cigar types and by cigar susceptibility. AIMS AND METHODS The larger study surveyed a U.S. sample of young adults (18-30 years old) who never used tobacco products (n = 948) through Qualtrics online panel services in August 2021-January 2022. We assessed participants' susceptibility to using different cigar types. Participants were randomly assigned to open-ended questions about one of the three cigar types to elicit behavioral, normative, and control beliefs. We conducted thematic analysis to code emergent themes within each belief and examined the frequency of reported themes at the intersection of cigar type and cigar susceptibility. RESULTS Cigar susceptible participants reported positive behavioral beliefs (eg, anticipated relaxation, mood regulation, being cool), friends as supportive referents, and easy-to-smoke control beliefs (eg, high accessibility, low cost) more frequently than non-susceptible participants. Varied frequency by cigar type also emerged. For example, cigarillo and little filtered cigar features were mentioned more frequently as easy-to-smoke control beliefs, while low accessibility was reported more frequently as a hard-to-smoke control belief for large cigars. CONCLUSIONS Findings identify salient beliefs about cigarillo, little filtered cigar, and large cigar smoking among young adult tobacco never-users. Future research should investigate the potential importance of these beliefs in cigar smoking susceptibility and initiation among young adults, and their potential utility in prevention research. IMPLICATIONS This thematic analysis identified salient beliefs about cigarillos, little filtered cigars, and large cigars among a U.S. young adult sample, and differentiated emergent beliefs by cigar susceptibility status and by cigar type. Given the lack of cigar smoking prevention media campaigns, identifying these beliefs is the one of the first steps in developing effective cigar smoking prevention strategies. Future quantitative studies are needed to confirm the relationships between these beliefs and smoking initiation of each cigar type to further inform the types of beliefs to be targeted in strategic communication and help prevent cigar smoking initiation among susceptible young adults.
Collapse
Affiliation(s)
- Lilianna Phan
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, Maryland
| | - Christen Seyl
- Department of Psychology, University of Nebraska-Lincoln, Lincoln, Nebraska
- Department of Biological Sciences, University of Nebraska-Lincoln, Lincoln, Nebraska
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey
- School of Public Health, Rutgers Biomedical and Health Sciences, Piscataway, New Jersey
| | - Jeff Niederdeppe
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York
- Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York
| | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, Richmond, Virginia
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia
| | - Kymberle L Sterling
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Sciences Center School of Public Health, Dallas, TX
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities, Division of Intramural Research, Bethesda, Maryland
| |
Collapse
|
6
|
Pennings JLA, Pauwels CGGM, Schenk E, Talhout R. Circumventing cigarette regulation: Product characteristics of cigarette-like cigarillos on the Dutch market. Tob Induc Dis 2023; 21:91. [PMID: 37456608 PMCID: PMC10347962 DOI: 10.18332/tid/167476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/02/2023] [Accepted: 06/06/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION Cigarillos have been reported to provide an alternative to cigarettes with a characterizing flavor, which are banned in the European Union. Additionally, they are cheaper than cigarettes. To better inform policy making, we wanted to gain better insight into the market situation for cigarillos in the Netherlands. METHODS We analyzed product data notified by manufacturers via the European Common Entry Gate system (EU-CEG), as extracted on the 1 June 2022. First, we identified parameters that allowed classifying cigarillos into cigar-like, cigarette-like and intermediate-type cigarillos. Next, we compared product characteristics for these groups. RESULTS We identified five parameters that allowed classifying cigarillos into subtypes: product weight, filter presence, leaf tobacco percentage in the product, flue-cured tobacco percentage in the product, and the number of flavorings. Almost a quarter (71/285) of the cigarillos on the Dutch market were classified as cigarette-like. Compared to other cigarillo types, these have a high number of flavorings (average n=43), including many sweet and fruity flavorings. The package types of cigarette-like cigarillos resemble those of cigarettes. However, 85% of the cigarette-like cigarillos are available in smaller pack sizes than allowed for cigarettes. When comparing data over the period 2019-2022, we found a decrease in the number of cigar-like cigarillos and an increase in the number of cigarette-like cigarillos, which hints at a shift in the market composition. CONCLUSIONS Cigarette-like cigarillos can provide a way to evade cigarette regulation. Moreover, their characteristics make them attractive for consumers, including young people. Regulators should consider amending regulations to close the regulatory loopholes that allow evading tobacco legislation.
Collapse
Affiliation(s)
- Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Charlotte G G M Pauwels
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Erna Schenk
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
7
|
White AM, Barnes AJ, Garner W. Racial/ethnic differences in the association between menthol cigarette use and mental illness among adults who smoke in the United States. J Ethn Subst Abuse 2023:1-21. [PMID: 37052141 PMCID: PMC10570396 DOI: 10.1080/15332640.2023.2196645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Data from the National Survey on Drug Use and Health (2012-2018) were used to characterize the association between menthol cigarette use and indicators of Any (AMI) and Serious (SMI) Mental Illness among adults who smoke in the United States. In general, people who smoke menthol cigarettes were more likely to have AMI (aOR = 1.123 [1.063-1.194]) than people who smoke non-menthol cigarettes, but not SMI (aOR = 1.065 [0.966-1.175]). However, among non-Hispanic African American/Black people who smoke, those that used menthol cigarettes had lower adjusted odds of both AMI (aOR = 0.740 [0.572-0.958]) and SMI (aOR = 0.592 [0.390-0.899]) than their counterparts who used non-menthol cigarettes. Results suggest there may be race/ethnicity-specific drivers of the association between menthol cigarette use and mental illness.
Collapse
Affiliation(s)
- Augustus M. White
- Department of Health Behavior and Policy, Virginia
Commonwealth University, 830 E. Main St., 9 Floor, Richmond, VA, 23219
USA
- Center for the Study of Tobacco Products, Virginia
Commonwealth University, 100 W. Franklin St., Suite 200, Richmond, VA, 23220
USA
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia
Commonwealth University, 830 E. Main St., 9 Floor, Richmond, VA, 23219
USA
- Center for the Study of Tobacco Products, Virginia
Commonwealth University, 100 W. Franklin St., Suite 200, Richmond, VA, 23220
USA
| | - William Garner
- Department of Public Health, University of North Texas at
Dallas, 7300 University Hills Boulevard, Dallas, TX 75241, USA
| |
Collapse
|
8
|
Reimold AE, Kong AY, Delamater PL, Baggett CD, Golden SD. Urban-rural differences in tobacco product availability in food retailers, United States, 2017. J Rural Health 2023; 39:338-346. [PMID: 35708094 PMCID: PMC9755460 DOI: 10.1111/jrh.12687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE Tobacco use prevalence is higher in rural compared to urban settings, possibly due to differences in tobacco availability, including the option to purchase food and other essential items in stores that do not sell tobacco (tobacco-free food retailers). The goal of this research is to determine whether tobacco-free food retailer availability varies by urbanicity/rurality. METHODS Using the 2017 National Establishment Time-Series database, we identified food retailers across all census tracts containing food retailers in the United States (n = 66,053). We used multivariable logistic and linear regression models to test whether tobacco-free food retailer availability varied across 4-levels of census tract urbanicity/rurality (urban, suburban, large town, and small town/rural) for 2 outcomes: (1) the presence of at least 1 tobacco-free food retailer and (2) the percent of all food retailers that were tobacco-free. FINDINGS Compared to urban core census tracts, suburban census tracts had a lower odds (aOR = 0.77, 95% CI = 0.73, 0.81) of having at least 1 tobacco-free food retailer, while small town/rural census tracts had greater odds (aOR = 1.23, 95% CI = 1.15, 1.32). Suburban census tracts (B = -2.29, P < .001) and large town census tracts (B = -1.90, P < .001) also had a lower percentage of tobacco-free food retailers compared to urban census tracts. CONCLUSIONS Compared to urban cores, tobacco-free food retailers were less prevalent in suburban and large town areas, though similarly or slightly more available in rural areas. Future research should assess whether these differences depend on varying store types.
Collapse
Affiliation(s)
- Alexandria E. Reimold
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Amanda Y. Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Paul L. Delamater
- Department of Geography, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Christopher D. Baggett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Shelley D. Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
9
|
Mills SD, Rosario C, Yerger VB, Kalb MD, Ribisl KM. Recommendations to advance equity in tobacco control. Tob Control 2022:tc-2022-057670. [PMID: 36535756 PMCID: PMC10277310 DOI: 10.1136/tc-2022-057670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/23/2022] [Indexed: 12/24/2022]
Abstract
Reducing racial and socioeconomic inequities in smoking has been declared a priority for tobacco control in the USA for several decades. Yet despite the rhetoric, these inequities persist and some have actually worsened over time. Although tobacco companies have targeted racially and ethnically diverse and lower-income tobacco users, which substantially contributes to these disparities, less attention has been given to the role of individuals and organisations within the tobacco control movement who have allowed progress in eliminating disparities to stagnate. We examine the failure of tobacco control professionals to ensure the widespread adoption of equity-focused tobacco control strategies. Review of major US tobacco control reports found that the focus on equity often stops after describing inequities in tobacco use. We suggest ways to advance equity in tobacco control in the USA. These recommendations fall across five categories: surveillance, interventions, funding, accountability and addressing root causes. Policy interventions that will have a pro-equity impact on smoking and related disease should be prioritised. Funding should be designated to tobacco control activities focused on eliminating racial and socioeconomic inequities in smoking, and tobacco control programmes should be held accountable for meeting equity-related goals.
Collapse
Affiliation(s)
- Sarah D Mills
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carrie Rosario
- Department of Public Health Education, The University of North Carolina at Greensboro, Greensboro, North Carolina, USA
| | - Valerie B Yerger
- Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, California, USA
| | - Marlene Donato Kalb
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kurt M Ribisl
- Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
10
|
Ganz O, Wackowski OA, Gratale S, Chen-Sankey J, Safi Z, Delnevo CD. The Landscape of Cigar Marketing in Print Magazines from 2018-2021: Content, Expenditures, Volume, Placement and Reach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16172. [PMID: 36498246 PMCID: PMC9739552 DOI: 10.3390/ijerph192316172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
Cigar consumption has increased in the U.S. over the past decade, yet gaps remain in research on cigar promotion in print magazines. This study examines ad placement, volume, ad characteristics, and associated expenditures for cigars from 2018-2021, and readership data for magazines containing cigar ads. We merged content analysis data with Kantar Media data on magazine placement and expenditures and used magazine readership data from MRI-Simmons. The only brand in print magazines was Black & Mild (B & M), a top cigar brand in the U.S. There were 30 unique B & M magazine ads and 284 occurrences (i.e., appearances in magazines), translating to $46,504,578 in expenditures. All ads featured the word "enjoy/enjoyment" and a warning label. Filtered cigars were the most featured cigar type (75%) and sweets was the most featured flavor (78%). Nearly half of the publications in which B & M were advertised in have substantial Black/African American readership and were featured in publications with disproportionate young adult and Hispanic/Latino readership. This study identified tactics used in print advertising for a top cigar brand. Future research should examine how these tactics impact consumer perceptions. Findings of cigar ads reaching vulnerable populations may inform the FDA's efforts to reduce health disparities through regulations and public education.
Collapse
Affiliation(s)
- Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Stefanie Gratale
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
| | - Julia Chen-Sankey
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Zeinab Safi
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Piscataway, NJ 08854, USA
| |
Collapse
|
11
|
Phan L, McNeel TS, Chen-Sankey J, Niederdeppe J, Tan ASL, Choi K. U.S. Trends in Age of Cigar Smoking Initiation by Race/Ethnicity and Education. Am J Prev Med 2022; 63:624-629. [PMID: 35618548 PMCID: PMC9509412 DOI: 10.1016/j.amepre.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 04/04/2022] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Younger age of initiating cigar smoking is associated with greater nicotine dependence and current use. Age of initiating cigarette smoking has increased over time, whereas trends in age of initiating cigar smoking remain understudied. These trends were examined by race/ethnicity, by education, and at their intersection. METHODS The analytic sample included U.S. Hispanic, Black, and White cigar-ever-smokers aged 24‒25 years (n=29,715) from the 2002‒2019 National Survey on Drug Use and Health. Participants reported their age, race/ethnicity, sex, education (≤high school; some college; ≥bachelor's degree), age of initiating cannabis use, and cigar smoking. Weighted multivariable linear regressions adjusted for sex and age of cannabis use initiation were used to examine trends in age of initiating cigar smoking by race/ethnicity, education, and education Χ year interactions within racial/ethnic groups. Age of initiating cigar smoking comparisons across race/ethnicity and education were examined using the most recent 2019 data. RESULTS During 2002‒2019, across education, White cigar-ever-smokers started smoking cigars at an older age, whereas it remained unchanged among Hispanic cigar-ever-smokers. Among Black cigar-ever-smokers, age of initiating cigar smoking did not change among those with ≤high school and some college, and was older among those with ≥bachelor's degree. In 2019, age of initiating cigar smoking did not vary by educational level among Hispanic and White cigar-ever-smokers. Black cigar-ever-smokers with ≥bachelor's degree initiated cigar smoking at older ages than their White counterparts. CONCLUSIONS Black individuals experienced widening education-related disparities, and Hispanic individuals had no progress in delaying age of initiating cigar smoking. Regulatory action banning cigar flavors may impact these trends.
Collapse
Affiliation(s)
- Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities Bethesda, Maryland.
| | | | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, New Jersey; School of Public Health, Rutgers University, Piscataway, New Jersey
| | - Jeff Niederdeppe
- Jeb E. Brooks School of Public Policy, Cornell University, Ithaca, New York; Department of Communication, College of Agriculture and Life Sciences, Cornell University, Ithaca, New York
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities Bethesda, Maryland
| |
Collapse
|
12
|
Vassey J, Donaldson S, Dormanesh A, Allem JP. THEMES IN TIKTOK VIDEOS FEATURING LITTLE CIGARS AND CIGARILLOS: A CONTENT ANALYSIS (Preprint). J Med Internet Res 2022; 24:e42441. [DOI: 10.2196/42441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 10/26/2022] [Accepted: 11/01/2022] [Indexed: 11/05/2022] Open
|
13
|
The Impact of Influencers on Cigar Promotions: A Content Analysis of Large Cigar and Swisher Sweets Videos on TikTok. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19127064. [PMID: 35742315 PMCID: PMC9222503 DOI: 10.3390/ijerph19127064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 02/04/2023]
Abstract
Little is known about the content, promotions, and individuals in cigar-related videos on TikTok. TikTok videos with large cigar and Swisher Sweets-related hashtags between July 2016 and September 2020 were analyzed. Follower count was used to identify influencers. We compared content characteristics and demographics of featured individuals between cigar types, and by influencer status. We also examined the association between content characteristics and video engagement. Compared to large cigar videos, Swisher Sweets videos were more likely to feature arts and crafts with cigar packages, cannabis use, and flavored products. In addition, Swisher Sweets videos were also more likely to feature females, Black individuals, and younger individuals. Both Swisher Sweets and large cigar influencers posted more videos of cigar purchasing behaviors than non-influencers, which was associated with more video views. None of the videos disclosed sponsorship with #ad or #sponsored. Videos containing the use of cigar packages for arts and crafts, and flavored products highlight the importance of colorful packaging and flavors in the appeal of Swisher Sweets cigars, lending support for plain packaging requirements and the prohibition of flavors in cigar products to decrease the appeal of cigars. The presence and broad reach of cigar promotions on TikTok requires stricter enforcement of anti-tobacco promotion policies.
Collapse
|
14
|
Glasser AM, Nemeth JM, Quisenberry AJ, Shoben AB, Trapl ES, Klein EG. Cigarillo Flavor and Motivation to Quit among Co-Users of Cigarillos and Cannabis: A Structural Equation Modeling Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5727. [PMID: 35565122 PMCID: PMC9101063 DOI: 10.3390/ijerph19095727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 11/16/2022]
Abstract
Flavored cigar restrictions have the potential to benefit public health. Flavor availability facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis, an increasingly prevalent behavior among young adults. Data were collected (2020-2021) in a cross-sectional online survey administered to a convenience sample of young adults who smoked cigarillos from 15 areas with high cigar use prevalence. We assessed the relationship between flavored cigarillo use and motivation to quit cannabis and cigarillo use among past 30-day co-users (N = 218), as well as several covariates (e.g., cigarillo price and flavor/cannabis policy). Flavored cigarillo perceived appeal and harm were hypothesized parallel mediators. Most co-users reported usually using flavored cigarillos (79.5%), which was not significantly associated with motivation to quit cigarillos or cannabis. Perceived cigarillo harm (β = 0.17, 95% CI = 0.00, 0.33), advertising exposure (β = 0.12, 95% CI = 0.00, 0.24), and income (among racial/ethnic minorities; β = -0.13, 95% CI = -0.25, -0.02) were significant predictors of motivation to quit cigarillos. There were no significant predictors of motivation to quit cannabis. Cigarillo flavor was not associated with motivation to quit, so findings could suggest that banning flavors in cigars may have a neutral impact on co-use with cannabis among young adults.
Collapse
Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY 14263, USA;
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH 43210, USA;
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
| | - Elizabeth G. Klein
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, OH 43210, USA; (J.M.N.); (E.G.K.)
| |
Collapse
|
15
|
Broun A, Phan L, Duarte DA, Ajith A, Jewett B, Mead-Morse EL, Choi K, Chen-Sankey J. Physical and Sociocultural Community-Level Influences on Cigar Smoking among Black Young Adults: An In-Depth Interview Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4430. [PMID: 35457307 PMCID: PMC9025611 DOI: 10.3390/ijerph19084430] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/04/2022] [Accepted: 04/06/2022] [Indexed: 01/22/2023]
Abstract
Black young adults experience disparately high rates of cigar use and its health consequences. Little research has explored community-level influences on cigar smoking in this population, especially concerning product-specific influences and cigar smokers' perceptions. We conducted in-depth interviews with 40 Black young adult (ages 21-29) cigar smokers in the Washington, D.C. area and analyzed themes regarding physical and sociocultural community-level factors perceived to influence cigar use. Themes were further analyzed based on participants' predominant cigar products (cigarillos, large cigars, blunts). Participants reported easy access to affordable cigarillos, widespread cigarillo sales and targeted marketing, norms of cigar and blunt smoking for stress relief, socialization, and cultural participation, and ubiquitous cigar and blunt smoking cues, all of which promoted cigar use in their communities. Future research should further explore how community-level influences contribute to disproportionate cigar use among Black young adults. Our findings suggest that programs and policies addressing physical and sociocultural community-level pro-smoking influences may help mitigate cigar smoking disparities.
Collapse
Affiliation(s)
- Aaron Broun
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (A.B.); (D.A.D.)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (L.P.); (B.J.); (K.C.)
| | - Danielle A. Duarte
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA; (A.B.); (D.A.D.)
| | - Aniruddh Ajith
- School of Medicine, University of Pittsburgh, Pittsburgh, PA 15201, USA;
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (L.P.); (B.J.); (K.C.)
| | - Erin L. Mead-Morse
- School of Medicine, University of Connecticut, Farmington, CT 06032, USA;
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (L.P.); (B.J.); (K.C.)
| | - Julia Chen-Sankey
- Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, New Brunswick, NJ 08901, USA
| |
Collapse
|
16
|
Gratale SK, Teotia A, Chen-Sankey J, Ganz O, Delnevo CD, Strasser AA, Wackowski OA. Cigar Warning Noticing and Demographic and Usage Correlates: Analysis from the United States Population Assessment of Tobacco and Health Study, Wave 5. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:3221. [PMID: 35328908 PMCID: PMC8952384 DOI: 10.3390/ijerph19063221] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/03/2022] [Accepted: 03/05/2022] [Indexed: 12/10/2022]
Abstract
Although cigars pose health risks similar to cigarettes, their packaging/marketing is not subject to commensurate regulation in the US. In a 2000 agreement with the Federal Trade Commission, seven major manufacturers agreed to use some form of cigar warning. In 2016, the Food and Drug Administration passed a rule requiring larger standardized warnings, but the requirement was successfully challenged in court. Here, we examined U.S. population-level trends in noticing existing cigarillo, traditional and filtered cigar warnings. We analyzed Wave 5 Population Assessment of Tobacco and Health adult data to assess prevalence of past-30 day warning noticing and associations with socio-demographic and tobacco use variables. Noticing was higher among current users of cigarillos (27%), filtered (34%) and traditional cigars (21%), than non-users (8% for each product, p < 0.0001), and among every-day vs. some-day users, established vs. experimental users, and past-30 day users vs. those without past-30 day use. Results varied by product, but generally indicated lower noticing among non-Hispanic Whites and dual cigarette users, but higher noticing among those purchasing cigars by the box/pack (vs. not purchasing for themselves). Low overall noticing but higher prevalence among frequent users underscores a need for a stronger, uniform cigar warning label policy in the US.
Collapse
Affiliation(s)
- Stefanie K. Gratale
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
| | - Arjun Teotia
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
| | - Julia Chen-Sankey
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Cristine D. Delnevo
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| | - Andrew A. Strasser
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA;
| | - Olivia A. Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Rutgers University, New Brunswick, NJ 08901, USA; (A.T.); (J.C.-S.); (O.G.); (C.D.D.); (O.A.W.)
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, Rutgers University, Piscataway, NJ 08854, USA
| |
Collapse
|
17
|
Phan L, McNeel TS, Choi K. Prevalence of current large cigar versus little cigar/cigarillo smoking among U.S. adults, 2018-2019. Prev Med Rep 2022; 24:101534. [PMID: 34976610 PMCID: PMC8683982 DOI: 10.1016/j.pmedr.2021.101534] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 08/19/2021] [Accepted: 08/22/2021] [Indexed: 11/29/2022] Open
Abstract
Prevalence of cigar use varied by type, age, and race/ethnicity in the U.S. Current large cigar smoking was more prevalent among non-Hispanic White adults. Little cigar/cigarillo (LCC) smoking was more common in non-Hispanic Black adults. LCC smoking varied significantly depending on both age and race/ethnicity. LCC smoking was most prevalent among non-Hispanic Black young adults (18–30 years).
Cigar smoking is increasing among non-Hispanic Black adults in the U.S. However, the prevalence of large and little cigar/cigarillo (LCC) smoking varying jointly by age and race/ethnicity has not been reported. We analyzed data from the 2018–2019 Tobacco Use Supplement to the Current Population Survey (n = 134,900) to fill this knowledge gap. Participants reported the type of cigar they used most often in the past 30 days (either large cigars, little cigars, or cigarillos). We estimated the prevalence of current large cigar and LCC smoking by sociodemographic characteristics. We then examined sociodemographic correlates of large cigar and LCC smoking in comparison to non-cigar smoking using a multivariable multinomial logistic regression model, and sociodemographic correlates of LCC smoking compared to large cigar smoking using a multivariable logistic regression model. Age*race/ethnicity interaction on cigar smoking was tested. Age-stratified multivariable multinomial logistic regression and logistic regression models were used to examine associations between race/ethnicity and large cigar and LCC smoking by age, adjusting for other sociodemographic variables. Overall, 1.1% and 0.8% of U.S. adults currently smoked large cigars and LCCs, with younger adults more likely to smoke both types of cigars and non-Hispanic Black adults more likely than non-Hispanic White adults to smoke LCCs. Prevalence of currently smoking LCCs varied greatly by age and race/ethnicity, with the highest prevalence of current LCC smoking being among 18–30 year-old non-Hispanic Black adults. Cigar smoking prevention and cessation efforts should prioritize non-Hispanic Black young adults who are most at risk for cigar smoking health effects.
Collapse
Affiliation(s)
- Lilianna Phan
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, Bethesda, MD 20892, USA
| | - Timothy S McNeel
- Information Management Services, Inc., 3901 Calverton Blvd., MD 20705, USA
| | - Kelvin Choi
- National Institute on Minority Health and Health Disparities Division of Intramural Research, 9000 Rockville Pike, Bethesda, MD 20892, USA
| |
Collapse
|
18
|
Awareness, use and perceptions of cigarillos, heated tobacco products and nicotine pouches: A survey among Dutch adolescents and adults. Drug Alcohol Depend 2021; 229:109136. [PMID: 34763136 DOI: 10.1016/j.drugalcdep.2021.109136] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Many tobacco and related products (TRPs) are less strictly regulated and marketed as less harmful than cigarettes. Little is known about their awareness, use, user profile, use behavior, reasons for use and risk perception, especially for the newest products. In an exploratory survey study among Dutch adolescents and adults, we have investigated three examples of non-cigarette TRPs available on the worldwide market. METHODS In a two-step web-based design, data on cigarillos, heated tobacco products (HTPs) and nicotine pouches were collected. In the first step (N = 5805), a representative sample (≥13 years) was studied to quantify their awareness, ever and current use in the Dutch population. In the second step (N = 526), in-depth data regarding use behavior, reasons for use and risk perception were collected among users and non-users. RESULTS Awareness (<50%) and use (<15% ever use and <2% current use) is relatively low for all three products, but overall higher among men, (e-)cigarette users and respondents with higher education and social economic status. Most participants became aware of the products through people they knew. Reasons for use were mainly curiosity, pleasant taste, flavour variety, and lower harmfulness. All products were perceived as (slightly) less harmful and addictive than cigarettes. CONCLUSIONS This study is one of the first to investigate awareness and use of cigarillos, HTPs and nicotine pouches. To prevent increased use, we recommend regulators to extend flavour and smoking bans to these products. In addition, public information may discourage use by increasing awareness of health risks.
Collapse
|
19
|
Holmes LM, McQuoid J, Shah A, Cruz T, Akom A, Ling PM. Piloting a spatial mixed method for understanding neighborhood tobacco use disparities. Soc Sci Med 2021; 291:114460. [PMID: 34655940 PMCID: PMC8671214 DOI: 10.1016/j.socscimed.2021.114460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 08/21/2021] [Accepted: 10/05/2021] [Indexed: 11/18/2022]
Abstract
The tobacco retail environment is where most advertising dollars are spent. However, most research on the retail environment has not methodologically situated tobacco retailers as part of a larger community, and few studies have incorporated community member perspectives of their own tobacco use in relation to their local environments. The purpose of this study is to describe and evaluate a multilevel, multimodal, mixed methods approach for understanding tobacco use in context. We combine quantitative data collected from tobacco retailer audits and geographically-explicit interviews with neighborhood residents to tell a more complete story of tobacco use behavior among adults in San Francisco's Marina district, and the Oakland Coliseum neighborhood in Alameda County, California. We find that while area-level and retail data provide a broad snapshot of two distinct communities with respect to sociodemographic characteristics and tobacco availability, interviews with community residents who use tobacco add important perspectives regarding how tobacco retailers are viewed and how residents interact with their neighborhood landscapes on a daily basis. The method we describe and critique has the potential to be scaled to incorporate a broader set of geographies, or tailored to address a multitude of health-related questions. Our approach further demonstrates the utility of including geolocated participant narratives as a means of understanding where researcher interpretations of urban environments diverge from those of community residents.
Collapse
Affiliation(s)
- Louisa M Holmes
- Departments of Geography and Demography, And the Social Science Research Institute, Pennsylvania State University, 302 Walker Building, University Park, PA, 16802, USA.
| | - Julia McQuoid
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, 655 Research Parkway, OK, 73104, USA
| | - Aekta Shah
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Tessa Cruz
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Antwi Akom
- Streetwyze, 1330 Broadway Suite 300, Oakland, CA 94612 & USA and Social Innovation and Urban Opportunity Lab, UCSF & San Francisco State University, 1600 Holloway Ave, San Francisco, CA, 94132, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, 530 Parnassus Avenue, Suite 366 Library, San Francisco, CA, 94143-1390, USA
| |
Collapse
|
20
|
Timberlake DS, Rhee J, Silver LD, Padon AA, Vos RO, Unger JB, Andersen-Rodgers E. Impact of California's tobacco and cannabis policies on the retail availability of little cigars/cigarillos and blunt wraps. Drug Alcohol Depend 2021; 228:109064. [PMID: 34600261 DOI: 10.1016/j.drugalcdep.2021.109064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Recent changes in California's tobacco and cannabis policies could impact the retail availability of little cigars/cigarillos (LCCs) and blunt wraps that are used for blunt smoking. This study was intended to test whether tobacco flavor bans and minimum pack sizes of LCCs have reduced tobacco availability in California jurisdictions, whereas, permissive policies on sales and marketing of cannabis increased availability. METHODS Measures of retail availability of LCCs and blunt wraps were obtained from the 2016-2019 longitudinal sample of licensed tobacco retailers (LTRs, n = 4062) from California's Healthy Stores for Healthy Communities campaign. Additional data sources included the California Cannabis Local Laws database and geographic location of 1063 cannabis retailers used for constructing a spatial index of accessibility to the LTRs. Two-level generalized structural equation models were developed to assess effects of store- and jurisdiction-level predictors of change in tobacco availability (+, -, no change). RESULTS Neither permissive cannabis policies nor accessibility to cannabis retailers were associated with an increase in retail availability of the tobacco products. Enactment of a tobacco flavor ban, however, was associated with reduced availability of LCCs and blunt wraps, which was more pronounced in jurisdictions that had permissive cannabis policies (i.e. policy interaction). CONCLUSIONS A tobacco flavor ban may be an effective strategy to reduce retail availability of LCCs, blunt wraps and possibly other tobacco in California jurisdictions. This finding is of particular relevance as the tobacco industry has successfully petitioned for a referendum vote on California's statewide flavor ban in the 2022 election.
Collapse
Affiliation(s)
- David S Timberlake
- Program in Public Health, College of Health Sciences, University of California, Irvine, Anteater Instruction & Research Building, Irvine, CA 92697, United States.
| | - Joshua Rhee
- Program in Public Health, College of Health Sciences, University of California, Irvine, Anteater Instruction & Research Building, Irvine, CA 92697, United States
| | | | | | - Robert O Vos
- Spatial Sciences Institute, University of Southern California, Los Angeles, CA, United States
| | - Jennifer B Unger
- Preventive Medicine, University of Southern California, Los Angeles, CA, United States
| | | |
Collapse
|
21
|
Rose SW, Anesetti-Rothermel A, Westneat S, van de Venne J, Folger S, Rahman B, Azam T, Zhou Y, Debnam C, Ribisl K, Cohn AM. Inequitable distribution of FTP marketing by neighborhood characteristics: further evidence for targeted marketing. Nicotine Tob Res 2021; 24:484-492. [PMID: 34687204 PMCID: PMC8887586 DOI: 10.1093/ntr/ntab222] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 10/19/2021] [Indexed: 12/18/2022]
Abstract
Introduction Flavored tobacco products (FTPs) are disproportionately used among young people and racial/ethnic minority populations. However, few studies have examined the retail distribution of such product marketing beyond menthol cigarettes. This study created geographic-based predictions about marketing of FTPs (overall, cigarettes, cigars, e-cigarettes, and smokeless) in stores across Washington, DC neighborhoods. We examined neighborhood-level demographic correlates of the amount of FTP and non-FTP marketing. Methods We conducted photographic audits of interior and exterior tobacco marketing in 96 Washington, DC tobacco retailers visited by 149 young adult respondents between 2018–2019. We created a geographic predictive surface of overall and product-specific tobacco marketing and then estimated the average predicted amount of marketing at the census-tract level using zonal statistics. Using linear regression, we examined neighborhood demographic correlates (race/ethnicity, family poverty, and youth population under 18) of FTP and non-FTP marketing. Results The predicted amount of non-FTP ads/displays were evenly distributed with no neighborhood variability (Range 8.46–8.46). FTP marketing overall was geographically concentrated with greater range across neighborhoods (Range 6.27–16.77). Greater FTP marketing overall and flavored cigar marketing was available in neighborhoods with higher percentages of Black residents. Flavored cigar marketing was less available in neighborhoods with more Hispanic residents, but there was greater flavored smokeless tobacco marketing. Nonflavored marketing overall and by product did not vary across neighborhoods. Conclusions This study provides evidence of disproportionate distribution of FTP marketing in Black neighborhoods, especially for flavored cigars, at the point-of-sale. Policies that restrict the sale of FTPs may enhance health equity. Implications Tobacco marketing has frequently been shown to be more prevalent in neighborhoods with lower household income and more Black residents. Using geographic-based predictions, we find that greater flavored tobacco marketing in these neighborhoods, not decreased marketing for nonflavored tobacco, is driving this disparity. Targeting Black neighborhoods with increased marketing of flavored tobacco products, which has been found to be more appealing, easier to use, and harder to quit is a social justice issue.
Collapse
Affiliation(s)
- Shyanika W Rose
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY.,Markey Cancer Center, Lexington, KY
| | - Andrew Anesetti-Rothermel
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY.,Center for Tobacco Products, US Food and Drug Administration, Silver Spring, MD, USA
| | - Susan Westneat
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY
| | - Judy van de Venne
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY
| | | | - Basmah Rahman
- Truth Initiative Schroeder Institute, Washington, DC
| | - Tofial Azam
- University of Kentucky College of Medicine Department of Behavioral Science and Center for Health Equity Transformation, Lexington, KY.,University of Kentucky, College of Public Health, Department of Biostatistics, Lexington, KY
| | - Yitong Zhou
- Truth Initiative Schroeder Institute, Washington, DC
| | | | - Kurt Ribisl
- University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Department of Health Behavior, Chapel Hill, NC
| | - Amy M Cohn
- University of Oklahoma Health Sciences Center, TSET Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK.,Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences, Oklahoma City, OK
| |
Collapse
|
22
|
Ajith A, Broun A, Duarte DA, Jewett B, Phan L, Mead-Morse EL, Guy MC, Choi K, Chen-Sankey J. Cigar-Smoking-Cessation Interest and Experience among Black Young Adults: A Semi-Structured In-Depth Interview Investigation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7309. [PMID: 34299759 PMCID: PMC8307651 DOI: 10.3390/ijerph18147309] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/02/2021] [Accepted: 07/06/2021] [Indexed: 12/21/2022]
Abstract
Although Black/African American populations have high cigar-smoking prevalence, little is known about cigar-smoking cessation among this group. This study explored the perceptions and experiences of cigar-smoking cessation and assistance received from healthcare providers among forty Black young-adult cigar smokers (ages 21-29). Semi-structured in-depth phone interviews were transcribed and coded. Qualitative data were analyzed by using thematic analysis. Participants mostly smoked cigarillos, large cigars, and blunts. Overall, many regular cigarillo smokers reported interest in quitting eventually, while large-cigar and blunt smokers shared less interest in quitting because they perceived low harm from smoking these products. The reasons for cigar-smoking cessation were health concerns and financial constraints. Most of the participants who attempted to quit cigars did not use any cessation aids. The reasons for relapse included nicotine withdrawal, stress, and easy access. Additionally, most participants reported their healthcare providers did not ask whether they smoked cigars, and even when they knew, little assistance for cigar-smoking cessation was provided. Informing Black cigar smokers of the harm of cigar smoking and encouraging healthcare providers to screen for and assist with cigar-smoking cessation may alleviate the health burden of cigar smoking in this population.
Collapse
Affiliation(s)
- Aniruddh Ajith
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Aaron Broun
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Danielle A. Duarte
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Bambi Jewett
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Lilianna Phan
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Erin L. Mead-Morse
- School of Medicine, University of Connecticut, Farmington, CT 06032, USA;
| | - Mignonne C. Guy
- Department of African American Studies, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, VA 23220, USA;
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| | - Julia Chen-Sankey
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD 20814, USA; (A.A.); (A.B.); (D.A.D.); (B.J.); (L.P.); (K.C.)
| |
Collapse
|
23
|
Abstract
Objectives Past research has not examined secondhand and thirdhand smoke (THS) exposure in children of cigar smokers. We examined hand nicotine and cotinine levels in children of cigar smokers to explore the contribution of cigar smoke to tobacco smoke exposure (TSE). Methods Participants were children (N = 24; mean (SD) age = 6.5 (3.6) years) whose parents smoked cigars only or poly-used cigars and/or cigarettes. Primary outcomes were hand nicotine and urinary cotinine levels. Results All children had detectable hand nicotine (range: 7.6-312.5ng/wipe) and cotinine (range: 0.3-100.3ng/ml). Positive correlations were found between hand nicotine and cotinine (r = 0.693, p = .001), hand nicotine and parents who also smoked cigarettes (r = 0.407, p = .048), and hand nicotine and number of smokers around the child (r = 0.436, p = .03). Hand nicotine (r = -0.464, p = .02), but not cotinine (r = -0.266, p = .26), was negatively correlated with child age. Multiple regression results indicated a positive association between hand nicotine and cotinine (p = .002; semi-partial r2 = 0.415), irrespective of child age. Conclusions The significant association of hand nicotine with urinary cotinine suggests that THS pollution should be assessed in evaluating children's overall TSE to cigars and other tobacco products, and hand nicotine may be a proxy for overall TSE. Younger children may have increased THS pollutant uptake.
Collapse
|
24
|
Zhu Y, Pasch KE, Loukas A, Sterling KL, Perry CL. Exposure to cigar Point-of-Sale marketing and use of cigars and cigarettes among young adults. Addict Behav 2021; 116:106821. [PMID: 33482429 DOI: 10.1016/j.addbeh.2021.106821] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/16/2020] [Accepted: 01/05/2021] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Few 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. METHOD Data 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. RESULTS Participants 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). CONCLUSION Findings 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.
Collapse
Affiliation(s)
- Yenan Zhu
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto D3700, Austin, TX 78712, USA
| | - Keryn E Pasch
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto D3700, Austin, TX 78712, USA.
| | - Alexandra Loukas
- Department of Kinesiology and Health Education, The University of Texas at Austin, 2109 San Jacinto D3700, Austin, TX 78712, USA
| | - Kimberle L Sterling
- School of Public Health, The University of Texas Health Science Center at Houston Dallas Campus, 6011 Harry Hines Blvd V8.112, Dallas, TX 75235, USA
| | - Cheryl L Perry
- School of Public Health, The University of Texas Health Science Center at Houston Austin Campus 1616 Guadalupe Street, Suite 6.300, Austin, TX 78701, USA
| |
Collapse
|
25
|
Handayani S, Rachmani E, Saptorini KK, Manglapy YM, Nurjanah, Ahsan A, Kusuma D. Is Youth Smoking Related to the Density and Proximity of Outdoor Tobacco Advertising Near Schools? Evidence from Indonesia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2556. [PMID: 33806511 PMCID: PMC7967388 DOI: 10.3390/ijerph18052556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Smoking was among the top contributors to deaths and disability as the prevalence among male adults remains high, and that among male youth increases in Indonesia. While local studies have shown high visibility of outdoor tobacco advertising around schools, the country still has no outdoor tobacco advertising ban. OBJECTIVE To examine the association between youth smoking behavior and measures of outdoor tobacco advertising density and proximity in Indonesia. METHODS We combined two primary data sources, including outdoor tobacco advertising and smoking behavior among male youth in Semarang city. We randomly selected and interviewed 400 male students at 20 high schools in the city. In addition, we interviewed 492 male adults who lived near the schools for comparison. RESULTS We found significant associations between smoking use among youth (but not among adults) and measures of outdoor tobacco advertising density and proximity in Semarang city. Youth at schools with medium and high density of outdoor tobacco advertising were up to 2.16 times more likely to smoke, compared to those with low density. Similarly, youth at senior high schools with proximity to outdoor tobacco advertising were 2.8 times more likely to smoke. Also, young people at poorer-neighborhood schools with a higher density of and proximity to outdoor tobacco advertising were up to 5.16 times more likely to smoke. CONCLUSIONS There were significant associations between smoking use among male youth (but not among male adults) and measures of outdoor tobacco advertising density and proximity in Indonesia. This highlights the need to introduce an outdoor tobacco advertising ban effectively, at least near schools.
Collapse
Affiliation(s)
- Sri Handayani
- Public Health Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (S.H.); (Y.M.M.); (N.)
| | - Enny Rachmani
- Health Information Management Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (E.R.); (K.K.S.)
| | - Kriswiharsi Kun Saptorini
- Health Information Management Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (E.R.); (K.K.S.)
| | - Yusthin Merianti Manglapy
- Public Health Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (S.H.); (Y.M.M.); (N.)
| | - Nurjanah
- Public Health Program, Faculty of Health Sciences, Universitas Dian Nuswantoro, Semarang 50131, Indonesia; (S.H.); (Y.M.M.); (N.)
| | - Abdillah Ahsan
- Faculty of Economics and Business, University of Indonesia, Depok 16424, Indonesia;
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London SW7 2AZ, UK
| |
Collapse
|
26
|
Kim S, Mourali A, Allem JP, Unger JB, Boley Cruz T, Smiley SL. Instagram Posts Related to Backwoods Cigarillo Blunts: Content Analysis. JMIR Public Health Surveill 2021; 7:e22946. [PMID: 33560242 PMCID: PMC7902186 DOI: 10.2196/22946] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 11/27/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022] Open
Abstract
Background Instagram, one of the most popular social media platforms among youth, offers a unique opportunity to examine blunts—partially or fully hollowed-out large cigars, little cigars, and cigarillos that are filled with marijuana. Cigarillo brands like Backwoods (Imperial Tobacco Group Brands LLC) have product features that facilitate blunt making, including a variety of brand-specific flavors that enhance the smoking experience (eg, honey, dark stout). Backwoods has an active online presence with a user-friendly website. Objective This study examined the extent to which Backwoods cigarillo–related posts on Instagram showed blunt making. Instagram offers a unique opportunity to examine blunt making as Instagram accounts will contain images reflective of behavior occurring without the prime of a researcher. Methods Data consisted of publicly available Instagram posts with the hashtag #backwoods collected from August 30 to September 12, 2018. Inclusion criteria for this study included an Instagram post with the hashtag “#backwoods”. Rules were established to content analyze posts. Categories included Type of post (ie, photo, video, or both); Blunt-related hashtags (ie, the corresponding post caption contained one or more hashtags like #blunts, #cannabis, and #weed that were identified in previous social media research); Rolling blunts (ie, the post contained an image of one or more individuals rolling a Backwoods cigarillo visibly containing marijuana); and Smoking blunts (ie, the post contained an image of one or more individuals blowing smoke or holding a lit blunt). We coded images for Product flavor reference, where a code of 1 showed a Backwoods cigarillo pack with a brand-specific flavor (eg, honey, dark stout, Russian crème) visible in the blunt-related image, and a code of 0 indicated that it was not visible anywhere in the image. Results Among all posts (N=1206), 871 (72.2%) were coded as Blunt-related hashtags. A total of 125 (10.4%) images were coded as Smoking blunts, and 25 (2.1%) were coded as Rolling blunts (ie, Backwoods cigarillo explicitly used to roll blunts). Among blunt images, 434 of 836 (51.9%) were coded as Product flavor (ie, a Backwoods pack with a brand-specific flavor was visible). Conclusions Most Backwoods cigarillo–related Instagram images were blunt-related, and these blunt-related images showed Backwoods packages indicating flavor preference. Continued monitoring and surveillance of blunt-related posts on Instagram is needed to inform policies and interventions that reduce the risk that youth may experiment with blunts. Specific policies could include restrictions on product features (eg, flavors, perforated lines, attractive resealable foil pouches, sale as singles) that facilitate blunt making.
Collapse
Affiliation(s)
- Stephanie Kim
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Alia Mourali
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jon-Patrick Allem
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Jennifer B Unger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Tess Boley Cruz
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Sabrina L Smiley
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| |
Collapse
|
27
|
Montgomery L, Plano Clark VL, Twitty D, Budney AJ, Prochaska JJ, Winhusen T. Is it "loud" enough?: A qualitative investigation of blunt use among African American young adults. J Ethn Subst Abuse 2020; 21:747-761. [PMID: 32744476 DOI: 10.1080/15332640.2020.1801548] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Heavy blunt use is common among young adult cannabis users, especially African Americans. This exploratory qualitative study aimed to examine how African American young adults understand, talk about and experience their blunt use. Semi-structured interviews were conducted with adults reporting daily or almost daily blunt use in the past month (N = 20; 75% male). Thematic analysis of the audio-recorded interviews revealed aspects of how blunts are described, made and used among heavy blunt users. The three emergent themes have implications for the assessment of cannabis use and intervention development for heavy blunt users.
Collapse
Affiliation(s)
| | | | - Dylanne Twitty
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | | | | | | |
Collapse
|
28
|
Smiley SL, Kim S, Mourali A, Allem JP, Unger JB, Boley Cruz T. Characterizing #Backwoods on Instagram: "The Number One Selling All Natural Cigar". INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4584. [PMID: 32630567 PMCID: PMC7345638 DOI: 10.3390/ijerph17124584] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/29/2020] [Accepted: 06/06/2020] [Indexed: 11/30/2022]
Abstract
We sought to assess the proportion of Backwoods (Imperial Tobacco Group Brands LLC) cigar-related posts to Instagram that may contain misleading claims, nature-evoking imagery, and appealing flavors. Inclusion criteria for this study included an Instagram post with the hashtag "#backwoods" from 30 August to 12 September 2018. Rules were established to content analyze (n = 1206) posts. Categories included misleading packaging (i.e., the post contained an image of a Backwoods product with the descriptor "natural" on the packaging), misleading promo (i.e., the corresponding caption to the post contained hashtag(s) like "#natural", "#authentic", "#alwaystrue"), nature-evoking imagery (i.e., the post contained images of grass, water, and pastural views along with a Backwoods product), flavors (i.e., the post contained a Backwoods product with brand-specific flavors on the packaging), flavor promo (i.e., the corresponding caption to the post contained hashtag(s) of Backwoods' brand-specific flavors), marijuana-related (i.e., the post contained an image of marijuana next to a Backwoods pack, rolled cigars visibly contained marijuana, or hollowed-out cigars next to marijuana), smoking (the post contained an image of smoke or a lit cigar), brand-specific promo (i.e., the post contained an image of a Backwoods t-shirt, sweatshirt, hat, etc.), and perceived gender. Among the posts analyzed, 645 (53.5%) were marijuana-related, 564 (46.8%) were flavors, 463 (38.4%) were misleading packaging, 335 (27.8%) were flavor promo, 309 (25.6%) were misleading promo, 188 (15.6%) were nature-evoking imagery, 165 (13.7%) were smoking, 157 (13.0%) were brand-specific promo, and 239 (19.8%) were perceived male gender. Backwoods cigar-related posts to Instagram often contained misleading images and promotions of a "natural" tobacco product, images of marijuana use (in the form of blunt-making), brand-specific flavors, smoking, and promotional merchandise. Misleading images and the depictions of marijuana use in addition to the variety of flavor options may increase product appeal to consumers. These results underscore the need for comprehensive regulation of cigar products similar to cigarettes.
Collapse
Affiliation(s)
- Sabrina L. Smiley
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90032-3628, USA; (S.K.); (A.M.); (J.-P.A.); (J.B.U.); (T.B.C.)
| | | | | | | | | | | |
Collapse
|