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Pike Moore S, Osborn C, Suratkal J, Vasu P, Koopman Gonzalez S, Trapl E. What Is (Un)Flavored? A Scoping Review of the Conceptualization of Flavored Cigarillos. Nicotine Tob Res 2024; 26:1120-1131. [PMID: 38401171 PMCID: PMC11339174 DOI: 10.1093/ntr/ntae039] [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: 08/23/2023] [Revised: 02/12/2024] [Accepted: 02/19/2024] [Indexed: 02/26/2024]
Abstract
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.
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Affiliation(s)
- Stephanie Pike Moore
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Catherine Osborn
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Jessica Suratkal
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Pranav Vasu
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Sarah Koopman Gonzalez
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
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Simuzingili M, Hoetger C, Garner W, Everhart RS, Hood KB, Nana-Sinkam P, Cobb CO, Barnes AJ. What influences demand for cigars among African American adult cigar smokers? Results from a hypothetical purchase task. Exp Clin Psychopharmacol 2022; 30:479-485. [PMID: 34110888 PMCID: PMC8660958 DOI: 10.1037/pha0000491] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
African Americans (AA) have historically been targeted by the tobacco industry and have the highest rates of current cigar use among racial/ethnic groups in the U.S. Yet, there is limited evidence on other factors influencing cigar use. Amongst a sample of 78 AA current cigar (any type) smokers, log-linear regression models examined correlates of cigar demand obtained from a validated behavioral economic purchase task. Mean intensity, or cigar demand when free, was 6.68 cigars (standard deviation [SD]: 8.17), while mean breakpoint, or the highest price a participant was willing to pay, was $4.62 (SD: 3.88). Mean maximum daily expenditure, Omax was $15.20 (SD: 25.73) and Pmax, the price at Omax was $5.25 (SD: 3.95). Participants aged 21 to 30 years compared to those aged 18 to 20 years, those with higher levels of dependence, and females compared to males, had a significantly higher intensity. Participants with cannabis use above the sample median in the last 30 days (4 + days) had significantly higher intensity and Omax than those below the median. Further, participants with a high school education or more had a significantly lower intensity, breakpoint, and Omax than those with less than high school education. Individuals with income below the federal poverty line (FPL) also had a significantly lower breakpoint and Omax than those above. Finally, tobacco harm perceptions were inversely associated with Pmax. Stricter policies on cigar products, such as higher taxes and product-specific harm messaging, may have an immediate and sustained impact on health disparities related to cigar use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
| | - Cosima Hoetger
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Psychology, Virginia Commonwealth University
| | - William Garner
- Department of Life and Health Sciences, University of North Texas at Dallas
| | | | | | | | - Caroline O. Cobb
- Center for the Study of Tobacco Products, Virginia Commonwealth University
- Department of Psychology, Virginia Commonwealth University
| | - Andrew J. Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University
- Center for the Study of Tobacco Products, Virginia Commonwealth University
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Impact of Little Cigars and Cigarillos Packaging Features on Product Preference. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111443. [PMID: 34769959 PMCID: PMC8583443 DOI: 10.3390/ijerph182111443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
Background: We conducted a discrete choice experiment (DCE) among young adult cigarette smokers in the period July–August 2018 to examine their preference for cigarillos in response to various packaging-related attributes, including flavor, flavor description, quality descriptors, pack size, and prices. Methods: A convenience sample of 566 US young adult cigarette smokers aged 18–34, among whom 296 were current little cigar and cigarillo (LCC) smokers, were recruited using Facebook ads and invited to participate in an online (Qualtrics) tobacco survey containing DCE and tobacco use questions. In the experiment, participants chose among two cigarillo products or “neither” (opt-out). Results: We analyzed preferences for LCCs using multinomial, nested, random parameter logit models. Results showed that young adult cigarette smokers preferred grape over menthol, tobacco/regular, and wine flavors; “color only” and “color and text” flavor depictions over text only; “smooth” and “sweet” quality descriptors over “satisfying”; and larger pack sizes and lower prices. Conclusions: Regulating packaging-related features will impact LCC choices among US young adult smokers. FDA regulation over these packaging-related features may impact LCC use among young adult smokers.
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Sutter ME, Everhart RS, Miadich S, Rudy AK, Nasim A, Cobb CO. Patterns and Profiles of Adolescent Tobacco Users: Results From the Virginia Youth Survey. Nicotine Tob Res 2019; 20:S39-S47. [PMID: 30125014 PMCID: PMC6093380 DOI: 10.1093/ntr/nty032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 02/26/2018] [Indexed: 11/13/2022]
Abstract
Background Cigarette smoking has decreased to a record low among youth across the United States, including in Virginia. Rates of alternative tobacco use, however, are rising and polytobacco use is common. A better understanding of the shifting use patterns and associated risk factors is important for informing tobacco prevention, cessation, and policy efforts. Methods Weighted data from the 2013 Virginia Youth Survey were used. The sample was limited to 1168 youth who reported past 30-day tobacco use of ≥1 product (cigarettes, smokeless tobacco [smokeless], or cigars/little cigars/cigarillos [cigars]). Latent class analysis categorized individuals based on current tobacco use frequency/intensity. Multivariable multinomial logistic regressions compared classes on demographics, other tobacco-related factors, other substance use, and health/psychosocial factors. Results The five-class model indicated the best fit with classes characterized as "Chippers" (28.0%; high probability of low-frequency/intensity cigarette use), "Moderate Poly-Users" (23.6%; low- to high-frequency/moderate intensity cigarette use; moderate probability smokeless/cigar use), "Cigar Users" (20.9%; no-low-probability cigarette/smokeless use; high-probability cigar use), "Smokeless Users" (17.3%; no-low-probability cigarette/cigar use; moderate-high-probability smokeless use), and "Heavy Poly-Users" (10.4%; daily/high-intensity cigarette use, moderate-high-probability smokeless/cigar use). Classes differed significantly by demographics and inconsistently by other tobacco-related factors. Heavy Poly-Users were more likely to engage in other substance use behaviors, report suicidal ideation, and report being bullied because of gender. Conclusions Classes identified indicate that a large proportion of youth engage in polytobacco use and certain subgroups may be at greater risk for negative health consequences due to elevated psychosocial and behavioral risk factors. Implications These findings suggest distinct patterns of current tobacco use, including a high proportion of youth engaging in polytobacco use. Heavy polytobacco use co-occurs with other health risk behaviors and may be attributed to psychosocial risk factors. Results underscore the need for detailed monitoring of shifting youth tobacco use patterns as well as targeted prevention, cessation, and policy efforts.
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Affiliation(s)
- Megan E Sutter
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL.,Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Robin S Everhart
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
| | - Samantha Miadich
- Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Department of Psychology, Arizona State University, Tempe, AZ
| | - Alyssa K Rudy
- Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
| | - Aashir Nasim
- Institute for Inclusion, Inquiry and Innovation, Virginia Commonwealth University, Richmond, VA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, VA.,Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, VA
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Antognoli E, Cavallo D, Trapl E, Step M, Koopman Gonzalez S, Perez R, Flocke S. Understanding Nicotine Dependence and Addiction Among Young Adults Who Smoke Cigarillos: A Qualitative Study. Nicotine Tob Res 2019; 20:377-382. [PMID: 28184877 DOI: 10.1093/ntr/ntx008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Accepted: 01/06/2017] [Indexed: 11/13/2022]
Abstract
Introduction Cigarillo use is increasing, particularly among young adults. Nicotine dependence (ND) is important for understanding smoking behavior and cessation, but the development of measures of ND has focused almost exclusively on cigarette smokers. We examined smoking patterns, preferences, and beliefs of cigarillo users to better understand their experience of addiction and expression of ND symptoms. Methods Using purposive sampling, we conducted in-depth interviews between June 2015 and January 2016 with 30 young adults aged 18-28 who reported smoking ≥1 cigarillo per week. Interviews were based on a semi-structured guide designed to capture participants' smoking levels and patterns as well as their experiences of smoking and addiction. Interviews were audio-recorded and transcribed. Analysis was guided by a phenomenological approach designed to identify emergent themes. Results Participants had a mean age of 23, with a majority being female (56%) and African American (80%). The median number of cigarillos smoked per week was 20; 70% also smoked cigarettes, and 43% also smoked marijuana blunts. Our analysis highlighted the complexity of measuring cigarillo use due to product manipulation, sharing, and multiple product use. Participants expressed a preference for smoking in a social group where cigarillos were shared, and not smoking an entire cigarillo at once when alone. Most cigarillo users did not consider themselves to be addicted. Conclusions Cigarillo users express unique smoking practices and beliefs that signify the need for a more product-inclusive measure of ND, and can inform the development of tobacco cessation interventions tailored to cigarillo users. Implications The increasing use of cigarillos among young adults has significant public health consequences. Addressing this issue requires accurate measurement and effective treatment of dependence on cigarillo products. The results of this study directly inform the development of a revised measure of ND, and can contribute to the efficacy of cessation interventions for cigarillo users.
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Affiliation(s)
- Elizabeth Antognoli
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland, OH
| | - Erika Trapl
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
| | - Mary Step
- Department of Social and Behavioral Sciences, College of Public Health, Kent State University, Kent, OH
| | - Sarah Koopman Gonzalez
- Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
| | - Rose Perez
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH
| | - Susan Flocke
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, OH.,Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland, OH
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Wall CS, Bono RS, Lester RC, Hoetger C, Lipato T, Guy MC, Eissenberg TE, Bickel WK, Barnes AJ, Cobb CO. Triangulating abuse liability assessment for flavoured cigar products using physiological, behavioural economic and subjective assessments: a within-subjects clinical laboratory protocol. BMJ Open 2018; 8:e023850. [PMID: 30309993 PMCID: PMC6252773 DOI: 10.1136/bmjopen-2018-023850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION In the USA, Food and Drug Administration regulations prohibit the sale of flavoured cigarettes, with menthol being the exception. However, the manufacture, advertisement and sale of flavoured cigar products are permitted. Such flavourings influence positive perceptions of tobacco products and are linked to increased use. Flavourings may mask the taste of tobacco and enhance smoke inhalation, influencing toxicant exposure and abuse liability among novice tobacco users. Using clinical laboratory methods, this study investigates how flavour availability affects measures of abuse liability in young adult cigarette smokers. The specific aims are to evaluate the effect of cigar flavours on nicotine exposure, and behavioural and subjective measures of abuse liability. METHODS AND ANALYSES Participants (projected n=25) are healthy smokers of five or more cigarettes per day over the past 3 months, 18-25 years old, naive to cigar use (lifetime use of 50 or fewer cigar products and no more than 10 cigars smoked in the past 30 days) and without a desire to quit cigarette smoking in the next 30 days. Participants complete five laboratory sessions in a Latin square design with either their own brand cigarette or a session-specific Black & Mild cigar differing in flavour (apple, cream, original and wine). Participants are single-blinded to cigar flavours. Each session consists of two 10-puff smoking bouts (30 s interpuff interval) separated by 1 hour. Primary outcomes include saliva nicotine concentration, behavioural economic task performance and response to various questionnaire items assessing subjective effects predictive of abuse liability. Differences in outcomes across own brand cigarette and flavoured cigar conditions will be tested using linear mixed models. ETHICS AND DISSEMINATION The Virginia Commonwealth University Institutional Review Board approved the study (VCU IRB: HM20007848). Dissemination channels for study findings include scientific journals, scientific meetings, and policy briefs. TRIAL REGISTRATION NUMBER NCT02937051.
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Affiliation(s)
- Catherine S Wall
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rose S Bono
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Rebecca C Lester
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Cosima Hoetger
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thokozeni Lipato
- Department of Internal Medicine, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Mignonne C Guy
- Department of African American Studies, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Thomas E Eissenberg
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Warren K Bickel
- Department of Psychology, Virginia Tech Carilion Research Institute, Roanoke, Virginia, USA
| | - Andrew J Barnes
- Department of Health Behavior and Policy, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Caroline O Cobb
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Center for the Study of Tobacco Products, Virginia Commonwealth University, Richmond, Virginia, USA
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Pickworth WB, Rosenberry ZR, Koszowski B. Toxicant exposure from smoking a little cigar: further support for product regulation. Tob Control 2016; 26:269-276. [DOI: 10.1136/tobaccocontrol-2015-052633] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 03/31/2016] [Indexed: 01/17/2023]
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