Patterns of cigarillo use among Canadian young adults in two urban settings

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

INTRODUCTION

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

AIMS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPLICATIONS

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

Young adults' cigarillo risk perceptions, attention to warning labels and perceptions of proposed pictorial warnings: a focus group study

OBJECTIVE

Although cigars pose similar health risks to cigarettes, they are not uniformly required to carry a warning label on their packaging in the USA. The US Food and Drug Administration's 2016 deeming rule established a cigar warning requirement, but it was challenged in federal court for failing to document warning effects on prevention/cessation, thus necessitating an evidentiary base for such requirements. We sought to explore young adult users' understanding of cigarillo risks and addictiveness, as well as their perceptions of current (voluntary) and proposed cigar warning labels.

DESIGN

In December 2020-January 2021, we conducted eight focus groups with young adult cigarillo smokers. We asked participants their first associations of cigarillos and beliefs about product harms/addictiveness, and then discussed existing warning labels and examples of potential pictorial warnings.

SETTING

Focus groups were conducted remotely via the Adobe Connect platform, with participants from 20 US states.

PARTICIPANTS

Participants included 42 young adults (ages 18-29; 50% male), who were recent cigarillo users (ie, past 30 days) or less frequent users (ie, past 12 months).

RESULTS

Participants frequently used cigarillos as blunts and often conveyed uncertainty about cigarillo risks and addictiveness, in general and relative to cigarettes. Participants typically paid little attention to current text warnings, but many expressed that pictorial warnings would more effectively promote knowledge of product risks and discourage use among prospective users.

CONCLUSIONS

US young adult cigarillo users may lack knowledge about product risks and addictiveness. Standardised warning requirements, particularly pictorial labels, may help address this knowledge gap and deter use.

Prevalence and characteristics of cigarillo smoking in Canada: results from the Canadian Tobacco Use Monitoring Survey

OBJECTIVES

Cigarillo smoking has been associated with many adverse outcomes; however, little is known about its use in Canada. The aim of this study was to assess the prevalence and characteristics of ever and the current use of cigarillo in Canada.

STUDY DESIGN

This study was a cross-sectional study.

METHODS

This study was a secondary data analysis of the 2012 cycle of the Canadian Tobacco Use Monitoring Survey collected by Statistics Canada, examining tobacco use among Canadians aged 15 years or older in all 10 provinces. The two main outcomes of the present study were 'ever use' and 'current use' of cigarillos. Covariates examined included the following: demographic factors, socio-economic factors, and smoking-related factors.

RESULTS

The overall prevalence of ever and current cigarillo smoking were 38.4% and 3.1%, respectively. Factors that had the highest association with cigarillo smoking included being a male and being young. Cigarette and marijuana use were also associated with increased use of cigarillo. Specifically, marijuana users were at two-fold increase of the current cigarillo smoking (odds ratio = 2.18, 95% confidence interval: 1.97-2.41).

CONCLUSIONS

This study highlights the importance of correcting public perception about cigarillos and directing government resources to prevent an increase in their use.

Marijuana use among adolescent multiple tobacco product users and unique risks of dual tobacco and marijuana use

BACKGROUND

Adolescence is a peak time for uptake of both tobacco and marijuana (dual use). This study aimed to identify clusters of lifetime tobacco and marijuana use patterns and associated risk factors, and to determine whether dual tobacco and marijuana use is uniquely associated with greater risk than use of either tobacco or marijuana alone.

METHOD

High school students participated in a survey during Fall 2014 (N = 976; 68% Hispanic; 57% parental education < high school). Items from national youth surveys were used to measure lifetime and current use of tobacco products, marijuana, alcohol, drug use, and other risk behaviors, and literature-based surveys were used to measure psychological constructs.

RESULTS

Latent Class Analysis identified three clusters of lifetime tobacco use patterns (no tobacco, one or two products, and more than two products), each with a correspondingly distinct profile of risk behaviors; risk escalated with use of more tobacco products. Multinomial modeling characterized personal, environmental, and behavioral correlates of dual lifetime tobacco and marijuana use, including lower parental monitoring, lower grades, higher guilt, higher lifetime alcohol and drug use, and more substance use by friends, in reference to single lifetime use of either tobacco or marijuana.

CONCLUSION

Broader use of tobacco (i.e., more products) was associated with numerous risk factors. Dual lifetime use of tobacco and marijuana was associated with numerous risks compared to single use of either tobacco or marijuana. Longitudinal work is needed to understand temporal relationships between risk variables to determine optimal timing for interventions to reduce harmful behaviors.

The effect of cigarillo packaging elements on young adult perceptions of product flavor, taste, smell, and appeal

Introduction

Product packaging has long been used by the tobacco industry to target consumers and manipulate product perceptions. This study examines the extent to which cigarillo packaging influences perceptions of product flavor, taste, smell, and appeal.

Methods

A web-based experiment was conducted among young adults. Participants viewed three randomly selected cigarillo packs, varying on pack flavor descriptor, color, type, branding, and warning—totaling 180 pack images. Mixed-effects models were used to estimate the effect of pack elements on product perceptions.

Results

A total of 2,664 current, ever, and never little cigar and cigarillo users participated. Cigarillo packs with a flavor descriptor were perceived as having a more favorable taste (β = 0.21, p < .001) and smell (β = 0.14, p < .001) compared to packs with no flavor descriptor. Compared to packs with no color, pink and purple packs were more likely to be perceived as containing a flavor (β = 0.11, p < .001), and were rated more favorably on taste (β = 0.17, p < .001), smell (β = 0.15, p < .001), and appeal (β = 0.16, p < .001). While warnings on packs decreased favorable perceptions of product taste (pictorial: β = -0.07, p = .03) and smell (text-only: β = -0.08, p = .01; pictorial: β = -0.09, p = .007), warnings did not moderate the effects of flavor descriptor or color.

Conclusions

To our knowledge, this study provides the first quantitative evidence that cigarillo packaging alters consumers’ cognitive responses, and warnings on packs do not suffice to overcome the effects of product packaging. The findings support efforts at federal, state, and local levels to prohibit flavor descriptors and their associated product flavoring in non-cigarette products such as cigarillos, along with new data that supports restrictions on flavor cues and colors.

Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review

Objective

This systematic review examines the impact of non-menthol flavours in tobacco products on tobacco use perceptions and behaviours among youth, young adults and adults.

Data sources

English-language peer-reviewed publications indexed in 4 databases were searched through April 2016.

Study selection

A search strategy was developed related to tobacco products and flavours. Of 1688 articles identified, we excluded articles that were not English-language, were not peer-reviewed, were qualitative, assessed menthol-flavoured tobacco products only and did not contain original data on outcomes that assessed the impact of flavours in tobacco products on perceptions and use behaviour.

Data extraction

Outcome measures were identified and tabulated. 2 researchers extracted the data independently and used a validated quality assessment tool to assess study quality.

Data synthesis

40 studies met the inclusion criteria. Data showed that tobacco product packaging with flavour descriptors tended to be rated as more appealing and as less harmful by tobacco users and non-users. Many tobacco product users, especially adolescents, reported experimenting, initiating and continuing to use flavoured products because of the taste and variety of the flavours. Users of many flavoured tobacco products also showed decreased likelihood of intentions to quit compared with non-flavoured tobacco product users.

Conclusions

Flavours in most tobacco products appear to play a key role in how users and non-users, especially youth, perceive, initiate, progress and continue using tobacco products. Banning non-menthol flavours from tobacco products may ultimately protect public health by reducing tobacco use, particularly among youth.

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

INTRODUCTION

In 2016, the Food and Drug Administration announced that it would regulate little cigars and cigarillos (LCCs) and expressed concern about the concomitant use of combustible tobacco products. To understand LCC use among socially-disadvantaged cigarette smokers, we assessed (1) the prevalence of concomitant use of subtypes of LCCs: LCC-tobacco, LCC-blunt, and LCC- poly use, which includes use of both LCC-tobacco and LCC-blunt and (2) and its association with sociodemographic factors and substance use behaviors using race/ethnicity and gender stratified models.

METHODS

In 2015, a web-based survey was administered to a national probability sample of black/African American, Hispanic/Latino, and white cigarette smokers aged 18-44 (n = 1018). Weighted estimates were used to assess current LCC-tobacco, LCC-blunt, and LCC-poly use. Multinomial regression models assessed sociodemographic, other tobacco and substance use correlates associated with LCC user subtypes.

RESULTS

Of cigarette smokers, 63% did not smoke LCCs; 15.1% were LCC-tobacco users; 11.1% were LCC-blunt users; and 10.5% were LCC-poly users. Black/African American and Hispanic/Latino cigarette smokers had higher odds of LCC-tobacco, LCC-blunt, and LCC-poly use compared to white cigarette smokers. Blacks/African Americans who initiated cigarette smoking before age 18 and smoked other tobacco products had greater odds of LCC-tobacco use than whites. Male cigarette smokers who smoked other tobacco products and females who had early onset of cigarette use also had greater odds of LCC-tobacco use.

CONCLUSIONS

Over 30% of cigarette smokers concomitantly used LCCs, which may prolong smoking. Accurate estimates of diverse LCC use behaviors may increase our understanding of the potential harms of concomitant use.

IMPLICATIONS

Aggregate measures of LCC smoking do not distinguish subtypes of use among socially-disadvantaged cigarette smokers (ie, young adults, blacks/African Americans, Hispanics/Latinos), who may engage in these unique smoking behaviors. We document the prevalence of young adult cigarette smokers who dual use LCC-tobacco and LCC-blunts and are poly users of LCC-tobacco + LCC-blunts, and identify sociodemographic groups at risk for use. The Food and Drug Administration is concerned about concomitant behavior, which may increase chronic disease risk and addiction. Accurate estimates of LCC smoking behaviors may increase our understanding of the harms of concomitant use; which can inform prevention programs that specifically target LCC subtypes.

Little Cigars and Cigarillos: Users, Perceptions, and Reasons for Use

OBJECTIVE

This study examines little cigar and cigarillo (LCC) adult user characteristics, perceived addictiveness, use and importance of flavors, intentions to continue use, and reasons for use to inform prevention efforts and regulatory policy.

METHODS

Data come from the 2014 Tobacco Products and Risk Perceptions Survey of a national probability sample of 5717 US adults, conducted online, June-November, 2014. The analytic sample consisted of 141 current LCC users.

RESULTS

Current LCC smokers were more likely to be male, younger, black or Hispanic, lower SES, current cigarette smokers, and to report poorer health than non-smokers. Perceived addictiveness was low overall, with 73.6% considering themselves "not at all" addicted, although female LCC users and dual users of cigarettes were more likely to consider themselves addicted to LCCs. Use of flavored LCCs was widespread. Flavors were cited as important reasons for use, especially among younger users, as were favorable comparisons with affordability and burn time of cigarettes.

CONCLUSIONS

Most LCC users do not perceive themselves addicted to LCCs. Users report being influenced most by flavorings and affordability, indicating that appropriate regulations and education to improve health perceptions could help reduce use of these harmful products.

Differences in Tobacco Product Use Among Past Month Adult Marijuana Users and Nonusers: Findings From the 2003-2012 National Survey on Drug Use and Health

INTRODUCTION

This study assessed differences in individual tobacco product use between past month marijuana users and nonusers, and trends in overall tobacco use and use of specific tobacco products among marijuana users.

METHODS

Data were obtained from 378 459 adults participating in the 2003-2012 National Survey on Drug Use and Health, a cross-sectional, household interview survey conducted annually. Data from the most recent 2 years (2011-2012) were used to assess differences in the prevalence of various tobacco products by past month marijuana status. Data from all years were used to assess historical trends in overall tobacco use, and use of cigarettes, cigars, and blunts among marijuana users; trend significance was assessed using orthogonal polynomials.

RESULTS

From 2011-2012, the prevalence of any past month tobacco use among the 9727 past month marijuana users was 68.6% excluding blunts, and 78.3% including blunts (vs. 25.3% for nonusers, P < .0001); 77.3% of past month marijuana users reported past month combusted tobacco use (vs. 23.4% of non-MJ users, P < .0001). By product, 60.1% of past month marijuana users reported past month cigarette use, 42.0% reported past month blunt use, and 20.6% reported past month cigar use. Overall, adjusted trends in past month cigarette use decreased, while trends in past month blunt use increased; cigar use did not change.

DISCUSSION

Tobacco use is highly prevalent among adult marijuana users and represents an important potential comorbidity of marijuana use. In light of increasing policies legalizing marijuana, it is critical to monitor changes in overall and specific tobacco product use.