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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:ntae039. [PMID: 38401171 DOI: 10.1093/ntr/ntae039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Indexed: 02/26/2024]
Abstract
PURPOSE 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. 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 backwards and forwards 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. CONCLUSION 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
| | - Catherine Osborn
- Department of Population and Quantitative Health Sciences Case Western Reserve University, Cleveland, OH
| | - Jessica Suratkal
- Department of Population and Quantitative Health Sciences Case Western Reserve University, Cleveland, OH
| | - Pranav Vasu
- Department of Population and Quantitative Health Sciences Case Western Reserve University, Cleveland, OH
| | - Sarah Koopman Gonzalez
- Department of Population and Quantitative Health Sciences Case Western Reserve University, Cleveland, OH
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences Case Western Reserve University, Cleveland, OH
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Abstract
Background: Research suggests flavor facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis ("co-use"), which is common among young adult smokers. This study's aim was to determine the role of the cigarillo flavor in co-use among young adults. Methods: Data were collected (2020-2021) in a cross-sectional online survey administered to young adults who smoked ≥2 cigarillos/week (N = 361), recruited from 15 urban areas in the United States. A structural equation model was used to assess the relationship between flavored cigarillo use and past 30-day cannabis use (flavored cigarillo perceived appeal and harm as parallel mediators), including several social-contextual covariates (e.g., flavor and cannabis policies). Results: Most participants reported usually using flavored cigarillos (81.8%) and cannabis use in the past 30 days ("co-use") (64.1%). Flavored cigarillo use was not directly associated with co-use (p = 0.90). Perceived cigarillo harm (β = 0.18, 95% CI = 0.06, 0.29), number of tobacco users in the household (β = 0.22, 95% CI = 0.10, 0.33), and past 30-day use of other tobacco products (β = 0.23, 95% CI = 0.15, 0.32) were significantly positively associated with co-use. Living in an area with a ban on flavored cigarillos was significantly negatively associated with co-use (β = -0.12, 95% CI = -0.21, -0.02). Conclusions: Use of flavored cigarillos was not associated with co-use; however, exposure to a flavored cigarillo ban was negatively associated with co-use. Cigar product flavor bans may reduce co-use among young adults or have a neutral impact. Further research is needed to explore the interaction between tobacco and cannabis policy and use of these products.
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Affiliation(s)
- Allison M. Glasser
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Julianna M. Nemeth
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Amanda J. Quisenberry
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, New York, 14263, USA
| | - Abigail B. Shoben
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
| | - Erika S. Trapl
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, 44106, USA
| | - Elizabeth G. Klein
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, 43210, USA
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Sterling KL, Masyn K, Moore SP, Fryer CS, Trapl E, Shang C, Gunzler D. Tobacco Whack-A-Mole: A Consumption Taxonomy of Cigar & Other Combustible Tobacco Products among a Nationally Representative Sample of Young Adults. Int J Environ Res Public Health 2022; 19:ijerph192215248. [PMID: 36429968 PMCID: PMC9690741 DOI: 10.3390/ijerph192215248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 11/01/2022] [Accepted: 11/11/2022] [Indexed: 05/26/2023]
Abstract
INTRODUCTION Little filtered cigars and cigarillos (LCCs) are consumed infrequently, co-administered with marijuana, and concurrently used with other tobacco products. Reliance on the past 30-day use estimate, a marker of tobacco user status, may underestimate the dynamic nature of intermittent LCC and other tobacco product use. We developed a framework to capture the intermittent nature of exclusive LCC use and dual/poly use with cigarettes and large cigars using broader timing of last product use categories and product use modality (e.g., with marijuana). METHODS Data come from the baseline C'RILLOS study, a U.S. nationally representative sample of young adults aged 18-34 (n = 1063) collected in October 2019. We developed a consumption taxonomy framework that accounted for respondents' modality of LCC use (i.e., use with tobacco, LCC-T, or use with marijuana as blunts, LCC-B), the exclusive use of LCCs and other tobacco products (i.e., cigarettes, and large cigars) or their co-use and the timing of last product use (i.e., ever and past 30 days, past 3 months, past 6 months, greater than 6 months). RESULTS Seventy-five percent of our sample reported ever use of any combustible tobacco product, including LCCs. The most common ever use pattern was poly use of LCC-T + LCC-B + cigarettes (16%). Our consumption taxonomy framework demonstrated the fluid nature of combustible tobacco product use among LCC users. For instance, among past 30-day cigarette users, 48% reported using LCC-T, 39% reported using LCC-B, and 32% reported using large cigars in the past 3 months or more. DISCUSSION The tobacco use field currently classifies 'tobacco users' based on the product they smoked in the past 30 days. Any tobacco product use beyond the past 30-day period is considered 'discontinued use' and not the focus of intervention or tobacco regulatory science decisions. We documented the substantial proportion of young adult LCC, cigarette, and large cigar users who either exclusively or dual/poly used these combustible products in recent (e.g., past 3 months) periods. To prevent underestimation of use, surveillance measures should assess the use modality, timing of last product use, and exclusive/multiple product use to more accurately identify the smoking status of young adult LCC users.
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Affiliation(s)
- Kymberle Landrum Sterling
- Department of Health Promotion & Behavioral Sciences, School of Public Health, University of Texas Health Sciences Center, Dallas, TX 75207, USA
| | - Katherine Masyn
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA 30302, USA
| | - Stephanie Pike Moore
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Craig S. Fryer
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA
| | - Ce Shang
- Department of Internal Medicine, Wexner Medical Center, Ohio State University, Columbus, OH 43210, USA
| | - Douglas Gunzler
- Department of Medicine, The MetroHealth System, Case Western Reserve University, Cleveland, OH 44106, USA
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Atem FD, Bluestein MA, Harrell MB, Chen B, Messiah SE, Kuk AE, Sterling KL, Spells CE, Pérez A. Precise Estimation for the Age of Initiation of Tobacco Use Among U.S. Youth: Finding from the Population Assessment of Tobacco and Health (PATH) Study, 2013-2017. Biostat Biom Open Access J 2022; 11:555801. [PMID: 36777448 PMCID: PMC9912413 DOI: 10.19080/bboaj.2022.11.555801] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Context Youth tobacco use remains a prominent United States public health issue with a high economic and health burden. Method We pooled never and ever users at youth's first wave of PATH participation (waves 1-3) to estimate age of initiation for hookah, e-cigarettes, cigarettes, traditional cigars, cigarillos, and smokeless tobacco prospectively (waves 2-4). Age of initiation of each tobacco product was estimated using weighted interval-censored survival analyses. Weighted interval censoring Cox-proportional hazards regression models were used to assess the association of ever use of the TP at the first wave of PATH participation, sex, and race/ethnicity on the age of initiation of ever use of each tobacco product. Sensitivity analyses were performed to understand the impact of the recalled age of initiation for the left-censored participants by replacing the recalled age of initiation with a uniform "6" years lower bound. Results The proportion of those who ever used each tobacco product at the first wave of PATH participation ranged from 1.8% for traditional cigars to 10.4% for cigarettes. There was a significant increase in ever use of each tobacco product after the age of 14, with e-cigarettes and cigarettes showing the highest cumulative incidence of initiation by age 21, while smokeless and cigarillos recorded the lowest cumulative incidence by age 21. The adjusted Cox models showed boys initiated at earlier ages for all of these tobacco products except for hookah, which showed no difference. Similarly, apart from ever use of hookah, non-Hispanic White youth were more likely to initiate each tobacco product at earlier ages compared to Hispanic, non-Hispanic Black, and non-Hispanic Other youth. Conclusion The increased sample size and the inclusion of ever users yielded greater precision for age of initiation of each tobacco product than analyses limited to never users at the first wave of PATH participation. These analyses can help elucidate population selection criteria for estimating the age of initiation of tobacco products.
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Affiliation(s)
- Folefac D. Atem
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Meagan A. Bluestein
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Melissa B. Harrell
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701,Consultant with litigation involving the vaping industry, Austin TX
| | - Baojiang Chen
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Sarah E. Messiah
- The University of Texas Health Science Center at Houston, School of Public Health,Center for Pediatric Population Health, Children's Health System of Texas and UT Health Science Center School of Public Health, School of Public Health in Dallas, 2777 N Stemmons Fwy, Dallas, TX
| | - Arnold E. Kuk
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Kymberle L. Sterling
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Charles E. Spells
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
| | - Adriana Pérez
- The University of Texas Health Science Center at Houston, School of Public Health,Michael & Susan Dell Center for Healthy Living, 1616 Guadalupe Suite 6.300 Austin TX 78701
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Lee E, Moore SP, Trapl E, Fryer CS, Gunzler D, Sterling KL. Changes in Little Cigar and Cigarillo Use during the COVID-19 Pandemic: A Cross-Sectional Analysis of a Nationally Representative Sample of Young Adult Users. Int J Environ Res Public Health 2022; 19:ijerph19158933. [PMID: 35897303 PMCID: PMC9331994 DOI: 10.3390/ijerph19158933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/18/2022] [Accepted: 07/21/2022] [Indexed: 02/01/2023]
Abstract
We examined the smoking behaviors of U.S. young adults ages 18-36 regarding little cigars and cigarillos (LCCs) during the COVID-19 pandemic. Survey data were collected from a nationally representative sample of young adults between October and November 2020. Respondents who reported using LCCs with tobacco (CAI) and/or with marijuana (CAB) within the past 6 months prior to the survey (n = 399) were included in the study. Logistic regression analyses assessed the association between their perceived risk of having COVID when smoking LCCs and pandemic-related behavioral changes in CAI and CAB use (e.g., worrying, quit attempts, smoking more, smoking less). Findings showed that users with a higher perceived risk of getting COVID-19 when smoking LCCs were more likely to endorse trying to quit CAI and CAB during the pandemic. Compared to the non-Hispanic White population, the non-Hispanic Black population were less likely to endorse smoking less CAI and trying to quit CAB during the pandemic. Dual users of CAI and CAB and females were more likely to endorse smoking more CAB compared to CAB-only users and males, respectively. Tailored cessation strategies are needed for dual users, non-Hispanic Black young adults, and young women. Raising awareness about the risks of LCC use can be an effective strategy for LCC smoking cessation.
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Affiliation(s)
- Eugenia Lee
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, TX 75207, USA;
- Correspondence:
| | - Stephanie Pike Moore
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; (S.P.M.); (E.T.); (D.G.)
| | - Erika Trapl
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; (S.P.M.); (E.T.); (D.G.)
| | - Craig S. Fryer
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD 20742, USA;
| | - Douglas Gunzler
- Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH 44106, USA; (S.P.M.); (E.T.); (D.G.)
| | - Kymberle L. Sterling
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Dallas Regional Campus, Dallas, TX 75207, USA;
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6
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Flocke SA, Ishler K, Albert E, Cavallo D, Lim R, Trapl E. Measuring nicotine dependence among adolescent and young adult cigarillo users. Nicotine Tob Res 2022; 24:1789-1797. [PMID: 35512368 PMCID: PMC9596997 DOI: 10.1093/ntr/ntac117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 03/11/2022] [Accepted: 05/02/2022] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Current measures of nicotine dependence (ND) were developed and validated for cigarette smokers only, limiting their utility for other combustible tobacco users. This study evaluates the psychometric properties of a pool of new and adapted items to measure ND among cigarillo and multiple tobacco product users. METHODS Items were drawn from the PROMIS Nicotine Dependence Item Bank which were adapted to be product neutral and new items were developed from a qualitative study of 60 adolescent and young adult cigarillo smokers. A total of 42 ND items were included in a web-based survey. Eligible participants were 14 to 28 year olds who smoked a minimum of 2 cigarillos per week. Analyses included confirmatory factor analysis, item response theory analysis, analysis of differential item functioning (DIF) and reliability. Ordinary least square regression was used to test the association of ND score with deciles of nicotine consumption. RESULTS Among the 1089 participants, the median number of cigarillos smoked per week was 20; 54% of participants also smoked cigarettes. All PROMIS items and 8 of 10 new items met the IRT fit criteria. Two PROMIS items had non-ignorable DIF. The pool of 40 items had good score reliability for a range of 2 standard deviations. Twenty-, eight-, and four-item short forms showed similarly good measurement properties; each was positively associated with decile of nicotine consumption, p<.001; R 2 = 0.33. CONCLUSIONS This adapted bank of ND items is psychometrically sound and includes items that are product neutral, making it suitable for assessing ND among cigarillo and polytobacco users. IMPLICATIONS This study rigorously evaluates adapted items to measure ND among cigarillo and polytobacco users and reports the reliability initial evidence of validity of short form scores.
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Affiliation(s)
- Susan A Flocke
- Department of Family Medicine, Oregon Health & Science University, Portland OR, USA
| | - Karen Ishler
- Jack, Joseph and Morton Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland OH, USA
| | - Elizabeth Albert
- Center for Community Health Integration, Case Western Reserve University, Cleveland OH,USA
| | - David Cavallo
- Department of Nutrition, Case Western Reserve University, Cleveland OH, USA
| | - Rock Lim
- Case Western Reserve University, Center for Community Health Integration, Cleveland OH, USA
| | - Erika Trapl
- Department of Population and Quantitative Health Sciences and the Prevention Research Center for Healthy Neighborhoods, Case Western Reserve University, Cleveland OH, USA
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Jones DM, Kulik MC, Baezconde-Garbanati L, Bullock S, Guy MC, Fagan P. Menthol Smoking and Nicotine Dependence among Black/African American Women Smokers Living in Low-Resource, Rural Communities. Int J Environ Res Public Health 2021; 18:10877. [PMID: 34682623 DOI: 10.3390/ijerph182010877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/07/2021] [Accepted: 10/13/2021] [Indexed: 12/23/2022]
Abstract
Black/African American women from low-resource, rural communities bear a disproportionate burden of tobacco-related morbidity and mortality. This study examined associations between menthol smoking and socioeconomic deprivation with nicotine dependence and quitting behaviors among Black/African American women cigarette and/or little cigar/cigarillo smokers, aged 18–50 living in low-resource, rural communities. Baseline survey data from a randomized controlled behavioral/intervention trial (#NCT03476837) were analyzed (n = 146). Outcomes included time to first tobacco product (cigarette/little cigar/cigarillo) use within 5 min of waking, Fagerstrom Test for Nicotine Dependence (FTND) score, and ever attempting to quit cigarettes. Socioeconomic deprivation measures included education, income, and receiving supplemental nutritional assistance (SNAP) program benefits. In adjusted regression analyses, menthol smoking was associated with both greater FTND scores and time to first tobacco product use within 5 min of waking, but not ever attempting to quit cigarettes. Regardless of menthol status, only 25.0% of smokers reported that they would quit smoking if menthol cigarettes were banned. The proportion of smokers who smoked their first tobacco product within 5 min of waking increased slightly with greater socioeconomic deprivation. Additional research and targeted efforts are needed to reduce nicotine dependence among Black/African American women smokers living in rural, low-resource communities where access to cessation services is limited.
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Cornacchione Ross J, Reboussin DM, Noar SM, Wiseman KD, Sutfin EL. What Do Adolescents and Young Adults Think a Cigarillo Is? Implications for Health Communication. Int J Environ Res Public Health 2021; 18:3311. [PMID: 33806872 PMCID: PMC8004959 DOI: 10.3390/ijerph18063311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/18/2022]
Abstract
Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term "cigarillo" in such efforts. The study goal was to assess adolescent and young adult perceptions of the term "cigarillo". We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13-25). We asked participants "what is a cigarillo?" with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question "what is a cigarillo" was "I don't know" (51% of participants), followed by "a thinner and smaller version of a traditional cigar" (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was "I don't know" (54.9%) followed by "a thinner and smaller version of a traditional cigar" (45.1%). Cigarillo users were more likely to select the "a thinner and smaller version of a traditional cigar" response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term "cigarillo". Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness.
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Affiliation(s)
- Jennifer Cornacchione Ross
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - David M. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston Salem, NC 27157, USA;
| | - Seth M. Noar
- Hussman School of Journalism and Media, University of North Carolina, Chapel Hill, NC 27599, USA;
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kimberly D. Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
| | - Erin L. Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston Salem, NC 27157, USA; (K.D.W.); (E.L.S.)
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9
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Abdelwahab SH, Reidel B, Martin JR, Ghosh A, Keating JE, Haridass P, Carpenter J, Glish GL, Tarran R, Doerschuk CM, Kesimer M. Cigarillos Compromise the Mucosal Barrier and Protein Expression in Airway Epithelia. Am J Respir Cell Mol Biol 2020; 63:767-779. [PMID: 32877614 PMCID: PMC7790145 DOI: 10.1165/rcmb.2019-0085oc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 09/02/2020] [Indexed: 12/22/2022] Open
Abstract
Smoking remains a leading cause of preventable morbidity and mortality worldwide. Despite a downward trend in cigarette use, less-regulated tobacco products, such as cigarillos, which are often flavored to appeal to specific demographics, such as younger people, are becoming increasingly popular. Cigar/cigarillo smoking has been considered a safer alternative to cigarettes; however, the health risks associated with cigar in comparison with cigarette smoking are not well understood. To address this knowledge gap, we characterized the effects of multiple brands of cigarillos on the airway epithelium using ex vivo and in vivo models. To analyze these effects, we assessed the cellular viability and integrity of smoke-exposed primary airway cell cultures. We also investigated the protein compositions of apical secretions from cigarillo-exposed airway epithelial cultures and BAL fluid of cigarillo-exposed mice through label-free quantitative proteomics and determined the chemical composition of smoke collected from the investigated cigarillo products. We found that cigarillo smoke exerts similar or greater effects than cigarette smoke in terms of reduced cell viability; altered protein levels, including those of innate immune proteins; induced oxidative-stress markers; and greater nicotine delivery to cells. The analysis of the chemical composition of the investigated cigarillo products revealed differences that might be linked to the differential effects of these products on cell viability and protein abundance profiles, which have been associated with a range of health risks in the context of airway biology. These findings contradict the assumption that cigarillos might be safer and less harmful than cigarettes. Instead, our results indicate that cigarillo smoke is associated with equal or greater health risks and the same or increased airway toxicity compared with cigarette smoke.
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Affiliation(s)
| | - Boris Reidel
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
| | | | | | | | | | - Jerome Carpenter
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
| | | | - Robert Tarran
- Marsico Lung Institute
- Department of Cell Biology and Physiology, and
| | - Claire M. Doerschuk
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
- Department of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mehmet Kesimer
- Department of Pathology and Laboratory Medicine
- Marsico Lung Institute
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Stalgaitis CA, Navarro MA, Wagner DE, Walker MW. Who Uses Tobacco Products? Using Peer Crowd Segmentation to Identify Youth at Risk for Cigarettes, Cigar Products, Hookah, and E-Cigarettes. Subst Use Misuse 2020; 55:1045-1053. [PMID: 32024418 DOI: 10.1080/10826084.2020.1722698] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.
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Affiliation(s)
| | - Mario A Navarro
- Center for Tobacco Products, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
| | | | - Matthew W Walker
- Center for Tobacco Products, Food and Drug Administration (FDA), Silver Spring, Maryland, USA
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11
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Sterling KL, Jones DM, Majeed B, Nyman AL, Weaver SR. Affect Predicts Small Cigar Use in a National Sample of US Young Adults. TOB REGUL SCI 2019; 5:253-63. [PMID: 31656828 DOI: 10.18001/TRS.5.3.4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objectives Affect is an important dimension of risk perceptions, which are proximal determinants of little cigar and cigarillo (LCC) smoking. We examined the association among affect, risk perceptions, and current LCC use and susceptibility in a national probability sample of US young adults, aged 18-29. Methods Structural equation models examined the effect of affect, via risk perceptions, on LCC current use and susceptibility for 772 young adults who took the 2015 Tobacco Products and Risk Perceptions Survey, which asked about affect for images related to LCCs and health risks of daily LCC use. Results Positive affect toward LCCs was associated with lower perceived risks of daily LCC smoking (p < .001). Lower perceived risks were associated with higher probability of current LCC smoking (p = .008) among young adults who were aware of LCCs and with susceptibility to use among young adult never LCC users (p < .001). A direct effect of positive affect on current LCC use (p < .02) and susceptibility to use LCCs also was found. Conclusions Future research should investigate how regulatory policy or enforcement actions can be used to regulate LCC components (eg, flavoring, advertising, etc) that influence affect and risk perceptions.
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Allem JP, Uppu SP, Boley Cruz T, Unger JB. Characterizing Swisher Little Cigar-Related Posts on Twitter in 2018: Text Analysis. J Med Internet Res 2019; 21:e14398. [PMID: 31325291 PMCID: PMC6676793 DOI: 10.2196/14398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/03/2019] [Accepted: 06/18/2019] [Indexed: 11/18/2022] Open
Abstract
Background Little cigars are growing in popularity in the United States, and Swisher is the market leader. The contexts and experiences associated with the use of Swisher-related products is understudied, but such information is available via publicly available posts on Twitter. Objective This study aimed to analyze Twitter posts to characterize Twitter users’ recent experiences with Swisher-related products. Methods Twitter posts containing the term “swisher” were analyzed from January 1, 2018, to December 31, 2018. Text classifiers were used to identify topics in posts (n=81,333). Results The most prevalent topic was Person Tagging (mentioning a Twitter account in a post; 32.77%), followed by Flavors (eg, Grape and Strawberry; 20.96%) and Swisher use (eg, smoke swisher; 17.44%). Additional topics included Cannabis use (eg, blunt, roll, and gut swisher; 6.26%), Appeal (eg, like Swisher; 5.92%), Dislike (eg, posts that showed dissatisfaction with Swisher products; 3.53%), Purchases (eg, buy swisher; 1.90%), and Cigar comparison (eg, mentions of other cigar products including White-owl and Backwoods; 1.64%). Conclusions This paper describes common contexts and experiences associated with the use of Swisher little cigars from the population posting on Twitter in 2018. These online messages may have offline consequences for tobacco-related behaviors, indicating the need for countering from public health officials. Findings should inform us about targets for surveillance, policy, and interventions addressing Swisher little cigars as well as communication planning and tobacco product counter messaging on Twitter.
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Affiliation(s)
| | - Sree Priyanka Uppu
- Department of Computer Science, University of Southern California, Los Angeles, CA, United States
| | - Tess Boley Cruz
- Keck School of Medicine of USC, Los Angeles, CA, United States
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Lawler TS, Stanfill SB, deCastro BR, Lisko JG, Duncan BW, Richter P, Watson CH. Surveillance of Nicotine and pH in Cigarette and Cigar Filler. TOB REGUL SCI 2017; 3:101-16. [PMID: 28989950 DOI: 10.18001/TRS.3.2(Suppl1).11] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We examined differences between nicotine concentrations and pH in cigarette and cigar tobacco filler. METHODS Nicotine and pH levels for 50 cigarette and 75 cigar brands were measured. Non-mentholated and mentholated cigarette products were included in the analysis along with several cigar types as identified by the manufacturer: large cigars, pipe tobacco cigars, cigarillos, mini cigarillos, and little cigars. RESULTS There were significant differences found between pH and nicotine for cigarette and cigar tobacco products. Mean nicotine concentrations in cigarettes (19.2 mg/g) and large cigars (15.4 mg/g) were higher than the other cigars types, especially the pipe tobacco cigars (8.79 mg/g). The mean pH for cigarettes was pH 5.46. Large cigars had the highest mean pH value (pH 6.10) and pipe tobacco cigars had the lowest (pH 5.05). CONCLUSIONS Although cigarettes are the most common combustible tobacco product used worldwide, cigar use remains popular. Our research provides a means to investigate the possibility of distinguishing the 2 tobacco product types and offers information on nicotine and pH across a wide range of cigarette and cigar varieties that may be beneficial to help establish tobacco policies and regulations across product types.
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Abstract
OBJECTIVE Although most cigarillos and little cigars smokers also smoke cigarettes (dual use), there are few studies comparing toxicant exposure and smoking behavior in cigars and cigarettes. METHODS Two groups of dual users smoked their usual brand of cigarette and either a Winchester unflavored little cigar (N = 21) or a Black & Mild cigarillo (N = 23). Acute exposure of nicotine and exhaled carbon monoxide (CO) and puffing topography parameters were collected. Individual cigar puffing data were used to machine-replicate smoking for analysis of volatile organic compounds (VOC) and semi-volatile organic compounds (SVOC) in mainstream smoke. RESULTS There were significant differences in puff topography, plasma nicotine and exhaled CO after cigarettes, little cigars, and cigarillos. Puff topography differences between cigarillos and cigarettes were due to the difference in the size of the article. Mainstream cigar and cigarette smoke was qualitatively similar; the yield was dependent on the smoking behavior. When smoke yield was adjusted for weight of tobacco burned or puff volume, exposure differences decreased. CONCLUSIONS There is a wide range of delivery of both SVOC and VOC components of cigar and cigarillo smoke. The difference in exposure is largely dependent on the article size and the amount consumed.
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