Advertisement

Youth Acquisition and Situational Use of Cigars, Cigarillos, and Little Cigars:

A Cross-sectional Study
Published:October 04, 2016DOI:https://doi.org/10.1016/j.amepre.2016.08.011

      Introduction

      Although adolescent use of cigars, cigarillos, and little cigars (CCLCs) has been increasing, little research has been conducted to understand how adolescents acquire CCLCs and the situations in which they smoke CCLCs. Thus, this study aims to understand how adolescent smokers acquire CCLCs and the situations in which they smoke them.

      Methods

      Data were drawn from the 2011 Cuyahoga County Youth Risk Behavior Survey. Current CCLC smoking was assessed; analysis was limited to current smokers (n=1,337). Current users were asked to identify situations in which they use cigars and ways in which they get cigars. Bivariate analyses assessed differences by sex, race, and concurrent substance use. Data were analyzed in 2014.

      Results

      Youth acquired CCLCs most commonly by buying (64.2%). CCLC smokers also reported high rates of social use (81.1%). There were no significant differences is situational use across sexes, but female adolescents were significantly more likely than male adolescents to share CCLCs and significantly less likely to buy or take CCLCs. Conversely, significant differences were seen for situational use by race/ethnicity, with whites significantly more likely to use in social situations and less likely to use in solitary situations versus blacks and Hispanics. Finally, significant differences were observed in both acquisition and use for youth who concurrently used CCLCs and cigarettes compared with CCLCs only; fewer differences were noted among those who concurrently used CCLCs and marijuana compared with CCLCs only.

      Conclusions

      These findings highlight how adolescents acquire and use CCLCs and can inform tobacco control strategies to prevent and reduce CCLC use.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Preventive Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Centers for Disease Control and Prevention (CDC)
        Current tobacco use among middle and high school students—United States, 2011.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 581-585
        • Thomas R.E.
        • McLellan J.
        • Perera R.
        School-based programmes for preventing smoking.
        Cochrane Database Syst Rev. 2013; 4: CD001293https://doi.org/10.1002/ebch.1937
        • Farrelly M.C.
        • Loomis B.R.
        • Han B.
        • et al.
        A comprehensive examination of the influence of state tobacco control programs and policies on youth smoking.
        Am J Public Health. 2013; 103: 549-555https://doi.org/10.2105/AJPH.2012.300948
        • Centers for Disease Control and Prevention (CDC)
        Best Practices for Comprehensive Tobacco Control Programs—2014.
        CDC, Atlanta, GA2014
        • Symm B.
        • Morgan M.V.
        • Blackshear Y.
        • Tinsley S.
        Cigar smoking: an ignored public health threat.
        J Prim Prev. 2005; 26: 363-375https://doi.org/10.1007/s10935-005-5389-z
        • Food and Drug Administration
        Deeming tobacco products to be subject to the Federal Food, Drug, and Cosmetic Act, as amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the sale and distribution of tobacco products and required warning statements for tobacco products.
        Fed Regist. 2016; 81 (Codified at 21 CFR Parts 1100, 1140, and 1143): 28974-29106
        • Castrucci B.C.
        • Gerlach K.K.
        • Kaufman N.J.
        • Orleans C.T.
        Adolescents’ acquisition of cigarettes through noncommercial sources.
        J Adolesc Health. 2002; 31: 322-326https://doi.org/10.1016/S1054-139X(02)00393-2
        • Seo D.-C.
        • Huang Y.
        Systematic review of social network analysis in adolescent cigarette smoking behavior.
        J Sch Health. 2012; 82: 21-27https://doi.org/10.1111/j.1746-1561.2011.00663.x
        • Kaestle C.E.
        How girls and boys get tobacco: adults and other sources.
        J Adolesc Health. 2009; 45: 208-210https://doi.org/10.1016/j.jadohealth.2009.02.010
        • Hahn G.
        • Charlin V.L.
        • Sussman S.
        • et al.
        Adolescents’ first and most recent use situations of smokeless tobacco and cigarettes: similarities and differences.
        Addict Behav. 1990; 15: 439-448https://doi.org/10.1016/0306-4603(90)90030-2
        • Sussman S.
        • Hahn G.
        • Dent C.W.
        • Stacy A.W.
        • Burton D.
        • Flay B.R.
        Naturalistic observation of adolescent tobacco use.
        Int J Addict. 2009; 28: 803-811https://doi.org/10.3109/10826089309039657
        • Acosta M.C.
        • Eissenberg T.
        • Nichter M.
        • Nichter M.
        • Balster R.L.
        Characterizing early cigarette use episodes in novice smokers.
        Addict Behav. 2008; 33: 106-121https://doi.org/10.1016/j.addbeh.2007.09.005
        • Proctor C.
        • Barnett J.A.
        • Muilenburg J.
        Investigating race, gender, and access to cigarettes in an adolescent population.
        Am J Health Behav. 2012; 36: 513-521https://doi.org/10.5993/AJHB.36.4.8
        • Vu M.
        • Leatherdale S.T.
        • Ahmed R.
        Examining correlates of different cigarette access behaviours among Canadian youth: data from the Canadian Youth Smoking Survey (2006).
        Addict Behav. 2011; 36: 1313-1316https://doi.org/10.1016/j.addbeh.2011.07.010
        • Centers for Disease Control and Prevention (CDC)
        Consumption of cigarettes and combustible tobacco—United States, 2000-2011.
        MMWR Morb Mortal Wkly Rep. 2012; 61: 565-580
      1. U.S. DHHS. Preventing Tobacco Use among Youth and Young Adults: A Report of the Surgeon General. Atlanta, GA; 2012.

        • Friedman L.S.
        • Lichtenstein E.
        • Biglan A.
        Smoking onset among teens: an empirical analysis of initial situations.
        Addict Behav. 1985; 10: 1-13https://doi.org/10.1016/0306-4603(85)90048-6
        • Biglan A.
        • McConnell S.
        • Severson H.H.
        • Bavry J.
        • Ary D.
        A situational analysis of adolescent smoking.
        J Behav Med. 1984; 7: 109-114https://doi.org/10.1007/BF00845349
        • Botvin G.
        Preventing drug abuse in schools: social and competence enhancement approaches targeting individual-level etiologic factors.
        Addict Behav. 2000; 25: 887-897https://doi.org/10.1016/S0306-4603(00)00119-2
        • Sussman S.
        • Dent C.W.
        • Stacy A.W.
        • et al.
        Project towards no tobacco use: 1-year behavior outcomes.
        Am J Public Health. 1993; 83: 1245-1250https://doi.org/10.2105/AJPH.83.9.1245
        • Powers Noland M.
        • Kryscio R.J.
        • Riggs R.S.
        • Linville L.H.
        • Ford V.Y.
        • Tucker T.C.
        The effectiveness of a tobacco prevention program with adolescents living in a tobacco-producing region.
        Am J Public Health. 1998; 88: 1862-1865
        • Prokhorov A.V.
        • Kelder S.H.
        • Shegog R.
        • et al.
        Impact of A Smoking Prevention Interactive Experience (ASPIRE), an interactive, multimedia smoking prevention and cessation curriculum for culturally diverse high-school students.
        Nicotine Tob Res. 2008; 10: 1477-1485https://doi.org/10.1080/14622200802323183
        • Davis S.M.
        • Lambert L.C.
        • Cunningham-Sabo L.
        • Skipper B.J.
        Tobacco use: baseline results from Pathways to Health, a school-based project for southwestern American Indian youth.
        Prev Med (Baltim). 1995; 24: 454-460https://doi.org/10.1006/pmed.1995.1073
        • Perry C.L.
        • Kelder S.H.
        • Murray D.M.
        • Klepp K.I.
        Communitywide smoking prevention: long-term outcomes of the Minnesota Heart Health Program and the Class of 1989 Study.
        Am J Public Health. 1992; 82: 1210-1216https://doi.org/10.2105/AJPH.82.9.1210
        • Elder J.P.
        • Wildey M.
        • de Moor C.
        • et al.
        The long-term prevention of tobacco use among junior high school students: classroom and telephone interventions.
        Am J Public Health. 1993; 83: 1239-1244https://doi.org/10.2105/AJPH.83.9.1239
        • Bauman K.E.
        • Foshee V.A.
        • Ennett S.T.
        • et al.
        The influence of a family program on adolescent tobacco and alcohol use.
        Am J Public Health. 2001; 91: 604-610https://doi.org/10.2105/AJPH.91.4.604
        • Lantz P.M.
        Investing in youth tobacco control: a review of smoking prevention and control strategies.
        Tob Control. 2000; 9: 47-63https://doi.org/10.1136/tc.9.1.47
        • Accessibility of tobacco products to youths aged 12-17 years—United States, 1989 and 1993
        MMWR Morb Mortal Wkly Rep. 1996; 45: 125-130
      2. FDA. Regulations Restricting the Sale and Distribution of Cigarettes and Smokeless Tobacco to Protect Children and Adolescents. www.gpo.gov/fdsys/pkg/FR-2010-03-19/pdf/2010-6087.pdf. Accessed April 7, 2015.

      3. Substance Abuse and Mental Health Services Administration (SAMHSA). 2013 Annual Synar Reports: Tobacco Sales to Youth. http://store.samhsa.gov/product/2013-Annual-Synar-Reports-Tobacco-Sales-to-Youth/SYNAR-14. Published December 2014. Accessed August 19, 2015.

      4. Zaza S. Briss P. Harris K. The Guide to Community Preventive Services: What Works to Promote Health? Oxford University Press, Oxford2005
        • Chaloupka F.J.
        • Straif K.
        • Leon M.E.
        Effectiveness of tax and price policies in tobacco control.
        Tob Control. 2011; 20: 235-238https://doi.org/10.1136/tc.2010.039982
        • Forster J.
        Social exchange of cigarettes by youth.
        Tob Control. 2003; 12: 148-154https://doi.org/10.1136/tc.12.2.148
        • DiFranza J.R.
        • Coleman M.
        Sources of tobacco for youths in communities with strong enforcement of youth access laws.
        Tob Control. 2001; 10: 323-328https://doi.org/10.1136/tc.10.4.323
        • Lenk K.M.
        • Toomey T.L.
        • Shi Q.
        • Erickson D.J.
        • Forster J.L.
        Do sources of cigarettes among adolescents vary by age over time?.
        J Child Adolesc Subst Abuse. 2014; 23: 137-143https://doi.org/10.1080/1067828X.2012.750972
        • Wakefield M.
        • Terry-McElrath Y.
        • Emery S.
        • et al.
        Effect of televised, tobacco company-funded smoking prevention advertising on youth smoking-related beliefs, intentions, and behavior.
        Am J Public Health. 2006; 96: 2154-2160https://doi.org/10.2105/AJPH.2005.083352
        • U.S. DHHS.
        Preventing Tobacco Use Among Youth and Young Adults: A Report of the Surgeon General.
        U.S. DHHS, Washington, DC2012
        • Biglan A.
        A randomised controlled trial of a community intervention to prevent adolescent tobacco use.
        Tob Control. 2000; 9: 24-32https://doi.org/10.1136/tc.9.1.24
        • Cohn A.
        • Cobb C.O.
        • Niaura R.S.
        • Richardson A.
        The other combustible products: prevalence and correlates of little cigar/cigarillo use among cigarette smokers.
        Nicotine Tob Res. 2015; 17: 1473-1481https://doi.org/10.1093/ntr/ntv022
        • Cohn A.
        • Villanti A.
        • Richardson A.
        • et al.
        The association between alcohol, marijuana use, and new and emerging tobacco products in a young adult population.
        Addict Behav. 2015; 48: 79-88https://doi.org/10.1016/j.addbeh.2015.02.005
        • Rait M.A.
        • Prochaska J.J.
        • Rubinstein M.L.
        Reporting of cigar use among adolescent tobacco smokers.
        Addict Behav. 2016; 53: 206-209https://doi.org/10.1016/j.addbeh.2015.06.035
        • Cohn A.
        • Johnson A.
        • Ehlke S.
        • Villanti A.C.
        Characterizing substance use and mental health profiles of cigar, blunt, and non-blunt marijuana users from the National Survey of Drug Use and Health.
        Drug Alcohol Depend. 2015; 160: 105-111https://doi.org/10.1016/j.drugalcdep.2015.12.017
        • Creamer M.R.
        • Portillo G.V.
        • Clendennen S.L.
        • Perry C.L.
        Is adolescent poly-tobacco use associated with alcohol and other drug use?.
        Am J Health Behav. 2016; 40: 117-122https://doi.org/10.5993/AJHB.40.1.13
        • Creamer M.R.
        • Perry C.L.
        • Harrell M.B.
        • Diamond P.M.
        Trends in multiple tobacco product use among high school students.
        Tob Regul Sci. 2015; 1: 204-214https://doi.org/10.18001/TRS.1.3.2
        • Ali M.
        • Gray T.R.
        • Martinez D.J.
        • Curry L.E.
        • Horn K.A.
        Risk profiles of youth single, dual, and poly tobacco users.
        Nicotine Tob Res. 2016; 18: 1614-1621https://doi.org/10.1093/ntr/ntw028
        • Prevention Research Center for Healthy Neighborhoods (PRCHN)
        2011 Cuyahoga County High School Youth Risk Behavior Survey (YRBS) Report: Grades 9–12. PRCHN, Department of Epidemiology and Biostatistics, Case Western Reserve University, Cleveland, OH2012
      5. Centers for Disease Control and Prevention (CDC). Methodology of the Youth Risk Behavior Surveillance System—2013. www.cdc.gov/mmwr/preview/mmwrhtml/rr6201a1.htm. Accessed May 25, 2016.

        • Boyce W.
        • Torsheim T.
        • Currie C.
        • Zambon A.
        The Family Affluence Scale as a measure of national wealth: validation of an adolescent self-report measure.
        Soc Indic Res. 2006; 78: 473-487https://doi.org/10.1007/s11205-005-1607-6
        • Currie C.
        • Molcho M.
        • Boyce W.
        Researching health inequalities in adolescents: the development of the Health Behaviour in School-Aged Children (HBSC) family affluence scale.
        Soc Sci Med. 2008; 66: 1429-1436https://doi.org/10.1016/j.socscimed.2007.11.024
        • Trapl E.S.
        • Terchek J.J.
        • Danosky L.
        • Cofie L.
        • Brooks-Russell A.
        • Frank S.H.
        Complexity of measuring “cigar use” in adolescents: results from a split sample experiment.
        Nicotine Tob Res. 2011; 13: 291-295https://doi.org/10.1093/ntr/ntq247
        • Terchek J.J.
        • Larkin E.M.G.
        • Male M.L.
        • Frank S.H.
        Measuring cigar use in adolescents: inclusion of a brand-specific item.
        Nicotine Tob Res. 2009; 11: 842-846https://doi.org/10.1093/ntr/ntp074
        • Nasim A.
        • Blank M.D.
        • Berry B.M.
        • Eissenberg T.
        Cigar use misreporting among youth: data from the 2009 Youth Tobacco Survey, Virginia.
        Prev Chronic Dis. 2012; 9: E42
        • Corey C.G.
        • Dube S.R.
        • Ambrose B.K.
        • King B.A.
        • Apelberg B.J.
        • Husten C.G.
        Cigar smoking among U.S. students: reported use after adding brands to survey items..
        Am J Prev Med. 2014; 47(2): S28-S35https://doi.org/10.1016/j.amepre.2014.05.004
      6. Centers for Disease Control and Prevention (CDC). National Youth Tobacco Survey. www.cdc.gov/tobacco/data_statistics/surveys/nyts/index.htm. Published 2011.

      7. Institute of Medicine. Public health implications of raising the minimum age of legal access to tobacco products. http://nationalacademies.org/HMD/Reports/2015/TobaccoMinimumAgeReport.aspx. Published March 12, 2015. Accessed April 8, 2015.

        • Leatherdale S.T.
        • Ahmed R.
        Alcohol, marijuana, and tobacco use among Canadian youth: do we need more multi-substance prevention programming?.
        J Prim Prev. 2010; 31: 99-108https://doi.org/10.1007/s10935-010-0211-y
        • Ringel J.S.
        • Wasserman J.
        • Andreyeva T.
        Effects of public policy on adolescents’ cigar use: evidence from the National Youth Tobacco Survey.
        Am J Public Health. 2005; 95: 995-998https://doi.org/10.2105/AJPH.2003.030411
        • Tworek C.
        • Yamaguchi R.
        • Kloska D.D.
        • et al.
        State-level tobacco control policies and youth smoking cessation measures.
        Health Policy. 2010; 97: 136-144https://doi.org/10.1016/j.healthpol.2010.04.009
      8. Campaign for Tobacco Free Kids. State excise tax rates for non-cigarette tobacco products. www.tobaccofreekids.org/research/factsheets/pdf/0169.pdf. Published 2015.

        • Arrazola R.A.
        • Singh T.
        • Corey C.G.
        • et al.
        Tobacco use among middle and high school students—United States, 2011–2014.
        MMWR Morb Mortal Wkly Rep. 2015; 64: 381-385
      9. Koopman Gonzalez SJ, Cofie LE, Trapl ES. “I just use it for weed”: the modification of little cigars and cigarillos by young adult African American male users. J Ethn Subst Abuse. In press. Online December 7, 2015. http://dx.doi.org/10.1080/15332640.2015.1081117.

        • Dickinson D.M.
        • Johnson S.E.
        • Coleman B.N.
        • Tworek C.
        • Tessman G.K.
        • Alexander J.
        The language of cigar use: focus group findings on cigar product terminology.
        Nicotine Tob Res. 2016; 18: 850-856https://doi.org/10.1093/ntr/ntv285