Seven-Year Patterns in US Cigar Use Epidemiology Among Young Adults Aged 18–25 Years: A Focus on Race/Ethnicity and Brand

摘要

Objectives. We examined patterns in cigar use among young adults, aged 18–25 years, focusing on race/ethnicity and brand. Methods. We conducted a secondary data analysis of cross-sectional waves of the National Survey on Drug Use and Health, 2002–2008, using multivariate logistic regression to assess time trends in past 30 days cigar use, past 30 days use of a “top 5” cigar brand, cigar use intensity, and age at first cigar use. Results. Cigar use has increased among White non-Hispanic men aged 18 to 25 years, from 12.0% in 2002 to 12.7% in 2008. Common predictors of all outcomes included male gender and past 30 days use of cigarettes, marijuana, and blunts. Additional predictors of past 30 days cigar and “top 5” brand use included younger age, non-Hispanic Black or White race, lower income, and highest level of risk behavior. College enrollment predicted intensity of use and “top 5” brand use. Conclusions. Recent legislative initiatives have changed how cigars are marketed and may affect consumption. National surveys should include measures of cigar brand and little cigar and cigarillo use to improve cigar use estimates. During the last decade, cigar industry data have demonstrated a rapid and substantial increase in cigar sales. 1 In 2007, US cigar sales represented a $3.5 billion a year industry. 1 – 3 The Maxwell Report , a trade publication that provides sales data for cigars, reported that from 1995 to 2008 annual sales of large cigars increased by 17%, sales of cigarillos increased by 255%, and sales of little cigars increased by 316%. 1 By definition, a cigar is any roll of tobacco wrapped in leaf tobacco or in any other substance containing tobacco, including paper that contains tobacco or tobacco extract. 3 For the purposes of taxation, large cigars are those weighing more than 3 pounds per 1000 cigars and small or little cigars are those weighing 3 pounds or less. 3 Although little cigars differ from large ones with respect to weight, this is not the only, nor arguably the most important, distinction between them. Other characteristics of little cigars that set them apart from large ones are features common to cigarettes, such as size, filters, and packaging. 3 , 4 Cigarillos are intermediate in size between a little and a large cigar, contain about 3 grams of tobacco, and are taxed the same as large cigars. 2 Historically, higher rates of cigar use have been observed among men than among women and in White than in Black populations. 1 However, several small studies indicate that cigarillos and little cigars have become popular among young adult populations, with some suggestion of racial/ethnic differences in use. 5 – 7 However, these racial/ethnic differences have yet to be confirmed in large, nationally representative young adult study samples. Cigars pose significant health risks, contributing to cancers of the mouth, lung, esophagus, and larynx and possibly the development of chronic obstructive pulmonary disease. 3 , 5 – 7 Like other carcinogenic products, risk increases with consumption and depth of inhalation. 8 Data suggest that little cigars may be smoked differently from large cigars, with deeper inhalation. 9 , 10 This is likely the result of their physical similarity to cigarettes. Although there is considerable variability in nicotine content across cigar brands and types, a single cigar typically contains more nicotine than a single cigarette. 3 , 8 Factors that affect nicotine delivery are nicotine content, cigar pH and size, and smoker inhalation patterns. 3 As a result, cigars may be just as, if not more, addictive for smokers as are cigarettes. 8 Additionally, there is concern over the combined use of cigars and marijuana, in which a user replaces a cigar's tobacco filling with marijuana—known as “blunting” 11 —or smokes a cigar after smoking marijuana to increase the effect of the latter. 12 Cigar smokers may not fully appreciate the health risks associated with the use of these products. Indeed, several research studies indicate that cigar smokers misperceive little cigars and cigarillos as less addictive, more “natural,” and less harmful compared with cigarettes. 13 – 15 Moreover, their packaging does not always carry a warning label, and so health warnings may go unnoticed by cigar users. A content analysis of the Web sites of leading health organizations indicates that limited information is provided about the harm posed by cigar use. 6 Thus, the popularity of cigarillo and little cigar products may be, in part, attributable to misperceptions of reduced harm relative to cigarette smoking. Other factors related to their popularity include lower taxes for cigarillos and little cigars than for cigarettes, industry marketing practices, and possibly, the