Nicotine & Tobacco Research, 2015, 1473–1481 doi:10.1093/ntr/ntv022 Original investigation Advance Access publication January 29, 2015
Original investigation
Downloaded from http://ntr.oxfordjournals.org/ at Washington University School of Medicine Library on March 21, 2016
The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers Amy Cohn PhD1, Caroline O. Cobb PhD1, Raymond S. Niaura PhD1,2,3, Amanda Richardson PhD2,4 Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; 2Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC; 4Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 1
Corresponding Author: Amy Cohn, PhD, Schroeder Institute, Legacy, 1724 Massachusetts Avenue, NW, Washington, DC 20036, USA. Telephone: 202-454-5918; Fax: 202-454-5785; E-mail: [email protected]
Abstract Background: Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. Methods: A geographically diverse sample of current cigarette smokers were included in analyses (n = 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics. Results: Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. Conclusions: A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.
Introduction Use of little cigars and cigarillos (LCCs) in the United States has been increasing,1 and these products remain largely unregulated by the Food and Drug Administration, Center for Tobacco Products.2 The absence of regulation, a significant price/tax advantage, and the use of flavors in LCCs relative to cigarettes may explain their rising
prevalence. This raises concerns because the use of large cigars and LCCs is associated with many of the same negative health effects as cigarettes, including increased risk of cancer,3 coronary heart disease, and chronic obstructive pulmonary disease.4 According to Connolly and colleagues,5 dual use of LCCs and cigarettes may be appealing to certain sub-groups of smokers such
© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
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Methods Sample Data for this study were drawn from Wave 4 of the Legacy Longitudinal Smoker Cohort (n = 1487), a large study of smokers who were surveyed with the purpose of evaluating Legacy’s televised “Become An EX” smoking cessation media campaign. This final survey wave included the most comprehensive set of questions concerning alternative tobacco use and mental health/substance use factors. Further details of the study design and methods are available elsewhere.25 In brief, the baseline survey was fielded between February and April 2008, and comprised 5616 current cigarette smokers between the ages of 18 to 49, living in eight designated market areas across the United States The designated market areas correspond to metro areas in which the EX media campaign was run, and were selected to ensure variation with respect to racial/ethnic composition, smoking prevalence, and location-based tobacco control policies. The sample was stratified by race/ethnicity to capture sufficient numbers of Blacks and Hispanics. Households were selected via list-assisted Random Digit Dialing methodology. Participants were interviewed using computer-assisted telephone interviews delivered in either English or Spanish. The current study was based on n = 1270 current cigarette smokers who completed the baseline and Wave 4 (fielded between June and September 2011). This study was approved by the Westat IRB, the organization that conducted the data collection, and Copernicus Group IRB, an external IRB used by Legacy.
Measures Demographics The following demographic characteristics were assessed: age in years was adjusted to account for approximately 3 years between the baseline survey and the fourth wave (18–24, 25–34, 35–39, 40–49, 50+), gender (male/female), race (White non-Hispanic, Black or African/ American non-Hispanic, Hispanic [any race], and other non-Hispanic [all other races/combinations]), education (less than high school, high school or General Education Degree (GED), some college/associate degree, or college or higher), employment status (employed or not currently employed), and income (
Original investigation
Downloaded from http://ntr.oxfordjournals.org/ at Washington University School of Medicine Library on March 21, 2016
The Other Combustible Products: Prevalence and Correlates of Little Cigar/Cigarillo Use Among Cigarette Smokers Amy Cohn PhD1, Caroline O. Cobb PhD1, Raymond S. Niaura PhD1,2,3, Amanda Richardson PhD2,4 Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC; 2Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; 3Department of Oncology, Georgetown University Medical Center/Cancer Prevention and Control Program, Lombardi Comprehensive Cancer Center, Washington, DC; 4Department of Health Behavior, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC 1
Corresponding Author: Amy Cohn, PhD, Schroeder Institute, Legacy, 1724 Massachusetts Avenue, NW, Washington, DC 20036, USA. Telephone: 202-454-5918; Fax: 202-454-5785; E-mail: [email protected]
Abstract Background: Despite the increasing consumption of little cigars and cigarillos (LCCs), few studies have examined unique predictors and correlates of LCC use among adult cigarette smokers. This study explored differences between cigarette smokers with and without a history of LCC use on harm perceptions, use of other tobacco products (chewing tobacco, snus, e-cigarettes, and dissolvables), cigarette smoking/cessation-related behaviors/cognitions, and mental health and substance use disorder symptoms. Methods: A geographically diverse sample of current cigarette smokers were included in analyses (n = 1270). Frequencies of LCC use, awareness, purchase, and harm perceptions were examined and logistic regression models investigated differences between LCC ever and never users on a variety of factors, controlling for demographics. Results: Bivariate analyses showed that LCC users were more likely to be male, younger, have lower income, have tried other tobacco products, perceive LCCs as less harmful than cigarettes, and endorse lifetime substance disorder symptoms. Menthol and other tobacco product use were the only significant correlates of LCC use in logistic regression models. Post-hoc analyses showed that other tobacco product use partially mediated an association between substance use disorder symptoms and LCC use. Conclusions: A third of the sample had tried LCCs, and LCC users were more likely to have experimented with other tobacco products and used menthol. The high degree of co-use of cigarette smoking and LCCs with other tobacco products and the association of LCC use to substance use suggests that these users have unique risk factors and deserve specific targeting in public health campaigns.
Introduction Use of little cigars and cigarillos (LCCs) in the United States has been increasing,1 and these products remain largely unregulated by the Food and Drug Administration, Center for Tobacco Products.2 The absence of regulation, a significant price/tax advantage, and the use of flavors in LCCs relative to cigarettes may explain their rising
prevalence. This raises concerns because the use of large cigars and LCCs is associated with many of the same negative health effects as cigarettes, including increased risk of cancer,3 coronary heart disease, and chronic obstructive pulmonary disease.4 According to Connolly and colleagues,5 dual use of LCCs and cigarettes may be appealing to certain sub-groups of smokers such
© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: [email protected].
1473
Nicotine & Tobacco Research, 2015, Vol. 17, No. 12
1474
Methods Sample Data for this study were drawn from Wave 4 of the Legacy Longitudinal Smoker Cohort (n = 1487), a large study of smokers who were surveyed with the purpose of evaluating Legacy’s televised “Become An EX” smoking cessation media campaign. This final survey wave included the most comprehensive set of questions concerning alternative tobacco use and mental health/substance use factors. Further details of the study design and methods are available elsewhere.25 In brief, the baseline survey was fielded between February and April 2008, and comprised 5616 current cigarette smokers between the ages of 18 to 49, living in eight designated market areas across the United States The designated market areas correspond to metro areas in which the EX media campaign was run, and were selected to ensure variation with respect to racial/ethnic composition, smoking prevalence, and location-based tobacco control policies. The sample was stratified by race/ethnicity to capture sufficient numbers of Blacks and Hispanics. Households were selected via list-assisted Random Digit Dialing methodology. Participants were interviewed using computer-assisted telephone interviews delivered in either English or Spanish. The current study was based on n = 1270 current cigarette smokers who completed the baseline and Wave 4 (fielded between June and September 2011). This study was approved by the Westat IRB, the organization that conducted the data collection, and Copernicus Group IRB, an external IRB used by Legacy.
Measures Demographics The following demographic characteristics were assessed: age in years was adjusted to account for approximately 3 years between the baseline survey and the fourth wave (18–24, 25–34, 35–39, 40–49, 50+), gender (male/female), race (White non-Hispanic, Black or African/ American non-Hispanic, Hispanic [any race], and other non-Hispanic [all other races/combinations]), education (less than high school, high school or General Education Degree (GED), some college/associate degree, or college or higher), employment status (employed or not currently employed), and income (
