The Role of Cigarillo Flavor in the Co-Use of Cigarillos and Cannabis among Young Adults

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.

[1]  S. Flocke,et al.  Measuring nicotine dependence among adolescent and young adult cigarillo users. , 2022, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[2]  Erika S. Trapl,et al.  Cigarillo Flavor and Motivation to Quit among Co-Users of Cigarillos and Cannabis: A Structural Equation Modeling Approach , 2022, International journal of environmental research and public health.

[3]  Ahmed Jamal,et al.  Tobacco Product Use Among Adults — United States, 2020 , 2022, MMWR. Morbidity and mortality weekly report.

[4]  R. Goodwin,et al.  A difference-in-difference approach to examining the impact of cannabis legalization on disparities in the use of cigarettes and cannabis in the United States, 2004-2017. , 2022, Addiction.

[5]  Amy M. Cohn,et al.  Age groups differences in the prevalence and popularity of individual tobacco product use in young adult and adult marijuana and tobacco co-users and tobacco-only users: Findings from Wave 4 of the population assessment of tobacco and health study. , 2022, Drug and alcohol dependence.

[6]  Sharon Lipperman-Kreda,et al.  Youth tobacco and cannabis use and co-use: Associations with daily exposure to tobacco marketing within activity spaces and by travel patterns. , 2021, Addictive behaviors.

[7]  R. Vos,et al.  Impact of California's tobacco and cannabis policies on the retail availability of little cigars/cigarillos and blunt wraps. , 2021, Drug and alcohol dependence.

[8]  Lilianna Phan,et al.  Prevalence of current large cigar versus little cigar/cigarillo smoking among U.S. adults, 2018–2019 , 2021, Preventive medicine reports.

[9]  B. Kelly,et al.  Further Consideration of the Impact of Tobacco Control Policies on Young Adult Smoking in Light of the Liberalization of Cannabis Policies. , 2021, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[10]  K. Cummings,et al.  Increasing cannabis use is associated with poorer cigarette smoking cessation outcomes: Findings from the ITC Four Country Smoking and Vaping Surveys, 2016-2018. , 2021, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[11]  S. McPherson,et al.  Predictors of cannabis and tobacco co-use in youth: exploring the mediating role of age at first use in the population assessment of tobacco health (PATH) study , 2021, Journal of Cannabis Research.

[12]  L. Montgomery,et al.  Prevalence and correlates of daily blunt use among U.S. African American, Hispanic, and White adults from 2014 to 2018. , 2021, Psychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors.

[13]  J. McClure,et al.  Recognizing and Preventing Participant Deception in Online Nicotine and Tobacco Research Studies: Suggested Tactics and a Call to Action. , 2021, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[14]  A. McNeill,et al.  Social norms as a predictor of smoking uptake among youth: a systematic review, meta-analysis and meta-regression of prospective cohort studies. , 2021, Addiction.

[15]  OUP accepted manuscript , 2021, Journal of the National Cancer Institute Monographs.

[16]  R. Coley,et al.  Recreational Marijuana Legalization and Adolescent Use of Marijuana, Tobacco, and Alcohol. , 2020, The Journal of adolescent health : official publication of the Society for Adolescent Medicine.

[17]  Ahmed Jamal,et al.  Tobacco Product Use Among Adults — United States, 2019 , 2020, MMWR. Morbidity and mortality weekly report.

[18]  S. Flocke,et al.  Tobacco and Marijuana Co-use Behaviors among Cigarillo Users , 2020 .

[19]  Raina D. Pang,et al.  Developmental Patterns of Tobacco Product and Cannabis Use Initiation in High School. , 2020, Addiction.

[20]  Joanna E Cohen,et al.  Global review of tobacco product flavour policies , 2020, Tobacco Control.

[21]  B. Reboussin,et al.  Longitudinal associations between marijuana and cigar use in young adults. , 2020, Drug and alcohol dependence.

[22]  Michael S. Amato,et al.  Characteristics and Reach Equity of Policies Restricting Flavored Tobacco Product Sales in the United States , 2020, Health promotion practice.

[23]  Bridget K. Ambrose,et al.  Prevalence and Reasons for Use of Flavored Cigars and ENDS among US Youth and Adults: Estimates from Wave 4 of the PATH Study, 2016-2017. , 2020, American journal of health behavior.

[24]  J. Barrington-Trimis,et al.  Blunt and Non-Blunt Cannabis Use and Risk of Subsequent Combustible Tobacco Product Use Among Adolescents. , 2019, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[25]  J. Audrain-McGovern,et al.  Association Between Adolescent Blunt Use and the Uptake of Cigars , 2019, JAMA network open.

[26]  Joseph D. Pane,et al.  Evaluating tobacco retailer experience and compliance with a flavoured tobacco product restriction in Boston, Massachusetts: impact on product availability, advertisement and consumer demand , 2019, Tobacco Control.

[27]  C. Stanton,et al.  Use of tobacco products/devices for marijuana consumption and association with substance use problems among U.S. young adults (2015-2016). , 2019, Addictive behaviors.

[28]  S. Quinn,et al.  Examining prevalence and correlates of cigarette and marijuana co-use among young adults using ten years of NHANES data. , 2019, Addictive behaviors.

[29]  Doris G. Gammon,et al.  Changes in cigar sales following implementation of a local policy restricting sales of flavoured non-cigarette tobacco products , 2019, Tobacco Control.

[30]  Craig S. Fryer,et al.  A Sequential Explanatory Mixed Methods Study of Young Adult Tobacco and Marijuana Co-Use , 2019, Substance use & misuse.

[31]  I. Agaku,et al.  Flavored tobacco product use and its association with indicators of tobacco dependence among U.S. adults, 2014-2015. , 2019, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[32]  S. Weaver,et al.  Affect Predicts Small Cigar Use in a National Sample of US Young Adults. , 2019, Tobacco regulatory science.

[33]  Thomas R. Kirchner,et al.  Flavored cigar smoking among African American young adult dual users: An ecological momentary assessment. , 2019, Drug and alcohol dependence.

[34]  R. Belanger,et al.  The Relationship Between Tobacco and Cannabis Use: A Review , 2018, Substance use & misuse.

[35]  E. Groce The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research , 2018, Journal of Medical Regulation.

[36]  D. Cavallo,et al.  Blunt Use among Adolescents and Young Adults: Informing Cigar Regulations. , 2018, Tobacco regulatory science.

[37]  M. Chaiton,et al.  Association of flavoured cigar regulations with wholesale tobacco volumes in Canada: an interrupted time series analysis , 2018, Tobacco Control.

[38]  M. Eriksen,et al.  Flavors and Risk: Perceptions of Flavors in Little Cigars and Cigarillos Among U.S. Adults, 2015 , 2018, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[39]  Anna Woodcock,et al.  Marijuana use among adolescent multiple tobacco product users and unique risks of dual tobacco and marijuana use. , 2018, Drug and alcohol dependence.

[40]  Erika S. Trapl,et al.  Attitudes and Risk Perceptions Toward Smoking Among Adolescents Who Modify Cigar Products. , 2018, Ethnicity & disease.

[41]  Amy M. Cohn,et al.  Patterns and Correlates of Tobacco and Cannabis co-use by Tobacco Product Type: Findings from the Virginia Youth Survey , 2018, Substance use & misuse.

[42]  K. Ethier,et al.  Youth Risk Behavior Surveillance — United States, 2017 , 2018, Morbidity and mortality weekly report. Surveillance summaries.

[43]  S. Martins,et al.  Age Differences in Daily and Nondaily Cannabis Use in the United States, 2002-2014. , 2018, Journal of studies on alcohol and drugs.

[44]  Dustin C. Lee,et al.  Co-use of cannabis, tobacco, and alcohol during adolescence: policy and regulatory implications , 2018, International review of psychiatry.

[45]  Miao Yang,et al.  Structural Equation Modeling With Many Variables: A Systematic Review of Issues and Developments , 2018, Front. Psychol..

[46]  G. Schauer,et al.  Correlates and trends in youth co-use of marijuana and tobacco in the United States, 2005-2014. , 2018, Drug and alcohol dependence.

[47]  Erika S. Trapl,et al.  The Social Context of Adolescent Co-Use of Cigarillos and Marijuana Blunts , 2018, Substance use & misuse.

[48]  J. Anthony,et al.  Does Starting to Smoke Cigars Trigger Onset of Cannabis Blunt Smoking? , 2018, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[49]  Steven C Martino,et al.  How Do Tobacco Power Walls Influence Adolescents? A Study of Mediating Mechanisms , 2017, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[50]  D. Manley,et al.  Confounding and collinearity in regression analysis: a cautionary tale and an alternative procedure, illustrated by studies of British voting behaviour , 2017, Quality & Quantity.

[51]  Erika S. Trapl,et al.  Cigar Product Modification Among High School Youth , 2016, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[52]  S. Gansky,et al.  Perceived Flavored Smokeless Tobacco Ease-of-use and Youth Susceptibility. , 2017, Tobacco regulatory science.

[53]  K. O’grady,et al.  Marijuana and Tobacco Cigarettes: Estimating Their Behavioral Economic Relationship Using Purchasing Tasks , 2017, Experimental and clinical psychopharmacology.

[54]  Hyoshin Kim,et al.  The Use of Flavored Cigars to Smoke Marijuana in a Sample of US Adults Co-using Cigarettes and Marijuana , 2017 .

[55]  D. Camenga,et al.  Reasons for Cigarillo Initiation and Cigarillo Manipulation Methods among Adolescents. , 2017, Tobacco regulatory science.

[56]  Hae-Young Kim,et al.  Statistical notes for clinical researchers: Chi-squared test and Fisher's exact test , 2017, Restorative dentistry & endodontics.

[57]  Jennifer L. Pearson,et al.  Flavored Tobacco Product Use in Youth and Adults: Findings From the First Wave of the PATH Study (2013-2014). , 2017, American journal of preventive medicine.

[58]  C. Delnevo,et al.  “They’re Pretty Much Made for Blunts”: Product Features That Facilitate Marijuana Use Among Young Adult Cigarillo Users in the United States , 2016, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[59]  A. Richardson,et al.  Impact of non-menthol flavours in tobacco products on perceptions and use among youth, young adults and adults: a systematic review , 2016, Tobacco Control.

[60]  D. Hatsukami,et al.  A review of the additive health risk of cannabis and tobacco co-use. , 2016, Drug and alcohol dependence.

[61]  Danielle E. Ramo,et al.  Medical marijuana legalization and cigarette and marijuana co-use in adolescents and adults. , 2016, Drug and alcohol dependence.

[62]  P. Fagan,et al.  The Most Natural Tobacco Used: A Qualitative Investigation of Young Adult Smokers' Risk Perceptions of Flavored Little Cigars and Cigarillos. , 2016, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[63]  David R. Holtgrave,et al.  Flavored Tobacco Products in the United States: A Systematic Review Assessing Use and Attitudes. , 2016, Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco.

[64]  Amy M. Cohn,et al.  Characterizing substance use and mental health profiles of cigar, blunt, and non-blunt marijuana users from the National Survey of Drug Use and Health. , 2016, Drug and alcohol dependence.

[65]  L. Montgomery Marijuana and tobacco use and co-use among African Americans: results from the 2013, National Survey on Drug Use and Health. , 2015, Addictive behaviors.

[66]  Natasha K. Bowen,et al.  Conducting Measurement Invariance Tests with Ordinal Data: A Guide for Social Work Researchers , 2015, Journal of the Society for Social Work and Research.

[67]  P. Fagan,et al.  Appeal and Impact of Characterizing Flavors on Young Adult Small Cigar Use. , 2015, Tobacco regulatory science.

[68]  Brian A. King,et al.  Tobacco Product Use Among Adults — United States, 2012–2013 , 2014, MMWR. Morbidity and mortality weekly report.

[69]  A. Agrawal,et al.  The co-occurring use and misuse of cannabis and tobacco: a review. , 2012, Addiction.

[70]  S. West,et al.  Model fit and model selection in structural equation modeling. , 2012 .

[71]  John B Carlin,et al.  Multiple imputation for missing data: fully conditional specification versus multivariate normal imputation. , 2010, American journal of epidemiology.

[72]  K. Emmons,et al.  Model for incorporating social context in health behavior interventions: applications for cancer prevention for working-class, multiethnic populations. , 2003, Preventive medicine.

[73]  R. Gonzalez Applied Multivariate Statistics for the Social Sciences , 2003 .

[74]  R. MacCallum,et al.  Power analysis and determination of sample size for covariance structure modeling. , 1996 .

[75]  Laura Kann,et al.  Youth Risk Behavior Surveillance--United States, 1993. CDC Surveillance Summaries. , 1995 .