Department of Health and Human Services 
OFFICE OF 
INSPECTOR GENERAL 
YOUTH USE OF CIGARS 
Patterns of Use and Perceptions of Risk 
JUNE GIBBS BROWN 
Inspector General 
FEBRUARY 1999 
OEI06-98-00030  OFFICE OF INSPECTOR GENERAL 
The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, is to 
protect the integrity of the Department of Health and Human Services programs as well as the 
health and welfare of beneficiaries served by them.  This statutory mission is carried out through a 
nationwide program of audits, investigations, inspections, sanctions, and fraud alerts.  The 
Inspector General informs the Secretary of program and management problems and recommends 
legislative, regulatory, and operational approaches to correct them. 
Office of Evaluation and Inspections 
The Office of Evaluation and Inspections (OEI) is one of several components of the Office of 
Inspector General.  It conducts short-term management and program evaluations (called 
inspections) that focus on issues of concern to the Department, the Congress, and the public.  The 
inspection reports provide findings and recommendations on the efficiency, vulnerability, and 
effectiveness of departmental programs. 
OEI's Dallas regional office  prepared this report under the direction of Chester B. Slaughter, 
Regional Inspector General.  Principal OEI staff included: 
REGION VI  HEADQUARTERS 
Michelle Adams Ph.D., Project Leader
 Elise Stein MPH, Program Specialist 
Jennifer Ring, Intern

Nancy Watts

Scott Whitaker, Intern

Lisa White

OTHER REGIONS 
Meredith A Vey  Suzanne G. Johnson 
Jennifer Caves  Dennis J. Tharp 
Lauren McNulty  Thomas A. Purvis 
Jeanne S. Cathell 
To obtain copies of this report, please call the Dallas Regional Office at 1-800-848-8960. 
Reports are also available on the World Wide Web at our home page address: 
http://www.dhhs.gov/progorg/oei  E X E C U T I V E  S U M M A R Y

PURPOSE 
To describe patterns of cigar use among teens in our focus groups and their peers, specifically 
exploring the initiation, frequency, and variations of use, as well as the motivations and influences 
to use.  In addition, to ascertain their access to cigars and awareness of health risks associated 
with cigar use. 
BACKGROUND 
This descriptive report highlights patterns of teen cigar use based on the results of focus group 
discussions.  Prior to our study, little information was known about teen cigar use aside from 
prevalence data showing high teen cigar use.  This study was requested by the Centers for Disease 
Control and Prevention, Office on Smoking and Health, to explore the issues surrounding cigar 
use by minors.  It does not provide any prevalence information, but was conducted to gain insight 
into the patterns and circumstances of teen cigar use.  It also supports the goal of the President 
and Secretary of Health and Human Services (HHS) to reduce minors tobacco use. 
Using a modified focus group approach, 230 participants completed a self-administered survey 
instrument that addressed tobacco in general, and more specifically patterns of cigar use.  Based 
on our research and the study issues, we developed and pretested a standardized protocol which 
we used to direct our discussions with teens participating in our focus groups.  The focus groups 
gave us an opportunity to obtain in-depth information about teen cigar use.  In all, we conducted 
18 focus groups:  thirteen with high school students, four with junior high students, and one with 
college students.  Focus group participants included a mix of cigar users and non-users from 
schools across the country.  Schools were selected to give us a mix of students with different 
socioeconomic backgrounds from urban and suburban areas.  The schools were located in ten 
major metropolitan areas across all regions of the country.  Because the information collected for 
this study was exploratory in nature, it should only be used as a starting point for further study of 
teen cigar use and should not be projected to all teens.  Nevertheless, we feel the information 
collected from teens in these focus groups can be very valuable in identifying further research 
needs and developing plans to address them. 
FINDINGS 
Patterns of Use 
Teens from our focus groups report widespread cigar use and experimentation among their 
peers. 
When reporting about their own use, high percentages of both male and female teens say they 
have smoked a cigar, with the highest use reported in urban versus suburban areas.  Fifty-four 
percent (122 of 227) of teens surveyed in our focus groups say they have personally smoked a 
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i  cigar sometime in their life, two-thirds (82 of 122) of these teens have done so in the past year, 
and over one-third (43 of 122) have smoked a cigar in the past 30 days.  Of the 82 past-year cigar 
smokers, 60 percent (49 of 82) report smoking cigarettes, while 16 percent (13 of 82) report 
having used spit tobacco products.  Although most teens first exposure to tobacco is through 
cigarettes, 22 percent (35 of 159) of our surveyed teens tried cigars first.  More research is 
needed to determine if cigars are attracting a new group of users who would otherwise have 
avoided using tobacco products. 
Cigar use appears to be increasing in popularity among teens, with 40 percent (66 of 165) 
reporting increased use among their peers since last year.  About half of suburban (39 of 80) and 
urban teens (41 of 80) expect to be using cigars in the next five years. 
Manufactured cigars, rather than premium cigars, are most commonly used by teens due to their 
ease of purchase, low cost, sweetened flavors, and pleasant aromas. 
Teens in our focus groups report they typically smoke cigars at parties, frequently while drinking 
alcohol. 
Blunts for Smoking Marijuana 
Teens in our focus groups report their peers use cigars as blunts for smoking marijuana. 
Teens report that many of their peers use cigars as blunts for smoking marijuana, especially in 
urban schools.  When blunting, the user cuts open or unrolls the cigar and replaces all or most of 
the tobacco filler with marijuana or other substances.  Based on our focus group discussions, teen 
references to cigar smoking and/or blunting behavior are often difficult to differentiate.  Although 
teens were specifically shown the different types of cigars prior to taking our survey, many 
(especially in urban schools) wanted us to clarify if we were talking about plain cigars or cigars 
with marijuana in them.  Teens report their peers smoke both regular cigars, as well as cigars used 
as blunts for smoking marijuana. 
Though common at parties on the weekends, urban teens report blunting often occurs everyday. 
Cigars used as blunts for smoking marijuana are popular with teens because they reportedly result 
in a better high, improve the flavor of marijuana, and burn more slowly than cigarette paper. 
Images and Promotion 
Though the media portrayals of cigar smoking are prevalent, exactly how they influence teens 
remains unclear.  However, teens in our focus groups can easily recall a wide assortment of 
television shows, movies, and famous celebrities associated with cigar smoking. 
Teens recall images of cigar smoking featured in popular sitcoms, cartoons, and movies. They 
identified entertainment personalities and sports figures, such as Michael Jordan, as cigar smokers. 
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ii  Additionally, they associate various rap/hip hop vocal artists with not only cigar smoking but 
blunting as well. 
Social Acceptability 
Smoking cigars is more socially acceptable among teens and adults than smoking cigarettes or 
using spit tobacco.  In addition, teens report their peers are most influenced by other friends 
using cigars, but say they, personally, are somewhat more influenced by the relaxing effect of 
cigars. 
Over half of the teens in our focus groups report having been with adults that have allowed teens 
to smoke cigars. 
Teens in our focus groups also frequently mentioned curiosity as an influence on why they and 
their peers smoke cigars.  Unlike cigarettes, the taste and aroma of cigars vary greatly, allowing 
teens a number of opportunities to experiment with a wide assortment of cigars before deciding 
whether or not cigars are for them. 
Access and Availability 
Over two-thirds of teens in our focus groups reported they know minors who were able to buy 
cigars, usually because clerks failed to ask for their identification or to closely examine it. 
The most common method used by teens to access cigars is to simply go buy them.  Most teens 
typically buy their cigars at gas stations or convenience stores, and many get cigars by having 
older people or friends buy for them.  Some stores facilitate easy access by placing cigars within 
reach, making it possible for some teens to steal them. 
Perceptions of Health Risks 
Though teens in our focus groups appear generally aware of the adverse effects of tobacco use, 
they tend to lack specific knowledge of the health risks of cigars.  A majority of teens in our 
focus groups think regular cigar smoking is addictive, but many are uncertain. 
Nevertheless, most of our teens believe smoking cigars is bad for a persons health and that the 
potential harm increases with more frequent use.  However, teens who have tried cigars rate their 
adverse health effects lower than teens who have never smoked cigars. 
CONCLUSIONS 
A Research Agenda On Teen Cigar Use Is Needed 
The findings of this report, however exploratory, provide important information about teen cigar 
use.  The information obtained through our focus groups leads to the conclusion that more 
research is needed to better understand teen cigar use.  Specifically, more research is needed on 
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iii  the following aspects of teen cigar use: 1) types and brands of cigars used, along with specific 
questions about using cigars to smoke marijuana; 2) extent of cigar use, including standardized 
information exploring differences in cigar use by teens demographic characteristics; 3) patterns of 
use, including information about unaltered cigars and blunts; 4) influences on use, including 
asking why teens try and continue to smoke cigars and about the extent of cigar use among their 
peers and closest friends; and 5) ease of purchase, magnitude of illegal cigar sales to minors and 
the potential of enhanced enforcement efforts to curtail cigar sales to minors. 
Action Steps to Discourage Cigar Use 
In our companion report, Youth Use of Cigars: Federal, State Regulation and Enforcement 
(OEI-06-98-00020), We recommend that the Department, under the leadership of the Assistant 
Secretary for Health develop an action plan to address the public health risks posed by cigars, 
particulary access by youth.  As a first step, we recommend an initiative to inform the public 
through a public awareness and educational effort appropriate for cigars.  This effort could also 
include pursuing a collaborative effort with the Federal Trade Commission and Congress to 
initiate a Surgeon Generals Warning Label for cigars.  As a second step, the Department should 
address the need for additional research on cigars including patterns and prevalence of use, youth 
access and ease of purchase, health effects, addictive potential, use of cigars to smoke marijuana, 
and an assessment of the adequacy of the Departments data collection and survey capacity for 
monitoring cigar use trends. 
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iv  T A B L E  O F  C O N T E N T S

EXECUTIVE SUMMARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  i

INTRODUCTION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

FINDINGS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Patterns of Use  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4

Blunts for Smoking Marijuana  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  9 

Images and Promotion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11

Social Acceptability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16

Access and Availability  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18

Perceptions of Health Risks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

CONCLUSIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  24

ENDNOTES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26

APPENDIX

A: Focus Group Information  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
 INTRODUCTION

PURPOSE 
To describe patterns of cigar use among teens in our focus groups and their peers, specifically 
exploring the initiation, frequency, and variations of use, as well as the motivations and influences 
to use.  In addition, to ascertain youth access to cigars, and their awareness of health risks 
associated with cigar use. 
BACKGROUND 
This descriptive report highlights patterns of teen cigar use based on the results of focus group 
discussions.  Prior to our study, little information was known about teen cigar use aside from 
prevalence data showing high rates of teen cigar use. 
This study was requested by the Centers for Disease Control and Prevention, Office on Smoking 
and Health, to explore the issues surrounding cigar use by minors.  It also supports the goal of 
the President and Secretary of Health and Human Services (HHS) to reduce minors tobacco use. 
Companion Office of Inspector General study 
This study is part of a larger effort by the OIG to better understand youth use of cigars.  In 
addition to this report, another OIG report describes the regulatory environment of cigars at the 
national and State levels, as well as State tobacco control and enforcement activities regarding 
minors access to cigars. That study involved reviews of existing Federal regulatory authority and 
agency oversight responsibilities for cigars, along with systematic collection of information from 
all 50 States and the District of Columbia.  We found that cigars do not receive the same Federal 
regulation and oversight as other tobacco products, such as cigarettes and spit tobacco. 
Additionally, State enforcement of laws and regulations prohibiting the sale to, and use of cigars 
by, minors is currently severely limited. 
Evidence of Cigar Use Among Minors 
In May 1997, the Centers for Disease Control and Prevention (CDC) first published data showing 
24 percent of 14 to 19 year male and female teenagers and 30 percent of 17-18 year old teens 
have smoked at least one cigar in the last year.1  Similar evidence was found in two separate State 
surveys of youth.  A Massachusetts study found that 28.1 percent of 9th to 12th grade students had 
smoked a cigar in the past year and 14.5 percent had smoked at least one cigar in the past month. 
Cigar use among males in grades 8 through 12 was also significantly higher than spit tobacco use.2 
A recent California tobacco survey found that approximately 34 percent of males and 17 percent 
of females aged 16 to 17 and 8 percent of males aged 12 to 13 had smoked at least one cigar in 
1996.3 
More alarming, are the number of high school students nationally that have used cigars in the past 
month.  Twenty-two percent of both male and female high school students combined were current 
1
 cigar users (used in the previous 30 days), according to CDCs 1997 Youth Risk Behavior 
Survey.4  Specifically, 31.2 percent of male students had used a cigar in the past month and 10.8 
percent of female students.  The number of current cigar users surpasses the number of spit 
tobacco users among high school males and females (22.0 and 9.3 percent), although the attention 
cigars have received nationally and at the State level has been far less.  As a counterpoint to these 
national and regional data, are the results of SAMHSAs 1997 National Household Survey on 
Drug Abuse which shows current past month cigar use by 12-17 year olds to be only five 
percent.5 
METHODOLOGY 
We used self-administered survey instruments and focus groups to obtain information about teens 
patterns of cigar use and awareness of health risks.  All information gathered was exploratory in 
nature and can not be projected beyond our focus group participants. 
Focus Group Participants 
Focus group participants included a mix of cigar users and non-users from schools across the 
country.  Schools were selected to give us a mix of students with different socioeconomic 
backgrounds from urban and suburban areas.  The schools were located in ten major metropolitan 
areas across all regions of the country.  Of the eighteen focus groups conducted, thirteen were 
with high school students, four with junior high students, and one with college students (College 
student data was limited and therefore not used for any college specific data breakouts.  In a few 
cases, quotes from college students were added for flavor). 
A total of 230 students completed our survey instrument.  A well-balanced racial mixture emerged 
from our overall participant group.  Focus group participants include 48 percent (106 of 223) 
White students, 33 percent (73 of 223) Black students, and 20 percent (44 of 223) other races, 
such as Asian and Hispanic/Latino.  A strong relationship exists between race and whether teens 
attend an urban or suburban school.  This relationship is expected based on the demographics of 
our study population.  Eighty-eight percent (64 of 73) of Black teens in our study are from urban 
schools.  Only nine Black students participating in our focus groups are from a school we classify 
as suburban.  The participant group also contains more female urban teens (67 percent, 73 of 109) 
than male urban teens (33 percent, 36 of 109).  Therefore, generalizations regarding our urban 
teens are heavily influenced by the responses of Black female teens. 
School officials were informed that participating students would be part of our national tobacco 
study. They were told this study is important for the Department of Health and Human Services 
to better understand young peoples use of tobacco products, in particular, cigars.  They were 
informed we were trying to determine how widespread teen cigar use is, which types of cigars 
teens are using, the influences of marketing and the media on teens, and how much teens know 
about the health risks of smoking cigars.  School officials were asked to find an equal distribution 
of students in 9th - 12th grade and to, if possible, get a mix of cigar users and non-users.  Parental 
permission slips were made available for schools requiring them. 
2
 Once students were selected to participate in our focus groups, we assured complete 
confidentially to students.  Participating students were told that we were interested in learning 
more information about people that use tobacco, and in particular, cigars. 
Two terms used throughout the report are peers and teens.  The term peers refers to 
people the participants know (about their age), while the term teens refers to students we 
surveyed (which ranged in age from 11-19 years of age).6  Questions about teens access to 
tobacco specifically referred to teens that were minors (< 18 years of age).  See Appendix A for 
more specific information about our focus group participants. 
Focus Group Approach 
Using a modified focus group approach, all participants completed a self-administered survey 
instrument that addressed tobacco in general, and more specifically patterns of cigar use.  Upon 
completing the survey, both cigar users and non-users were asked about their own perceptions of 
cigar use among people about their own age.  The focus group format allowed for a more free-
flowing, in-depth discussion among participants about such things as the perceived health effects 
of cigar smoking, a more in-depth analysis of the variations of cigar use, types of cigar products 
used (e.g. - premium vs. cheaper cigars), and the influence of the media on teens. 
Because the information collected for this study was exploratory in nature, it should only be used 
as a starting point for further study of teen cigar use.  Throughout the report we occasionally 
reference national prevalence data to compare the representativeness of our data.  However, the 
data should not be projected to all teens, since it applies only to those participating in our focus 
groups.  Nevertheless, we feel the information collected from teens in these focus groups can be 
very valuable in identifying, and planning to address, further research needs. 
This inspection was conducted in accordance with the Quality Standards for Inspections issued 
by the President's Council on Integrity and Efficiency. 
3
 F I N D I N G S

PATTERNS OF USE 
Peer Use 
Teens From Our Focus Groups Report Widespread Cigar Use And Experimentation 
Among Their Peers. 
Given the popularity, social acceptability, and high usage of cigars among adults in recent years, it 
should come as no surprise that teens are also using them.  To encourage candor, participating 
teens were first asked to assess the use of cigars by those they know about their age.  Seventy-six 
percent (171 of 225) of our high school and junior high teens know other teens about their age 
who smoke cigars.  They also report extensive experimentation with cigars among their 
classmates.  Of surveyed high school teens who knew peers who have smoked a cigar, 61 percent 
(79 of 130) say half or more of their peers have ever smoked a cigar, along with 39 percent (10 of 
26) of junior high teens.  Experimentation with cigars is slightly higher among urban than 
suburban high school teens, with 65 percent (53 of 82) of our urban teens reporting half or more 
of their peers have smoked at least one cigar in their lifetime, compared to 54 percent (26 of 48) 
of suburban teens. 
Cigar use by teens in our focus groups is not limited to certain areas of the country, rather it is 
reported by teens in all regions and among varied demographic groups.  National prevalence data 
also shows similar teen cigar use rates in all regions of the country.7 
Teens in our focus groups indicate that many of their peers are current users by reporting half 
or more of their peers have smoked a cigar in the past 30 days, with even higher use in urban 
high schools. 
The standard definition of a current cigar user is someone who has used cigars in the past 30 days. 
Of teens we surveyed, 41 percent (53 of 131) report that a quarter or fewer of their peers have 
smoked a cigar in the past 30 days, but another 35 percent (46 of 131) report that half or more 
have smoked a cigar in the past 30 days.8  Differences did emerge based on the teen respondents 
race, when they report on peer use.  Fifty-one percent (31 of 61) of our Black high school 
students report half or more of their peers are current cigar smokers compared to 22 percent (11 
of 50) of White students.  Based on our focus group results we found the highest cigar use in 
urban schools with large Black populations.  More research is necessary to better understand the 
differences in current cigar use by race and among urban/suburban school teens. 
Cigar use appears to be increasing in popularity among teens, with 40 percent reporting 
increased use among their peers since last year. 
Previously viewed as only a trend or fad, cigar use appears to be increasing in popularity in the 
United States.9  However, the lack of uniform questions on prevalence surveys makes it difficult 
to measure cigar use over time.  Forty percent (66 of 165) of the teens we surveyed report an 
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4  increase in cigar use among their peers since last year; another 35 percent (57 of 165) report use 
has remained the same.  Only nine percent (14 of 165) of teens say cigar use, among their peers, 
has decreased in the past year.10 
Ive heard a lot of teenagers are smoking. Ive seen a lot more cigar shops opening up. 
Like two opened up just around my neighborhood...they sell cigars and skateboards. 
Suburban college student 
Personal Use 
When reporting about their own use, high percentages of both male and female teens say they 
have smoked a cigar, with the highest use reported in urban versus suburban areas. 
Although much of the emphasis in our focus groups was on teens perception of cigar use among 
their peers, they were also surveyed about their own cigar consumption.  Fifty-four percent (122 
of 227) of teens surveyed in our focus groups say they have personally smoked a cigar sometime 
in their life (see Table 1).  Like cigarette use, both male and female teens admit they have smoked 
a cigar, with 59 percent (58 of 99) of males having smoked a cigar compared to 49 percent (59 of 
121) of females.  However, urban teens surveyed were more likely [62 vs. 46 percent] to have 
personally smoked a cigar, than their suburban counterparts.11 
Table 1: Personal Cigar Use By Focus Group Participants 
Personal Cigar Use  Number of Participants  Percent of Participants 
Ever Use (Lifetime Use)  122 of 227  54 percent 
Past Year Use  82 of 230  36 percent 
Current Use (past 30 days)  43 of 230  19 percent 
Of the teens in our focus groups who report ever smoking a cigar, 67 percent (82 of 122) have 
done so in the past year, with many using cigars in conjunction with other tobacco products. 
Of the 122 teens who have personally smoked a cigar in their lifetime, 67 percent (82 of 122) of 
teens have done so in the past year.  Some also report having used other tobacco products in 
addition to smoking cigars in the past year.  Of the 82 past-year cigar smokers, 60 percent (49 of 
82) report smoking cigarettes, while 16 percent (13 of 82) report having used spit tobacco 
products.  This use of multiple tobacco products is important for researchers to track, especially 
since the national prevalence data shows cigarette smokers were more than three times [54 vs. 14 
percent] as likely as non-cigarette smokers to report having smoked a cigar during the previous 
year.12  Of additional concern is the fact that some teens are beginning their tobacco use with 
cigars and later adding cigarettes.  More research is needed to determine if cigars are attracting a 
new group of users that would not normally be associated with tobacco use. 
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5  Over one-third of teens who reported having ever tried cigars, have smoked a cigar in the past 
30 days. 
Of the 122 teens surveyed who have personally tried a cigar in their lifetime, 35 percent (43 of 
122) report having smoked a cigar in the past 30 days.  These current cigar users varied only 
slightly by gender, with 38 percent (22 of 58) of males in our focus groups reporting current use 
compared with 34 percent of females (20 of 59).  We found almost no differences in current cigar 
use by race among our surveyed teens.  Of the 43 current cigar users, 30 teens were also current 
cigarette users and 6 were current spit tobacco users. 
Although our survey methodology cannot be used to calculate nationally representative 
prevalence data on teen cigar smoking, it can be used to gain insights and share information about 
patterns of use among teens.  Nonetheless, we were curious about how our data compares with 
the national data on parallel points.  The 30 day use rate was one of the few areas where such a 
comparison could be made.  Among the 230 high school and junior high school teens surveyed in 
our focus groups, the rate of current cigar smokers (past 30 days) among male and female teens is 
19 percent (43 of 230).  The most recent national prevalence data for current cigar use of U.S. 
male and female high school students combined is 22 percent for the Youth Risk Behavioral 
Survey 13  and 5 percent for the National Household Survey on Drug Abuse (NHSDA).14  While 
our date is clearly different from that found by the  NHSDA, the similarity between our data and 
the national data as seen in the YRBS and in data found in several regional studies is striking, 
especially since our sample includes several junior high teens below the age of 14 years who 
would have been excluded from the national prevalence survey.  Our results indicate that younger 
teens are smoking cigars, especially those attending urban schools. 
Among those who currently use cigars, about half of suburban and urban teens expect to be 
using cigars in the next five years. 
Much debate is occurring about whether cigar smoking, in general, is here to stay or just another 
passing fad.  We were also curious if teens in our focus groups who had smoked a cigar in past 
year expected to be smoking cigars in the next five years.  Surprisingly, our surveyed teens are 
almost evenly split about their future use, with 49 percent (39 of 80) of cigar smoking teens 
expecting to be using cigars in five years and 51 percent (41 of 80) not expecting to be cigar 
smokers in the future.  Suburban teens [53 percent] were slightly more likely to anticipate future 
cigar use compared to urban teens [46 percent].15  Although not all teens in our focus groups see 
themselves using cigars in the future, it is clear that nearly half of teens surveyed view their cigar 
use as more than a passing fad. 
Teens Begin Experimenting With Cigars At Somewhat Older Ages (About 16 Years) Than 
With Cigarettes And Most Often In The Presence Of Other Teens. 
Although most teens first exposure to tobacco is through cigarettes, 22 percent (35 of 159) of 
our surveyed teens tried cigars first.  Teens in our focus groups experimented with cigarettes at 
younger ages [mode = 12 years old] compared to those experimenting with cigars [mode = 16 
years old], although a few had tried cigars as early as nine years old.16  Teens experimenting with 
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6  cigars first is of concern because it highlights that some teens who had escaped cigarette smoking 
at an earlier age, have succumbed to the tobacco temptation in the form of cigars when they were 
older. 
Teens in our focus groups who personally experimented with cigars did so most frequently at 
parties or someone elses home.  However, some teens tried their first cigar at their own home or 
at an outdoor hangout, such as a parking lot or park.  Regardless of the setting, most 
experimentation with cigars occurred in the company of other teens.  Though youth resist 
attributing it to peer pressure, cigar usage is popular within teen culture. 
Half Of Teens in Our Focus Groups Found Their First Experience With Cigars To Be 
Pleasurable, While Half Did Not. 
Focus group participants expressed different reactions to their first experience smoking a cigar. 
Half said they enjoyed smoking their first cigar, while half did not.  Those enjoying their first cigar 
My first cigar was a cheap Swisher Sweet, I  The taste was terrible and the smoke was a 
enjoyed it because it tasted good. Plus, it was  lot stronger than smoking cigarettes. 
something my best friend and I did together. 
Bad experience 
Good experience 
liked the taste, said it relieved stress, and/or they found it relaxing.  However, other teens found 
their first cigar had a bad taste, was gross or nasty, and/or was too strong or irritating for them. 
Not surprising, of the teens who are current cigar smokers (past 30 days use) 86 percent (36 of 
42) said they enjoyed their first cigar, while only 14 percent did not (6 of 42). 
Manufactured Cigars, Rather Than Premium Cigars, Are Most Commonly Used By Teens 
Due To Their Ease of Purchase, Low Cost, Sweetened Flavors, And Pleasant Aromas. 
The majority of teens smoke cheaper,

Kids wont spend $20.00 on a cigar, theyll spend

manufactured cigars.  These cigars are usually 
$2.00 on five.
sold in packages of five at grocery stores or 
gas stations.  Teens report a number of types  Teen comment about a cigars price.

of cigars are smoked by their peers, with 59

percent (98 of 167) reporting their peers smoke cigarillos or pipe tobacco cigars, 50 percent (84

of 167) reporting they smoke regular manufactured cigars, 16 percent (26 of 167) reporting they

smoke little cigars, and only 12 percent (20 of 167) reporting their peers smoke premium cigars.17

Urban high school teens report wider use of cigarillos and pipe tobacco cigars [72 percent]

compared to suburban high school teens [48 percent].18  More suburban high school teens [58

percent] report their peers smoke regular manufactured cigars than their urban counterparts [47

percent].19

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7  Although teens typically smoke cheaper cigars, some teens in our focus groups occasionally 
purchase more expensive cigars for special occasions.  In fact, 20 teens said they had spent $10 or 
more for a cigar, with one teen admitting he had spent $55 for a single cigar. 
it has a nice taste, its a mild taste....doesnt taste 
Types of cigars mentioned by teens which 
too strong, and they smell good. 
were more popular include sweetened cigars, 
Typical comment about sweetened cigars & pipe tobacco cigars  cigars filled with pipe tobacco, and blunted 
cigars.  Specific popular brands often 
...Our Sweets business [referring to the sweetened
mentioned by teens were Swisher Sweets, 
cigar products] has been a growth business since we 
Black and Mild, and Phillie Blunts.  A cigars  first got into it in 1958. Sweets products are a niche 
flavor and scent seem to influence what type  that has a different taste from our mainline cigars 
of cigars teens smoke, as well as its price.  and they seem to appeal more to first-time cigar 
smokers. They appeal particularly strong in the 21-
to-35 group. So its a real sub-growth segment 
within the cigar business. 
Timothy Mann, Swisher President 
The Level of Cigar Smoking Among Teens In Our Focus Groups Varies Greatly, With 
Urban Teens Reporting More Frequent Use. 
Most teens smoke cigars on the weekends, however, urban teens report use during weekdays. 
Although cigar smoking among teens is widespread, the frequency of use varies between the 
occasional user to the more frequent user.  Similar patterns of cigar use exist for adults especially 
young adults. To provide a sense of levels of frequency of use, in our companion report (OEI-06-
98-00020) we define a regular cigar smoker as someone who uses cigars 3-4 times per week. 
The National Cancer Institutes monograph, Cigars: Health Effects and Trends, Smoking and 
Tobacco Control, does not formally define regular cigar use,however our definition fits into this 
same common definition which appears through out the monograph.According to a 1986 study, 
66 percent of 18-24 year old current cigar smokers used cigars less than once a week, compared 
to the average of 52 percent for all ages.20  Additionally, young adults were more likely [33 vs. 18 
percent] to smoke cigars at least once a week compared to the norm and were the least likely to 
smoke cigars once a day [2 vs. 30 percent].21  Given that our data was collected after the recent 
increase in popularity of cigar smoking, we anticipated more frequent cigar use among teens in 
our focus groups than the 1986 study reported. 
We found cigar use among our surveyed teens to be extremely varied, though daily or almost 
daily use was higher among our surveyed teens than that of young adults surveyed in 1986.  The 
majority [61 percent, 101 of 166] of teens we surveyed report their peers are occasional cigar 
users.  Of the 61 percent of occasional cigar users, 42 percent (70 of 166) report their peers 
smoke cigars two days or less a week and another 19 percent (31 of 166) report their peers 
smoke cigars during special events only, such as parties or birthdays.  However, 39 percent (65 of 
166) of teens report their peers smoke more frequently, with 25 percent (41 of 166) of teens 
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8  reporting their peers use cigars daily or almost daily and 14 percent (24 of 166) reporting their 
peers use cigars between 3-4 days per week.  This frequent teen use of cigars is of concern 
because cigar smoking for some is occurring at levels approaching those of cigarette smoking. 
Given the high levels of nicotine in cigars, the frequent usage levels may increase the risk of 
tobacco addiction or possible switching to cigarettes. 
Suburban teens were much more likely than urban teens to report cigar use among their peers 
only occurred occasionally (2 or less times a week).  Fifty-six percent (37 of 66) of suburban 
teens surveyed said their peers smoke cigars two days or less a week compared to 33 percent (33 
of 100) of urban teens.  Additionally, 33 percent (22 of 66) of suburban teens report their peers 
only smoke cigars during special occasions compared to 9 percent (9 of 100) of their urban 
counterparts.  The remaining 58 percent (58 of 100) of urban teens report cigar use at much 
higher levels, with 39 percent (39 of 100) reporting their peers smoke cigars daily or almost daily 
and 19 percent (19 of 100) reporting they smoke cigars at least 3-4 days per week.  We found no 
major differences in the frequency of cigar use reported by teens in high school compared to 
junior high, possibly indicating higher levels of use are occurring among younger teens also. 
Teens Typically Smoke Cigars At Parties, Frequently While Drinking Alcohol. 
Teens most commonly smoke cigars in the presence of other teens in a social setting.  Parties, 
usually held on the weekends, are the most likely place to find teens smoking cigars.  Sixty-five 
percent (46 of 71) of our teens who had smoked a cigar in the past year said they usually smoke 
cigars at parties, while 49 percent (35 of 71) said they smoke cigars at someone elses home.22 
Another likely place for teens to smoke cigars is at outdoor hangouts (such as parking lots, 
parks), with 47 percent (33 of 71) of teens reporting such a location.  Outdoor activities (such as 
fishing, camping, hunting, or golfing), concerts, and/or restaurants are other locations where teens 
often smoke cigars. 
However, cigar smoking among teens in our focus groups does not occur exclusively in a social 
setting.  Forty-one percent (33 of 80) of our teens report they sometimes smoke cigars alone. 
Urban teens were more likely [47 percent] to smoke alone compared to suburban teens [33 
percent].23  Teens apparently do not always leave their own house to smoke cigars because 34 
percent of teens (24 of 71) said they usually smoke cigars at home.  Of concern, is the mixing of 
cigars and alcohol by teens surveyed, since combining alcohol with tobacco dramatically increases 
the users cancer risk.24  Fully 47 percent (36 of 77) of teens smoking cigars in the past year 
report they usually smoke cigars when drinking alcohol. 
BLUNTS FOR SMOKING MARIJUANA 
Teens In Our Focus Groups Report Their Peers Use Cigars As Blunts For Smoking 
Marijuana. 
Blunting was reported more extensively by teens in our urban schools. 
Teen cigar use often goes beyond smoking cigars in the typical manner.  A practice called blunting 
)))))))))))
9  has become quite popular.  When blunting, the

user cuts open or unrolls the cigar and replaces all  You crack them down the middle, you dump

or most of the tobacco filler with marijuana or  the tobacco out, fill it up with weed and roll it

other substances.  The Office of National Drug  back up.

Control Policy cites sources in Texas, California, 
Urban teen

and Georgia who report that young users combine

marijuana with a variety of substances such as crack, PCP or heroin and roll it into blunts. 

Though none of the teens in our focus groups explicitly stated what other substances, besides

marijuana, they or their peers use in blunts, a few alluded to other things which can be added,

indicating that marijuana is not the exclusive additive. To ensure confidentially and encourage

openness, we did not directly ask teens in our focus groups if they personally use cigars as blunts

for smoking marijuana.  However, teens reported that the practice of blunting is common in their

schools. 

Of the teens who participated in our focus groups, 73 percent (123 of 169) know people about

their age who use cigars as blunts for smoking marijuana.  Only 17 percent (28 of 169) report

none of their peers blunt.25  Familiarity with blunting increases dramatically in urban schools. 

Eighty-two percent (84 of 102) of urban teens admit knowing someone about their age who uses

cigars as blunts, compared to 58 percent (39 of 67) of suburban teens.

Though common at parties on the weekends, urban teens report blunting often occurs everyday. 
According to teens in our focus groups,  ...on a regular day after school, but at parties they 
smoking cigars in a party environment, while  get more because they gather up and get more 
using alcohol and/or as blunts filled with  (marijuana). 
marijuana is fairly common.  Urban teens 
Junior high, urban teen speaking about when other teens smoke blunts. 
report blunting occurs sometimes among their 
peers on a daily basis, but parties are a more likely place to see the most extensive use. 
Urban teens not only report blunting is more extensive among their peers, but that it is also done 
more frequently.  Of the teens reporting their peers use cigars as blunts, 72 percent (52 of 72) of 
urban teens report this is done very often or always by their peers compared to only 29 percent (7 
of 24) of their suburban counterparts.  Urban 
teens are more likely to report blunting occurs 
They smoke it [blunts] in the car, outside, inside, 
among their peers everyday, while suburban 
walking from school, walking to school. 
teens report such use mostly on the weekends 
Urban teen on blunting  and usually at parties. 
Confusion exists among teens over what is meant by a cigar.  Is it a plain cigar or a marijuana-
filled blunt? 
Based on our focus group discussions, teen

references to cigar smoking and/or blunting 
...a lot of people who smoke cigars smoke weed, too.

behavior are often difficult to differentiate. 

Although teens were specifically shown the  Urban teen

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10  different types of cigars prior to taking our survey, many (especially in urban schools) wanted us 
to clarify if we were talking about plain cigars or cigars with marijuana in them.  Teens report 
their peers smoke both regular cigars, as well as cigars used as blunts for smoking marijuana, 
especially in the urban schools.26  Thus, the two usages do not appear to be mutually exclusive. 
As a result, our findings do not always explicitly delineate cigars used as blunts for smoking 
marijuana.  The overwhelming rationale teens give for using cigars as blunts is the larger size of 
cigars compared to other alternatives.  Cigars used as blunts hold a greater quantity of marijuana 
or other additives than typical cigarette rolling paper, making it a desirable method for smoking 
these substances.  Simply due to its size, smoking a blunt filled with marijuana and/or other 
substances results in a greater amount of the drug being consumed and therefore delivers a bigger, 
better, and/or longer-lasting high.  Teens also report that cigars used as blunts enhance the flavor 
of the marijuana, burn more slowly than cigarette rolling paper, and camouflage the smell of 
marijuana. 
Teens prefer the cheaper brands for making blunts.  Phillie Blunts and Swisher Sweets are the 
most prevalent brands teens report their peers use for blunting, however, several teens also named 
Black and Mild.  As mentioned earlier, the 
emergence of new blunted cigars by 
All we need is the paper [if they sold the outer leaf,  manufacturers opens up additional avenues
they wouldnt need to buy the cigars]...thats 
for future discovery by teens.  A few 
paraphernalia. 
manufacturers are now selling roll up 
Urban teens view of using cigars as blunts for smoking marijuana.  blunts.  For example, Royal Blunts, professes 
to be the number one blunt rolling leaf in the 
world, and is selling eight cognac honey dipped pre-cut ready-to-roll blunts for around $2.49.  No 
teens in our focus groups had seen the newer blunt rolling leaves yet, but some said such a 
product would be popular, since most teens discard the inner contents of cigars anyway in order 
to make a blunt.  Using a blunt rolling leaf will reduce waste, cost, and the hassle of hollowing out 
the cigars currently used for blunts.  Future research will need to closely monitor the production 
and sales of such products, especially given that they are composed of tobacco, unlike cigarette 
rolling paper. 
IMAGES AND PROMOTION 
Though Media Portrayals Of Cigar Smoking Are Prevalent, Exactly How They Influence 
Teens Remains Unclear.  However, Teens In Our Focus Groups Can Easily Recall A Wide 
Assortment Of Television Shows, Movies, And Famous Celebrities Associated With Cigar 
Smoking. 
Teens personal images of cigar smokers vary. 
When teens in our focus groups describe their image 
of a cigar smoker three common attributes emerge.27 
Yes, anybody can smoke, but mostly men.  The most frequent image credits a cigar smoker with
Ive seen a lot of older men. Kind of like 
being:  rich, successful, or high-class [9 focus
successful. 
groups].  The second most popular image is that of 
Female students image of a cigar smoker 
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11  an older man [7 focus groups], often cited in conjunction with the first.  These two images follow 
the traditional, more stereotypical perception of a cigar smoker.  However, the third most 
frequently cited image by teens indicates a cigar smoker could be anyone, including themselves or 
other teens [4 focus groups].  This newer image of a cigar smoker diverges from the first two, 
reflecting the medias more recent portrayal of younger men, women, and cartoon characters also 
smoking cigars. 
Also odd, is the gender specificity in teens responses.  Though female focus group participants 
are almost as likely to use cigars as males in our study, teen participants of both sexes often 
specifically mentioned males, but not females in their description of a cigar smoker.  It is possible 
there is an element of denial among teens regarding their own behavior.  While they can readily 
provide a definition of a cigar smoker, it usually often fails to contain attributes which would 
include them.  Whether intentional or not, teens appear hesitant to define themselves as a cigar 
smoker, despite their own use.  Possibly their resistance lies in the term cigar smoker and its 
implications of a frequency of use which they dont feel they exhibit.  In their own minds, perhaps 
they are the exception to the rule. 
Popular sitcoms and cartoons are two types of television shows which teens recall as 
showingcigar smoking. 
Our focus group participants had no difficulty reporting popular television shows that portray 
cigar smoking.  In fact, overall, teens could recall 26 different television shows where they 
remembered seeing cigar smoking.28  Such extensive recall is a testament to the widespread 
portrayal of cigar smoking and reinforces the fact that teens notice such usage.  The television 
shows most frequently noted as showing characters smoking cigars include Seinfeld and cartoons. 
Though cartoons such as the Simpsons and Beavis and Butthead were cited by our teens, they 
also listed Looney Tunes cartoons (including Bugs Bunny and Yosemite Sam), Rocky and 
Bullwinkle and others which are also viewed by very young children. 
Teens in our focus groups readily named popular films depicting cigar smoking, as well as 
famous personalities who are cigar smokers. 
Overall, teens cited 45 different movies in which they remembered seeing cigar smoking. 
Independence Day, a more recent film, was referenced by 10 of our focus groups as portraying 
cigar smoking.  Though not always, past appearances of cigars on film have sometimes been the 
result of product placement, a practice which the Cigar Association of America recently 
announced plans to admonish its members to halt.29 
In addition to films, our participants were just as adept at naming entertainment personalities who 
are personally associated with smoking cigars.  Some of these individuals used cigars in 
conjunction with one or more of the films referenced above, while others smoke cigars in their 
public/personal life.  In total, teens listed 25 different entertainers as recognizable cigar users. 
They most frequently recalled comedian George Burns as a celebrity who smoked cigars [7 focus 
groups].  Burns promoted and smoked an average of 10 El Producto brand cigars a day and lived 
to 100 years old.30  Due to his long life span and consistent cigar use several teens questioned how 
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12  cigars could really be that harmful.  Other film entertainers frequently mentioned include: 
Sylvester Stallone, Robert DeNiro, Arnold Schwarzenneger, Vanessa Williams, and Milton Berle. 
Sports figures are also associated with smoking cigars by teens, especially outstanding athletes 
such as Michael Jordan. 
Not only can they list a lot of entertainment

personalities associated with cigar use, but  On ESPN you always see people smoking cigars.

teens in our focus groups also mention a

number of professional sports figures who  ...theres some celebrities I dont care about. But, if

I see Michael Jordan smoking on a stogie, that would 
smoke them as well.  Several teens said golf 
influence me.
is the sport they most commonly associate 
with cigar smoking.  In all, our participants  Male teens 
recall 14 different sports personalities they 
have seen smoking cigars.  Though the list was quite diverse, Michael Jordan was the most 
frequently mentioned sports figure. 
Our focus groups occurred prior to Jordan and his teammates of the Chicago Bulls lighting up 
cigars on national television to celebrate their sixth NBA championship in June 1998.  Shortly 
after this public celebration, the American Medical Association (AMA) voted to urge sports teams 
and the television industry to keep tobacco products off television during and after sports events. 
Historically, the use of sports figures in 
tobacco advertising has occurred since the 
...it was only after a generation of young males  1940's.  In fact, by the 1940's and early
became addicted to smokeless tobacco that

1950's, athletes and movie celebrities

endorsement by athletes was discontinued because of 
publically promoted various cigarette brands.31

its appeal to youth. 
In response to growing health concerns about 
NIH Monograph 9 Cigars: Health Effects and Trends  cigarette smoking during the mid 1960's, the 
tobacco industry adopted a voluntary 
prohibition of athlete and celebrity endorsements perceived to appeal to youth.  In the 1970's 
similar marketing practices were applied to spit tobacco with celebrities and athletes again 
recruited to promote the product in print media and on television (where cigarette advertising was 
prohibited). 
A similar message is being delivered by the  cigar industry through claims that cigars are not

dangerous because users do not usually inhale them.  Like their other tobacco product

predecessors, cigars are currently being

promoted by celebrities and sports icons. 

Whether they are intentional spokespeople or  Athletes are once again endorsing cigar use

merely visible extensions of popular culture,  including such prominent super stars as Wayne

Gretzky.

sports figures are sending strong messages to 
the public and teens about healthy, 
NIH Monograph 9 Cigars: Health Effects and Trends

successful people enjoying cigars.  A July

1998 issue of Sports Illustrated features former Chicago Bears and current New Orleans Saints

head coach Mike Ditka smoking a cigar on the front cover.  Titled Holy Smoke!, the article

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13  highlights his new bad boy turned good image as a model for success. 
The article describes him chewing on the 
tip of a Cuban cigar at one point, while 
no cussing, no booze, no negative thoughts, no 
another photo shows him lighting a cigar 
unhealthy foods, no temper tantrums, no missing Mass, 
no unnecessary gabbing to the press, no more than three  for his wife.  The potential influence that 
cigars a day, [and] no gambling.  cigar smoking sports personalities have 
over youth must be addressed.
Mike Ditkas new self-improvement campaign 
Teens associate various rap/hip hop vocal artists with cigar smoking and blunting. 
The other area mentioned by teens as having a high number of recognizable cigar users was the 
music industry.  Among famous cigar users they could enumerate, focus group participants named 
a total of 11 different rap/hip hop artists.  Those most frequently mentioned were Puff Daddy and 
Master P, both well known rap/hip-hop vocal artists.  Unlike the spheres of television, film, and 
sports, these elements of the music industry 
have been fairly forthright in their 
promotion of not just cigars, but their use  I like to smoke weed, but gettin high just to get 
high isnt beneficial...sometimes when I smoke a 
as blunts.  Many artists appear on album 
blunt, Ill just want to relax, but other times weed 
covers and in videos with what can be 
enhances the creative process. I use the stimulation 
perceived as the trappings of success:  gold  to my advantage. 
jewelry, attractive women, expensive cars, 
A popular hip-hop artist 
and cigars.  Yet, their lyrics clarify that 
these are not just plain cigars, but blunts. 
Blunting references permeate the rap/hip-hop music, and are even celebrated by some artists as an 
important element in the creative process.  Even songs with titles like, Fire It Up, Budsmokers 
Only, and Ghetto Dope have made it into the musical mainstream patronized by many young 
people.  Within our focus groups, most teens believe cigars used by these performers are used as 
blunts.  Even in magazine promotional pictures of these musicians which may have used plain 
cigars as photography props, students were convinced they were holding blunts.  For example, the 
May 1998 cover of Vibe magazine features rapper/hip-hop success Master P with a cigar in his 
mouth.  After viewing this image, students in one of our focus groups assumed it was a blunt 
because, ...thats all he talk[s] about.  This facet of the music industry is hitting youth with 
strong images of cigars being used as drug delivery devices.  Through the lyrics and lifestyles of 
the artists, blunting is portrayed, not only as a symbol of successful living, but also as a necessary 
element for daily life.  Though fans prone to emulation may not be able to afford the cars or 
jewelry, most can somehow obtain a blunt and imitate their icons in that respect. 
In an attempt to combat these influences, some states are trying to send positive messages via the 
same medium.  As noted previously, the state of Massachusetts has recently released an anti-cigar 
campaign produced in the rap/hip-hop style.  Under the guise of a music video, the piece conveys 
the message that teens are being manipulated by the cigar industry to use their products.  The 
intent is that painting teens as victims of a selfish enterprise will cause them to rethink and, 
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14  hopefully, discontinue their cigar use. 
Teens observe cigar advertising in magazines, on billboards, and on novelty apparel. 
Teens in our focus groups were able to recall 
The renaissance of the cigar business is due to the
various types of cigar advertisement, but not 
impact of Cigar Aficionado magazine, which has
all ads highlighted a specific brand of cigars. 
helped to bring cigars more into fashion...The cigar 
Sixty-three percent (140 of 222) of teens  has always been a symbol of success. 
recall seeing cigar advertising, with most 
Swisher President Timothy Mann in a 1995 interview with the U.S.
reporting seeing such ads in magazines [68 
Distribution Journal 
percent] and/or on billboards [57 percent].32 
Television [40 percent] and newspaper ads [36 percent] were two other places where teens 
remembered seeing cigars promoted.33  In many cases, they mentioned seeing cigars advertised 
generically, without any reference to a particular brand, such as a billboard advertising a tobacco 
or cigar shop.  We assume this is true for many of the television and newspaper ads teens have 
seen.  Nonetheless, they specifically mentioned speciality cigar magazines like Cigar Aficionado 
and were able to recall many of the famous actors they had seen on the cover.  Teens also said 
sports magazines include cigar advertisements, with one teen reporting his High School Football 
Weekly magazine included such ads.  His comment was ...thats kind of weird cause its like high 
school guys in it. 
A number of teens also mentioned seeing 
...like on spring break when we went to Florida 
cigars advertised on t-shirts and hats. 
there were a bunch of shirts there with cigars on 
Although much of the merchandise was not 
them. 
brand specific, teens mentioned seeing
Junior high female teen 
Phillie Blunts advertised on clothing items. 
Teens also identified one teen-oriented 
speciality shop found at many malls nationally that sell cigar t-shirts.  We personally observed 
several cigar t-shirts during our field work, such as a cigar smoking Betty Boop t-shirt. 
Thanks to other manufacturers capitalizing on the cigar craze, teens and adults can purchase cigar 
desk accessories, such as cigar picture frames, notepad holders, and pens.  We also found one 
tobacco shop in a popular strip in Alexandria, Virginia proudly displaying a talking cigar called 
Mr. Smoke.The Big Brown Public Toy Company features this stuffed toy as a Museum Quality 
Collectors edition.  Though it retails for $39.95, the company openly promotes that kids 
lovem! and finally a character that you and the kids can agree on.  In all likelihood this toy 
will not become the hottest new Christmas sensation for kids, but it does deliver a message to kids 
and adults that smoking cigars is socially acceptable.  It is also unlikely that we will ever see a 
cigarette version of this toy.  No teens in our focus groups had ever seen Mr Smoke, but they 
reacted very positively to the toy when we showed it to them.  One teen said [the toy is] 
glorifying a blunt as a kid product. 
Overall, teens report that cigar advertising is not as widespread as cigarette advertising. 
However, cigars are being embraced by the media and have become the socially acceptable 
tobacco choice.  Perhaps, as a result, cigars have not needed the same extent of promotion as 
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15  other tobacco products.  With the number of low-cost cigar competitors increasing, we can 
expect to see more product differentiation and brand name marketing.  This is apparent with the 
addition of larger free-standing merchandising displays being used by brands like Swisher Sweets. 
Additionally, as competition from less known brands continues to increase, so will the desire for 
market share.  We are concerned that such a trend will only draw more teens into experimenting 
with and using cigars.  The addition of new cigar product lines and advertising, especially of the 
blunted and sweetened cigars so popular among teens, should be monitored. 
Also, of concern is the use of the Internet and mail-order catalogs to further advertise cigars. 
Although very few teens report using either of these resources to access cigars, we have seen 
creative Internet sites that are using mass distribution lists to advertise their on-line cigar 
companies to unsuspecting users.  The only disclaimer found on some of these messages is that 
only those 18 years and over should read it. 
SOCIAL ACCEPTABILITY 
Smoking Cigars Is More Socially Acceptable Among Teens And Adults Than Smoking 
Cigarettes Or Using Spit Tobacco. 
Cigars have been spared the intensity of anti-cigarette and spit tobacco campaigns launched in 
recent years.  They have also not faced the same degree of Federal regulation and oversight as 
other tobacco products (OEI-06-98-00020).  In addition, the latest National Cancer Institute 
monograph reveals a surprising relationship between cigar use, income, and education.  While 
cigarette use decreases as income rises, cigar use actually increases.  The same phenomena exists 
with higher educational attainment.  As education increases, cigarette usage goes down while 
cigar use goes up.  According to the monograph, this data raises concerns that past success in 
reducing smoking among these groups may be at risk of slowing down or reversing, as former 
cigarette smokers are reintroduced to nicotine through cigars.  In addition, the use of cigars by 
these groups corroborates and promotes the norms created by cigar marketers that portray cigar 
use as a socially acceptable, sophisticated and relatively safe behavior.34 
Parents often deliver the message that cigar smoking is acceptable but cigarette smoking is not. 
The social acceptability of cigar use is sometimes conveyed to teens tacitly, but at other times 
very directly.  The level to which teens 
observe and emulate adult behavior is 
My parents know that I smoke cigars...but if they  unknown, but we assume that such influence 
had any idea that I smoked cigarettes, they would  is greater when coming from the adults in
kill me. 
their own lives. 
Suburban male 
Fifty-five percent (94 of 171) of teens in our focus groups report having been with adults that 
have allowed teens to smoke cigars.  The social acceptability of teen cigar use is highest in 
suburban areas.  Sixty-four percent (43 of 67) of suburban teens report having been around adults 
that have allowed teen cigar smoking, as contrasted with 49 percent (51 of 104) of urban teens. 
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16  Some teens also report parents are more accepting of smoking cigars than cigarettes, possibly due 
to the belief that cigars are relatively safer than other tobacco products.  A few teens even admit 
they smoke cigars in front of their parents, or even with them at times. 
Teens Report Their Peers Are Most Influenced By Other Friends Using Cigars, But Say 
They, Personally, Are Somewhat More Influenced By The Relaxing Effect Of Cigars. 
Though teens in our focus groups can recall images of cigar smoking in various aspects of 
contemporary culture, their more subtle influence was not mentioned frequently by teens as a 
reason why they or their peers smoke cigars.  However, 41 teens did report their peers smoke 
cigars because it is trendy and popular, but only 10 teens surveyed acknowledge this as a reason 
why they personally smoke cigars. 
Ninety-six teens report that other friends smoking cigars is one of the greatest influences on their 
peers, and also an important reason why they personally use them (see Table 2).  However, the 
top influence noted by teens who smoke cigars is the relaxing effect cigars have on them.  This 
emerged from both our survey results as well as the focus group discussions.  Teens say cigar 
smokers are more casual or relaxed than cigarette smokers.  Perhaps the high nicotine content in 
cigars helps explain why teens find them so relaxing.  It could also be that teens are thinking of 
marijuana-filled blunts instead of plain cigars. 
Teens in our focus groups also frequently mentioned curiosity as an influence on why they and 
their peers smoke cigars.  Unlike cigarettes, the taste and aroma of cigars vary greatly, allowing 
teens a number of opportunities to experiment with a wide assortment of cigars before deciding 
whether or not cigars are for them.  For example, if they do not enjoy a more basic cigar, they can 
try a variety of cigars with sweetened flavors or pipe tobacco cigars with pleasant aromas.  Quite 
a few teens list taste as a key influence on their peers and themselves to smoke cigars.  Some also 
say their peers are smoking cigars because they think they are safer than cigarettes or spit 
tobacco.  However, relatively few teens say they personally are influenced by this belief. 
Table 2: Top Influences On Teens To Smoke Cigars 
Why their peers smoke cigars  Why they personally smoke cigars 
Friends use  96 teens  35 teens 
Relaxing  69 teens  41 teens 
Curiosity  53 teens  35 teens 
Taste  42 teens  35 teens 
Trendy and popular  41 teens  10 teens 
Believe cigars are safer than  28 teens  12 teens 
cigarettes or spit tobacco 
Popular entertainers or  18 teens  0 teens 
celebrities use 
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17  ACCESS AND AVAILABILITY 
Over Two-thirds Of Teens In Our Focus Group Reported They Know Minors Who Were 
Able To Buy Cigars, Usually Because Clerks Failed Either To Ask For Their Identification 
Or To Closely Examine It. 
The most common method used by teens to access cigars is to simply go buy them. 
Over two-thirds (149 of 220) of teens in our focus groups said they know minors who were able

to buy cigars.  Urban teens report an even higher frequency of cigar purchases among minors,

with 80 percent (86 of 108) of urban teens reporting such purchases compared to 56 percent (63

of 112) of suburban teens.  Of the teens who knew minors who have purchased cigars, 82 percent

(121 of 147) said it was fairly easy [42 percent, 62 of 147] or very easy [40 percent, 59 of 147]

for them to buy them.  Only 12 percent (17 of 147) of teens report it is fairly difficult or very

difficult for minors to purchase cigars, while 6 percent (9 of 147) did not know the difficulty

minors have in purchasing cigars. 

Teens also told us they purchase cigars at

minor friendly establishments.  Such  Buying cigars is easier...I was buying snuff and

establishments allow minors to purchase cigars  Swisher Sweets before I was buying cigarettes.

because either clerks do not always ask for 
Suburban teen

identification or do not closely examine teens

identification to verify their age or the authenticity of the identification.  Only 32 percent (70 of

218) of teens surveyed in our focus groups report minors are always or very often asked by clerks

for identification prior to purchasing cigars, while 24 percent (53 of 218) report this only occurs

about half the time.  Another 30 percent (66 of 218) of teens said clerks requiring identification

for cigar purchases rarely or never occurs.  Urban teens are more likely to purchase their own

cigars than suburban teens.  Forty-five percent (47 of 105) of teens in our urban focus groups

report that identification is rarely or never asked for by clerks, compared to only 17 percent (19 of

113) of their suburban counterparts. 

The ease with which minors are able to access cigars is not surprising given the limited State

enforcement of tobacco laws and regulations, as applied to cigars.  A 1998 companion OIG report

(OEI-06-98-00020) found that, although all States and the District of Columbia have tobacco

laws broad enough to encompass cigars, States do not evenly enforce these laws and regulations. 

States also lack a general awareness of the extent of cigar sales to minors, the ease with which

minors can purchase cigars, and the degree to which minors use of cigars is a problem in their

State. 

Teens typically buy cigars at gas stations or convenience stores, but many get cigars by having 
older people or friends buy for them. 
Though teens typically purchase cigars at a variety of places, the most commonly mentioned 
places include gas stations, convenience stores, supermarkets, and drug stores.  Sixty-nine percent 
(148 of 214) of teens in our focus groups said their peers purchase cigars at gas stations or 
)))))))))))
18  convenience stores, while 49 percent (104 of 214) report teens make such purchases at

supermarkets or drug stores.  Only 21 percent (45 of 214) of teens mentioned tobacco shops as a

likely place their peers obtain cigars. 

Not all teens purchase their own cigars.  Fifty

My dad actually gives them [cigars] to me.

percent (106 of 214) report their peers get 
cigars from their friends, some of whom may  Male cigar smoker

be legally old enough to purchase cigars. 

Surprisingly, 26 percent (56 of 214) of teens report cigars are obtained from parents or other

family members.  Though not all respondents indicated that family members knew they obtained

cigars through them, some clearly did, again reinforcing the social acceptability of cigar smoking. 

Other teens report their peers will proposition older people outside of stores to purchase cigars

for them.  Many teens specifically classified these adults as junkies or street people they

encounter near the stores and pay a nominal fee for their assistance.  This was mentioned more

frequently in urban areas, where teens have easier access to more adults hanging out near stores.

Some stores facilitate easy access by placing cigars within reach, making it possible for some 
teens to steal them. 
Teens in our focus groups did not report a consistent merchandising setup for selling cigars 
among retailers.  Forty-four percent (97 of 219) of teens said cigars are displayed behind the 
counter, while 30 percent (66 of 219) of teens said cigars are displayed both behind the counter 
and within reach.  Another 15 percent (32 of 219) of teens said cigars are always placed within 
reach.  We have seen stores that display cigars right next to childrens school supplies, such as 
crayons.  Prior to a newly passed law in Texas, cigars were prominently displayed next to candy in 
most grocery stores.  Though many problems 
are obvious with this sort of convenient access 
to cigars, one of the most troubling problems 
I work at ....[a discount drug store]. One thing I 
expressed by teens is that this makes cigars 
noticed ...the cigars...was [were] on aisle six but all 
easy to steal.  Twenty-seven percent (58 of  the cigarettes were behind the counter...I thought 
218) of teens in our focus groups know other  that was weird but I know we had a lot of five-finger 
peers who steal cigars, most commonly from  discount types - these people come in, you know, 
and get them and walk out... 
stores (41).35  Teens also report their peers 
steal cigars from family members (18) or  Suburban college student 
friends (11). 
PERCEPTIONS  OF HEALTH RISKS 
Though Teens In Our Focus Groups Appear To Be Generally Aware Of The Adverse 
Effects Of Tobacco Use, They Tend To Lack Specific Knowledge Of The Health Risks Of 
Cigars. 
Sixty-five percent (141 of 218) of teens in our focus groups report having heard or read about the 
health effects of smoking cigars.  Yet, teens usually cannot recall the source of their information, 
nor is it specific to cigars.  In general, it appears teens in our focus groups have heard very little 
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19  about the health effects of cigar use, but draw general conclusions about cigar-related health risks 
from information learned about other forms of tobacco use.  They rationalize that cigars, like 
cigarettes, are generally harmful to ones health and/or can cause cancer, but are fairly evenly 
divided in their beliefs about the comparative risks of cigars versus other forms of tobacco.  When 
asked about any cigar health effects, without any prompting, a total of 50 teens said that cigars 
cause some type of cancer.  In addition, another 53 teens enumerate a variety of maladies 
attributed to cigar smoking.  Of those, lung disease, death, and blackened lungs are most 
frequently mentioned. 
We asked teens whether they agree or disagree that cigar smoking can cause three specific types 
of cancer.  Though there are numerous disease risks associated with cigar smoking, we focused 
on both lung and mouth cancer because of their strong link to cigar use.  However, to test 
response reliability, we also asked teens whether they believe cigar smoking is linked to stomach 
cancer, a linkage without supporting scientific evidence.  Interestingly, the greatest disease risk 
for cigar smokers, mouth cancer, is not most frequently identified by teens.  Rather, 88 percent 
(194 of 221) of teens agree or strongly agree that cigar smoking can cause lung cancer, but only 
71 percent (155 of 220) of teens agree or strongly agree that cigar smoking causes mouth cancer. 
What seems clear about teens assessment of the disease risks of cigar smoking is that they are not 
receiving sufficiently explicit information to clearly articulate the true health hazards of cigars. 
This is particularly apparent when 51 percent (112 of 220) agree or strongly agree that cigar 
smoking causes stomach cancer. 
Additionally, although some teens acknowledge the possibility of fatal consequences from cigar 
use, most seriously underestimate the real-life probabilities of harm.  For example, most teens 
think car accidents, rather than tobacco use, are the leading cause of preventable death in 
America.  In actuality, tobacco use is the most preventable cause of death in our society.36 
In all, 42 percent (92 of 219) of teens think cigars pose the same health risks as cigarettes, but 25 
percent (55 of 219) believe cigar smoking is less risky or not risky at all.  Despite their inability to 
demonstrate explicit knowledge of the effects of cigar use, the remaining one-third (72 of 219) of 
teens believe cigars to be more risky or much more risky than cigarettes.  We expected fewer 
teens to judge cigars as more risky, especially since popular opinion holds cigars are relatively 
safer than cigarettes because most adult users do not typically inhale cigar smoke.  Perhaps some 
teens assumed cigars are riskier than cigarettes because cigars were the focus of our study.  Thus, 
they may have selected what they deemed as the correct answer, rather than one based on their 
own knowledge.  Otherwise, it is hard to imagine that such high numbers of teens would be 
indulging in a practice they consider so dangerous.  The extent to which these teens truly believe 
that cigars are as harmful or more harmful than cigarettes is unknown and requires further study. 
Nevertheless, Most Of Our Teens Believe Smoking Cigars Is Bad For A Persons Health 
And That The Potential Harm Increases With More Frequent Use. 
Regardless of how teens view the risks of cigar smoking as compared to cigarettes, teens are not 
naive enough to believe smoking cigars has no health effects.  Ninety-four percent (208 of 222) of 
teens report they believe smoking cigars is bad for a persons health.  Several teens note that, 
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20  since tobacco in general is harmful, cigars have to be somewhat dangerous, but they do not know 
specifically how dangerous.  Teens also view the risks of daily cigar use as particularly harmful. 
Seventy-one percent (158 of 222) of teens conclude that smoking one cigar a day is very harmful 
(see Table 3).  However, the perceived risks of cigar smoking drastically diminish as frequency of 
use becomes more occasional.  Only 30 percent (66 of 222) of teens think smoking one cigar a 
week is very harmful, while 51 percent (114 of 222) believe it is somewhat harmful and 11 
percent (24 of 222) believe it is not harmful.  Far fewer teens are convinced that smoking one 
cigar a month is harmful.  In fact, only 15 percent (33 of 221) say this level of cigar smoking is 
very harmful, 54 percent (120 of 221) say it is somewhat harmful, and another 23 percent (51 of 
221) of teens say smoking one cigar a month is not harmful. 
Table 3: Teens Perception of Health Risk of Cigar Smoking 
at Different Usage Levels 
Smoking one cigar  Smoking one cigar  Smoking one cigar 
a day  a week  a month 
Very Harmful  71 %  30 %  15% 
(158)  (66)  (33) 
Somewhat Harmful  19 %  51 %  54 % 
(41)  (114)  (120) 
Not Harmful  4 %  11 %  23 % 
(9)  (24)  (51) 
Dont Know  6 %  8 %  8 % 
(14)  (18)  (17) 
Our Teens Who Have Tried Cigars Rate Their Adverse Health Effects Lower Than Teens 
Who Have Never Smoked Cigars. 
Teen assessments of the adverse health effects of cigar smoking varied by whether or not they 
have ever tried cigars.  Of teens participating in our focus groups, 54 percent (122 of 227) have 
tried a cigar in their lifetime, while 46 percent (105 of 227) teens have never tried them.  We 
found those who have tried cigars rate the health risks lower than those who have not.  In fact, 
nearly all (98 percent, 101 of 103) of teens who never have smoked a cigar said they believe 
smoking cigars is bad for your health, compared to 90 percent (105 of 117) of teens who have 
tried cigars.37 
Teens with cigar experience are more likely to rate smoking one cigar a month as not harmful [28 
percent] than teens with no cigar experience [18 percent].38  Similarly, assessing the risks of 
smoking one cigar a week, 26 percent (30 of 117) of teens with cigar experience say it is very 
harmful compared to 34 percent (35 of 103) of those without such experience.  As usage levels 
increase to smoking one cigar a day, 79 percent (81 of 103) of teens without cigar experience rate 
such frequent use as very harmful compared to only 65 percent (76 of 117) of teens who have 
)))))))))))
21  smoked cigars.  Teens who have tried cigars are also more likely to say that, compared to 
cigarettes, cigars are less risky.  Thirty percent (35 of 116) of teen cigar users made such a 
statement, compared to only 10 percent (10 of 101) of teens with no cigar experience.  Cigar 
smoking teens expressed a comparable view when comparing the risk of cigars to spit tobacco 
products.  Twenty-seven percent (31 of 117) of teens with cigar experience said cigars are less 
risky than spit tobacco, compared to 20 percent (20 of 101) of teens with no cigar exposure. 
Teens with cigar experience are also somewhat less likely [83 vs. 93 percent] to agree or strongly 
agree that cigar smoking can cause lung cancer than teens with no cigar experience.39 
While A Majority Of Teens In Our Focus Groups Think Regular Cigar Smoking Is 
Addictive, Many Are Uncertain. 
Though 59 percent (129 of 220) of teens report regular cigar smoking is very addictive, another 
23 percent (51 of 220) report it is only somewhat addictive, and 4 percent (9 of 220) said it is not 
addictive.  Fourteen percent (31 of 220) of teens did not know about the addictive effects of 
regular cigar smoking.  It should come as no surprise that teens are unclear about the addictive 
effects of cigar smoking, given the limited amount of scientific evidence available and the lack of 
specific information delivered to teens about the health effects of smoking cigars. 
Much of the dispute about the addictive nature of cigars hinges around how the nicotine is 
delivered.  Cigars, unlike other tobacco products are capable of introducing nicotine into the body 
via multiple pathways.  Since the pH of cigar smoke is alkaline enough to allow efficient nicotine 
absorption through the oral and nasal mucosa, those who dont inhale still receive doses of the 
drug.40  Thus, those who hold the smoke in their mouth prior to exhaling, or those who merely 
hold an unlit cigar in their mouth, are still receiving nicotine (similar to spit tobacco).  When 
inhaled, cigar smoke is as readily absorbed in the lungs as cigarette smoke.  The latest NCI Cigar 
Monograph states cigar smoke may be inhaled, producing the same virtually instantaneous 
effects of nicotine delivery produced by cigarette smoking, or cigar smoke may be held in the 
nose and mouth providing a somewhat slower rate of nicotine absorption as occurs with 
smokeless tobacco products.  As a result, even cigar smokers who purposely dont inhale as a 
preventive measure, arent entirely avoiding the potential pitfalls of nicotine use. 
The broad assumption is cigar smokers have lower rates of inhalation compared to cigarette 
smokers, use less frequently, and begin use in adulthood.  According to the Monograph, this 
combination of factors may lessen the addictive nature of cigars.  However, it also warns the the 
current trend of adolescent cigar use generates a concern that prior low adult rates of 
developing dependence may not apply to cigar use begun during adolescence. 
Teens Report They And Their Peers Always Inhale When Smoking Blunted Cigars And 
Sometimes Also Inhale When Smoking Unaltered Cigars. 
The addictive potential of cigars is a concern, given that 64 percent (52 of 81) of teens using 
cigars in our focus groups said they have inhaled when smoking cigars.  This alarming number of 
teens admitting they inhale when smoking cigars, suggests the real number of inhalers is probably 
even higher.  The monograph highlights that cigar smokers are often unaware of the extent to 
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22  which they actually inhale, even more so if they are, or were, cigarette users.  Previous cigarette 
users who now use cigars demonstrate higher rates of inhalation of cigar smoke compared to 
cigar smokers who never smoked cigarettes.  In addition, previous cigarette users also 
demonstrate higher rates of most diseases resulting from smoking than cigar smokers who never 
used cigarettes in the past.41 
Although we did not directly ask teens whether or not they personally use cigars as blunts for 
smoking marijuana, many of them shared that those who blunt always inhale to get high. 
Otherwise, as many stated in their responses, what would be the point?  Yet, many teens in our 
focus groups seem unaware of any adverse effects of inhaling blunted cigars, aside from the 
effects of using marijuana.  Numerous teens believe they are removing the harmful effects of the 
cigar when they hollow cigars out, because they assume what is left is only brown paper. 
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23  C O N C L U S I O N S

The findings of this report, however exploratory, provide important information about teen cigar 
and blunt use.  Information obtained through our focus groups leads to the conclusion that more 
research is needed to better understand teen cigar use.  Though this study was primarily designed 
to inform future research and survey work, it provides important new information on teen cigar 
and blunt use and reinforces in our minds the need for an action plan to address this problem. 
A Research Agenda Is Needed On The Following Aspects Of Teen Cigar and Blunt Use: 
Types and Brands Used - Based on the confusion teens in our focus groups had over what is 
meant by a cigar, we advise that all surveys of youth and young adults explicitly ask questions 
about plain cigar use, along with questions about blunt use.  Currently, national prevalence 
surveys do not ask questions about blunting.  Without this information, assessments of cigar use 
among teens and young adults might underestimate the number purchasing and using cigars. 
Additionally, information should be collected about the type and brands of cigars teens are 
smoking as plain cigars and as blunts, including cigar wrappers used to smoke marijuana. 
Extent of Cigar Use - Tracking cigar use patterns over time requires more trend data.  Questions 
are currently being added to a number of national prevalence surveys; however, the information is 
not always standardized.  Information should also be collected to explore differences in teens 
demographic characteristics, especially geographic and urban/suburban/rural differences. 
Patterns of Cigar Use - Though not all teens smoke cigars on a frequent basis, teens report some 
of their peers smoke cigars and blunts at very high levels.  Very specific information should also 
be collected about how often and where teens smoke blunts and cigars. 
Influences on Cigar Use - In order to better understand why teens are experimenting with and 
using cigars, additional questions should be included on surveys asking teens why they enjoy 
smoking cigars, along with questions about the extent of cigar use among their peers and closest 
friends.  Such research can help guide future intervention and prevention programs. 
Ease of Cigar Purchase - Teens in our focus groups can easily buy cigars, most commonly at 
gas stations and convenience stores.  Research is needed on the ease of purchase, extensiveness of 
illegal cigar sales to minors and the potential of enhanced enforcement efforts to curtail cigar sales 
to minors. 
Action Steps to Discourage Cigar Use and Develop Research Agenda 
In our companion report, Youth Use of Cigars: Federal, State Regulation and Enforcement 
(OEI-06-98-00020), we recommend that the Department, under the leadership of the Assistant 
Secretary for Health develop an action plan to address the public health risks posed by cigars, 
particulary access by youth.  As a first step, we recommend an initiative to inform the public 
through a public awareness and educational effort appropriate for cigars.  This effort could also 
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24  include pursuing a collaborative effort with the Federal Trade Commission and Congress to 
initiate a Surgeon Generals Warning Label for cigars.  As a second step, the Department should 
address the need for additional research on cigars including patterns and prevalence of use, youth 
access and ease of purchase, health effects, addictive potential, use of cigars to smoke marijuana, 
and an assessment of the adequacy of the Departments data collection and survey capacity for 
monitoring cigar use trends. 
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25  E N D N O T E S

1.	 U.S. Department of Health and Human Services, Public Health Service, Centers for 
Disease Control and Prevention.  Cigar Smoking Among Teenagers - United States, 
Massachusetts, and New York, 1996.  Morbidity and Mortality Weekly Report 
(MMWR).  May 23, 1997.  46: Online.  Internet. 
2.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
3.	 News Release.  California Department of Health Services.  California Launches Public 
Awareness Campaign Targeting the Increase in Cigar Use, March 30th, 1998. 
4.	 U.S. Department of Health and Human Services, Public Health Service, Centers for 
Disease Control and Prevention.  Tobacco Use Among High School Students -- United 
States, 1997. Morbidity and Mortality Weekly Report (MMWR).  April 3, 1998.  47: 12. 
5.	 Data from SAMHSAs 1997 National Household Survey on Drug Abuse (NHSDA) 
shows current past month cigar use for 12-17 year olds to be only 5 percent.  One of the 
biggest discrepancies in the YRBS data and the NHSDA data is the methodology used to 
collect the data.  The 1997 YRBS data is based on a representative sample of 16,262 
students in grades 9-12 in the 50 States and the District of Columbia.  The 1997 NHSDA 
data is based on a household survey of 24,505 respondents including 7,844 young people 
aged 12-17. The NHSDA cigar data is obtained through a self-administered questionnaire 
taken by the child.  While every effort is made to afford the child privacy during the 
interview, the childs parent may or may not be in the room at the time.  Additionally, the 
NHSDA cigar questions were located in a non-core section of the 1997 questionnaire 
that also inquired about needle use and other hard core drug use.  The YRBS cigar 
questions are located in a separate section about tobacco use.  These two differences 
could help explain some of the discrepancies in the two sources of data.  Beginning in 
1999, the NHSDA questionnaire will be administered using a computer assisted 
technology.  Also in 1999, the NHSDA will include cigar questions in a separate section 
with other tobacco use. 
6.	 Of our participants that werent technically teens, three students were 11 years of age and 
twelve were 12 years of age.  Of the 230 surveyed teens, 32 were 18 years of age and 
eight were 19 years of age. 
7.	 U.S. Department of Health and Human Services, Public Health Service, Centers for 
Disease Control and Prevention.  May 23, 1997.  46: Online.  Internet. 
8.	 An additional 24 percent (32 of 131) of teens surveyed did not know how many of their 
peers have smoked a cigar in the past 30 days. 
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26  9.	 Although good prevalence trend data for adults and teens is currently lacking, cigar 
consumption in the United States has increased nearly 50 percent between 1993 and 1997. 
10.	 Seventeen percent (28 of 165) of teens said they didnt know about changes in cigar use 
among their peers. 
11.	 For this question, 62 percent represents 70 of 113 urban high school teens who have 
personally smoked a cigar compared to 46 percent or 52 of 113 suburban teens. 
12.	 U.S. Department of Health and Human Services, Public Health Service, Centers for 
Disease Control and Prevention.  May 23, 1997.  46: Online.  Internet. 
13.	 U.S. Department of Health and Human Services, Public Health Service, Centers for 
Disease Control and Prevention.  Tobacco Use Among High School Students -- United 
States, 1997. Morbidity and Mortality Weekly Report (MMWR).  April 3, 1998.  47: 12. 
14.	 U.S. Department of Health and Human Services, Substance Abuse and Mental Health 
Administration, Preliminary results from the 1997 National Household Survey on Drug 
Abuse (NHSDA): Online.  Internet 
15.	 For this question, 53 percent represents 18 of 34 suburban teens who expect to be 
smoking cigars in five years and 46 percent represents 21 of 46 urban teens. 
16.	 The mean age of first cigarette use for our users was 13 years old, with a modal age of 12. 
However, the mean age of first cigar use was 14.5 years old, with a modal age of 16. 
17.  Nine percent (15 of 167) of teens did not know the type of cigars smoked by their peers. 
18.	 For this question, 72 percent represents 61 of 85 urban high school teens and 48 percent 
represents 23 of 48 suburban teens. 
19.	 For this question, 58 percent represents 28 of 48 suburban high school teens and 47 
percent represents 40 of 85 urban teens. 
20.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
21.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
22.  Multiple response question so answers will total over 100 percent. 
23.	 Forty-seven percent represents 22 of 47 urban teens who have ever smoked cigars alone 
and 33 percent represents 11 of 33 suburban teens. 
)))))))))))
27  24.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Institute on Alcohol Abuse and Alcoholism.  Alcohol Alert.  No. 39. 
January 1998. 
25.	 Eleven percent (18 of 169) of teens did not know whether people their age use blunts for 
smoking marijuana. 
26.  We did not directly ask teens if they personally use cigars as blunts for smoking marijuana. 
27.	 The top responses from each focus group were analyzed to compile the three common 
attributes emerging from all groups. 
28.	 We were interested in the number of television shows teens in our focus groups listed. 
However, we did not check whether or not cigar smoking actually occurred in each show 
listed by teens. 
29.	 This subtle marketing approach employs the practice of paying Hollywood brokers to 
place cigars in the mouths of popular actors or appealing characters in movies or television 
sitcoms.  The Washington Post, March 21, 1998.  Online.  Internet. 
30.	 Rudman, Theo.  1995.  Rudmans Complete Guide to Cigars: How to Find, Select and 
Smoke Them.  Triumph: Chicago. 
31.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
32.	 For this question, 68 percent represents 95 of 139 teens and 57 percent represents 79 of 
139 teens. 
33.	 For this question, 40 percent represents 55 of 139 teens and 36 percent represents 50 of 
139 teens. 
34.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
35.	 Forty-nine percent (107 of 218) of teens report they are not aware of their peers stealing 
cigars, while another 24 percent (53 of 218) do not know whether or not their peers steal 
cigars. 
36.	 Peto R, Lopez AD, Boreham J, Thun M, Heath C, Jr.  1994.  Mortality from Smoking in 
Developed Countries 1950-2000.  Oxford University Press: New York. 
37.	 Not all teens responded to our questions on health effects, thus explaining the difference in 
the denominator of these questions. 
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28  38.	 For this question, 28 percent represents 33 of 116 teens and 18 percent represents 18 of 
103 teens. 
39.	 For this question, 83 percent represents 98 of 118 teens and 93 percent represents 94 of 
101 teens. 
40.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
41.	 U.S. Department of Health and Human Services, Public Health Service, National Institutes 
of Health, National Cancer Institute.  Cigars: Health Effects and Trends, Smoking and 
Tobacco Control.  Monograph Number 9, April 1998. 
)))))))))))
29  APPENDIX A

Focus Group Participants 
Two basic screening criteria were used in selecting schools for our study.  First, schools were 
selected within DHHS regional cities to give us a broad representation of students across the 
country. One additional school, located outside a DHHS city, was selected to better represent a 
slightly more rural population in the Mid-West.  We aimed for a mix of both urban and suburban 
schools, and students with different socioeconomic backgrounds.  Though our focus was mainly 
on high school students, four junior high schools and one college were included to obtain the 
perspectives and experiences of other age groups.  Second, we only included schools willing for 
us to conduct focus groups on school property either before, during, or after school.  In most 
cases, a teacher, coach, or school principal selected students or classes that he/she felt would best 
represent the demographics of his/her school.  In some cases, students were recruited, but none 
were required to participate in our focus groups.  Cigar users were not over-sampled.  Only one 
focus group was conducted outside a school setting with high school students.  This group of five 
students was selected because they were known to be heavier, premium cigar users.  Although the 
information from these users added flavor, their information did not bias our results. 
Out of the 18 separate focus groups, a total of 230 participants completed our surveys.  Basic 
demographic information was provided by nearly all participants (see Table 1). 
Urban/Suburban School Status 
Schools are classified as urban or suburban based on whether the school is located within the main 
DHHS regional city, or in a suburban city outside city limits.  Seven schools participating in our 
focus groups are classified as urban.  In one case a school was classified as urban because it was 
located very near the city.In nearly all cases, urban schools are located in very populated areas and 
resemble a more typical central city school, often surrounded by security fences.  Eleven schools 
are classified as suburban and are clearly located in areas outside of a central city.  Though some 
schools are located in less densely populated areas, no schools are classified as rural. 
The total participant pool is fairly evenly split along urban/suburban lines.  Of the 230 participants 
completing our surveys, 49.6 percent (116) are from urban schools and 50.4 percent (114) are 
from suburban schools.  Focus groups in urban schools include a larger number of participants, 
averaging around 16 students per focus group compared to an average of just over 10 students in 
suburban schools. 
Race 
A well-balanced racial mixture emerged from our overall participant group.  Focus group 
participants include 48 percent (106) White students, 33 percent (73) Black students, and 20 
percent (44) other races, such as Asian and Hispanic/Latino.  A strong relationship exists between 
race and whether teens attend an urban or suburban school.  This relationship is expected based 
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30  on the demographics of our study population.  Eighty-eight percent (64 of 73) of Black teens in 
our study are from urban schools.  Only nine Black students participating in our focus groups are 
from a school we classify as suburban.  They also make up a large part of our total urban sample, 
which includes 59 percent (64) Black teens, 26 percent (28) other races, such as Asian and 
Hispanic/Latino, and 16 percent White teens (17). 
The participant group contains more female urban teens (67 percent, n = 73) than male urban 
teens (33 percent, n = 36).  Therefore, generalizations regarding our urban teens are heavily 
influenced by the responses of Black female teens. 
Junior High vs. High School 
Seventy-three percent (159) of our participants attend high school, while 28 percent (60) are in 
junior high school.  Of the 60 junior high participants, 73 percent (44) attend a suburban school. 
Our single college focus group was extremely small, resulting in only four useable surveys. 
Therefore, the perspectives of these participants are not included in any individual breakouts by 
school status.  However, their viewpoints are reflected in several cases throughout the report to 
add useful, qualitative information. 
Table 1: Characteristics of Focus Group Participants 
Demographic  Urban/Suburban School 
Characteristics  Overall 
Urban  Suburban 
Gender: 
Female  55.6% (124)  67.0% ( 73)  44.7% (51) 
Male  44.4% ( 99)  33.0% ( 36)  55.3% (63) 
Race: 
White  47.5% (106)  15.6% ( 17)  78.1% ( 89) 
Black  32.7% ( 73)  58.7% ( 64)  7.9% (9) 
Other  19.7% ( 44)  25.7% ( 28)  14.0% ( 16) 
School: 
Junior High  27.4% ( 60)  14.7% ( 16)  40.0% ( 44) 
High School  72.6% (159)  85.3% ( 93)  60.0% ( 66) 
TOTALS  49.6% (114)  50.4% (116) 
Focus Group Approach 
Information from prior focus group studies served as a starting point for constructing the content 
and approach of our focus groups.  For consistency purposes, the same moderator conducted all 
focus groups using a formal, focus group script with open-ended questions.  Assistant moderators 
documented information from the focus groups and transcribed the recorded tapes for all focus 
groups. 
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31  Focus groups ranged in length from 60 - 90 minutes and usually included between 10-15 
participants.  The smallest focus group included five students and the largest included 17 students. 
Although we intended to use only a focus group format, seven schools made arrangements for us 
to talk with students during a class period.  Therefore, seven of the eighteen focus groups were 
classified as classroom discussions.  The students all took the same self-administered survey, but 
the discussions in a classroom setting were more limited due to restricted time.  However, in 
comparing the focus group discussions with the classroom discussions, we found both to be 
equally revealing.  The term focus group will be used throughout the report and will include 
information collected through both the focus groups and classroom discussions. 
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32