Little Cigars and Cigarillos: Users, Perceptions, and Reasons for Use.

Whereas cigarette consumption in the United States (US) has declined,1,2 use of other combustible tobacco products continues to rise. Use of cigars in general, and little cigars and cigarillos (LCCs) in particular, has been steady and increasing among certain groups.3–6 In a national probability sample of US adults from 2014, 30.6% of respondents reported ever using LCCs and 2.8% of respondents reported using LCCs in the past month.7 Several studies have focused on the demographic characteristics of cigar smokers and found that young adults, African Americans, lower socioeconomic status (SES) populations, and current users of other tobacco products have had higher usage rates of some cigar types, including LCCs.3,5,8–12 The increasing popularity of LCCs has raised concerns about the toxic constituents being delivered to growing numbers of users; cigar use is at least as harmful as cigarette use, and the risk of harm increases with the frequency and intensity of use.13,14 The popularity of LCCs can be attributed to many factors, including their lower price as a result of lower tax policies in relation to cigarettes in many states.15,16 As a result, these products are cheaper than cigarettes and are appealing to price-conscious consumers.16 Additionally, an increase in cigar products that are flavored is believed to have contributed to their rise in use, especially among younger and minority users.17–19 Historically, flavors have been used by the tobacco industry specifically to recruit new smokers.20,21 The popularity of LCCs can be further attributed to product advertising and promotion at point-of-sale.22 Lower SES communities and those with high young adult and African-American populations are typically exposed to greater advertising and promotions and lower prices on LCCs,23 which in turn, may fuel prevalence for those groups. Though few prior studies have segmented cigar use by the type of cigar smoked, there is evidence to suggest that distinguishing between small cigars (LCCs) and large cigars (traditional, premium cigars) may illuminate important demographic differences between product users. For example, a study of National Adult Tobacco Survey (NATS) data from 2012–2013 that divided cigar use into 3 categories (little filtered cigars, cigarillos/other mass market cigars, and premium cigars) found that the prevalence of cigarillos was highest of any cigar type and highest among young adults and non-Hispanic Blacks.24 Furthermore, few previous studies have attempted to delineate the reasons why people smoke LCCs or to explore other characteristics of LCC use. One qualitative study that explored reasons for use found that 18–24 year-old African-American LCC smokers preferred LCCs to cigarettes for the taste and smell, the “buzz” they provided, social status elements, and perceived reduction in harm and addiction.25 Results of more recent qualitative research suggest that flavored tobacco in LCCs made smoking more palatable and enhanced users’ moods. Additionally, the visual, smell, and taste cues from the LCC packaging influenced some adults’ affect and their subsequent smoking behavior.26 A survey of Canadian young adult cigarillo users found that the primary reasons for using cigarillos were for the flavor and as a replacement for cigarettes. More than half of these users did not consider themselves at all addicted.27 Our study is the first to use a national probability sample of US adults in 2014 to broaden and update the profile of the LCC user using more recent data to monitor LCC use trends. The goals of this study were to describe the sociodemographic characteristics of the lifetime user and current user of LCCs, to examine factors associated with current LCC use, such as perceptions of addiction, use of flavors, and intentions to continue using, and to determine current users’ reasons for smoking LCCs. As the US Food and Drug Administration (FDA) currently does not regulate LCCs, but with proposed deeming regulations to be decided on in the near future,28 this study aids in understanding the motivations for using LCCs, and thus, will help inform eventual regulatory policies and lead to the crafting of more effective and targeted LCC health-risk messaging.