Adolescent and Young Adult Perceptions of Hookah and Little Cigars/Cigarillos: Implications for Risk Messages

Abstract

Use of hookah and little cigars/cigarillos (LCCs) is high among adolescents and young adults. Although these products have health effects similar to cigarettes, adolescents and young adults believe them to be safer. This study examined adolescent and young adult perceptions of hookah and LCCs to develop risk messages aimed at discouraging use among users and at-risk nonusers. Ten focus groups with 77 adolescents and young adults were conducted to explore their perceptions about the perceived risks and benefits of hookah and LCC use. Participants were users of other (non-cigarette) tobacco products (n=47) and susceptible nonusers (n=30). Transcripts were coded for emergent themes on participants’ perceptions of hookah and LCCs. Participants did not perceive health effects associated with hookah and LCC use to be serious or likely to happen given their infrequency of use and perceptions that they are less harmful than cigarettes. Participants generally had positive associations with smoking hookah and LCCs for several reasons, including that they are used in social gatherings, come in various flavors, and can be used to perform smoke tricks. Because adolescents and young adults underestimate and discount the long-term risks associated with hookah and LCC use, effective messages may be those that focus on the acute/immediate health and cosmetic effects.

Reasons for Cigarillo Initiation and Cigarillo Manipulation Methods among Adolescents

“…This finding is unexpected given that other studies reported that youth perceived cigars to have lower health risks than cigarettes. 15,25,26 Although youth may hold beliefs that cigarillos are less harmful than cigarettes, our study findings show that these are not commonly endorsed reasons for initiation. For adolescents, avoiding long-term health risks may not be a compelling reason to initiate and/or discontinue tobacco use because they may believe that they can quit easily, 44 and that negative health effects from cigarillos are less likely to happen to them because they do not use it regularly.…”

“…24 Existing evidence suggests that youth perceive cigar products as less harmful than cigarettes. 15,25,26 If adolescents are initiating cigarillos because they perceive cigarillos to have lower harm than cigarettes, then education and prevention campaigns can focus on informing youth about the health risks of cigarillos relative to cigarettes.…”

Young adult waterpipe tobacco users’ perceived addictiveness of waterpipe tobacco

“…Responses to open-ended items were coded and analyzed using an iterative, constant comparison method where responses are reviewed, initial codes are developed, responses are re-reviewed, codes are revised, and applied to the data 47,48 . Similar methods were used in recent studies of youth and young adult perceptions of WTS and other emerging tobacco products 22,[49][50][51][52] . Two trained coders reviewed open-ended responses independently to inductively identify common themes in the data, developed a codebook comparing themes identified, and coded the data.…”

“…Despite evidence to the contrary, many young adults maintain the belief that WTS is less addictive than cigarettes [20][21][22] . However, much of the evidence on young adults' WTS beliefs and perceptions comes from population surveillance surveys [20][21][22] .…”

“…However, much of the evidence on young adults' WTS beliefs and perceptions comes from population surveillance surveys [20][21][22] . There is limited research on the potential reasons underlying the perception that WTS is less addictive than cigarette smoking among young people [23][24] .…”