Do smokers’ harm perceptions of cigarillos differ by modified use of the tobacco product? Findings from waves 3 and 4 of the PATH study.

Abstract

Objective: The harm perceptions of individuals who smoke either blunts or the Black & Mild (B&M) brand, which is often "freaked," have seldom been investigated. Since these practices could affect users' perceived health risks of the cigarillo, this study was intended to compare such risks among cigarillo users by modified use of the tobacco product. Method: Adult cigarillo and blunt smokers were selected from the Population Assessment of Tobacco and Health Study for cross-sectional (Wave 4; n = 3,331) and longitudinal (Waves 3-4; n = 1,898) analyses of predictors of general and relative harm perceptions of cigarillos. Ordinal and multinomial logistic regression methods were employed for testing whether adjusted odds of perceiving cigarillo harms were greater in blunt versus cigarillo smokers. In a separate model (n = 1,258), preference for B&M cigarillos was examined as a correlate of harm perception due to the perceived health benefits of removing the inner tobacco liner. Results: Cross-sectional estimates indicated that blunt smokers, mixed cigarillo/blunt smokers, and those who preferred B&M brand perceived significantly more risk than conventional cigarillo smokers. Longitudinal estimates indicated that among those who underwent a transition in use, former blunt and former cigarillo smokers had significantly greater odds of reporting an increase in perceived harm compared to new users. Conclusions: The change in blunt smokers' harm perceptions upon transitioning in blunt use suggests acknowledgment of the harm of using cigarillos in some form. Given their high perceived risk of cigarillos, blunt smokers might be receptive to replacing the tobacco product with a nontobacco wrap. Public Health Significance StatementThis study indicates that individuals who modify cigarillos for harm reduction and/or cannabis delivery perceive more harm from smoking cigarillos than those who use the product as intended. This finding has important implications for blunt smokers who may be receptive to switching to a nontobacco product.

Young adults’ cigarillo risk perceptions, attention to warning labels and perceptions of proposed pictorial warnings: a focus group study

“…33 34 Many of these issues around warning noticeability could also apply to cigarette and other tobacco packaging, yet in this context, they highlight concerns about the inconsistent application of cigar warnings and the need for uniform regulations like those applied to cigarettes. Recent survey research has found high cigarillo harm perceptions among users who more frequently noticed warnings, 13 but relatively low levels of noticing cigarillo warnings. 35 Despite overall inattention to warnings, participants across groups supported the use of PWLs on cigarillo packaging, even stating they were drawn to PWLs they previously encountered.…”

“…The FDA has emphasised the importance of warning labels as a policy mechanism to promote product awareness and knowledge of risks 31. While strengthening label standards may include strategies to improve attention to them, it may also entail the development of additional warning message statements to improve knowledge,32 and/or more tailored versions of existing ones 13 29. For example, even a slight adjustment to the current FDA recommended nicotine warning to explicitly include the wrapper (eg, ‘This product, including the wrapper, contains nicotine…’) may be useful to address uncertainty and increase basic knowledge about cigar/cigarillo wrappers, which are made from tobacco.…”

“…3 4 8 9 Some also misperceive cigarillos as more natural and less harmful than cigarettes and/or characterise health effects as less serious and less likely to occur. [10][11][12] Research suggests that some of these perceptions can be influenced by product use patterns and modifications (eg, for use as blunts), 13 though cigarillo risk perception studies do not consistently consider such patterns.…”