VOLUME 5: NO. 3 JULY 2008 ORIGINAL RESEARCH Exploring the Use of Little Cigars by Students at a Historically Black University David H. Jolly, DrPH Suggested citation for this article: Jolly DH. Exploring Conclusion the use of little cigars by students at a historically black Use of little cigars should be addressed in tobacco university. Prev Chronic Dis 2008;5(3). http://www.cdc. research, use prevention, and use cessation efforts, tar- gov/pcd/issues/2008/jul/07_0157.htm. Accessed [date]. geting students at historically black colleges and perhaps other young African Americans. Results also suggest that PEER REVIEWED clear distinctions should be made among cigarettes, little cigars, and cigars, and that tobacco use prevention and cessation programs should debunk myths that little cigars Abstract are a safe alternative to cigarettes. Study findings should be confirmed and elucidated through additional research. Introduction Considerable evidence exists that little cigars are popu- lar among African American adolescents and young adults Introduction who smoke. However, few studies have been published on the use of this tobacco product by young blacks in the Evidence exists in both scientific literature (1-3) and United States. This research investigated little-cigar use the media (4) that little cigars are popular among African among students at a historically black university in the American adolescents and young adults who smoke. southeastern United States. However, few studies have been published in tobacco research literature on this form of tobacco or its use by Methods young blacks in the United States (1,2,5). As a follow-up to a survey on tobacco use among fresh- men that revealed unexpectedly high rates of little-cigar African Americans aged 18 to 24 years are less likely use, 3 focus groups were conducted with current or former to smoke tobacco than their white contemporaries (6,7). smokers of little cigars. Topics included preferred brands Nevertheless, college-aged African Americans should be of little cigars, preference for little cigars over cigarettes, considered a priority population in tobacco control efforts social contexts for smoking little cigars, perceived health for several reasons. First, African American smokers start risks of smoking little cigars relative to smoking ciga- using tobacco later than white smokers, often after high rettes, and thoughts about quitting. school (8,9), and, as adults, smoke cigarettes at about the same rate (10). Second, blacks are disproportionately Results affected by smoking-related diseases (11). Third, young Focus group participants preferred little cigars to ciga- blacks are targeted heavily by the tobacco industry. rettes for various reasons, among them taste, smell, a Tobacco companies have long marketed their products to better “buzz,” social purposes, status, and perceptions that young African Americans (12-14); recent promotions such smoking little cigars is less addictive and less harmful as Brown & Williamson’s Kool Mixx campaign suggest no than smoking cigarettes. Opinions on health risks var- inclination to cease these efforts (15,16). ied; some participants believed that health risks can be reduced by removing the inner liner of little cigars. Smoking behaviors include choosing tobacco products. The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. www.cdc.gov/pcd/issues/2008/jul/07_0157.htm • Centers for Disease Control and Prevention VOLUME 5: NO. 3 JULY 2008 This paper focuses on the use of little cigars (e.g., Black were much more likely than nonusers to agree with the & Milds, Swisher Sweets). Also known as cigarillos, little statements that cigars “taste good,” “smell good,” and cigars are slightly larger than cigarettes but much smaller are “something different to try” than the statements that than traditional full-sized cigars. Some (e.g., Black & cigars “are not as bad for you as cigarettes” or “give you a Milds) are filled with pipe tobacco. In recent years, manu- good buzz.” Unfortunately, this study did not differentiate facturers have introduced flavored little cigars, marketing between full-sized cigars and little cigars, and whether them heavily to young adults. Little cigars are generally these findings pertain to African Americans is unclear, as sold in packages of 5. In North Carolina in 2007, a pack data were not analyzed by race and only 2.1% of respon- cost approximately $2.50, and singles were sold for $0.75. dents were black. Between 1990 and 2005, annual taxable sales of cigarettes in the United States declined 31%, but during the same The largest exploration of young people’s patterns of period sales of little cigars doubled (17). cigar use and their perceptions of cigar health risk was conducted by the Office of the Inspector General (26). The health risks associated with smoking cigars are well The study involved a survey and focus groups with 230 documented (18-22) and include coronary heart disease, urban (i.e., predominantly black) and suburban (i.e., chronic obstructive pulmonary disease, and cancers of predominantly white) teenagers. Most teenagers were in the oral cavity, larynx, esophagus, and lung. In addition high school or middle school, and one third were current to health concerns, cigars pose the risk of addiction to smokers of cigars. Cigar use in general and little-cigar use nicotine. Both full-sized cigars and little cigars contain in particular were higher among the urban students than considerable amounts of nicotine. Although total nicotine among the suburban students. Cigar smokers noted that content of little cigars differs from product to product (23), they typically smoked at parties, often when they were one report suggests that, compared with cigarettes, little drinking alcohol, and although they knew the general cigars can deliver between 2 and 5 times the nicotine per risks of tobacco use, they were much less aware of the gram of tobacco (24). specific risks of smoking cigars. Most cigar smokers agreed that regular cigar smoking was addictive, but many were A literature review revealed only a few published stud- uncertain. Unfortunately, findings from the focus groups ies that specifically address the use of little cigars. Malone did not distinguish between urban and suburban youth, et al (1) conducted focus groups with African American black and white youth, or full-sized and little cigars. adolescents aged 14 to 18 years about little-cigar use. They found that many youths were smoking little cigars without The research described here was conducted among stu- identifying the product as either cigar or cigarette, and the dents at a historically black university in the southeastern youths often viewed little cigars as being safer than both. United States. Focus groups of current or former smokers Page and Evans (2) revealed a similar phenomenon in of little cigars were used to explore reasons for using this their ethnographic observations and interviews with black product, the contexts of that use, and perceived health adolescents aged 11 to 15 years. risks of smoking little cigars. Richter et al (5) used focus groups to explore young adult smokers’ perceptions of the health risks of cigarettes and Methods nontraditional tobacco products, including little cigars. Compared with black participants, Hispanic and non- In fall 2003, a brief paper-and-pencil, self-administered Hispanic white participants were more likely to rate little survey on tobacco use was conducted in sections of a cigars as more harmful than their preferred cigarette. Black required freshman course at a historically black univer- participants were more likely than other participants to sity. The survey revealed unexpectedly high rates of little- view all tobacco products as equally risky or to rate little cigar use. Of the 684 students (219 male and 465 female) cigars as safer than their preferred cigarette. who completed the survey, 25% (63 male students and 107 female students) reported smoking tobacco in the past 30 In one of the few studies to explore why youth use cigars, days. Asked what products they had smoked in the past Soldz and Dorsey (25) conducted a survey of middle and month, students reported little cigars much more often high school students and found that current cigar users than cigarettes (74% vs 44%). The preference for little The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above. 2 Centers for Disease Control and Prevention • www.cdc.gov/pcd/issues/2008/jul/07_0157.htm VOLUME 5: NO. 3 JULY 2008 cigars over cigarettes was stronger among male students Results than among female students but held for both groups. Of male smokers, 84% reported smoking little cigars (either Three focus groups were held, and 21 African American exclusively or in combination with cigarettes), and only students, 17 male and 4 female, participated. Ages ranged 33% smoked cigarettes (either exclusively or in combina- from 19 to 25 years. Of participants, 20 were current tion with little cigars). The comparable figures among smokers of little cigars; one was a former user. Only 6 female smokers were 69% for little cigars and 50% for of the 21 also smoked cigarettes; one other was a former cigarettes. cigarette smoker. Black & Milds (often referred to simply as Blacks) were overwhelmingly the brand of choice for To explore these findings further, 3 focus groups were little cigars.