101. The Role of Cigarillo Flavor and Price in Co-Use of Cigarillos and Cannabis: An Explanatory Sequential Mixed Methods Study
- Author
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Glasser, Allison
- Subjects
- Public Health
- Abstract
When developing regulations, such as a product standard to ban characterizing flavors in tobacco products, the potential impact on use of cannabis, which is commonly co-used with tobacco, should be considered. About three-quarters of adult cannabis users also use tobacco, with co-use highest among young adults.1 To anticipate the consequences of tobacco regulation on cannabis use, particularly among young adults, it is critical to understand the role that characteristics of tobacco products play in co-use patterns. The most commonly used tobacco product among co-users of tobacco and cannabis is cigars, particularly cigarillos. Qualitative research suggests that cigarillos are preferred for cannabis/blunt use because they are inexpensive and the flavoring masks the smell and enhances the experience of creating and smoking blunts.2,3 Flavor and price have been identified as among the most valued tobacco product attributes for blunt use.4 Research shows that cheap price and availability of flavors facilitates access to and appeal of cigarillos,5-8 but it is unknown what role these product characteristics play in patterns of co-use of cigarillos and cannabis. Experts in the field of tobacco control have identified concomitant use of cannabis and tobacco as a key research priority to inform tobacco regulatory policy,9 and understanding the impact of changes in tobacco product characteristics on behaviors is a national research priority for the U.S. Food and Drug Administration (FDA).10 Given the recent announcement of a proposed rule to ban the sale of menthol cigarettes and flavored cigars,11 it is critical to anticipate unintended (both positive and negative) consequences of these product standards. The overall objective of this dissertation project was to examine and better understand young adult cigarillo and cannabis co-use behaviors and the impact of cigarillo characteristics on those behaviors. The study sought to achieve the following aims: 1) Determine the role of cigarillo characteristics (flavor, price) in co-use of cigarillos and cannabis (including blunt use) among young adults; 2) Among co-users of cigarillos and cannabis (including blunt users), determine the role of cigarillo characteristics (flavor, price) in motivation to quit among young adults; and 3) Identify social-contextual factors that influence cigarillo and cannabis co-use (including blunt use) preferences to inform regulatory approaches to reduce cigarillo use. The overall study design is an explanatory sequential mixed-methods study. First, I analyzed data from the Cigarillo Flavor and Abuse Liability, Attention, and Substitution (C-FLASH) study of young adult cigarillos users. I then conducted one-on-one qualitative semi-structured interviews with participants from this study. The C-FLASH study was intended to examine the influence of tobacco packaging and price on young adults’ perception of little cigar or cigarillo use, and this dissertation extended the C-FLASH study objective by examining the influence of cigarillo characteristics (flavor, price) on young adult co-use of cannabis and cigarillos. Three key findings emerged from the dissertation. First, although appealing, cigarillo flavor may be outweighed by other product characteristics and social-contextual factors in driving cigarillo and cannabis co-use among young adults. Second, the low cost of cigarillos facilitates co-use with cannabis, but similar to flavor, may be outweighed by other product characteristics and social-contextual factors in driving cigarillo and cannabis co-use among young adults. Third, multilevel factors are associated with cigarillo and cannabis co-use, most salient of which are easy access to cigarillos, use to manage health (mental and physical), and widespread positive co-use norms. Although many young adult co-users of cigarillos and cannabis in this study did not anticipate quitting smoking if cigar flavors were banned or if price increased, none expected to increase cannabis use. To reduce co-use, policymakers should consider additional approaches, such as reducing retail accessibility of cigarillos or interventions to address psychosocial and structural determinants of use.
- Published
- 2022