Flavored little cigar and cigarillo (LCC) smoking prevalence rate is increasing among young adults; little is known about their comprehension of its risks. To inform tobacco control regulatory policy and prevention methods, we explored young adult smokers’ risk perceptions of flavored LCC products and its use. Purposive samples ( n = 90) of African American, Hispanic, and white young adults who self-identified as dual (smoked ≥ 1 LCC and cigarette in past 30 days) and cigarette-only (≥1 cigarette in past 30 days) smokers participated in 12 audiotaped focus groups and a semi-structured interview conducted in the Southeastern United States. Participants discussed their experiences smoking flavored LCCs and perceived health risks of smoking flavored LCCs. A brief survey was administered to characterize participants. The participants had a mean age of 25.1 years ( SD = 4.5), were majority male (53.1%), and were 60.0% African American, 29.5% white, and 17.5% Hispanic. Along with health risks and addiction, three major themes emerged as underlying contributors of risk perceptions: affect, participants’ smoking practices (amount smoked and inhalation), and beliefs about the components of LCCs (including flavoring and filters). Participants’ reported intention to smoke flavored LCCs with its tobacco or as blunts (filled with marijuana) also influenced perceptions. Flavored LCCs were viewed along a continuum of risks compared to cigarettes and blunt smoking. Our study revealed dimensions that were important for the formation of risk perceptions about flavored LCCs. A multidimensional conceptual model and a measure of risk perceptions that is inclusive of these dimensions should be developed and examined for LCC use patterns.

Less than half of college students who have smoked in the past month identify themselves as smokers. Thus, we examined (a) how college students define the term “smoker” and (b) how this definition impacts smoking behavior and attitudes. We conducted 12 focus groups with a total of 73 college student smokers drawn from survey participants at two colleges in Minnesota (a two-year technical college and a four-year university). Each group was homogenous in terms of gender and school (two-year, four-year). The majority (56.2%) were female, 49.3% attended a 2-year college, and 32.9% were regular smokers (smoked ≥25 of the last 30 days). Participants described a “smoker” in terms of (a) smoking frequency, ranging from smoking infrequently to smoking daily; (b) contextual factors, such that smoking alone indicates being a smoker rather than smoking at parties; (c) time since initiation; (d) whether one purchases cigarettes, such that “smokers” buy cigarettes while nonsmokers borrow them; (e) addiction and being able to quit without great effort; (f) whether smoking is habitual; and (g) personality and physical characteristic. These beliefs had implications on experiences in quitting smoking, motivation to quit, and perceived barriers. Many participants indicated confidence in being able to quit but believed that they were not “smokers” and thus did not need to quit. College students use a broad range of criteria to define who is a smoker. These criteria impact how motivated students are to quit smoking and their perception of needing to “quit smoking.”

Objective: To understand how affect for characterizing flavors influences little cigar and cigarillo (LCC) smoking uptake behaviors among young adults. Methods: A convenience sample of multi-ethnic young adults (N = 90; mean age = 25.1 years; 53.1% male; 47.4% African-American, 35.5% white, 17.1% Hispanic) who were dual (LCC+ cigarette) and cigarette-only smokers participated in 12 focus groups and a semi-structured interview in the southeastern United States. Results: Though they self-identified at enrollment as dual or cigarette-only smokers, 64.4% re- ported LCC-only smoking, 27.8% dual smoking, and 7.8% cigarette-only smoking. Participants acknowledged that the flavored tobacco made smoking LCCs more palatable, and it enhanced their moods. The variety of available sweet and fruit flavored LCCs and the visual, smell, and taste cues from the LCC packaging influenced the young adults' affect, their susceptibility to and initiation of LCC smoking, and their switch from cigarettes to flavored LCC smoking. Conclusions: Characterizing flavored tobacco in LCCs contributed to young adults' susceptibility and initiation of use. The FDA is proposing to deem LCCs under its authority. Once these products are deemed, our results suggest that the FDA make a product standard restricting characterizing flavors in LCCs.

Evidence suggests that hookah smoking is growing among adolescents, particularly among those with a history of cigarette smoking, and is an emerging public health concern. We examined hookah use and its correlates among a sample of adolescents who have ever smoked and may be considered high risk for hookah use. We examined differences between hookah users and nonusers among a cohort of 951 adolescents (75.3% of the baseline sample, mean age 17.6 years at 24 months), consisting exclusively of youth who reported ever smoking cigarettes who were participating in a longitudinal study of adolescent smoking predictors and patterns. Ever and 30-day hookah use were assessed at 24 months. Of the 951 participants, 58.5% reported ever use and 30.2% reported smoking hookah at least 1 day in the past 30 days. Multivariate logistic regression analyses found that 30-day hookah use was associated with sex (p < .05); race (p < .001); current cigarette (p < .0001), cigar (p < .01), kretek (p < .05), and alcohol use (p < .01); and attending a hookah bar, lounge, or restaurant (p < .001). Participants who were male, White, and were concurrent users of multiple tobacco products and other substances had increased odds of 30-day hookah use. Prevalence of hookah use is high among youth who have already tried cigarette smoking and is associated with a variety of tobacco and other substance use behaviors. Evidence-based programs may be needed to prevent initiation of or reduce Hookah smoking, as well as address cooccurring problem behaviors, to lessen the health risks associated with use among adolescents.

Objective: To assess small cigar use among college students in the southeastern United States. Methods: Data from a 2010 online survey were analyzed to examine small cigar smoking and its sociodemographic and psychosocial correlates among 4388 college students, aged 18-30. Results: Small cigar users were more likely to be younger, male, black, and current cigarette, cigar, hookah, or marijuana smokers (p's < .05). They reported lower perceived harm of smoking and greater sensation seeking and perceived stress. Menthol cigarette smokers were more likely to smoke small cigars. Conclusions: Small cigar use and the co-occurrence of other tobacco and substance use should be addressed among college students.