Mary Hrywna

Examining market trends in the United States smokeless tobacco use: 2005–2011

Background While cigarette consumption in the USA continues to decline, promotion for and consumption of smokeless tobacco (SLT) is growing. However, little research has explored what product features are driving SLT growth, despite awareness that product-level factors may be important in SLT use. This study analyses national sales data to better understand the impact of product features on SLT sales. Methods Data on sales of SLT in US convenience stores from 2005 to 2011 were obtained from Nielsen Research Company. Each listed product was coded for attributes such as type, brand, flavouring and form to calculate their respective total sales, market share and contribution to overall SLT growth. Results Sales of moist snuff products (including snus) increased by 65.6% between 2005 and 2011. Sales of pouched and flavoured forms of moist snuff increased by 333.8% and 72.1%, respectively, and contributed to 28% and 59.4% of the total growth in the moist snuff category, respectively. Value/discount brands accounted for 42% of moist snuff sales in 2011 among the top 10 selling brands, largely driven by Grizzly. After 2 years on the national market, Camel Snus was also one of the top 10 selling moist snuff brands. Conclusions Sales of moist snuff, both overall and for particular styles, are increasing. Growing pouch use may be attributed to new SLT users, which may include cigarette smokers using them as starter SLT products. Increased sales of flavoured and discounted snuff raise concerns about use and appeal to youth. Continued surveillance of SLT sales trends is warranted.

“A Whole ’Nother Smoke” or a Cigarette in Disguise: How RJ Reynolds Reframed the Image of Little Cigars

Present-day consumption of little cigars rivals that of the early 1970s when sales of little cigars boomed. This boom was largely attributed to RJ Reynolds, and documents reveal how and why they became a powerful force in little cigar sales. RJ Reynolds designed a little cigar, Winchesters, for cigarette smokers and produced one as close to a cigarette as legally possible. Initially, RJ Reynolds intended to capitalize on the cigarette advertising broadcast ban, but the price and tax structure was more critical to Winchesters success. Today, the tobacco industry is fighting again to sustain its unique application of federal definitions for little cigars. Regulatory efforts are needed to close taxation loopholes for the little cigar.

Smoking-Cessation Prevalence Among U.S. Smokers of Menthol Versus Non-Menthol Cigarettes

BACKGROUND The Food and Drug Administration currently is assessing the public health impact of menthol cigarettes. Whether menthol cigarettes pose increased barriers to quitting is a critical issue because previous declines in smoking prevalence have stalled. PURPOSE To explore whether menthol cigarette smokers are less likely to quit than non-menthol smokers at the population level and whether this relationship differs by race/ethnicity. METHODS Cross-sectional analyses of the 2003 and 2006/2007 Tobacco Use Supplement to the Current Population Survey were conducted in 2010. Multiple logistic regressions were used to calculate the adjusted odds of cessation for menthol smoking relative to non-menthol smoking. Five different sample restrictions were used to assess the robustness of the findings. RESULTS In the broadest sample restriction, menthol smokers were less likely to have quit smoking (AOR=0.91, 95% CI=0.87, 0.96). This relationship holds among whites (AOR=0.93, 95% CI=0.88, 0.98) and blacks (AOR=0.81, 95% CI=0.67, 0.98). The magnitude of the relationship among Hispanics was similar to that among whites, but differed by Hispanic origin. Among those of Mexican origin, the AOR for menthol smokers was protective but not significant (AOR=1.29, 95% CI=0.99, 1.61), whereas among those of Puerto Rican origin, menthol smokers were less likely to have quit (AOR=0.57, 95% CI=0.37, 0.87). These findings were robust and significant in four of five sample restrictions. CONCLUSIONS Smoking menthol cigarettes is associated with decreased cessation at the population level, and this association is more pronounced among black and Puerto Rican smokers. These findings support the recent calls to ban menthol flavoring in cigarettes.

Cigar, marijuana, and blunt use among US adolescents: Are we accurately estimating the prevalence of cigar smoking among youth?

National estimates and industry trade publications indicate that annual cigar consumption in the US continues to increase annually and more than doubled between 1990 and 2007 (USDT, 2009; Maxwell, 2008). Past month cigar use is highest among adolescents and young adults (USDHHS, 2009). Some adolescent and young adult smokers who use cigars may be engaging in a practice known as “blunting.” Blunting involves hollowing out the tobacco in the cigar and replacing it with marijuana. Some research suggests that blunt users do not consider themselves a tobacco or cigar user (Yerger et al., 2001; Soldz et al., 2003). This paper examines whether blunt use contributes to an underestimation of cigar use using the 2007 National Survey on Drug Use and Health (NSDUH), which included questions on cigars, marijuana and blunt use. We analyzed data from 36,044 adolescents and young adults, ages 12 through 25, who completed the 2007 NSDUH (USDHSS, 2009). Cigars were comprehensively described to include cigars, cigarillos, and little cigars. Blunts were described as taking “some tobacco out of a cigar and replacing it with marijuana.” We defined past month cigar and marijuana use as any use in the past 30 days. We also formulated new operational definitions of past month cigar and marijuana use that were inclusive of past month blunt use (e.g., affirmative response to cigar or blunt question). Sample weights were applied and analyses were performed using SAS 9.2. We generated prevalence estimates with 95% confidence intervals, and kappa coefficients were calculated to measure agreement between the two operational definitions. Overall, 8.6% of respondents between the ages of 12 and 25 reported past month use of cigars based on the standard definition while 13.4% reported past month use when the definition of cigar use included blunts. As shown in Table 1, agreement between reported cigar use and cigar-inclusive-of-blunt use was substantial (kappa=.76) but varied considerably by gender and race (Landis and Koch, 1977). Agreement between the two cigar measures was lower among females (kappa=0.65) than males (kappa=0.80); this difference was consistent across race and age groups. By race, Blacks had the lowest agreement between measures, especially among adolescents ages 12 to 17; and although Whites had significantly higher cigar prevalence rates than Blacks, the two groups had nearly identical cigar-inclusive prevalence rates. In contrast, agreement between reported marijuana use and marijuana-inclusive-of-blunt use was almost perfect (kappa=0.98). Table 1 Unweighted prevalence and concordance of current cigar use with and without blunt inclusion among adolescents and young adults aged 12–25, by gender and race/ethnicity, NSDUH 2007. Our findings raise more questions than answers. Young people recognize blunts as a form of marijuana use but do not recognize it as cigar use. Indeed, consistent with other research, only one-third of blunt users classified themselves as a past month cigar user (Golub et al., 2005). Should blunt smokers be counted as cigar users? Some argue that blunt use does not constitute cigar use because much of the cigar content is discarded during blunt preparation (Golub et al., 2005). Also, Soldz et al. (2003) suggests that the majority of blunt users are not current cigar users and that youth are able to make a distinction between the use of a cigar and of a blunt. However, a blunt is made with a cigar, which in turn contributes to sales and consumption. In addition, nicotine may be extracted directly from oral contact with the cigars tobacco wrapper (Henningfield et al., 1999). It is plausible that blunt use contributes to nicotine intake although we do not know to what degree, especially given that the amount of tobacco discarded likely varies. Subsequently, we must recognize that while blunt smoking is a potential form of tobacco initiation and use, youth may not identify it as such. Blunt and cigar use needs further research including product testing to determine the extent of tobacco exposure from blunt use.

Tobacco Industry Direct Marketing after the Master Settlement Agreement

Although Master Settlement Agreement (MSA) provisions have led to significant changes in tobacco marketing, expenditures and emphasis on marketing strategies and populations not bound by the MSA have increased significantly. This article discusses tobacco industry direct marketing practices, including direct mail, coupons, sweepstakes, brand loyalty programs, event sponsorship, and tobacco industry magazines, and the implications of such strategies. An analysis of a survey of New Jersey adult smokers provides context and documents notable rates of participation. In addition to bypassing marketing restrictions, many of these strategies operate out of sight of the public health community and most of the public and so go unchecked by either tobacco control advocates or public opinion. This article suggests that a first step in countering these practices is to increase awareness and understanding of them, followed by development of strategies to address them and to limit or eliminate their use in tobacco marketing.

Relationships between cigarette smoking and weight control in young women.

While multiple risk factors are associated with smoking, body weight concern is a significant risk factor for smoking among young women, including adolescents. This article explores the relationship between frequency of smoking and weight loss strategies among a nationally representative sample of high school females (n = 7,828). Adjusted odds ratios were generated for smoking, weight goals, and weight loss strategies, controlling for demographics. Daily smokers were two to four times more likely to fast, use pills, and purge to control their weight than nonsmokers. Tobacco control efforts for young women must address the influence of weight concern on smoking in this population.

Hookah use among New Jersey youth: associations and changes over time.

OBJECTIVES To assess hookah use among youth for prevalence, associations, and changes over time. METHODS Data from the 2008 and 2010 New Jersey Youth Tobacco Survey were analyzed to examine hookah smoking by gender, race/ethnicity, and grade level. RESULTS Prevalence of hookah use increased significantly among black and Hispanic students. Frequency of use was generally occasional. In multivariate models, Asian race; Hispanic ethnicity; and concurrent use of cigarettes, cigars, and bidis predicted current hookah smoking. CONCLUSIONS Prevalence of hookah use is rising among New Jerseys youth, particularly among minority populations, representing a growing public health concern.

TRADING TOBACCO: ARE YOUTHS CHOOSING CIGARS OVER CIGARETTES?

The analysis of Ringel and colleagues,1 who found that youths’ cigar use is sensitive to price, highlights an important but overlooked issue in public health—the use of tobacco products other than cigarettes. However, since 1999 and 2000, when the data used by Ringel et al. were collected, there have been many changes that deserve discussion. Cigar consumption in the United States increased by more than 28% between 2000 and 2004, whereas cigarette consumption during the same period declined by 10%.2 Groups that historically have not smoked cigars—youths and females—constitute an increasing proportion of new cigar smokers.3 The average state cigarette excise tax has almost doubled, from

Prevalence and correlates of internet cigarette purchasing among adult smokers in New Jersey

0.64 (1999) to

The Relationship of Cigars, Marijuana, and Blunts to Adolescent Bidi Use

1.17 (2004), raising the average price per pack by