Changes in Little Cigar and Cigarillo Use during the COVID-19 Pandemic: A Cross-Sectional Analysis of a Nationally Representative Sample of Young Adult Users.

We examined the smoking behaviors of U.S. young adults ages 18-36 regarding little cigars and cigarillos (LCCs) during the COVID-19 pandemic. Survey data were collected from a nationally representative sample of young adults between October and November 2020. Respondents who reported using LCCs with tobacco (CAI) and/or with marijuana (CAB) within the past 6 months prior to the survey (n = 399) were included in the study. Logistic regression analyses assessed the association between their perceived risk of having COVID when smoking LCCs and pandemic-related behavioral changes in CAI and CAB use (e.g., worrying, quit attempts, smoking more, smoking less). Findings showed that users with a higher perceived risk of getting COVID-19 when smoking LCCs were more likely to endorse trying to quit CAI and CAB during the pandemic. Compared to the non-Hispanic White population, the non-Hispanic Black population were less likely to endorse smoking less CAI and trying to quit CAB during the pandemic. Dual users of CAI and CAB and females were more likely to endorse smoking more CAB compared to CAB-only users and males, respectively. Tailored cessation strategies are needed for dual users, non-Hispanic Black young adults, and young women. Raising awareness about the risks of LCC use can be an effective strategy for LCC smoking cessation.

Acute Eosinophilic Pneumonia Caused by Cigar Smoking

Introduction: Eosinophilic lung diseases (ELD) are a group of conditions that are characterized by pulmonary eosinophilia. Acute eosinophilic pneumonia (AEP) may be idiopathic in many patients, however, changes in smoking habits and drug use can trigger the disease. Case: A 24-year-old female presented to the emergency room with dyspnea for 1 week. She also had productive cough, fever of 38.7C (101.7F) and chest tightness. Although she had been vaping for the past year she switched to heavy cigar smoking 3 weeks prior to admission. Vital signs on presentation were blood pressure 127/72 mmHg, heart rate 122 beats/min, respiratory rate 28/min, oral temperature 37.4°C (99.4°F) and oxygen saturation 88% on room air. Lung exam revealed mild rhonchi. Blood work showed leukocytosis 29.13 x 103/mcL (N:4-12 x 103/mcL) with neutrophilia 26.6 x 103/mcL (N: 1.60-7.71 x 103/mcL), mild lymphopenia 1.07 x 103/mcL and a normal metabolic panel. SARS-CoV-2 PCR was negative 3 times. CT chest revealed consolidative opacities involving the right lung more than left and small bilateral pleural effusions. The patient was provided supplemental oxygen via nasal cannula and started on ceftriaxone and azithromycin for community acquired pneumonia. She rapidly declined requiring endotracheal intubation for invasive mechanical ventilation. Antibiotic coverage was broadened to vancomycin, piperacillin-tazobactam, doxycycline and levofloxacin. Further negative work up included viral pathogen panel, respiratory cultures, HIV screening, fungal antibodies, urine pneumococcal and legionella antigens, ANA and ANCA, and serum next-generation sequencing. She developed peripheral eosinophilia on hospital day 2 which peaked at 3.29 x 103/mcL (N: 0.0-0.40 x 103/mcL) on day 6. Bronchoscopy revealed no organisms on gram stain and there was no alveolar hemorrhage. Cell count from bronchoalveolar lavage (BAL) was not available. She was started on methylprednisone 60 mg every 6 hours IV for presumed AEP with marked improvement over the next 48 hours. She was discharged home shortly thereafter on an 8 week steroid taper. Discussion: AEP has been associated with new onset or resumption of cigarette smoking. Our patient had an acute onset febrile illness rapidly progressing to hypoxic respiratory failure, initial peripheral neutrophilic leukocytosis with subsequent peripheral eosinophilia, patchy bilateral ground glass and consolidative opacities with small pleural effusions, and immediate response to steroids. Prognosis is excellent if the disease is recognized and treated promptly. Conclusion: AEP is a rare cause of acute respiratory failure that can be confidently diagnosed with careful history, a constellation of symptoms and signs, and BAL eosinophilia (>20-25%).

Exploring changes in cigar smoking patterns and motivations to quit cigars among black young adults in the time of COVID-19.

INTRODUCTION: The COVID-19 pandemic has disproportionately impacted the Black/African American communities in the U.S. The objective of this study is to understand the change in cigar smoking patterns and motivations to quit cigars during the COVID-19 pandemic among Black young adult cigar smokers. METHODS: During May-June 2020, in-depth telephone interviews were conducted to investigate cigar (i.e., large cigars, cigarillos, filtered cigars, and blunts) smoking behaviors during the pandemic among self-identified, non-Hispanic Black/African American young adult cigar smokers (n = 40; ages 21-29). Interviews were audio-recorded, transcribed verbatim, and coded separately by three coders. Thematic analysis was used to assess thematic patterns arising from the interviews. RESULTS: Most participants reported smoking cigarillos and blunts in higher frequency and quantity to cope with COVID-19-induced stress, anxiety, loneliness, and boredom due to economic losses and physical isolation. Some also reported contextual changes in cigarillo and blunt smoking, including smoking around the clock, smoking immediately after waking up, and smoking an entire cigarillo or blunt in one setting. Very few participants reported motivations to quit cigars during the pandemic. Perceiving higher risks of progressed COVID-19 outcomes did not prompt participants' increased motivations for quitting cigars. CONCLUSIONS: Black young adults in this study increasingly smoked cigarillos and blunts during the COVID-19 pandemic, mainly attributed to daily life stressors. Participants did not have increased motivations for quitting cigars to reduce COVID-19-related risks. Promoting contextually appropriate healthy coping and cigar smoking cessation may minimize COVID-19-related health consequences of cigar smoking and reduce health disparities among Black young adults.

Tobacco Quit Intentions and Behaviors among Cigar Smokers in the United States in Response to COVID-19.

Combustible tobacco users appear to be at greater risk for serious complications from COVID-19. This study examined cigar smokers' perceived risk of COVID-19, quit intentions, and behaviors during the current pandemic. We conducted an online study between 23 April 2020 to 7 May 2020, as part of an ongoing study examining perceptions of different health effects of cigars. All participants used cigars in the past 30 days (n = 777). Three-quarters of the sample (76.0%) perceived they had a higher risk of complications from COVID-19 compared to non-smokers. The majority of participants (70.8%) intended to quit in the next six months due to COVID-19, and almost half of the sample (46.5%) reported making a quit attempt since the start of the COVID-19 pandemic. Far more participants reported increasing their tobacco use since COVID-19 started (40.9%) vs. decreasing their tobacco use (17.8%). Black or African American participants, participants who reported using a quitline, and participants with higher COVID-19 risk perceptions had higher intentions to quit using tobacco due to COVID-19, and higher odds of making a quit attempt since COVID-19 started. More research is needed to understand how tobacco users are perceiving COVID-19 risks and changing their tobacco use behaviors.