Blunt and Non-Blunt Cannabis Use and Risk of Subsequent Combustible Tobacco Product Use Among Adolescents.

INTRODUCTION: Cannabis-including blunts (cannabis rolled in tobacco-containing cigar casing) -is commonly the first substance used among adolescents and may increase the likelihood of subsequent initiation of combustible tobacco products. AIMS AND METHODS: Data were pooled from two prospective studies of adolescents in California and Connecticut (total N = 4594). Logistic regression models assessed the association of baseline ever blunt use and ever non-blunt cannabis use (vs. never cannabis use) with subsequent initiation of any combustible tobacco-only product (ie, cigarettes, cigars, or cigarillos) by 1-year follow-up after adjustment for demographic characteristics and other tobacco product use at baseline. We also assessed whether estimates differed by prior e-cigarette or hookah use at baseline. RESULTS: Among never combustible tobacco-only product users (N = 2973), 221 (7.4%) had ever used a blunt and 114 (3.8%) had ever used only non-blunt cannabis at baseline. Blunt use (adjusted odds ratio [AOR] = 1.98, 95% confidence interval [CI]: 1.30 to 3.01) and non-blunt cannabis use (AOR = 2.38, 95% CI: 1.41 to 4.00) were independently associated with greater odds of combustible tobacco-only product initiation by follow-up. Among those who had not tried e-cigarettes or who had not tried hookah, blunt use and non-blunt cannabis use were associated with significantly increased odds of combustible tobacco product initiation; among those who had tried e-cigarettes or hookah, the association was not significant. CONCLUSIONS: We found blunt and non-blunt cannabis use to be associated with subsequent combustible tobacco-only product initiation, particularly among adolescents who had not also tried other products containing nicotine. IMPLICATIONS: Adolescent-focused tobacco prevention efforts should consider incorporating cannabis products, including blunts. More research is needed to understand how blunt use and cannabis use more broadly are associated with initiation of tobacco products.

Harm Perceptions of Alternative Tobacco Products among US Adolescents.

OBJECTIVES: In this study, we identified groups of adolescents who share similar awareness and perceptions of harm regarding e-cigarettes, cigars, hookah, and smokeless tobacco. METHODS: We used latent class analyses (LCA) with the data from Wave 1 (2013-14) of the Population Assessment of Tobacco and Health youth and parent survey (PATH; N = 13,650) to address the research goal. Multinomial logistic regression analysis assessed the associations between identified classes with demographic characteristics and tobacco use. RESULTS: LCA identified 5 classes: (1) perceived harm across all alternative tobacco products (36.6%); (2) perceived harm for e-cigarettes and smokeless tobacco but never heard of cigars and hookah (48.2%); (3) never heard of alternative tobacco products (8.6%); (4) mix of no harm and harm across alternative tobacco products (5.2%); and (5) "don't know" the harm across alternative tobacco products (1.4%). Relative to the class who perceived harm across all alternative tobacco products, classes of adolescents who were unaware of the products or did not know the harms were more likely to be non-white, younger, have lower parental education, and less likely to have tried an alternative tobacco product. CONCLUSIONS: Tobacco prevention should target vulnerable youth, such as adolescents who are non-white, young, and have low parental education.

Longitudinal associations between use and co-use of cigars and cigarettes: A pooled analysis of three adolescent cohorts.

INTRODUCTION: Patterns of adolescent tobacco product use are evolving rapidly and need examination. We assessed whether ever use of cigars (i.e., lifetime use) was related to an increased risk of subsequent cigarette initiation and dual use of cigars and cigarettes. METHODS: Leveraging data from three prospective cohort studies of adolescents (n = 6258), we assessed the odds of initiating cigarettes at one-year follow-up among ever cigar users at baseline, relative to never cigar users, after adjusting for demographics and e-cigarette use. We also assessed patterns of transition between exclusive use of cigars, exclusive use of cigarettes, and dual use of both cigars and cigarettes between baseline and follow-up and whether these associations differed by e-cigarette use. RESULTS: Among never cigarette smokers (n = 4876; 79.3% of the total sample), 3.4% reported ever cigar use by baseline. Ever cigar use by baseline was associated with higher likelihood of initiating cigarettes by follow-up (31.3%) relative to never cigar use at baseline (8.4%; adjusted odds ratio = 2.26, 95% confidence interval: 1.52, 3.35). Effect estimates were stronger if e-cigarette was used by baseline. Furthermore, exclusive ever cigar use by baseline was associated with a 2-4-fold increase in the odds of transition to exclusive cigar, exclusive cigarette, and dual use at follow-up relative to non-users of either product by baseline. CONCLUSIONS: Comprehensive tobacco regulations and early prevention efforts focused on reducing youth appeal of cigars may be warranted, as cigar use may place youth at risk for subsequent cigarette use as well as dual use of cigars and cigarettes.