The Role of Cigarillo Flavor in the Co-Use of Cigarillos and Cannabis among Young Adults

Figures & data

Table 1. Demographics and other characteristics of young adults who used cigarillos in the past 30 days (N = 361).

			Usually smoke flavored cigarillos^a					Past 30-day cannabis useb
	Total (N = 361)		Yes (n = 270; 81.8%)		No (n = 60; 18.2%)			Yes (n = 218; 64.1%)		No (n = 122; 35.9%)
	n	%	n	%	n	%	p value^g	n	%	n	%	p value^g
Age, mean (SD)	–	24.7 (2.1)	–	24.7 (2.1)	–	24.7 (2.2)	0.966^c	–	24.6 (2.2)	–	24.7 (2.2)	0.752^c
Gender identity^h
Male	205	57.6	161	60.3	35	58.3	0.924^d	122	56.2	76	63.9	0.185^d
Female	142	30.9	98	36.7	24	40.0		91	41.9	39	32.8
Gender non-conforming	9	2.5	8	3.0	1	1.7		4	1.8	4	3.4
Race
Black, non-Hispanic	114	33.5	88	34.1	14	24.6	0.261^e	60	28.9	46	41.1	0.071^e
White, non-Hispanic	100	29.4	75	29.1	20	35.1		62	29.8	31	27.7
Hispanic	80	23.5	64	24.8	12	21.1		58	27.9	19	17.0
Other, non-Hispanic	46	13.5	31	12.0	11	19.3		28	13.5	16	14.3
Annual income
<$25,000	176	57.3	142	59.2	30	53.6	0.691^d	117	58.2	55	55.6	0.799^d
$25,000–$49,999	84	27.4	62	25.8	18	32.1		55	27.4	27	27.3
$50,000–$99,999	42	13.7	32	13.3	8	14.3		25	12.4	16	16.2
$100,000+	5	1.6	4	1.7	0	0.0		4	2.0	1	1.0
# household tobacco users, mean (SD)	–	1.6 (0.7)	–	1.6 (0.8)	–	1.6 (0.7)	0.408^c	–	1.7 (0.8)	–	1.4 (0.7)	<0.001^c
Other tobacco product use (past 30 days)
No	69	19.2	52	19.3	15	25.0	0.324^e	30	13.8	39	32.2	<0.001^e
Yes	291	80.8	217	80.7	45	75.0		188	86.2	82	67.8
Price usually paid for cigarillos per unit usually purchased, median (IQR)	–	1.3 (2.0)	–	1.3 (2.3)	–	1.1 (1.0)	0.262^f	–	1.2 (1.0)	–	1.7 (4.0)	0.026^f
Nicotine dependence^i, mean (SD, range)	–	14.3 (7.4, 0–32)	–	14.4 (7.5, 0–32)	–	12.0 (7.0, 0–30)	0.023^c	–	14.1 (7.3, 0–32)	–	14.3 (7.7, 0–32)	0.897^c
Frequency noticed smoking ads (past 6 months)
Never	31	9.3	21	8.1^1	9	15.8^1	<0.001^d	20	9.6^1	10	8.9^1	0.030^e
Rarely	88	26.3	60	23.2^1	27	47.4^2		65	31.1^1	22	19.5^2
Sometimes	124	37.0	103	39.8^1	14	24.6^2		74	35.4^1	45	39.8^1
Often	73	21.8	62	23.9^1	5	8.8^2		44	21.1^1	25	22.1^1
Very often	19	5.7	13	5.0^1	2	3.5^1		6	2.9^1	11	9.7^2
“Flavored cigarillos are appealing”
Strongly disagree	17	4.8	8	3.0^1	9	15.3^2	<0.001^d	8	3.7	8	6.7	0.252^d
Disagree	13	3.7	5	1.9^1	6	10.2^2		8	3.7	2	1.7
Somewhat disagree	19	5.4	8	3.0^1	8	13.6^2		14	6.5	4	3.3
Neither disagree nor agree	36	10.2	18	6.7^1	14	23.7^2		25	11.6	10	8.3
Somewhat agree	71	20.1	56	20.9^1	8	13.6^1		46	21.3	20	16.7
Agree	109	30.9	92	34.3^1	10	17.0^2		59	27.3	45	37.5
Strongly agree	88	24.9	81	30.2^1	4	6.8^2		56	25.9	31	25.8
Perceived cigarillo harm^i, median (IQR, range)	–	14.0 (11.0, 0–21)	–	14.0 (11.0, 0–21)	–	15.0 (7.0, 3–21)	0.008^f	–	15.0 (11.0, 0–21)	–	14.0 (6.0, 0–21)	0.010^f
Live in area with flavored cigarillo ban
No	312	86.7	226	83.7	57	95.0	0.024^d	196	90.3	98	80.3	0.009^e
Yes	48	13.3	44	16.3	3	5.0		21	9.7	24	19.7
Live in area with legalized recreational cannabis
No	260	72.2	195	72.2	48	80.0	0.216^e	161	74.2	83	68.0	0.225^e
Yes	100	27.8	75	27.8	12	20.0		56	25.8	39	32.0
Cannabis use (past 30 days)
No	122	35.9	100	38.0	16	27.6	0.134^e	–	–	–	–	–
Yes	218	64.1	163	62.0	42	72.4		–	–	–	–
Usual Cigarillo Flavored
No	60	18.2	–	–	–	–	–	42	20.5	16	13.8	0.134^e
Yes	270	81.8	–	–	–	–		165	79.5	104	86.2

^aObserved frequencies, n = 31 missing this item; ^b observed frequencies, n = 21 missing this item; ^c Student’s t-test; ^d Fisher’s Exact Test; ^e Pearson’s Chi-square Test for Independence; ^f two-sample Wilcoxon rank-sum (Mann–Whitney) test; ^g for significant tests (variables ≥3 levels), groups not sharing superscript numerals are significantly different (p < 0.05) by usual flavored use or cannabis use in post-hoc pairwise contrasts; ^h due to limited power for multiple-group testing, we combined male + trans male/man and female + trans female/woman, and gender non-conforming individuals were dropped from the multiple-group testing portion of the analysis; ⁱ based on confirmatory factor analysis results, see Supplemental Table 2 for scale indicators.

Table 2. Structural equation model fit statistics and standardized path estimates across competing models.

Fit Statistic, mean (SD)^a	Model 1	Model 2	Model 3	Model 4
χ^2	308.623 (5.073)	299.594 (4.603)	308.402 (5.245)	295.003 (3.853)
RMSEA	0.023 (0.001)	0.021 (0.001)	0.023 (0.001)	0.021 (0.001)
CFI	0.992 (0.001)	0.993 (0.001)	0.992 (0.001)	0.994 (0.001)
TLI	0.991 (0.001)	0.992 (0.001)	0.991 (0.001)	0.993 (0.001)
SRMR	0.067 (0.000)	0.057 (0.000)	0.068 (0.000)	0.056 (0.000)
Pathway, β (95% CI)
Usual Flavor (UF)
UF to Harm	−0.22 (−0.33, −0.12)**	–	−0.22 (−0.32, −0.12)**	–
UF to Appeal	0.42 (0.31, 0.52)***	0.42 (0.32, 0.51)***	–	–
UF to Cannabis use (Direct)	0.15 (−0.16, 0.46)	0.01 (−0.13, 0.15)	0.27 (−0.27, 0.80)	0.01 (−0.13, 0.16)
UF to Harm to Cannabis Use (Indirect 1)	−0.05 (−0.08, −0.02)*	–	−0.05 (−0.08, −0.01)*	–
UF to Appeal to Cannabis Use (Indirect 2)	−0.02 (−0.07, 0.04)	−0.02 (−0.08, 0.04)	–	–
UF Total Indirect	−0.07 (−0.14, 0.06)	−0.02 (−0.08, 0.04)	−0.05 (−0.08, −0.01)*	–
UF Total	−0.05 (−0.32, 0.01)	−0.01 (−0.15, 0.13)	0.22 (−0.32, 0.76)	–
Covariates
Harm to Cannabis Use	0.22 (0.10, 0.34)**	0.17 (0.06, 0.29)*	0.22 (0.07, 0.37)**	0.18 (0.06, 0.29)*
Appeal to Cannabis Use	−0.04 (−0.17, 0.09)	−0.04 (−0.18, 0.09)	−0.16 (−0.40, 0.09)	−0.06 (−0.19, 0.06)
Per Unit Price (ln) to Cannabis Use	0.04 (−0.13, 0.22)	0.02 (−0.16, 0.19)	−0.03 (−0.22, 0.16)	0.02 (−0.16, 0.20)
Dependence to Cannabis Use	0.02 (−0.11, 0.15)	0.00 (−0.12, 0.13)	0.03 (−0.10, 0.16)	0.00 (−0.13, 0.14)
Income to Cannabis Use	−0.02 (−0.31, 0.27)	−0.02 (−0.16, 0.11)	0.00 (−0.14, 0.14)	−0.02 (−0.16, 0.11)
Household Tobacco Users to Cannabis use	0.22 (0.10, 0.34)**	0.22 (0.10, 0.34)**	0.21 (0.10, 0.33)**	0.22 (0.10, 0.33)**
Ad Exposure to Cannabis Use	−0.17 (−0.33, −0.02)	−0.11 (−0.24, 0.01)	−0.20 (−0.41, 0.01)	−0.12 (−0.24, 0.010)
Other Tobacco Use to Cannabis Use	0.22 (0.14, 0.31)***	0.23 (0.15, 0.31)***	0.30 (0.14, 0.32)***	0.23 (0.15, 0.32)***
Flavor Ban to Cannabis Use	−0.20 (−0.44, 0.04)	−0.12 (−0.21, −0.02)**	−0.28 (−0.70, 0.13)	−0.12 (−0.21, −0.02)*
Legal Recreational Cannabis to CannabisUse	−0.08 (−0.25, 0.09)	−0.07 (−0.24, 0.11)	−0.07 (−0.24, 0.10)	−0.07 (−0.25, 0.11)
R^2 for Cannabis Use
	0.21**	0.20**	0.23*	0.20**

^aAveraged across 5 imputed datasets; to see χ² p value and RMSEA 90% Confidence Intervals for each dataset, see Supplemental Table 4.

Model 1: Original hypothesized model; Model 2: No indirect effect from usual flavor to cannabis use via harm perceptions; Model 3: No indirect effect from usual flavor to cannabis use via appeal; Model 4: No indirect effect from usual flavor to cannabis use.

*p < 0.05, ** p < 0.01 *** p < 0.001.

Figure 1. Conceptual model diagram (originally hypothesized model; model 1).

Figure 2. Structural equation model 4 standardized results.

Data availability statement

Data are available upon reasonable request.