1. Little Cigars: The Preferred Tobacco Product Among Freshmen at an HBCU Presentation to HWTF Teen Tobacco Use Prevention and Cessation grantees June 17, 2010

2. Survey Methods In fall 2003, a paper and pencil, self-administered screening survey on tobacco use was administered to NCCU freshmen in sections of a required introductory course. In fall 2003, a paper and pencil, self-administered screening survey on tobacco use was administered to NCCU freshmen in sections of a required introductory course. Survey was part of a one-year cohort study on factors influencing the initiation and entrenchment of smoking among freshmen at an historically Black university. Survey was part of a one-year cohort study on factors influencing the initiation and entrenchment of smoking among freshmen at an historically Black university.

3. Screener Sample 684 freshmen (57%) completed screening survey 68% female 68% female 96% African American 96% African American 88% living on campus 88% living on campus 99% full-time students 99% full-time students

4. Summary of Screener Data N% Have you ever used a tobacco product in your life? Yes34450% What tobacco products have you used?Cigarettes Little cigars Other cigars Pipe Chew 237 255 115 2 15 69% 74% 33% 1% 4% During the past 30 days have you smoked at least one cigarette or little cigar? Yes 17350% Which have you used in the past 30 days?Cigarette Little cigar 76 128 44% 74% Have you smoked in the last 7 days?Yes12035%

5. Little Cigars Vs. Cigarettes Though the preference was stronger for males than females, both preferred little cigars to cigarettes. Though the preference was stronger for males than females, both preferred little cigars to cigarettes.

6. An Intro To Little Cigars (LCs) Also known as cigarillos Also known as cigarillos Much smaller than traditional cigars Much smaller than traditional cigars Big cigars are sometimes hollowed out and filled with marijuana. Big cigars are sometimes hollowed out and filled with marijuana. For some blunts are big tobacco-filled cigars (e.g., Philly Blunts); for others they are marijuana-filled cigars. For some blunts are big tobacco-filled cigars (e.g., Philly Blunts); for others they are marijuana-filled cigars. It gets confusing, but clear distinctions are critical! It gets confusing, but clear distinctions are critical!

7. An Intro To Little Cigars (LCs) Nicotine content of LCs is unclear, but most users inhale - to get a buzz. Nicotine content of LCs is unclear, but most users inhale - to get a buzz. In a social setting one LC is often passed around among friends, much like a joint. In a social setting one LC is often passed around among friends, much like a joint. 5 per pack; in NC cost about $2.50 pack 5 per pack; in NC cost about $2.50 pack Singles or loosies sell for $.75 Singles or loosies sell for $.75

8. Hyping A process some smokers engage in to make the LC burn more quickly and “pull easier” A process some smokers engage in to make the LC burn more quickly and “pull easier” Tobacco is completely emptied from the LC, the filter is taken off, a paper (sometimes called the cancer stick) that lines the little cigar is removed, then the tobacco is put back in. Tobacco is completely emptied from the LC, the filter is taken off, a paper (sometimes called the cancer stick) that lines the little cigar is removed, then the tobacco is put back in. Requires time and technique; a ritual for some Requires time and technique; a ritual for some

9. Focus Groups: Exploring the Use of Little Cigars In July 2005, 3 focus groups were conducted with NCCU students who were current or former smokers of little cigars. In July 2005, 3 focus groups were conducted with NCCU students who were current or former smokers of little cigars. 21 students participated 21 students participated 16 males, 5 females; all African American 16 males, 5 females; all African American Focus groups lasted 60-90 minutes Focus groups lasted 60-90 minutes Participants received a $30 gift certificate Participants received a $30 gift certificate

10. Topics Current smoking status Current smoking status Brands of LCs smoked Brands of LCs smoked Reasons for smoking LCs Reasons for smoking LCs Social context of smoking Social context of smoking Amount smoked Amount smoked Risks relative to cigarettes – addiction and health problems Risks relative to cigarettes – addiction and health problems Thoughts about quitting Thoughts about quitting

11. Smoking Status 20 of 21 currently smoked LCs; one was a former user 20 of 21 currently smoked LCs; one was a former user Only 6 of 21 also smoked cigarettes; one other was a former user Only 6 of 21 also smoked cigarettes; one other was a former user

12. Brands of LCs Smoked Black and Milds (aka Blacks) were overwhelmingly the brand of choice. Black and Milds (aka Blacks) were overwhelmingly the brand of choice. In fact, Blacks were synonymous with little cigars (like Kleenex and Jello). In fact, Blacks were synonymous with little cigars (like Kleenex and Jello). Some had tried other brands (Swisher Sweets, Black Magic) but preferred Blacks. Some had tried other brands (Swisher Sweets, Black Magic) but preferred Blacks. A few smoked flavored Blacks (e.g., vanilla). A few smoked flavored Blacks (e.g., vanilla).

13. Why Little Cigars Over Cigarettes? Better taste and smell Better taste and smell “Black & Milds are smooth. Cigarettes taste like chemicals.” “Black & Milds are smooth. Cigarettes taste like chemicals.” “Cigarettes smell your clothes.” “Cigarettes smell your clothes.” “Girls say [cigarettes] stink.” “Girls say [cigarettes] stink.” Better buzz/high Better buzz/high “I get more of a buzz with my first cigarette. But when I smoke Black & Milds, I get a buzz every time I pull.” “I get more of a buzz with my first cigarette. But when I smoke Black & Milds, I get a buzz every time I pull.”

14. Why Little Cigars Over Cigarettes? It’s part of partying. It’s part of partying. “It went hand in hand at parties.” “It went hand in hand at parties.” “Drinking and Blacks go together.” “Drinking and Blacks go together.” It’s more social. It’s more social. “Normally people smoke and pass.” “Normally people smoke and pass.” “We might share while in the line at the club.” “We might share while in the line at the club.” Status Status “They look cool.” “They look cool.” “It’s the fad in fashion.” “It’s the fad in fashion.”

15. Why Little Cigars Over Cigarettes? They’re less addictive. They’re less addictive. “I started smoking blacks in order to stop smoking cigarettes.” “I started smoking blacks in order to stop smoking cigarettes.” “People who smoke cigarettes feign for cigarettes. With blacks if you don’t have one, it’s cool.” “People who smoke cigarettes feign for cigarettes. With blacks if you don’t have one, it’s cool.” They’re less harmful. They’re less harmful. “They’re not as many toxic gases.” “They’re not as many toxic gases.” “My grandma died from cigarettes.” “My grandma died from cigarettes.” You can make them safer by “hyping” You can make them safer by “hyping” “When you remove the cancer paper, it takes out some of the stuff.” “When you remove the cancer paper, it takes out some of the stuff.”

16. When and Where Do You Smoke? When drinking at the club or a party When drinking at the club or a party After a meal (but not on an empty stomach – laxative effect!) After a meal (but not on an empty stomach – laxative effect!) When stressed. When stressed. “I smoke after class, after work, after an argument to mellow out and get my head together. It keeps me calm.” “I smoke after class, after work, after an argument to mellow out and get my head together. It keeps me calm.” With friends With friends When smoking marijuana. When smoking marijuana. “Now I smoke after weed to get an extra boost.” “Now I smoke after weed to get an extra boost.”

17. How Much Do You Smoke and How Do You Smoke It? Responses ranged from a pack a day to a pack every 2 weeks. Responses ranged from a pack a day to a pack every 2 weeks. Those who also smoked cigarettes smoked more cigarettes than LCs. Those who also smoked cigarettes smoked more cigarettes than LCs. “A pack [of LCs] lasts me 2 weeks, but I smoke cigarettes every day for stress.” “A pack [of LCs] lasts me 2 weeks, but I smoke cigarettes every day for stress.” “I might smoke a pack of Blacks in a week and 3 packs of cigarettes the next week.” “I might smoke a pack of Blacks in a week and 3 packs of cigarettes the next week.”

18. How Much Do You Smoke and How Do You Smoke It? But many people don’t smoke a whole LC at one time. But many people don’t smoke a whole LC at one time. “It is hard to smoke a whole black. When I smoke, I have 3 sessions with one Black.” “It is hard to smoke a whole black. When I smoke, I have 3 sessions with one Black.” “I smoke, then put it out, then smoke the rest later.” “I smoke, then put it out, then smoke the rest later.” “I can’t smoke a whole Black. You have to share.” “I can’t smoke a whole Black. You have to share.” Most people share. Most people share. “Collectively we might smoke 5 to 6 Blacks in a day.” “Collectively we might smoke 5 to 6 Blacks in a day.” “Everyone wants to hit Blacks.” “Everyone wants to hit Blacks.” “No one is stingy with Blacks.” “No one is stingy with Blacks.”

19. Beliefs About Addiction There was widespread belief that LCs are not as addictive as cigarettes. There was widespread belief that LCs are not as addictive as cigarettes. “You can shake the habit of Blacks, but you can’t do that with cigarettes.” “You can shake the habit of Blacks, but you can’t do that with cigarettes.” “People do not smoke cigarettes for leisure. Black & Milds are smoked for leisure.” “People do not smoke cigarettes for leisure. Black & Milds are smoked for leisure.” “Smoking Blacks you don’t feel as addicted.” “Smoking Blacks you don’t feel as addicted.” A minority disagreed. A minority disagreed. “I don’t understand, it’s all tobacco.” “I don’t understand, it’s all tobacco.” “It’s the same. It’s a different gun but the same bullet.” “It’s the same. It’s a different gun but the same bullet.”

20. Beliefs About Health Risks Some believed LCs are less harmful than cigarettes - for various reasons. Some believed LCs are less harmful than cigarettes - for various reasons. “I don’t think it’s as bad because people do not smoke Black & Milds as much.” “I don’t think it’s as bad because people do not smoke Black & Milds as much.” “Cigarettes have more chemicals.” “Cigarettes have more chemicals.” “When you smoke a cigarette, the paper turns brown. But when you smoke a Black & Mild, there is no color change. So it is not as harmful.” “When you smoke a cigarette, the paper turns brown. But when you smoke a Black & Mild, there is no color change. So it is not as harmful.” Some believed the risks were equivalent. Some believed the risks were equivalent. “It’s the same thing – tobacco is tobacco.” “It’s the same thing – tobacco is tobacco.” “With Blacks you might get the same diseases as cigarette smokers, but it will happen at a slower rate.” “With Blacks you might get the same diseases as cigarette smokers, but it will happen at a slower rate.”

21. Beliefs About Health Risks Some believed LCs are more harmful than cigarettes – for various reasons. Some believed LCs are more harmful than cigarettes – for various reasons. “It is worse. I heard one Black & Mild equals 10 cigarettes. “It is worse. I heard one Black & Mild equals 10 cigarettes. “Well, if we’re taking the filter out, it has to be worse. But it is still all smoke. The paper acts like a filter, right?” “Well, if we’re taking the filter out, it has to be worse. But it is still all smoke. The paper acts like a filter, right?” “The paper makes Blacks more dangerous.” “The paper makes Blacks more dangerous.”

22. Beliefs About Health Risks A number seemed genuinely confused and interested in learning more. A number seemed genuinely confused and interested in learning more. “My brother said that the cancer stick was a filter. But I thought it made the Black worse.” “My brother said that the cancer stick was a filter. But I thought it made the Black worse.” “I believe [Blacks are worse] but I hope to find out more.” “I believe [Blacks are worse] but I hope to find out more.” “What is in the paper that they make Blacks out of?” “What is in the paper that they make Blacks out of?” “Coming here makes me want to research more tonight. I thought it had fewer chemicals.” “Coming here makes me want to research more tonight. I thought it had fewer chemicals.”

23. Implications for Tobacco Prevention and Cessation Programs Address the use of little cigars. Address the use of little cigars. Make clear distinctions Make clear distinctions little cigars vs. big cigars vs. blunts little cigars vs. big cigars vs. blunts smoking tobacco vs. smoking marijuana smoking tobacco vs. smoking marijuana Many students want the truth about LCs. Give them straight information. Many students want the truth about LCs. Give them straight information. Debunk the myths that: Debunk the myths that: It’s not addictive. It’s not addictive. It’s a healthier alternative to cigarettes. It’s a healthier alternative to cigarettes. Hyping reduces the risk. Hyping reduces the risk.