Background: Flavors in tobacco products is a subject of public health debate and increasing regulatory attention. There is interest in gaining an in-depth understanding of flavored cigar smoking prevalence and behaviors to address the use of flavors in cigars and questions of public health.
Methods: Seven publicly available data resources that assess flavored cigar use were analyzed. Two focus on youth tobacco use (NYTS, MTF), four focus on adult tobacco use (HINTS-FDA, NATS, TPRPS, TUS-CPS), and one on both groups (PATH). Available data (2011-2019) were analyzed to assess usage trends over time. In addition, longitudinal analysis of PATH adult data examined whether flavored cigar use was associated with future use of cigarettes or increased use of cigars.
Results: Youth past 30-day estimates of cigar use ranged from 2%-10% for both flavored and non-flavored cigars, slightly higher in high school vs. middle school age subpopulations. These estimates have been stable or declined across all survey years within the respective surveys. Consistent trends were observed regarding frequency of use; most youth using cigars do so 1-2 days per month. Similar findings were observed for adult cigar users, with five surveys indicating less than 10% currently use cigars. Flavored cigar use is at less than 5% across all data sources. These overarching use estimates were essentially flat over time. Frequency of youth cigar use remained consistent over time, with most youth reporting cigar use on 1-2 days per month. In addition, multivariable modeling of PATH adult data did not identify an association between flavored cigar use and future use of cigarettes or increased use of cigars.
Conclusions: No evidence was found of increased use or different usage patterns, among either youth or adults, of flavored cigars vs. non-flavored cigars. While these trends should continue to be monitored, there is no indication of existing or emerging public health concerns related to flavored cigars within the seven large, nationally representative, US government-funded epidemiologic databases examined.