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Premium Cigars: Patterns of Use, Marketing, and Health Effects (2022)

Chapter: Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health

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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Appendix C

Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health

Authored by:1 Michelle T. Bover Manderski,2
Ollie Ganz,3 Julia Chen-Sankey4

BACKGROUND

In 2021, Food and Drug Administration (FDA) tasked the National Academy of Sciences, Engineering, and Medicine (the National Academies) to evaluate the current evidence base related to the health effects from use of premium cigars and identify areas for further research (NASEM, 2021). The committee’s scope of work included but was not limited to patterns of use for premium cigars, how those may differ among cigar types and other tobacco products, and data on both short- and long-term health effects of premium cigars. Given the paucity of published data on premium cigar use (Corey et al., 2014, 2018), the committee commissioned a paper to provide insight into U.S. premium and nonpremium cigar use with 10 years of data from the National Survey on Drug Use and Health (NSDUH; 2010–2019). Specifically, analyses were to focus on (1) use patterns over time, (2) demographic characteristics of premium versus nonpremium past 30-day cigar smokers, (3) tobacco use patterns among premium versus nonpremium past 30-day cigar smok-

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1 Committee member Cristine Delnevo oversaw this analysis, reviewed the results for accuracy, provided regular feedback to the authors, and edited the final paper.

2 Department of Biostatistics and Epidemiology, School of Public Health, Rutgers University.

3 Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University.

4 Department of Health Behavior, Society and Policy, School of Public Health, Rutgers University.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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ers, and (4) health indicators among premium versus nonpremium past 30-day cigar smokers.

METHODS

Data Source

NSDUH has collected data from residents of households, noninstitutional group quarters, and civilians living on military bases since 1971. Each year, approximately 56,500 individuals aged 12 and older are surveyed via a computer-assisted interview. The sample is equally distributed among three age groups: 12–17, 18–25, and 26+. The questionnaire contains many tobacco measures, including tobacco use patterns (except e-cigarettes), usual tobacco brand, age of initiation, frequency of tobacco product use, addiction indicators, alcohol and drug use/abuse, pregnancy status, mental health indicators, and some basic disease status measures (e.g., diagnoses with cancer, heart disease). For the present study, data from 2010 through 2019 were analyzed from the NSDUH Concatenated 2002–2019 Public Use File,5 except for analyses related to health outcomes, which included 2015–2019.

Coding of Cigar Type

In NSDUH, all past 30-day cigar users were asked to report the brand that they used most often in the past 30 days. NSDUH does not distinguish between premium versus nonpremium cigar types or brands, so all brands were manually coded. Three expert coders (Ganz, Villanti, and Sterling)6 independently coded each brand based on the following criteria for what defined a premium cigar from the National Academies committee: (1) handmade, (2) filler at least 50 percent natural long-leaf filler tobacco, (3) wrapped in whole leaf (i.e., not reconstituted tobacco), (4) weight of at least 6 lbs per 1,000, (5) no filters/tips, and (6) no characterizing flavor other than tobacco. Coders were able to look at brand and vendor websites to make their determinations. The three coders achieved 84 percent agreement (n = 110). Any disagreements (n = 21) were discussed among the three coders and an additional cigar expert (Delnevo).7 The majority of disagreements were resolved after review of additional

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5 See https://www.datafiles.samhsa.gov/dataset/nsduh-2002-2019-ds0001-nsduh-2002-2019-ds0001 (accessed June 1, 2021).

6 Ganz is an author of this paper; Villanti and Sterling are members of the NASEM committee.

7 Delnevo oversaw the development of this paper and is a member of the NASEM committee.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

brand and vendor websites indicated those that were (e.g., description of whole leaf wrapper) and were not (e.g., presence of a filter) consistent with the committee definition. Ultimately, the three coders and additional expert could not determine the category of four brands: Marsh Wheeling, Isla Del Sol, Java, and Acid. These brands were consistent with premium cigars outside of their use of characterizing flavors. The group decided to treat these brands as nonpremium but conducted a sensitivity analysis treating them as premium.

Codes were cross-referenced with definitions employed by Corey et al. (2018); only two brands were coded differently. Specifically, Corey et al. categorized Acid and Optimo as premium, whereas these were coded as nonpremium for this project. Furthermore, Corey et al. coded Marsh Wheeling as premium, whereas it was coded as both for this project (i.e., included in the sensitivity analysis). The final categorizations were shared for use in the Jeon and Mok, Population Assessment of Tobacco and Health replication commissioned paper (see Appendix D).

Measures

Tobacco Use

Using the coding scheme described above, individuals who had smoked a cigar in the past 30 days were categorized as premium or nonpremium based on the reported brand used most often in the past month. Individuals who cited a known cigarette brand (e.g., Marlboro, Camel, Newport) were excluded. Individuals for whom cigar type could not be determined (e.g., did not know the brand of cigar they smoked) were categorized as “Unknown/Insufficient Information.”

Current cigar use was defined as any cigar use in the past 30 days. Frequent cigar use was defined as at least 20 of the past 30 days. Daily cigar use was defined as 30 of the past 30 days.

Established cigarette smoking was defined as having smoked 100 or more cigarettes in one’s lifetime. Current established cigarette smoking was defined as having ever smoked 100 or more cigarettes and smoked cigarettes in the past 30 days. Former established cigarette smoking was defined as having ever smoked 100 or more cigarettes but NOT having smoked in the past 30 days.

Current use of other tobacco products (i.e., smokeless tobacco, pipe) was defined as use on one or more of the past 30 days; former use for each product was defined as ever having used it but not in the past 30 days; and never use was defined as not having used it even once. NSDUH does not include questions about e-cigarettes, so that was not considered in this analysis.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

Demographics

Age

The NSDUH Public Use File includes several age group variables but not a continuous age variable. For this study, age was categorized as 12–17, 18–25, 26–34, 35–49, 50–64, and 65+.

Gender

According to NSDUH documentation, participant gender is recorded by the survey interviewer as either male or female. This classification was retained for this study.

Race and ethnicity

A single race and ethnicity variable was used for this study, classifying respondents as non-Hispanic white, non-Hispanic Black, non-Hispanic American Indian or Alaska Native (AI/AN), non-Hispanic Native Hawaiian or Pacific Islander (NH/PI), non-Hispanic Asian, non-Hispanic other or multiple races, or Hispanic (any race).

Sexual identity

In 2015, NSDUH began asking adults about sexual identity. The question was “Which one of the following do you consider yourself to be? Heterosexual, that is, straight; Lesbian [if female] or Gay [if male]; Bisexual.” The classification was retained for this study; however, for adults during 2010–2014 and youth during any year, this information was not ascertained.

Education

For persons over age 18, NSDUH collects highest educational attainment with a question, “What is the highest grade or year of school you have completed?” with 21 response options ranging from “no school completed” to “professional degree beyond a bachelor’s degree” (e.g., M.D., D.D.S., D.V.M., L.L.B., J.D.). For this study, this was classified as less than high school education, high school graduate or equivalent (e.g., GED), some college or technical school, or college graduate.

Metropolitan status

NSDUH classifies respondents as living in a large metro, small metro, or nonmetropolitan county; this classification was retained for this study.

Poverty

Individuals were classified based on a ratio-to-poverty threshold as “living in poverty,” “income up to two times the federal poverty threshold,” or “income above two times the federal poverty threshold.”

Health Outcomes

In 2015, NSDUH began including a check-all-that-apply question about a variety of health conditions: “The following is a list of health conditions. Please read the list, and type in the numbers of any of these

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

conditions that a doctor or other medical professional has ever told you that you had.” For cancer, heart condition, chronic obstructive pulmonary disease (COPD), and asthma, respondents were classified as having a particular condition if they selected it and as not having it if they did not select it or selected “none of the above.”

Past-month serious psychological distress (SPD), past-year major depressive episode (MDE), past-year alcohol dependence, past-year cannabis dependence, and past-year illicit drug dependence (other than cannabis) are binary (yes or no) derived variables provided in the NSDUH concatenated datasets. These were retained for the present study.

Current pregnancy status was only asked of female respondents aged 12–44, so respondents not meeting this criterion were classified as “Not Applicable.”

Statistical Analysis

All analyses were performed using SAS software version 9.4 (SAS Institute, Cary, NC, USA) survey procedures using complex sampling and weight variables, per NSDUH documentation (SAMHSA, 2021). Variance was estimated using Taylor Series Linearization with missing values assumed to be not completely random; 95 percent confidence intervals (CIs) were computed and reported for all point estimates, which were considered significantly different if the CIs did not overlap.

Demographic characteristics of premium and nonpremium cigar smokers (Table C-1), prevalence of premium and nonpremium cigar smoking (Table C-2), and tobacco and substance use characteristics among premium and nonpremium cigar smokers (Table C-3) were calculated from pooled 2010–2019 data. Prevalence of medical conditions, mental health conditions, substance dependence, and pregnancy were calculated from pooled 2015–2019 data, because NSDUH did not begin assessing medical conditions until 2015. Estimates for which the coefficient of variation (CV) exceeded 0.3 were deemed statistically unreliable and not reported.

To demonstrate temporal trends, figures were created to show prevalence of current, frequent, and daily premium and nonpremium current cigar use among adults and premium cigar use by age group over time (2010–2019). Ultimately, only the figures showing the prevalence of current premium and nonpremium cigar use among adults (Figure C-1) and use by age over time (Figure C-2) were reported, since sample size limitations provided unreliable estimates for the other two figures, with some cells containing as few as four respondents.

Binary logistic regression modeling was used to assess the association between premium cigar smoking and each health characteristic, adjusted for age group and gender, given that both cigar type and risk vary by these factors. Age was included as a six-level (<18, 18–25, 25–34, 35–49,

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

50–64, 65+) ordinal variable. Ordinal age group (one parameter, no reference group), as opposed to nominal (five parameters, compared to a common reference group) was selected because it provided better model fit without substantively impacting the estimates of interest. Continuous age is not available in the NSDUH Public Use File, thus we could not model age as a continuous variable. Gender was included as a binary nominal variable (male or female). Four comparisons were modeled for adults: (1) premium versus nonpremium cigar smoking among those who smoked cigars in the past 30 days; (2) premium versus nonpremium cigar smoking among those who smoked cigars in the past 30 days adjusted for established cigarette smoking status (nominal variable: current, former, never); (3) past 30-day premium cigar smoking versus never-tobacco use; and (4) past 30-day premium cigar smoking versus current or former established cigarette smoking. The statistical significance of regression parameters was determined by a p value >.05.

RESULTS

Among civilian noninstitutionalized individuals ages 12+ living in the United States, 2010–2019, an estimated 4.7 percent (95 percent CI: 4.6–4.8) currently smoked cigars. Nonpremium cigar smoking (3.0 percent; 95 percent CI: 2.9–3.1) was significantly more prevalent than premium cigar smoking (0.9 percent; 95 percent CI: 0.8–0.9) and smoking of an unknown cigar type (0.8 percent; 95 percent CI: 0.7–0.8).

Distribution of Demographic Characteristics by Cigar Type

Table C-1 presents the distribution of demographic characteristics of people who currently smoke cigars, overall and by cigar type.

Age

The age distribution of premium cigar smokers trended older relative to nonpremium cigar smokers; an estimated 14.1 percent of premium cigar smokers were under age 25 compared to about 38.5 percent of nonpremium cigar smokers. Additionally, more than one-third (34.5 percent) of premium cigar smokers were 50+, compared to less than 20 percent (19.1 percent) of nonpremium cigar smokers.

Gender

Although female smokers are the minority among all cigar types, premium cigar smokers were substantially less likely than nonpremium smokers to be female (6.3 versus 25.8 percent).

Race and ethnicity

An overwhelming majority of premium cigar smokers were non-Hispanic white (78.0 percent), followed by Hispanic (12.1

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

percent) and non-Hispanic Black (5.5 percent). In contrast, nonpremium cigar smokers were more racially diverse, with 57.7 percent identified as non-Hispanic white, 11.5 percent Hispanic, and 25.7 percent non-Hispanic Black.

Sexual identity

A greater proportion of premium than nonpremium cigar smokers identified as heterosexual or straight (97.5 versus 89.6 percent); 3.1 percent and 6.6 percent of nonpremium cigar smokers identified as lesbian/gay or bisexual, respectively, compared to just 0.9 percent and 1.6 percent of premium cigar smokers, respectively.

Education

Premium cigar smokers tended to be more highly educated, with 47.5 percent having a college degree compared to 12.1 percent of nonpremium cigar smokers. Concurrently, 18.9 percent of nonpremium cigar smokers did not complete high school, compared to only 3.7 percent of premium cigar smokers.

Metropolitan status

Premium cigar smokers were more likely to live in a large metro area than nonpremium cigar smokers (65.0 versus 50.5 percent), while nonpremium cigar smokers were more likely to live in a nonmetropolitan area (16.5 versus 6.5 percent).

Poverty level

Income distribution trended higher for premium cigar smokers; they were significantly more likely to have an income above 200 percent of the poverty threshold (84.7 versus 49.8 percent) and significantly less likely to be living in poverty (5.8 versus 24.9 percent).

Prevalence of Premium and Nonpremium Cigar Smoking Among Demographic Groups

Table C-2 presents the prevalence of premium and nonpremium cigar smoking among civilian noninstitutionalized people aged 12+ living in the United States from 2010 to 2019, stratified by demographic characteristics.

Age

The prevalence of current any cigar smoking was highest among those aged 18–25 years (9.5 percent), followed by 26–34 (7.0 percent), 35–49 (4.6 percent), 50–64 (3.7 percent), 12–17 (2.3 percent), and 65+ (1.7 percent). The prevalence of current nonpremium cigar smoking followed a similar pattern, being highest among those aged 18–25 (7.5 percent) and lowest among those 65+ (0.8 percent). In contrast, prevalence of current premium cigar smoking was highest among those aged 26–34 (1.4 percent), followed by 35–49 (1.1 percent), 50–64 (1.0 percent), 18–25 (0.9 percent), 65+ (0.4 percent), and 12–17 (0.1 percent).

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

Gender

Male individuals were more likely to smoke cigars, regardless of type. Prevalence of any cigar smoking was 7.6 percent for male and 1.9 percent for female smokers. Current premium cigar smoking was reported by 1.7 percent of male and 0.1 percent of female smokers. Current nonpremium cigar smoking was reported by 4.6 percent of male and 1.5 percent of female smokers.

Race and ethnicity

The prevalence of current any cigar smoking was highest among people who are non-Hispanic Black (7.4 percent), followed by non-Hispanic multiracial (6.6 percent), non-Hispanic AI/AN (5.4 percent), non-Hispanic white (4.7 percent), non-Hispanic NH/PI (3.6 percent), Hispanic (3.3 percent), and non-Hispanic Asian (1.4 percent). The prevalence of current nonpremium cigar smoking followed a similar pattern, being highest among non-Hispanic Black people (6.5 percent) and lowest among non-Hispanic Asian people (0.6 percent). In contrast, non-Hispanic white people were more likely to be premium cigar smokers than any other group. Prevalence of current premium cigar smoking was highest among those who reported being non-Hispanic white (1.1 percent), followed by Hispanic (0.7 percent), non-Hispanic multiracial (0.7 percent), non-Hispanic AI/AN (0.5 percent), non-Hispanic NH/PI (0.5 percent), non-Hispanic Black (0.4 percent), and non-Hispanic Asian (0.4 percent).

Sexual identity

Among those aged 18+ during 2015 to 2019, the prevalence of current any cigar smoking was higher among adults who reported being bisexual (7.9 percent) or lesbian or gay (6.3 percent) than heterosexual or straight (4.6 percent). Similarly, prevalence of current nonpremium cigar smoking was higher among adults who reported being bisexual (6.3 percent) or lesbian or gay (4.8 percent) than heterosexual or straight (2.9 percent). In contrast, heterosexual or straight individuals were more likely to smoke premium cigars. Prevalence of current premium cigar smoking was higher among adults who reported being heterosexual or straight (1.0 percent) than bisexual (0.5 percent) or lesbian or gay (0.5 percent).

Education

Among those aged 18+, the prevalence of current any cigar smoking was highest among those with less than a high school education (5.6 percent), followed by those with some college or technical school education (5.5 percent), high school graduates (5.2 percent), and college graduates (3.8 percent). Prevalence of current nonpremium cigar smoking was also highest among people without a high school education (4.7 percent) and lowest among college graduates (1.3 percent). In contrast, the prevalence of current premium cigar smoking was higher among college graduates (1.5 percent) and those with some college or technical school

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

education (1.1 percent) and lower among high school graduates (0.6 percent) and those who did not finish high school (0.3 percent).

Metropolitan status

The prevalence of current any cigar smoking did not vary significantly by metropolitan status but was highest among people living in a small metropolitan area (5.0 percent), followed by those in a large metropolitan area (4.6 percent) and nonmetropolitan area (4.3 percent). The prevalence of current nonpremium cigar smoking was significantly lower among people living in a large metropolitan area (2.8 percent) than for those in a small metropolitan area (3.3 percent) or nonmetropolitan area (3.3 percent). The opposite was observed for premium cigar smoking—the prevalence of current premium cigar smoking was significantly higher among people living in a large metropolitan area (1.1 percent, than among those in a small metropolitan area (0.8 percent) or nonmetropolitan area (0.4 percent).

Poverty level

The prevalence of current any cigar smoking was higher among people living in poverty (6.1 percent) than those with income up to twice the poverty threshold (4.8 percent) or higher (4.3 percent). Similarly, the prevalence of current nonpremium cigar smoking was inversely associated with income: 5.0 percent for people with income below the poverty threshold, followed by those with income up to twice the threshold (3.8 percent) and higher (2.3 percent). In contrast, the prevalence of current premium cigar smoking was approximately threefold higher among people in the highest income group (1.2 percent) than those with income up to twice the poverty threshold (0.4 percent) or living in poverty (0.3 percent).

Table C-2a presents prevalence of any, nonpremium, premium, and unknown-type cigar smoking among civilian noninstitutionalized U.S. youth aged 12–17. Although prevalence of each type is lower, demographic patterns are similar to those observed for the full population. Race/ethnicity- and poverty-level-specific premium cigar prevalence estimates could not be reported due to imprecision of estimates (CV >0.3).

Gender

Current cigar smoking of any type was more prevalent among male (2.9 percent) than female (1.5 percent) smokers. Current premium cigar smoking was reported by 0.1 percent of male and 0.0 percent of female smokers. Current nonpremium cigar smoking was reported by 2.6 percent of male and 1.2 percent of female smokers.

Race and ethnicity

The prevalence of current any cigar smoking was higher among youth who reported being non-Hispanic white (2.7 percent), non-Hispanic multiracial (2.6 percent), non-Hispanic AI/AN (2.4

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

percent), non-Hispanic Black (2.1 percent), or Hispanic (1.6 percent) than non-Hispanic Asian (0.6 percent; see Table C-2a). The prevalence of current nonpremium cigar smoking was higher among youth identifying as non-Hispanic white (2.3 percent), non-Hispanic multiracial (2.3 percent), non-Hispanic AI/AN (2.1 percent), non-Hispanic Black (2.0 percent), Hispanic (1.3 percent), or non-Hispanic NH/PI (1.1 percent) than non-Hispanic Asian (0.4 percent).

Metropolitan status

The prevalence of current any cigar smoking was higher among youth living in a nonmetropolitan area (2.8 percent) or small metropolitan area (2.6 percent) than large metropolitan area (1.9 percent; Table C-2a). The prevalence of current premium cigar smoking was equivalent among youth in various metropolitan areas (0.1 percent). The prevalence of current nonpremium cigar smoking was higher among youth living in a nonmetropolitan area (2.5 percent) or small metropolitan area (2.2 percent) than large metropolitan area (1.6 percent).

Poverty level

The prevalence of current any cigar smoking was higher among youth living in poverty (2.4 percent) or up to twice the poverty threshold (2.3 percent) than those at higher than twice the threshold (2.2 percent; see Table C-2a). The prevalence of current nonpremium cigar smoking was higher among youth living in poverty (2.1 percent) or up to twice the poverty threshold (2.0 percent) than those at higher than twice the threshold (1.8 percent).

Table C-2b presents prevalence of any, nonpremium, premium, and unknown-type cigar smoking among civilian noninstitutionalized U.S. adults ages 18+. Demographic patterns are similar to those observed among the full population.

Age

See Table C-2.

Gender

Prevalence of any cigar smoking was 8.1 percent among male and 2.0 percent among female smokers. Current premium cigar smoking was reported by 1.9 percent of male and 0.1 percent of female smokers. Current nonpremium cigar smoking was reported by 4.8 percent of male and 1.5 percent of female smokers.

Race and ethnicity

The prevalence of current any cigar smoking was higher among adults identifying as non-Hispanic Black (8.1 percent), non-Hispanic multiracial (7.4 percent), non-Hispanic AI/AN (5.7 percent), non-Hispanic white (4.9 percent), non-Hispanic NH/PI (3.9 percent), or Hispanic (3.6 percent) than non-Hispanic Asian (1.5 percent).

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

The prevalence of current premium cigar smoking was higher among those identifying as non-Hispanic white (1.2 percent), Hispanic (0.8 percent), non-Hispanic multiracial (0.8 percent), or non-Hispanic NH/PI (0.6 percent) than non-Hispanic AI/AN (0.5 percent), non-Hispanic Black (0.5 percent), or non-Hispanic Asian (0.5 percent). The prevalence of current nonpremium cigar smoking was higher among adults who reported being non-Hispanic Black (7.0 percent), non-Hispanic multiracial (5.8 percent), non-Hispanic AI/AN (4.5 percent), non-Hispanic NH/PI (3.2 percent), non-Hispanic white (2.7 percent), or Hispanic (2.3 percent) than non-Hispanic Asian (0.6 percent).

Sexual identity

See Table C-2 (sexual identity was only asked of adults).

Education

See Table C-2 (educational attainment was only determined for adults).

Metropolitan status

The prevalence of current any cigar smoking was higher among adults living in a small metropolitan area (5.2 percent) or large metropolitan area (4.9 percent) than nonmetropolitan area (4.5 percent). The prevalence of current premium cigar smoking was higher among adults living in a large metropolitan area (1.2 percent) or small metropolitan area (0.9 percent) than a nonmetropolitan area (0.4 percent). The prevalence of current nonpremium cigar smoking was higher among adults living in a small metropolitan area (3.4 percent) or nonmetropolitan area (3.4 percent) than a large metropolitan area (2.9 percent).

Poverty level

The prevalence of current any cigar smoking was higher among adults living in poverty (6.6 percent) or with income up to twice the poverty threshold (5.1 percent) than those with higher income (4.5 percent; see Table C-2). The prevalence of current premium cigar smoking was higher among adults at higher than (1.3 percent) or up to twice (0.5 percent) the poverty threshold than those in poverty (0.4 percent). The prevalence of current nonpremium cigar smoking was higher among adults living in poverty (5.4 percent) or with income up to twice the poverty threshold (4.0 percent) than those with higher income (2.3 percent).

Tobacco and Substance Use Characteristics of Premium and Nonpremium Cigar Smokers

Table C-3 presents tobacco use characteristics and alcohol and cannabis use history among civilian noninstitutionalized people aged 12+ living in the United States from 2010 to 2019 who currently smoke cigars. Relative to nonpremium cigar smokers, premium cigar smokers were less

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

likely to initiate cigar smoking before age 18, smoke cigars frequently or daily, smoke cigarettes, or use cannabis but were more likely to consume alcohol.

Age first cigar smoked

Most current cigar smokers smoked their first cigar aged 18–29 (45.2 percent), followed by before 18 (38.0 percent), 30–49 (13.3 percent), and 50+ (3.5 percent). Among premium cigar smokers, a similar pattern was observed, with more than half (54.4 percent) initiating at 18–29 years and about one-fourth before 18 (24.5 percent). In contrast, nearly 45 percent of nonpremium cigar smokers initiated before 18.

Number of days cigars smoked in the past 30 days

Premium cigar smokers were more likely than nonpremium cigar smokers to smoke cigars on 1 or 2 days in the previous month (60.3 percent versus 38.1 percent) and less likely to do so daily (3.5 percent versus 13.1 percent).

Recency of established cigarette smoking

Cigarette smoking was much more common among nonpremium cigar smokers. Premium cigar smokers were about half as likely to be current established cigarette smokers (23.3 percent versus 50.7 percent). Most premium cigar smokers had quit cigarette smoking greater than 3 years ago (21.8 percent) or never established it (47.5 percent), as compared to 8.0 and 35.1 percent of nonpremium cigar smokers, respectively.

Recency of smokeless tobacco use

Smokeless tobacco use history differed minimally between premium and nonpremium cigar smokers. For both groups, about 13 percent were current smokeless tobacco users and a majority (49.1 percent of premium and 55.2 percent of nonpremium) had never used smokeless tobacco.

Recency of pipe smoking

Tobacco pipe smoking history varied somewhat by cigar type, although for both groups, the majority had never used a pipe (61.7 percent of premium, 70.5 percent of nonpremium). Nonpremium cigar smokers were more likely than premium cigar smokers to also use a pipe (6.8 versus 4.8 percent).

Recency of alcohol use

For both cigar types, alcohol consumption was common. However, premium cigar smokers were more likely than nonpremium cigar smokers to currently consume alcohol (89.0 versus 74.9 percent) and less likely to have never done so (1.1 versus 4.1 percent).

Recency of cannabis use

Cannabis use history differed notably by cigar type; nonpremium cigar smokers were more than twice as likely to have

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

used it in the past month (40.7 versus 16.8 percent). Significantly more premium cigar smokers had never used it (24.7 versus 18.7 percent).

Table C-3a presents tobacco use characteristics and alcohol and cannabis use history among civilian noninstitutionalized people aged 18+ living in the United States from 2010 to 2019 who currently smoke cigars. The patterns are virtually identical to what was observed for the entire 12+ population.

Trends in the Prevalence of Premium Versus Nonpremium Cigar Smoking (2010–2019)

Current nonpremium cigar smoking prevalence steadily declined 2010–2019 (from 3.4 to 2.7 percent). The prevalence of premium cigar smoking stayed almost unchanged (from 1.1 to 0.9 percent). By age group, the prevalence of premium cigar smoking slightly increased for individuals aged 50–64 (from 0.87 to 1.46 percent) and 65+ (from 0.25 to 0.48 percent) and slightly decreased for 12–17 (from 0.09 to 0.03 percent), 18–25 (from 1.12 to 0.84 percent), 26–34 (from 1.45 to 1.12 percent), and 35–49 (from 1.68 to 0.94 percent).

Health Characteristics of Adult Premium and Nonpremium Cigar Smokers, Cigarette Smokers, and Nontobacco Users

Table C-4 presents prevalence of medical, mental health, and substance dependence conditions among premium and nonpremium cigar smokers, current and former established cigarette smokers, and nontobacco users. These results are representative of civilian noninstitutionalized U.S. adults from 2015 to 2019. Relative to nonpremium cigar smokers, premium cigar smokers were more likely to have cancer but less likely to report COPD, SPD, an MDE, cannabis dependence, and illicit drug dependence. Premium cigar smokers and never-tobacco users had similar prevalence of cancer, heart condition, COPD, and asthma.

Cancer

Former established cigarette smokers had the highest prevalence of cancer (10.5 percent) followed by adults who had not used tobacco in the past 30 days (7.1 percent) and never-tobacco users (5.2 percent). Cancer prevalence among premium cigar smokers (5.1 percent) was comparable to that of never-tobacco users. Nonpremium cigar smokers had the lowest prevalence (2.2 percent), likely reflecting the younger age distribution of this group.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

Heart condition

Similar to cancer, prevalence of a heart condition was highest among former established cigarette smokers (17.8 percent), with both premium (8.0 percent) and nonpremium (7.4 percent) cigar smokers having marginally lower prevalence than current established cigarette smokers (8.8 percent) and never-tobacco users (8.4 percent).

COPD

Prevalence of COPD was lowest among premium cigar smokers (1.7 percent) and never-tobacco users (2.3 percent) and highest among current (8.0 percent) and former (7.5 percent) established cigarette smokers. It was moderate for nonpremium cigar smokers (4.6 percent).

Asthma

Asthma prevalence ranged from 8.8 percent among never-tobacco users to 10.4 percent among current nonpremium cigar smokers, with minimal variation across other groups.

SPD

Past-month SPD was significantly more prevalent among current nonpremium cigar smokers (14.5 percent) than among any other group, including current cigarette smokers (11.3 percent); in contrast, premium cigar smokers had the lowest prevalence (2.7 percent).

MDE

A similar pattern was observed for past-year MDE, with prevalence being highest among nonpremium cigar smokers (12.8 percent), followed by current cigarette smokers (11.1 percent). It was lowest among nonpremium cigar smokers (5.0 percent), who were similar to never-tobacco users (5.3 percent).

Alcohol dependence

Prevalence of past-year alcohol dependence was marginally higher among nonpremium (9.6 percent) and premium (7.3 percent) cigar smokers and current cigarette smokers (7.3 percent). It was lowest among never-tobacco users (0.8 percent).

Cannabis dependence

Past-year cannabis dependence was significantly more prevalent among nonpremium cigar smokers (7.4 percent) than any other group, being nearly threefold higher relative to current cigarette smokers (2.5 percent) and more than five times higher than premium cigar smokers (1.3 percent). It was lowest for never-tobacco users (0.2 percent).

Illicit drug dependence

Past-year illicit (other than cannabis) drug dependence was significantly higher among nonpremium cigar smokers (5.8 percent) than any other group, including current and former cigarette smokers (4.8 percent), and lowest among never-tobacco users (0.2 percent). Prevalence among premium cigar smokers was 1.9 percent.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

Pregnancy

Pregnancy was uncommon for all groups, ranging from approximately zero percent among premium cigar smokers to 1.1 percent among never-tobacco users.

Multivariable Associations Between Premium Cigar Smoking and Health Conditions

Table C-5 presents age- and sex-adjusted associations between premium cigar smoking and odds of medical, mental health, and substance dependence conditions. These results are representative of civilian noninstitutionalized U.S. adults from 2015 to 2019.

Premium versus nonpremium cigar smoking

Relative to nonpremium cigar smoking, premium cigar smoking was significantly associated with 83 percent increased odds of having cancer, but this was the only positive association. Premium cigar smokers had significantly lower odds of COPD (odds ratio [OR]: 0.32), past-month SPD (OR: 0.23), past-year MDE (OR: 0.50), alcohol dependence (OR: 0.75), cannabis dependence (OR: 0.26), and illicit drug dependence (OR: 0.34) compared to nonpremium cigar smokers. No significant association was observed for heart condition, asthma, or pregnancy.

Premium versus nonpremium cigar smoking, additionally adjusted for smoking status

Upon adjusting for established cigarette smoking status, the observed association between premium cigar type and cancer or alcohol dependence attenuated and became no longer significant (ORs: 1.67 and l.94, respectively). However, the negative associations with COPD, SPD, MDE, cannabis dependence, and illicit drug dependence persisted.

Premium cigar smoking versus never-tobacco use

Compared to never-tobacco users, premium cigar smokers had increased odds of cancer (OR: 1.47), alcohol dependence (OR: 7.99), cannabis dependence (OR: 8.30) and illicit drug dependence (OR: 7.22), and decreased odds of past-month SPD (OR: 0.67) and pregnancy (OR: 0.15). No significant associations were observed for heart condition, asthma, or past-year MDE.

Premium cigar smoking versus current/former established cigarette smoking

Compared to current or former established tobacco users, premium cigar smoking was not significantly associated with having cancer (OR: 1.09), a heart condition (OR: 0.69), asthma (OR: 1.16), or alcohol dependence (OR: 0.93). However, premium cigar smokers had significantly lower odds of COPD (OR: 0.19), past-month SPD (OR: 0.29), past--

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

year MDE (OR: 0.63), cannabis dependence (OR: 0.35), illicit drug dependence (OR: 0.08), and pregnancy (OR: 0.12).

SUMMARY AND LIMITATIONS

Overall, premium cigar smoking is less prevalent than nonpremium cigar smoking, especially among priority populations, including youth, racial and ethnic populations, those without a high school education, and those living in poverty. People who smoke premium cigars tend to do so infrequently and initiate later in life, relative to people who smoke nonpremium cigars. Premium cigar smokers are also less likely to also be established cigarette smokers or cannabis users. Finally, premium cigar smoking is negatively associated with poor mental health outcomes, COPD, and substance use relative to nonpremium cigar and established cigarette smoking.

These results should be reviewed in light of several limitations. First, cigar type is subject to misclassification for several reasons. Cigar brand was only assessed among past 30-day cigar smokers; thus, we were unable to classify cigar type among former cigar smokers. Additionally, information was insufficient to determine cigar type for a small proportion of past 30-day cigar smokers, and some respondents cited a cigarette brand when asked about their usual cigar brand, suggesting potential confusion about the cigar question. These respondents were excluded from analysis, but additional research into this observation is warranted.

A second set of limitations is related to the design and data source. The NSDUH sampling design excludes noncivilian and institutionalized populations who may have different tobacco use patterns than the general U.S. population. These results may not apply to these excluded populations. Additionally, the cross-sectional nature of this study prohibits inference about temporal associations, and data are based on self-report and subject to response bias. Moreover, prevalence estimates for health effects are not age adjusted and thus should be interpreted with caution, given that several of the reported health outcomes and premium cigar smoking are both positively associated with age. Although the reported ORs are adjusted for age and sex, they do not control for other potentially important confounders.

Finally, due to small numbers, particularly for subgroups of premium cigar smokers, some point estimates lacked adequate precision and could not be reported.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

REFERENCES

Corey, C. G., B. A. King, B. N. Coleman, C. D. Delnevo, C. G. Husten, B. K. Ambrose, B. J. Apelberg. 2014. Little filtered cigar, cigarillo, and premium cigar smoking among adults—United States, 2012–2013. Morbidity and Mortality Weekly Report 63(30):650–654.

Corey, C. G., E. Holder-Hayes, A. B. Nguyen, C. D. Delnevo, B. L. Rostron, M. Bansal-Travers, H. L. Kimmel, A. Koblitz, E. Lambert, J. L. Pearson, E. Sharma, C. Tworek, A. J. Hyland, K. P. Conway, B. K. Ambrose, and N. Borek. 2018. U.S. adult cigar smoking patterns, purchasing behaviors, and reasons for use according to cigar type: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013–2014. Nicotine & Tobacco Research 20(12):1457–1466.

NASEM (National Academies of Sciences, Engineering, and Medicine). 2021. Ad hoc committee announcement: Health effects and patterns of use of premium cigars. https://www.nationalacademies.org/our-work/health-effects-and-patterns-of-use-of-premium-cigars#sectionProjectScope (accessed January 20, 2022).

SAMHSA (Substance Abuse and Mental Health Services Administration). 2021. 2019 National Survey on Drug Use and Health (NSDUH) methodological resource book: Section 13: Statistical inference report. Rockville, MD: Substance Abuse and Mental Health Services Administration.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-1 Demographic Characteristics of Individuals Who Smoked Premium and Nonpremium Cigars in the Past 30 Days, 2010–2019 NSDUH

Any Cigar Type Nonpremium Cigars Premium Cigars Unknown Type
% (95% CI) % (95% CI) % (95% CI) % (95% CI)
Age group
12 to 17 years 4.5 (4.3 , 4.7) 6.0 (5.7 , 6.2) 0.6 (0.5 , 0.8) 3.4 (3.0 , 3.8)
18 to 25 years 26.4 (25.7 , 27.1) 32.5 (31.6 , 33.4) 13.5 (12.4 , 14.7) 17.5 (16.2 , 19.0)
26 to 34 years 21.5 (20.8 , 22.3) 21.5 (20.6 , 22.3) 23.1 (21.4 , 25.0) 19.8 (18.0 , 21.8)
35 to 49 years 22.8 (22.0 , 23.5) 21.0 (20.0 , 21.9) 28.2 (26.3 , 30.3) 23.4 (21.4 , 25.6)
50 to 64 years 18.4 (17.3 , 19.5) 14.2 (13.2 , 15.3) 26.6 (23.9 , 29.4) 25.1 (22.3 , 28.0)
65 years or older 6.4 (5.9 , 7.0) 4.9 (4.3 , 5.5) 7.9 (6.5 , 9.6) 10.8 (9.1 , 12.6)
Gender
Male 78.7 (78.0 , 79.3) 74.2 (73.4 , 75.1) 93.7 (92.7 , 94.7) 78.5 (76.4 , 80.4)
Female 21.3 (20.7 , 22.0) 25.8 (24.9 , 26.6) 6.3 (5.3 , 7.3) 21.5 (19.6 , 23.6)
Race/ethnicity
Non-Hispanic White 64.7 (63.8 , 65.6) 57.7 (56.5 , 58.8) 78.0 (76.0 , 79.9) 76.7 (75.1 , 78.3)
Non-Hispanic Black 18.9 (18.2 , 19.7) 25.7 (24.7 , 26.8) 5.5 (4.5 , 6.7) 8.1 (7.0 , 9.3)
Non-Hispanic American Indian/Alaskan Native 0.6 (0.5 , 0.7) 0.8 (0.7 , 0.9) 0.3 (0.2 , 0.5) 0.5 (0.3 , 0.8)
Non-Hispanic Native Hawaiian/Pacific Islander 0.3 (0.2 , 0.4) 0.4 (0.3 , 0.5) 0.2 (0.1 , 0.7) 0.1 (0.0 , 0.1)
Non-Hispanic Asian 1.6 (1.4 , 1.9) 1.1 (0.9 , 1.4) 2.6 (1.9 , 3.5) 2.7 (2.0 , 3.6)
Non-Hispanic Other/Multiple Race(s) 2.4 (2.2 , 2.6) 2.9 (2.6 , 3.3) 1.3 (0.9 , 1.8) 1.6 (1.2 , 2.0)
Hispanic 11.4 (10.9 , 12.0) 11.5 (10.8 , 12.1) 12.1 (10.5 , 14.0) 10.5 (9.1 , 12.0)
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Sexual identitya
Heterosexual or straight 92.3 (91.7 , 92.9) 89.6 (91.1 , 0.0) 97.5 (96.3 , 98.3) 93.3 (91.9 , 94.5)
Lesbian or gay 2.5 (2.2 , 2.9) 3.1 (2.6 , 3.6) 0.9 (0.5 , 1.6) 2.4 (1.7 , 3.5)
Bisexual 5.2 (4.7 , 5.6) 6.6 (6.0 , 7.2) 1.6 (1.0 , 2.5) 4.3 (3.3 , 5.5)
Education
Did not complete high school 14.6 (14.0 , 15.3) 18.9 (18.0 , 19.9) 3.7 (2.9 , 4.8) 10.4 (9.0 , 12.2)
High school diploma or GED 27.5 (26.8 , 28.2) 32.9 (32.0 , 33.9) 15.8 (14.3 , 17.4) 20.2 (18.3 , 22.3)
Some college/technical school 30.5 (29.7 , 31.4) 30.1 (29.0 , 31.2) 32.3 (30.5 , 34.3) 30.2 (28.0 , 32.4)
College graduate 22.8 (22.0 , 23.6) 12.1 (11.3 , 12.8) 47.5 (45.5 , 49.6) 35.7 (33.3 , 38.3)
Under 18 4.5 (4.3 , 4.7) 6.0 (5.7 , 6.2) 0.6 (0.5 , 0.8) 3.4 (3.0 , 3.8)
Metro status
Large metro 54.3 (53.3 , 55.2) 50.5 (49.3 , 51.8) 65.0 (62.8 , 67.1) 56.4 (53.7 , 59.0)
Small metro 31.9 (31.0 , 32.9) 33.0 (32.0 , 34.0) 28.5 (26.5 , 30.6) 31.7 (29.1 , 34.4)
Nonmetro 13.8 (13.2 , 14.5) 16.5 (15.7 , 17.4) 6.5 (5.6 , 7.6) 11.9 (10.5 , 13.5)
Poverty level
Living in poverty 19.5 (18.8 , 20.2) 24.9 (24.0 , 25.8) 5.8 (4.9 , 6.7) 14.4 (13.0 , 16.0)
Up to 2x threshold 20.9 (20.2 , 21.5) 25.3 (24.4 , 26.3) 9.6 (8.3 , 10.9) 16.8 (15.1 , 18.6)
Greater than 2x threshold 59.6 (58.7 , 60.5) 49.8 (48.6 , 50.9) 84.7 (83.1 , 86.2) 68.7 (66.4 , 71.0)

a Estimates for sexual identity categories were calculated using data from adult (ages 18+) respondents in years 2015 through 2019, because questions about sexual identity were added to NSDUH in 2015 and asked of adult respondents only.

NOTE: CI = confidence interval; NSDUH = National Survey on Drug Use and Health.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-2 Prevalence of Past 30-Day Premium and Nonpremium Cigar Smoking by Demographic Characteristics, 2010–2019 NSDUH

Any Cigar Type Nonpremium Cigars Premium Cigars Unknown Type
% (95% CI) % (95% CI) % (95% CI) % (95% CI)
Overall 4.7 (4.6 , 4.8) 3.0 (2.9 , 3.1) 0.9 (0.8 , 0.9) 0.8 (0.7 , 0.8)
Age group
12 to 17 years 2.3 (2.2 , 2.3) 1.9 (1.8 , 2.0) 0.1 (0.0 , 0.1) 0.3 (0.3 , 0.3)
18 to 25 years 9.5 (9.3 , 9.7) 7.5 (7.4 , 7.7) 0.9 (0.9 , 1.0) 1.1 (1.0 , 1.1)
26 to 34 years 7.0 (6.7 , 7.3) 4.5 (4.3 , 4.7) 1.4 (1.3 , 1.6) 1.1 (1.0 , 1.2)
35 to 49 years 4.6 (4.5 , 4.8) 2.7 (2.6 , 2.9) 1.1 (1.0 , 1.2) 0.8 (0.7 , 0.9)
50 to 64 years 3.7 (3.5 , 4.0) 1.8 (1.7 , 2.0) 1.0 (0.9 , 1.2) 0.8 (0.7 , 1.0)
65 years or older 1.7 (1.6 , 1.9) 0.8 (0.7 , 1.0) 0.4 (0.3 , 0.5) 0.5 (0.4 , 0.6)
Gender
Male 7.6 (7.4 , 7.8) 4.6 (4.5 , 4.7) 1.7 (1.6 , 1.8) 1.3 (1.2 , 1.3)
Female 1.9 (1.9 , 2.0) 1.5 (1.4 , 1.6) 0.1 (0.1 , 0.1) 0.3 (0.3 , 0.4)
Race/ethnicity
Non-Hispanic White 4.7 (4.6 , 4.8) 2.7 (2.6 , 2.8) 1.1 (1.0 , 1.2) 0.9 (0.9 , 1.0)
Non-Hispanic Black 7.4 (7.1 , 7.7) 6.5 (6.2 , 6.8) 0.4 (0.3 , 0.5) 0.5 (0.5 , 0.6)
Non-Hispanic American Indian/Alaskan Native 5.4 (4.7 , 6.1) 4.2 (3.7 , 4.9) 0.5 (0.3 , 0.9) 0.7 (0.4 , 1.1)
Non-Hispanic Native Hawaiian/Pacific Islander 3.6 (2.8 , 4.8) 3.0 (2.2 , 4.1) 0.5 (0.2 , 1.6) 0.1 (0.0 , 0.3)
Non-Hispanic Asian 1.4 (1.2 , 1.7) 0.6 (0.5 , 0.8) 0.4 (0.3 , 0.6) 0.4 (0.3 , 0.5)
Non-Hispanic Other/Multiple Race(s) 6.6 (5.9 , 7.3) 5.2 (4.6 , 5.8) 0.7 (0.5 , 0.9) 0.7 (0.6 , 0.9)
Hispanic 3.3 (3.2 , 3.5) 2.1 (2.0 , 2.3) 0.7 (0.6 , 0.8) 0.5 (0.4 , 0.6)
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Sexual identitya
Heterosexual or straight 4.6 (4.5 , 4.8) 2.9 (2.7 , 3.0) 1.0 (0.9 , 1.1) 0.8 (0.7 , 0.8)
Lesbian or gay 6.3 (5.5 , 7.2) 4.8 (4.1 , 5.6) 0.5 (0.3 , 0.8) 1.0 (0.7 , 1.5)
Bisexual 7.9 (7.2 , 8.6) 6.3 (5.7 , 7.0) 0.5 (0.3 , 0.8) 1.1 (0.8 , 1.4)
Education
Did not complete high school 5.6 (5.4 , 5.9) 4.7 (4.4 , 5.0) 0.3 (0.2 , 0.4) 0.7 (0.6 , 0.8)
High school diploma or GED 5.2 (5.1 , 5.4) 4.0 (3.9 , 4.1) 0.6 (0.5 , 0.6) 0.6 (0.6 , 0.7)
Some college/technical school 5.5 (5.3 , 5.7) 3.5 (3.3 , 3.6) 1.1 (1.0 , 1.2) 0.9 (0.8 , 1.0)
College graduate 3.8 (3.7 , 4.0) 1.3 (1.2 , 1.4) 1.5 (1.4 , 1.6) 1.0 (0.9 , 1.1)
Under 18 2.3 (2.2 , 2.3) 1.9 (1.8 , 2.0) 0.1 (0.0 , 0.1) 0.3 (0.3 , 0.3)
Metro status
Large metro 4.6 (4.5 , 4.7) 2.8 (2.7 , 2.9) 1.1 (1.0 , 1.1) 0.8 (0.8 , 0.9)
Small metro 5.0 (4.8 , 5.1) 3.3 (3.2 , 3.4) 0.8 (0.8 , 0.9) 0.8 (0.7 , 0.9)
Nonmetro 4.3 (4.1 , 4.5) 3.3 (3.1 , 3.5) 0.4 (0.3 , 0.5) 0.6 (0.5 , 0.7)
Poverty level
Living in poverty 6.1 (5.9 , 6.3) 5.0 (4.8 , 5.2) 0.3 (0.3 , 0.4) 0.7 (0.7 , 0.8)
Up to 2x threshold 4.8 (4.7 , 5.0) 3.8 (3.6 , 3.9) 0.4 (0.4 , 0.5) 0.7 (0.6 , 0.7)
Greater than 2x threshold 4.3 (4.2 , 4.4) 2.3 (2.2 , 2.4) 1.2 (1.1 , 1.2) 0.8 (0.8 , 0.9)

a Estimates for sexual identity categories were calculated using data from adult (ages 18+) respondents in years 2015 through 2019, because questions about sexual identity were added to NSDUH in 2015 and asked of adult respondents only.

NOTE: CI = confidence interval; NSDUH = National Survey on Drug Use and Health.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-2a Prevalence of Past 30-Day Premium and Nonpremium Cigar Smoking Among Youth Ages 12 to 17 by Demographic Characteristics, 2010–2019 NSDUH

Any Cigar Type Nonpremium Cigars Premium Cigars Unknown Type
% (95% CI) % (95% CI) % (95% CI) % (95% CI)
Overall 2.3 (2.2 , 2.3) 1.9 (1.8 , 2.0) 0.1 (0.0 , 0.1) 0.3 (0.3 , 0.3)
Gender
Male 2.9 (2.8 , 3.1) 2.6 (2.4 , 2.7) 0.1 (0.1 , 0.1) 0.3 (0.2 , 0.3)
Female 1.5 (1.4 , 1.7) 1.2 (1.1 , 1.3) 0.0 (0.0 , 0.0) 0.3 (0.2 , 0.3)
Race/ethnicity
Non-Hispanic White 2.7 (2.6 , 2.9) 2.3 (2.2 , 2.4) 0.1 (0.1 , 0.1) 0.4 (0.3 , 0.4)
Non-Hispanic Black 2.1 (1.9 , 2.4) 2.0 (1.7 , 2.2) -- -- -- 0.1 (0.1 , 0.2)
Non-Hispanic American Indian/Alaskan Native 2.4 (1.6 , 3.7) 2.1 (1.4 , 3.2) -- -- -- -- -- --
Non-Hispanic Native Hawaiian/Pacific Islander -- -- -- -- -- -- -- -- -- -- -- --
Non-Hispanic Asian 0.6 (0.4 , 0.9) 0.4 (0.3 , 0.7) -- -- -- -- -- --
Non-Hispanic Other/Multiple Race(s) 2.6 (2.2 , 3.0) 2.3 (1.9 , 2.7) -- -- -- 0.2 (0.2 , 0.4)
Hispanic 1.6 (1.4 , 1.8) 1.3 (1.2 , 1.5) -- -- -- 0.2 (0.2 , 0.3)
Metro status
Large metro 1.9 (1.8 , 2.1) 1.6 (1.5 , 1.7) 0.1 (0.0 , 0.1) 0.3 (0.2 , 0.3)
Small metro 2.6 (2.4 , 2.8) 2.2 (2.1 , 2.4) 0.1 (0.0 , 0.1) 0.3 (0.2 , 0.3)
Nonmetro 2.8 (2.6 , 3.1) 2.5 (2.3 , 2.7) 0.1 (0.0 , 0.1) 0.3 (0.2 , 0.4)
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Poverty level
Living in poverty 2.4 (2.2 , 2.6) 2.1 (1.9 , 2.3) -- -- -- 0.3 (0.2 , 0.4)
Up to 2x threshold 2.3 (2.1 , 2.5) 2.0 (1.9 , 2.2) -- -- -- 0.2 (0.2 , 0.3)
Greater than 2x threshold 2.2 (2.1 , 2.3) 1.8 (1.7 , 1.9) 0.1 (0.1 , 0.1) 0.3 (0.3 , 0.4)

NOTES: Data on sexual identity is not available for youth under age 18, because questions about sexual identity were added to NSDUH in 2015 and asked of adult respondents only. Prevalence by educational attainment is not reported, because it is not relevant for school-aged youth under age 18. Estimates for which the coefficient of variation exceeded 0.3 were deemed statistically unreliable and not reported and are denoted with --. CI = confidence interval; NSDUH = National Survey on Drug Use and Health.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-2b Prevalence of Past 30-Day Premium and Nonpremium Cigar Smoking Among Adults Ages 18+ by Demographic Characteristics, 2010–2019 NSDUH

Any Cigar Type Nonpremium Cigars Premium Cigars Unknown Type
% (95% CI) % (95% CI) % (95% CI) % (95% CI)
Overall 4.9 (4.8 , 5.0) 3.1 (3.0 , 3.2) 1.0 (0.9 , 1.0) 0.8 (0.8 , 0.9)
Age group
18 to 25 years 9.5 (9.3 , 9.7) 7.5 (7.4 , 7.7) 0.9 (0.9 , 1.0) 1.1 (1.0 , 1.1)
26 to 34 years 7.0 (6.7 , 7.3) 4.5 (4.3 , 4.7) 1.4 (1.3 , 1.6) 1.1 (1.0 , 1.2)
35 to 49 years 4.6 (4.5 , 4.8) 2.7 (2.6 , 2.9) 1.1 (1.0 , 1.2) 0.8 (0.7 , 0.9)
50 to 64 years 3.7 (3.5 , 4.0) 1.8 (1.7 , 2.0) 1.0 (0.9 , 1.2) 0.8 (0.7 , 1.0)
65+ years 1.7 (1.6 , 1.9) 0.8 (0.7 , 1.0) 0.4 (0.3 , 0.5) 0.5 (0.4 , 0.6)
Gender
Male 8.1 (7.9 , 8.3) 4.8 (4.7 , 5.0) 1.9 (1.8 , 2.0) 1.4 (1.3 , 1.5)
Female 2.0 (1.9 , 2.0) 1.5 (1.5 , 1.6) 0.1 (0.1 , 0.1) 0.3 (0.3 , 0.4)
Race/ethnicity
Non-Hispanic White 4.9 (4.8 , 5.0) 2.7 (2.7 , 2.8) 1.2 (1.1 , 1.3) 1.0 (0.9 , 1.0)
Non-Hispanic Black 8.1 (7.7 , 8.4) 7.0 (6.7 , 7.3) 0.5 (0.4 , 0.6) 0.6 (0.5 , 0.7)
Non-Hispanic American Indian/Alaskan Native 5.7 (4.9 , 6.6) 4.5 (3.9 , 5.2) 0.5 (0.3 , 1.0) 0.7 (0.4 , 1.2)
Non-Hispanic Native Hawaiian/Pacific Islander 3.9 (3.0 , 5.2) 3.2 (2.3 , 4.5) 0.6 (0.2 , 1.8) 0.1 (0.0 , 0.3)
Non-Hispanic Asian 1.5 (1.3 , 1.8) 0.6 (0.5 , 0.8) 0.5 (0.4 , 0.6) 0.4 (0.3 , 0.6)
Non-Hispanic Other/Multiple Race(s) 7.4 (6.6 , 8.2) 5.8 (5.1 , 6.5) 0.8 (0.6 , 1.1) 0.8 (0.6 , 1.1)
Hispanic 3.6 (3.4 , 3.8) 2.3 (2.1 , 2.4) 0.8 (0.7 , 0.9) 0.6 (0.5 , 0.6)
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Sexual identitya
Heterosexual or straight 4.6 (4.5 , 4.8) 2.9 (2.7 , 3.0) 1.0 (0.9 , 1.1) 0.8 (0.7 , 0.8)
Lesbian or gay 6.3 (5.5 , 7.2) 4.8 (4.1 , 5.6) 0.5 (0.3 , 0.8) 1.0 (0.7 , 1.5)
Bisexual 7.9 (7.2 , 8.6) 6.3 (5.7 , 7.0) 0.5 (0.3 , 0.8) 1.1 (0.8 , 1.4)
Education
Did not complete high school 5.6 (5.4 , 5.9) 4.7 (4.4 , 5.0) 0.3 (0.2 , 0.4) 0.7 (0.6 , 0.8)
High school diploma or GED 5.2 (5.1 , 5.4) 4.0 (3.9 , 4.1) 0.6 (0.5 , 0.6) 0.6 (0.6 , 0.7)
Some college/technical school 5.5 (5.3 , 5.7) 3.5 (3.3 , 3.6) 1.1 (1.0 , 1.2) 0.9 (0.8 , 1.0)
College graduate 3.8 (3.7 , 4.0) 1.3 (1.2 , 1.4) 1.5 (1.4 , 1.6) 1.0 (0.9 , 1.1)
Under 18 . . . . . . . . . . . .
Metro status
Large metro 4.9 (4.8 , 5.0) 2.9 (2.8 , 3.0) 1.2 (1.1 , 1.2) 0.9 (0.8 , 0.9)
Small metro 5.2 (5.0 , 5.4) 3.4 (3.3 , 3.5) 0.9 (0.8 , 1.0) 0.9 (0.8 , 1.0)
Nonmetro 4.5 (4.3 , 4.7) 3.4 (3.2 , 3.6) 0.4 (0.4 , 0.5) 0.7 (0.6 , 0.8)
Poverty level
Living in poverty 6.6 (6.4 , 6.9) 5.4 (5.2 , 5.6) 0.4 (0.3 , 0.5) 0.8 (0.7 , 0.9)
Up to 2x threshold 5.1 (4.9 , 5.3) 4.0 (3.8 , 4.1) 0.5 (0.4 , 0.5) 0.7 (0.6 , 0.8)
Greater than 2x threshold 4.5 (4.4 , 4.6) 2.3 (2.3 , 2.4) 1.3 (1.2 , 1.3) 0.9 (0.8 , 0.9)

a Estimates for sexual identity categories were calculated using data from years 2015 through 2019 because questions about sexual identity were added to NSDUH in 2015.

NOTE: CI = confidence interval; NSDUH = National Survey on Drug Use and Health.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-3 Tobacco and Substance Use Characteristics of Individuals Who Currently (Past 30-Days) Smoke Premium and Nonpremium Cigars, 2010–2019 NSDUH

Any Cigar Type Nonpremium Cigars Premium Cigars Unknown Type
% (95% CI) % (95% CI) % (95% CI) % (95% CI)
Age first smoked cigar
Less than 18 years 38.0 (37.1 , 38.8) 44.9 (43.8 , 45.9) 24.5 (22.5 , 26.6) 27.1 (25.3 , 29.0)
18 to 29 years 45.2 (44.3 , 46.1) 41.2 (40.1 , 42.2) 54.1 (52.0 , 56.3) 50.6 (48.2 , 53.0)
30 to 49 years 13.3 (12.5 , 14.1) 11.3 (10.4 , 12.3) 17.2 (15.2 , 19.4) 16.3 (14.3 , 18.6)
50 years or older 3.5 (3.1 , 4.0) 2.7 (2.2 , 3.2) 4.2 (3.1 , 5.7) 6.0 (4.6 , 7.8)
Past 30 days, number of days
1 or 2 days 46.0 (45.1 , 46.9) 38.1 (37.0 , 39.3) 60.3 (57.9 , 62.7) 59.8 (57.6 , 62.0)
3 to 5 days 20.4 (19.8 , 21.2) 21.8 (21.0 , 22.7) 21.5 (19.2 , 24.0) 13.8 (12.2 , 15.6)
6 to 9 days 5.0 (4.6 , 5.4) 5.5 (5.1 , 6.0) 4.5 (3.5 , 5.6) 3.8 (2.9 , 4.9)
10 to 19 days 11.2 (10.6 , 11.7) 13.7 (13.0 , 14.4) 6.1 (5.1 , 7.3) 7.3 (6.0 , 8.9)
20 to 29 days 6.5 (6.0 , 6.9) 7.7 (7.1 , 8.3) 4.1 (3.1 , 5.5) 4.6 (3.6 , 5.9)
30 days 10.9 (10.2 , 11.5) 13.1 (12.4 , 13.9) 3.5 (2.5 , 4.7) 10.7 (9.0 , 12.6)
Recency of established cigarette smokinga
Past 30 days 42.9 (41.9 , 43.8) 50.7 (49.6 , 51.9) 23.3 (21.5 , 25.2) 35.0 (32.4 , 37.7)
30 days to 1 year ago 3.7 (3.3 , 4.0) 3.5 (3.2 , 3.9) 4.1 (3.2 , 5.1) 3.7 (2.9 , 4.8)
1 to 3 years ago 2.7 (2.5 , 3.0) 2.6 (2.3 , 2.9) 3.3 (2.6 , 4.1) 2.6 (1.9 , 3.6)
More than 3 years ago 12.0 (11.1 , 12.8) 8.0 (7.3 , 8.9) 21.8 (19.8 , 24.0) 15.7 (13.8 , 17.9)
Never established 38.8 (37.9 , 39.7) 35.1 (34.2 , 36.0) 47.5 (45.0 , 50.0) 42.9 (40.2 , 45.8)
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Recency of SLT use
Past 30 days 12.1 (11.3 , 13.0) 12.5 (11.6 , 13.4) 12.9 (10.7 , 15.4) 10.0 (8.2 , 12.2)
30 days to 1 year ago 5.3 (4.9 , 5.7) 6.1 (5.6 , 6.6) 3.6 (2.7 , 4.6) 4.0 (3.1 , 5.3)
1 to 3 years ago 6.1 (5.6 , 6.6) 6.8 (6.2 , 7.4) 5.8 (4.5 , 7.4) 3.9 (3.0 , 5.1)
More than 3 years ago 22.1 (20.8 , 23.3) 19.4 (18.1 , 20.8) 28.7 (25.2 , 32.4) 25.0 (21.9 , 28.3)
Never used 54.4 (53.0 , 55.8) 55.2 (53.6 , 56.9) 49.1 (45.5 , 52.7) 57.0 (53.8 , 60.1)
Recency of pipe smoking
Past 30 days 6.2 (5.8 , 6.7) 6.8 (6.2 , 7.4) 4.8 (4.1 , 5.7) 5.7 (4.7 , 6.9)
More than 30 days ago 26.2 (25.3 , 27.1) 22.7 (21.8 , 23.7) 33.5 (31.2 , 35.8) 31.2 (28.9 , 33.7)
Never used 67.6 (66.6 , 68.5) 70.5 (69.5 , 71.4) 61.7 (59.2 , 64.1) 63.0 (60.3 , 65.6)
Recency of alcohol consumption
Past 30 days 78.7 (77.9 , 79.5) 74.9 (74.1 , 75.8) 89.0 (87.2 , 90.6) 81.4 (79.3 , 83.2)
30 days to 1 year ago 10.3 (9.8 , 10.9) 12.8 (12.2 , 13.4) 4.8 (3.7 , 6.3) 7.2 (6.1 , 8.5)
More than 1 year ago 7.6 (7.2 , 8.1) 8.2 (7.6 , 8.9) 5.1 (4.0 , 6.4) 8.3 (6.9 , 10.0)
Never used 3.3 (3.0 , 3.7) 4.1 (3.6 , 4.6) 1.1 (0.7 , 1.6) 3.1 (2.5 , 3.9)
Recency of cannabis use
Past 30 days 32.9 (32.1 , 33.8) 40.7 (39.7 , 41.8) 16.8 (15.2 , 18.6) 21.4 (19.9 , 23.1)
30 days to 1 year ago 11.0 (10.4 , 11.5) 11.5 (10.9 , 12.2) 9.7 (8.5 , 11.1) 10.4 (9.1 , 11.7)
More than 1 year ago 34.8 (33.8 , 35.7) 29.1 (28.0 , 30.2) 48.8 (46.4 , 51.2) 40.6 (38.4 , 42.8)
Never used 21.3 (20.5 , 22.2) 18.7 (17.8 , 19.7) 24.7 (22.8 , 26.6) 27.6 (25.4 , 30.0)

a Established cigarette smoking defined as having smoked at least 100 cigarettes.

NOTE: CI = confidence interval; NSDUH = National Survey on Drug Use and Health; SLT = smokeless tobacco.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-3a Tobacco and Substance Use Characteristics of Adults Ages 18+ Who Currently (Past 30-Days) Smoke Premium and Nonpremium Cigars, 2010–2019 NSDUH

Any Cigar Type Nonpremium Cigars Premium Cigars Unknown Type
% (95% CI) % (95% CI) % (95% CI) % (95% CI)
Age first smoked cigar
Less than 18 years 35.1 (34.2 , 35.9) 41.3 (40.3 , 42.4) 24.0 (22.1 , 26.2) 24.5 (22.7 , 26.4)
18 to 29 years 47.4 (46.4 , 48.3) 43.8 (42.7 , 44.9) 54.4 (52.3 , 56.6) 52.4 (49.9 , 54.9)
30 to 49 years 13.9 (13.1 , 14.8) 12.1 (11.1 , 13.1) 17.3 (15.3 , 19.5) 16.9 (14.8 , 19.3)
50 years or older 3.7 (3.2 , 4.2) 2.8 (2.4 , 3.4) 4.2 (3.1 , 5.7) 6.2 (4.8 , 8.1)
Past 30 days, number of days
1 or 2 days 45.8 (44.8 , 46.7) 37.6 (36.4 , 38.8) 60.3 (57.9 , 62.7) 59.3 (56.9 , 61.5)
3 to 5 days 20.3 (19.6 , 21.0) 21.6 (20.7 , 22.5) 21.5 (19.2 , 24.0) 13.8 (12.1 , 15.7)
6 to 9 days 5.0 (4.6 , 5.4) 5.5 (5.0 , 6.0) 4.4 (3.5 , 5.6) 3.8 (2.9 , 5.0)
10 to 19 days 11.1 (10.6 , 11.7) 13.7 (13.0 , 14.4) 6.1 (5.1 , 7.3) 7.4 (6.0 , 9.1)
20 to 29 days 6.6 (6.1 , 7.1) 7.8 (7.3 , 8.5) 4.1 (3.1 , 5.5) 4.7 (3.7 , 6.0)
30 days 11.3 (10.6 , 12.0) 13.8 (13.0 , 14.7) 3.5 (2.5 , 4.7) 11.0 (9.3 , 13.0)
Recency of established cigarette smokinga
Past 30 days 43.4 (42.4 , 44.4) 51.8 (50.7 , 53.0) 23.4 (21.5 , 25.3) 35.5 (32.8 , 38.3)
30 days to 1 year ago 3.8 (3.4 , 4.1) 3.6 (3.3 , 4.0) 4.1 (3.2 , 5.2) 3.8 (3.0 , 5.0)
1 to 3 years ago 2.8 (2.6 , 3.1) 2.7 (2.4 , 3.1) 3.3 (2.6 , 4.1) 2.7 (2.0 , 3.7)
More than 3 years ago 12.5 (11.7 , 13.4) 8.5 (7.7 , 9.4) 22.0 (19.9 , 24.2) 16.3 (14.3 , 18.5)
Never established 37.5 (36.6 , 38.4) 33.3 (32.3 , 34.2) 47.3 (44.8 , 49.8) 41.7 (38.9 , 44.6)
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Recency of SLT use
Past 30 days 11.6 (10.8 , 12.5) 11.8 (10.8 , 12.8) 12.7 (10.5 , 15.3) 9.9 (8.0 , 12.2)
30 days to 1 year ago 4.9 (4.4 , 5.3) 5.5 (5.0 , 6.1) 3.5 (2.7 , 4.6) 3.9 (2.9 , 5.2)
1 to 3 years ago 6.0 (5.5 , 6.6) 6.6 (6.0 , 7.3) 5.8 (4.5 , 7.4) 3.9 (2.9 , 5.1)
More than 3 years ago 23.1 (21.8 , 24.5) 20.6 (19.2 , 22.1) 28.9 (25.4 , 32.7) 26.0 (22.8 , 29.5)
Never used 54.4 (52.9 , 55.9) 55.5 (53.7 , 57.2) 49.1 (45.5 , 52.7) 56.4 (53.0 , 59.6)
Recency of pipe smoking
Past 30 days 6.1 (5.7 , 6.6) 6.7 (6.1 , 7.3) 4.8 (4.1 , 5.6) 5.7 (4.7 , 6.9)
More than 30 days ago 26.8 (25.9 , 27.8) 23.3 (22.3 , 24.3) 33.6 (31.3 , 35.9) 32.0 (29.5 , 34.5)
Never used 67.0 (66.0 , 68.0) 70.0 (69.0 , 71.0) 61.6 (59.1 , 64.0) 62.3 (59.6 , 65.0)
Recency of alcohol consumption
Past 30 days 79.4 (78.6 , 80.2) 75.6 (74.8 , 76.5) 89.1 (87.3 , 90.7) 82.2 (80.2 , 84.1)
30 days to 1 year ago 9.8 (9.2 , 10.3) 12.2 (11.6 , 12.9) 4.8 (3.7 , 6.2) 6.6 (5.5 , 7.9)
More than 1 year ago 7.7 (7.2 , 8.3) 8.4 (7.7 , 9.1) 5.1 (4.0 , 6.5) 8.5 (7.0 , 10.2)
Never used 3.1 (2.7 , 3.5) 3.8 (3.3 , 4.3) 1.0 (0.7 , 1.6) 2.8 (2.1 , 3.6)
Recency of cannabis use
Past 30 days 31.6 (30.7 , 32.4) 39.3 (38.2 , 40.4) 16.6 (14.9 , 18.4) 20.4 (18.9 , 22.0)
30 days to 1 year ago 10.8 (10.2 , 11.4) 11.3 (10.6 , 12.0) 9.7 (8.5 , 11.1) 10.1 (8.9 , 11.4)
More than 1 year ago 36.1 (35.1 , 37.1) 30.5 (29.4 , 31.7) 49.0 (46.6 , 51.5) 41.8 (39.5 , 44.1)
Never used 21.5 (20.7 , 22.4) 18.9 (17.9 , 20.0) 24.7 (22.8 , 26.6) 27.7 (25.4 , 30.1)

a Established cigarette smoking defined as having smoked at least 100 cigarettes.

NOTE: CI = confidence interval; NSDUH = National Survey on Drug Use and Health; SLT = smokeless tobacco.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-4 Health Characteristics of U.S. Adults by Tobacco Use Type, 2015–2019 NSDUH

Current Established Cigarette Smoking Former Established Cigarette Smoking Any Current Cigar Smoking Current Nonpremium Cigar Smoking Current Premium Cigar Smoking No Past 30-Day Tobacco Use Never Tobacco Use
% (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI) % (95% CI)
Ever told had cancer 4.0 (3.7 , 4.3) 10.5 (10.0 , 11.1) 3.0 (2.5 , 3.7) 2.2 (1.7 , 2.8) 5.1 (3.6 , 7.4) 7.1 (6.9 , 7.3) 5.2 (4.9 , 5.5)
Ever told had heart condition 8.8 (8.4 , 9.3) 17.8 (17.2 , 18.5) 7.8 (7.0 , 8.6) 7.4 (6.5 , 8.4) 8.0 (6.1 , 10.4) 11.2 (10.9 , 11.5) 8.4 (8.0 , 8.8)
Ever told had COPD 8.0 (7.6 , 8.5) 7.5 (7.0 , 7.9) 4.1 (3.4 , 4.9) 4.6 (3.9 , 5.5) 1.7 (1.0 , 2.6) 3.6 (3.5 , 3.8) 2.3 (2.1 , 2.5)
Ever told had asthma 8.9 (8.6 , 9.2) 9.7 (9.2 , 10.3) 9.9 (9.1 , 10.7) 10.4 (9.6 , 11.3) 9.2 (7.5 , 11.4) 9.6 (9.4 , 9.8) 8.8 (8.5 , 9.1)
Mental health
Serious psychological distress, past month 11.3 (10.9 , 11.6) 4.0 (3.8 , 4.2) 11.0 (10.2 , 11.8) 14.5 (13.4 , 15.6) 2.7 (1.9 , 3.7) 4.4 (4.2 , 4.5) 4.5 (4.3 , 4.8)
Major depressive episode, past year 11.1 (10.7 , 11.6) 6.5 (6.2 , 6.9) 10.7 (9.9 , 11.5) 12.8 (11.8 , 13.9) 5.0 (3.8 , 6.7) 6.1 (6.0 , 6.3) 5.3 (5.1 , 5.5)
Substance dependence
Alcohol dependence, past year 7.3 (7.0 , 7.6) 3.3 (3.0 , 3.6) 8.4 (7.7 , 9.2) 9.6 (8.9 , 10.4) 7.3 (5.7 , 9.3) 1.9 (1.8 , 2.1) 0.8 (0.7 , 0.9)
Cannabis dependence, past year 2.5 (2.3 , 2.6) 0.7 (0.6 , 0.8) 5.3 (4.9 , 5.8) 7.4 (6.6 , 8.1) 1.3 (0.9 , 1.8) 0.5 (0.5 , 0.5) 0.2 (0.1 , 0.2)
Illicit druga dependence, past year 4.8 (4.5 , 5.1) 4.8 (4.5 , 5.1) 4.5 (4.0 , 5.0) 5.8 (5.2 , 6.5) 1.9 (1.1 , 3.1) 0.5 (0.4 , 0.5) 0.2 (0.2 , 0.3)
Pregnancy status
Yes 0.6 (0.5 , 0.6) 0.7 (0.6 , 0.8) 0.3 (0.2 , 0.5) 0.5 (0.3 , 0.7) 0.0 (0.0 , 0.1) 1.0 (1.0 , 1.1) 1.1 (1.1 , 1.2)
No 22.5 (22.0 , 23.1) 11.3 (10.9 , 11.7) 16.7 (15.9 , 17.5) 21.6 (20.5 , 22.7) 3.7 (2.9 , 4.7) 22.7 (22.5 , 23.0) 28.3 (27.9 , 28.7)
N/Ab 76.9 (76.4 , 77.5) 87.9 (87.5 , 88.3) 83.0 (82.2 , 83.7) 77.9 (76.8 , 79.0) 96.3 (95.3 , 97.1) 76.2 (75.9 , 76.5) 70.5 (70.1 , 70.9)

a Other than cannabis.

b Males and females respondents not aged 12 to 44 years.

NOTE: CI = confidence interval; COPD = chronic obstructive pulmonary disease; NSDUH = National Survey on Drug Use and Health.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×

TABLE C-5 Age- and Sex-Adjusteda Associations Between Past-Month Premium Cigar Smoking and Various Health Characteristics Among U.S. Adults, 2015–2019 NSDUH

Premium vs. Nonpremium Cigar Smoking Premium vs. Nonpremium Cigar Smoking, Adjusted for Established Smoking Statusb Premium Cigar Smoking vs. Never Tobacco Use Premium Cigar Smoking vs. Current/Former Established Cigarette Smoking
aOR (95% CI) aOR (95% CI) aOR (95% CI) aOR (95% CI)
Ever told had cancer 1.83 (1.11 , 3.00) 1.67 (0.99 , 2.81) 1.47 (1.02 , 2.13) 1.09 (0.65 , 1.81)
Ever told had heart condition 0.80 (0.56 , 1.15) 0.78 (0.54 , 1.13) 1.01 (0.73 , 1.40) 0.69 (0.43 , 1.11)
Ever told had COPD 0.32 (0.19 , 0.52) 0.48 (0.28 , 0.82) 1.13 (0.69 , 1.84) 0.19 (0.08 , 0.46)
Ever told had asthma 1.19 (0.94 , 1.50) 1.15 (0.90 , 1.45) 1.22 (0.97 , 1.55) 1.16 (0.84 , 1.62)
Mental health
Serious psychological distress, past month 0.23 (0.16 , 0.32) 0.30 (0.21 , 0.42) 0.67 (0.47 , 0.96) 0.29 (0.20 , 0.43)
Major depressive episode, past year 0.50 (0.38 , 0.67) 0.59 (0.44 , 0.79) 1.29 (0.95 , 1.76) 0.63 (0.41 , 0.97)
Substance dependence
Alcohol dependence, past year 0.75 (0.57 , 0.98) 0.94 (0.72 , 1.22) 7.99 (5.67 , 11.25) 0.93 (0.59 , 1.48)
Cannabis dependence, past year 0.26 (0.18 , 0.38) 0.28 (0.19 , 0.42) 8.30 (4.98 , 13.85) 0.35 (0.17 , 0.73)
Illicit drugc dependence, past year 0.34 (0.20 , 0.57) 0.55 (0.33 , 0.91) 7.22 (3.98 , 13.12) 0.08 (0.04 , 0.18)
Pregnancy status
Yes vs. nod 0.28 (0.06 , 1.36) 0.38 (0.08 , 1.87) 0.15 (0.03 , 0.66) 0.12 (0.02 , 0.89)

a All models adjusted for age (6-level ordinal: <18, 18–25, 25–34, 35–49, 50–64, 65+) and sex (2-level nominal: male, female).

b Current established, former established, never established (Reference) cigarette smoking.

c Illicit drugs other than marijuana.

d Excludes males and females respondents not aged 12 to 44 years.

NOTE: aOR = adjusted odds ratio; CI = confidence interval; COPD = chronic obstructive pulmonary disease; NSDUH = National Survey on Drug Use and Health.

Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Image
FIGURE C-1 Prevalence of premium vs. nonpremium current cigar smoking, 2010–2019.
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
×
Image
FIGURE C-2 Prevalence of premium cigar smoking by age group, 2010–2019 NSDUH.
NOTE: NSDUH = National Survey on Drug Use and Health.
Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Suggested Citation:"Appendix C: Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health." National Academies of Sciences, Engineering, and Medicine. 2022. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington, DC: The National Academies Press. doi: 10.17226/26421.
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Next: Appendix D: Cross-Sectional Patterns and Longitudinal Transitions of Cigar Use by Type in the PATH Study »
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The early to mid-1990s saw a large surge in U.S. cigar consumption, including premium cigars. Based on recent import data, premium cigar use may be increasing, though they currently make up a small percent of the total U.S. cigar market. Premium cigars have also been the subject of legal and regulatory efforts for the past decade. In 1998, the National Cancer Institute undertook a comprehensive review of available knowledge about cigars - the only one to date. The resulting research recommendations have largely not been addressed, and many of the identified information gaps persist. Furthermore, there is no single, consistent definition of premium cigars, making research challenging.

In response, the Food and Drug Administration (FDA) and the National Institutes of Health commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee of experts to address this issue. The resulting report, Premium Cigars: Patterns of Use, Marketing, and Health Effects, includes 13 findings, 24 conclusions, and nine priority research recommendations and assesses the state of evidence on premium cigar characteristics, current patterns of use, marketing and perceptions of the product, and short- long-term health effects.

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