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Cigars and cigarillos are emerging as popular tobacco alternatives to cigarettes. However, these products may be equally harmful to human health than cigarettes and are associated with similar adverse health effects. We used 16S rRNA gene amplicon sequencing to extensively characterize the microbial diversity and investigate differences in microbial composition across 23 different products representing three different cigar product categories: filtered cigar, cigarillo, and large cigar. High throughput sequencing of the V4 hypervariable region of the 16 s rRNA gene revealed 2124 Operational Taxonomic Units (OTUs). Our findings showed that the three categories of cigars differed significantly in observed richness and Shannon diversity, with filtered cigars exhibiting lower diversity compared to large cigars and cigarillos. We also found a shared and unique microbiota among different product types. Firmicutes was the most abundant phylum in all product categories, followed by Actinobacteria. Among the 16 genera shared across all product types were Bacillus, Staphylococcus, Pseudomonas, and Pantoea. Nine genera were exclusively shared by large cigars and cigarillos and an additional thirteen genera were exclusive to filtered cigars. Analysis of individual cigar products showed consistent microbial composition across replicates for most large cigars and cigarillos while filtered cigars showed more inter-product variability. These findings provide important insights into the microbial diversity of the different cigar product types.

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OBJECTIVE: A systematic review was conducted to evaluate the use patterns, health perceptions, and cardiopulmonary health effects of cigars. DATA SOURCES: PubMed and Google Scholar were searched for peer-reviewed articles published between June 2014 and February 2021. Search keywords included cigars, cigarillos, little cigars, and cardiopulmonary health outcomes. STUDY SELECTION: Of 782 papers identified, we excluded non-English articles, review articles, commentaries, and those without empirical data on cigars. Three coders independently reviewed all articles and compared codes to resolve discrepancies. 93 articles met the inclusion criteria and were included. DATA SYNTHESIS: Cigars have evolved from premium cigars to encompass little cigars and cigarillos (LCCs). LCCs are available in an array of flavors and at a price advantage, and as a result, are used by different groups compared to premium cigars. LCCs are more frequently used by youth, young adults, and those who identify as Black/African American. LCCs are often used in combination with other tobacco products, alcohol, and cannabis. Despite limited regulation, cigars generate smoke of a similar composition as cigarettes. Among the studies identified, evidence suggests that cigar use is associated with cardiovascular and pulmonary toxicity. Higher all-cause and cancer-related mortalities are associated with cigar use, particularly with more frequent and deeper inhalation, compared to non-tobacco users. CONCLUSIONS: LCCs are used more frequently by at-risk groups compared to premium cigars. Recent studies evaluating cigar cardiopulmonary health effects are limited but suggest cigars have similar health risks as conferred by cigarette smoking. With the use of LCCs and targeted marketing on the rise among high-risk groups, there is a critical need for continued research in this area.

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Background: Health warnings in tobacco advertisements provide health information while also increasing the perceived risks of tobacco use. However, existing federal laws requiring warnings on advertisements for tobacco products do not specify whether the rules apply to social media promotions. Objective: This study aims to examine the current state of influencer promotions of little cigars and cigarillos (LCCs) on Instagram and the use of health warnings in influencer promotions. Methods: Instagram influencers were identified as those who were tagged by any of the 3 leading LCC brand Instagram pages between 2018 and 2021. Posts from identified influencers, which mentioned one of the three brands were considered LCC influencer promotions. A novel Warning Label Multi-Layer Image Identification computer vision algorithm was developed to measure the presence and properties of health warnings in a sample of 889 influencer posts. Negative binomial regressions were performed to examine the associations of health warning properties with post engagement (number of likes and comments). Results: The Warning Label Multi-Layer Image Identification algorithm was 99.3% accurate in detecting the presence of health warnings. Only 8.2% (n=73) of LCC influencer posts included a health warning. Influencer posts that contained health warnings received fewer likes (incidence rate ratio 0.59, P<.001, 95% CI 0.48-0.71) and fewer comments (incidence rate ratio 0.46, P<.001, 95% CI 0.31-0.67). Conclusions: Health warnings are rarely used by influencers tagged by LCC brands' Instagram accounts. Very few influencer posts met the US Food and Drug Administration's health warning requirement of size and placement for tobacco advertising. The presence of a health warning was associated with lower social media engagement. Our study provides support for the implementation of comparable health warning requirements to social media tobacco promotions. Using an innovative computer vision approach to detect health warning labels in influencer promotions on social media is a novel strategy for monitoring health warning compliance in social media tobacco promotions.

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Background: Research suggests flavor facilitates cigarillo use, but it is unknown if flavor impacts patterns of co-use of cigarillos and cannabis ("co-use"), which is common among young adult smokers. This study's aim was to determine the role of the cigarillo flavor in co-use among young adults. Methods: Data were collected (2020-2021) in a cross-sectional online survey administered to young adults who smoked ≥2 cigarillos/week (N = 361), recruited from 15 urban areas in the United States. A structural equation model was used to assess the relationship between flavored cigarillo use and past 30-day cannabis use (flavored cigarillo perceived appeal and harm as parallel mediators), including several social-contextual covariates (e.g., flavor and cannabis policies). Results: Most participants reported usually using flavored cigarillos (81.8%) and cannabis use in the past 30 days ("co-use") (64.1%). Flavored cigarillo use was not directly associated with co-use (p = 0.90). Perceived cigarillo harm (ß = 0.18, 95% CI = 0.06, 0.29), number of tobacco users in the household (ß = 0.22, 95% CI = 0.10, 0.33), and past 30-day use of other tobacco products (ß = 0.23, 95% CI = 0.15, 0.32) were significantly positively associated with co-use. Living in an area with a ban on flavored cigarillos was significantly negatively associated with co-use (ß = -0.12, 95% CI = -0.21, -0.02). Conclusions: Use of flavored cigarillos was not associated with co-use; however, exposure to a flavored cigarillo ban was negatively associated with co-use. Cigar product flavor bans may reduce co-use among young adults or have a neutral impact. Further research is needed to explore the interaction between tobacco and cannabis policy and use of these products.

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BACKGROUND: Smoking cannabis using a tobacco-derived cigar shell or wrap, called blunt smoking, exposes individuals to non-trivial amounts of nicotine. The extent smoking blunts impact the risk of initiating other tobacco products is not well understood. We investigated if past-year blunt smoking is related to the risk of initiating cigarettes, e-cigarettes, and cigars. METHODS: We obtained data on a nationally representative, non-institutionalized, civilian cohort of US residents aged 12 years and older who had never used cigarettes, e-cigarettes, or any cigar at baseline and surveyed annually for three years from the Population Assessment of Tobacco and Health Study. We estimated the proportional hazard (odds) of initiating these tobacco products associated with past-year blunt smoking, non-blunt cannabis use, or neither using discrete-time survival analyses. RESULTS: Smoking blunts increased the risk of starting cigarettes (OR = 4.5), e-cigarettes (OR = 3.7), and cigars (OR = 6.7) compared to using neither blunts nor cannabis. Non-blunt cannabis use also increased the risk of starting cigarettes (OR = 4.0) but moderately for e-cigarettes (OR = 2.8) and any cigar (OR = 2.2). Blunt use was strongly related to starting combustible tobacco (cigarettes or cigars; OR = 9.0) and any three tobacco products (OR = 10.9). Exploratory findings showed that cigarillos drove cigar results and effect modification by age, race/ethnicity, and sex. CONCLUSIONS: People who smoke blunts risk starting cigarettes, e-cigarettes, and cigars more than those who abstain from cannabis. Blunts may contribute to tobacco initiation above cannabis alone.

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BACKGROUND: Little cigars and cigarillos (LCCs) are popular tobacco products among youth (ie, adolescents and young adults). A variety of LCC-related promotional and user-generated content is present on social media. However, research on LCC-related posts on social media has been largely focused on platforms that are primarily text- or image-based, such as Twitter and Instagram. OBJECTIVE: This study analyzed LCC-related content on TikTok, an audio and video-based platform popular among youth. METHODS: Publicly available posts (N=811) that contained the LCC-related hashtags #swishersweets or #backwoods were collected on TikTok from January 2019 to May 2021. Metadata were also collected, including numbers of likes, comments, shares, and views per video. Using an inductive approach, a codebook consisting of 26 themes was developed to help summarize the underlying themes evident in the TikTok videos and corresponding captions. A pairwise co-occurrence analysis of themes was also conducted to evaluate connections among themes. RESULTS: Among the 811 posts, the LCC presence theme (ie, a visible LCC) occurred in the most prominent number of posts (n=661, 81.5%), followed by music (n=559, 68.9%), youth (n=332, 40.9%), humor (n=263, 32.4%), LCC use (n=242, 29.8%), flavors (n=232, 28.6%), branding (n=182, 22.4%), paraphernalia (n=137, 16.9%), blunt rolling (n=94, 11.6%), and price (n=84, 10.4%). Product reviews had the highest engagement, with a median 44 (mean 2857, range 36,499) likes and median 491 (mean 15,711, range 193,590) views; followed by product comparisons, with a median 44 (mean 1920, range 36,500) likes and median 671 (mean 11,277, range 193,798) views. Promotions had the lowest engagement, with a median 4 (mean 8, range 34) likes and median 78 (mean 213, range 1131) views. The most prevalent themes co-occurring with LCC presence were (1) music (434/811, 53.5%), (2) youth (264/811, 32.6%), (3) humor (219/811, 27%), (4) flavors (214/811, 26.4%), and (5) LCC use (207/811, 25.5%). CONCLUSIONS: LCC-related marketing and user-generated content was present on TikTok, including videos showing youth discussing, displaying, or using LCCs. Such content may be in violation of TikTok's community guidelines prohibiting the display, promotion, or posting of tobacco-related content on its platform, including the display of possession or consumption of tobacco by a minor. Further improvement in the enforcement of TikTok community guidelines and additional scrutiny from public health policy makers may be necessary for protecting youth from future exposure to tobacco-related posts. Observational and experimental studies are needed to understand the impact of exposure to LCC-related videos on attitudes and behaviors related to LCC use among youth. Finally, there may be a need for engaging antitobacco videos that appeal to youth on TikTok to counter the protobacco content on this platform.

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INTRODUCTION: Little filtered cigars and cigarillos (LCCs) are consumed infrequently, co-administered with marijuana, and concurrently used with other tobacco products. Reliance on the past 30-day use estimate, a marker of tobacco user status, may underestimate the dynamic nature of intermittent LCC and other tobacco product use. We developed a framework to capture the intermittent nature of exclusive LCC use and dual/poly use with cigarettes and large cigars using broader timing of last product use categories and product use modality (e.g., with marijuana). METHODS: Data come from the baseline C'RILLOS study, a U.S. nationally representative sample of young adults aged 18-34 (n = 1063) collected in October 2019. We developed a consumption taxonomy framework that accounted for respondents' modality of LCC use (i.e., use with tobacco, LCC-T, or use with marijuana as blunts, LCC-B), the exclusive use of LCCs and other tobacco products (i.e., cigarettes, and large cigars) or their co-use and the timing of last product use (i.e., ever and past 30 days, past 3 months, past 6 months, greater than 6 months). RESULTS: Seventy-five percent of our sample reported ever use of any combustible tobacco product, including LCCs. The most common ever use pattern was poly use of LCC-T + LCC-B + cigarettes (16%). Our consumption taxonomy framework demonstrated the fluid nature of combustible tobacco product use among LCC users. For instance, among past 30-day cigarette users, 48% reported using LCC-T, 39% reported using LCC-B, and 32% reported using large cigars in the past 3 months or more. DISCUSSION: The tobacco use field currently classifies 'tobacco users' based on the product they smoked in the past 30 days. Any tobacco product use beyond the past 30-day period is considered 'discontinued use' and not the focus of intervention or tobacco regulatory science decisions. We documented the substantial proportion of young adult LCC, cigarette, and large cigar users who either exclusively or dual/poly used these combustible products in recent (e.g., past 3 months) periods. To prevent underestimation of use, surveillance measures should assess the use modality, timing of last product use, and exclusive/multiple product use to more accurately identify the smoking status of young adult LCC users.

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We examined the smoking behaviors of U.S. young adults ages 18-36 regarding little cigars and cigarillos (LCCs) during the COVID-19 pandemic. Survey data were collected from a nationally representative sample of young adults between October and November 2020. Respondents who reported using LCCs with tobacco (CAI) and/or with marijuana (CAB) within the past 6 months prior to the survey (n = 399) were included in the study. Logistic regression analyses assessed the association between their perceived risk of having COVID when smoking LCCs and pandemic-related behavioral changes in CAI and CAB use (e.g., worrying, quit attempts, smoking more, smoking less). Findings showed that users with a higher perceived risk of getting COVID-19 when smoking LCCs were more likely to endorse trying to quit CAI and CAB during the pandemic. Compared to the non-Hispanic White population, the non-Hispanic Black population were less likely to endorse smoking less CAI and trying to quit CAB during the pandemic. Dual users of CAI and CAB and females were more likely to endorse smoking more CAB compared to CAB-only users and males, respectively. Tailored cessation strategies are needed for dual users, non-Hispanic Black young adults, and young women. Raising awareness about the risks of LCC use can be an effective strategy for LCC smoking cessation.

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Context: Youth tobacco use remains a prominent United States public health issue with a high economic and health burden. Method: We pooled never and ever users at youth's first wave of PATH participation (waves 1-3) to estimate age of initiation for hookah, e-cigarettes, cigarettes, traditional cigars, cigarillos, and smokeless tobacco prospectively (waves 2-4). Age of initiation of each tobacco product was estimated using weighted interval-censored survival analyses. Weighted interval censoring Cox-proportional hazards regression models were used to assess the association of ever use of the TP at the first wave of PATH participation, sex, and race/ethnicity on the age of initiation of ever use of each tobacco product. Sensitivity analyses were performed to understand the impact of the recalled age of initiation for the left-censored participants by replacing the recalled age of initiation with a uniform "6" years lower bound. Results: The proportion of those who ever used each tobacco product at the first wave of PATH participation ranged from 1.8% for traditional cigars to 10.4% for cigarettes. There was a significant increase in ever use of each tobacco product after the age of 14, with e-cigarettes and cigarettes showing the highest cumulative incidence of initiation by age 21, while smokeless and cigarillos recorded the lowest cumulative incidence by age 21. The adjusted Cox models showed boys initiated at earlier ages for all of these tobacco products except for hookah, which showed no difference. Similarly, apart from ever use of hookah, non-Hispanic White youth were more likely to initiate each tobacco product at earlier ages compared to Hispanic, non-Hispanic Black, and non-Hispanic Other youth. Conclusion: The increased sample size and the inclusion of ever users yielded greater precision for age of initiation of each tobacco product than analyses limited to never users at the first wave of PATH participation. These analyses can help elucidate population selection criteria for estimating the age of initiation of tobacco products.

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Earlier exposure to binge drinking and tobacco use is associated with higher odds of substance use disorders. Using national youth data from the PATH study, we prospectively estimate the age of initiating past 30-day use of (1) cigarettes, e-cigarettes, and binge drinking, and (2) cigarettes, cigarillos, and binge drinking. Cox proportional hazard models were used to estimate differences in the age of initiation by sex, race/ethnicity, and previous use of other tobacco products. By age 21, 4.4% (95% CI: 3.7-5.2) and 2.0% (95% CI: 1.2-2.8) of youth reported initiation of past 30-day use outcomes (1) and (2), respectively. After controlling for sex and previous use of other tobacco products, statistically significant differences in the age of initiation by race/ethnicity were found for each outcome: Hispanic and non-Hispanic Black youth were less likely than non-Hispanic White youth to initiate past 30-day use of both outcomes (1) and (2) at earlier ages. Although the initiation of both outcomes remained relatively low by age 21, these incidences represent 1.56 million and 700,000 youth, respectively. This study provides the public with evidence to identify the particular ages at which education campaigns may be most effective to prevent youth from initiating these three substances. Further research is needed to estimate the age of initiation of other dual tobacco use patterns with binge drinking.

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Black/African American women from low-resource, rural communities bear a disproportionate burden of tobacco-related morbidity and mortality. This study examined associations between menthol smoking and socioeconomic deprivation with nicotine dependence and quitting behaviors among Black/African American women cigarette and/or little cigar/cigarillo smokers, aged 18-50 living in low-resource, rural communities. Baseline survey data from a randomized controlled behavioral/intervention trial (#NCT03476837) were analyzed (n = 146). Outcomes included time to first tobacco product (cigarette/little cigar/cigarillo) use within 5 min of waking, Fagerstrom Test for Nicotine Dependence (FTND) score, and ever attempting to quit cigarettes. Socioeconomic deprivation measures included education, income, and receiving supplemental nutritional assistance (SNAP) program benefits. In adjusted regression analyses, menthol smoking was associated with both greater FTND scores and time to first tobacco product use within 5 min of waking, but not ever attempting to quit cigarettes. Regardless of menthol status, only 25.0% of smokers reported that they would quit smoking if menthol cigarettes were banned. The proportion of smokers who smoked their first tobacco product within 5 min of waking increased slightly with greater socioeconomic deprivation. Additional research and targeted efforts are needed to reduce nicotine dependence among Black/African American women smokers living in rural, low-resource communities where access to cessation services is limited.

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OBJECTIVES: Past research has not examined secondhand and thirdhand smoke (THS) exposure in children of cigar smokers. We examined hand nicotine and cotinine levels in children of cigar smokers to explore the contribution of cigar smoke to tobacco smoke exposure (TSE). METHODS: Participants were children (N = 24; mean (SD) age = 6.5 (3.6) years) whose parents smoked cigars only or poly-used cigars and/or cigarettes. Primary outcomes were hand nicotine and urinary cotinine levels. RESULTS: All children had detectable hand nicotine (range: 7.6-312.5ng/wipe) and cotinine (range: 0.3-100.3ng/ml). Positive correlations were found between hand nicotine and cotinine (r = 0.693, p = .001), hand nicotine and parents who also smoked cigarettes (r = 0.407, p = .048), and hand nicotine and number of smokers around the child (r = 0.436, p = .03). Hand nicotine (r = -0.464, p = .02), but not cotinine (r = -0.266, p = .26), was negatively correlated with child age. Multiple regression results indicated a positive association between hand nicotine and cotinine (p = .002; semi-partial r2 = 0.415), irrespective of child age. CONCLUSIONS: The significant association of hand nicotine with urinary cotinine suggests that THS pollution should be assessed in evaluating children's overall TSE to cigars and other tobacco products, and hand nicotine may be a proxy for overall TSE. Younger children may have increased THS pollutant uptake.

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Cigarillo use has increased among adolescents and young adults and has remained high. Public education efforts are needed to communicate with these populations about cigarillo use risks, but little is known about the implications of using the term "cigarillo" in such efforts. The study goal was to assess adolescent and young adult perceptions of the term "cigarillo". We conducted a nationally representative online survey of 3517 adolescents and young adults (ages 13-25). We asked participants "what is a cigarillo?" with several response options. Participants were 49.6% female, 69.8% white, 5.2% reported past 30-day cigarillo use, and 11.6% reported lifetime cigarillo use. The most common response to the question "what is a cigarillo" was "I don't know" (51% of participants), followed by "a thinner and smaller version of a traditional cigar" (30.1% of participants), which was chosen by 19.4% of adolescents and 36.8% of young adults. Among past 30-day cigarillo users, the most common response was "I don't know" (54.9%) followed by "a thinner and smaller version of a traditional cigar" (45.1%). Cigarillo users were more likely to select the "a thinner and smaller version of a traditional cigar" response than nonusers. Findings suggest that many adolescents and young adults have varied understandings of the term "cigarillo". Researchers and practitioners need to ensure that terminology used in health communication campaigns is clearly understood by the target audience to maximize effectiveness.

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Smoking remains a leading cause of preventable morbidity and mortality worldwide. Despite a downward trend in cigarette use, less-regulated tobacco products, such as cigarillos, which are often flavored to appeal to specific demographics, such as younger people, are becoming increasingly popular. Cigar/cigarillo smoking has been considered a safer alternative to cigarettes; however, the health risks associated with cigar in comparison with cigarette smoking are not well understood. To address this knowledge gap, we characterized the effects of multiple brands of cigarillos on the airway epithelium using ex vivo and in vivo models. To analyze these effects, we assessed the cellular viability and integrity of smoke-exposed primary airway cell cultures. We also investigated the protein compositions of apical secretions from cigarillo-exposed airway epithelial cultures and BAL fluid of cigarillo-exposed mice through label-free quantitative proteomics and determined the chemical composition of smoke collected from the investigated cigarillo products. We found that cigarillo smoke exerts similar or greater effects than cigarette smoke in terms of reduced cell viability; altered protein levels, including those of innate immune proteins; induced oxidative-stress markers; and greater nicotine delivery to cells. The analysis of the chemical composition of the investigated cigarillo products revealed differences that might be linked to the differential effects of these products on cell viability and protein abundance profiles, which have been associated with a range of health risks in the context of airway biology. These findings contradict the assumption that cigarillos might be safer and less harmful than cigarettes. Instead, our results indicate that cigarillo smoke is associated with equal or greater health risks and the same or increased airway toxicity compared with cigarette smoke.

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OBJECTIVES: In our cross-sectional study, we aimed to determine age verification and sales of little cigars and cigarillos (LCCs) online to underage teens. METHODS: We selected 100 popular Internet Little Cigar and Cigarillo Vendors (ILVs) for order attempts. From August to December 2015, we supervised 14 teens 14-17 years old making order attempts for LCCs. RESULTS: Of the 91 valid orders attempted, we received 89. For the valid orders attempted, 9.9% of ILVs used no age verification strategies at all, 84.6% used less effective forms of age verification, and 50.5% used more effective ones. Only one order was blocked during the order attempt and only one attempt was made to verify age at delivery. Most (79.8%) deliveries were left at the door and only 2 order attempts were rejected because of age verification strategies, resulting in a successful or valid buy rate of 97.8%. CONCLUSIONS: Our study demonstrated that ILVs selling LCCs were not making adequate efforts to verify the age of their customers, at the point-of-sale or point-of-delivery, facilitating easy access by minors. Few ILVs utilized age verification strategies that prevented online sales of LCCs to underage teens.

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Background: Understanding which adolescents are at greatest risk for cigarettes and other tobacco products is critical to inform tailored and targeted interventions. Objectives: We used peer crowds (macro-level subcultures) to identify subgroups of adolescents at-risk for using and being open to using cigarettes; cigars, cigarillos, and little cigars (cigar products); hookah; e-cigarettes; any tobacco product; and multiple products. Methods: In 2017, youth ages 12-17 in five U.S. states completed cross-sectional surveys (n = 1,167). Participants provided data on cigarette use (experimentation) and openness to use (susceptibility); cigar product, hookah, and e-cigarette use (ever use) and openness to use (curiosity); and identification with five peer crowds (Alternative, Country, Hip Hop, Mainstream, Popular). We used chi-square tests to compare rates by peer crowd, and multivariate logistic regressions to assess odds of use and openness for each crowd (reference: Mainstream). Results: Risk differed by peer crowd. Hip Hop youth reported high rates of use, ranging from 12.8% (cigarettes) to 33.4% (e-cigarettes). Regressions revealed increased odds of use for Hip Hop compared to Mainstream for all products, especially cigar products and multi-product use. Popular (cigar products, e-cigarettes) and Alternative (cigarettes) demonstrated increased odds of use compared to Mainstream. We also observed elevated odds of cigarette openness among Alternative, Country, and Hip Hop youth, and of hookah openness among Hip Hop and Popular youth compared to Mainstream. Conclusions/Importance: Peer crowd-tailored cigarette education campaigns can be extended to address other tobacco product risk, especially for higher-risk peer crowds such as Hip Hop.

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OBJECTIVES: Affect is an important dimension of risk perceptions, which are proximal determinants of little cigar and cigarillo (LCC) smoking. We examined the association among affect, risk perceptions, and current LCC use and susceptibility in a national probability sample of US young adults, aged 18-29. METHODS: Structural equation models examined the effect of affect, via risk perceptions, on LCC current use and susceptibility for 772 young adults who took the 2015 Tobacco Products and Risk Perceptions Survey, which asked about affect for images related to LCCs and health risks of daily LCC use. RESULTS: Positive affect toward LCCs was associated with lower perceived risks of daily LCC smoking (p < .001). Lower perceived risks were associated with higher probability of current LCC smoking (p = .008) among young adults who were aware of LCCs and with susceptibility to use among young adult never LCC users (p < .001). A direct effect of positive affect on current LCC use (p < .02) and susceptibility to use LCCs also was found. CONCLUSIONS: Future research should investigate how regulatory policy or enforcement actions can be used to regulate LCC components (eg, flavoring, advertising, etc) that influence affect and risk perceptions.

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The recent 2016 deeming of cigars by the US Food and Drug Administration (FDA) has led to increased interest in cigar science, including ways to accurately measure the harmful and potentially harmful constituents (HPHCs) found within mainstream cigar smoke. At present, there are standardized methods for evaluating HPHCs in mainstream cigarette smoke but none specific to cigar analysis except for nicotine and carbon monoxide. This study sought to analyze carbonyl delivery in marketed cigars and cigarillos and compare them against levels found in cigarettes. To accomplish this the standard cigarette method, CORESTA recommended method 74 (CRM-74), was optimized for cigar smoking including an evaluation of the trapping efficiency and the stability of the carbonyl-hydrazone adducts due to the increased smoke time required for cigar collection. On a per product basis, carbonyl delivery from cigars smoked under CRM-64 conditions was found to yield similar levels of formaldehyde and greater levels of acetaldehyde, acrolein and crotonaldehyde than measured in mainstream cigarette smoke collected under conditions prescribed under ISO standard 3308. Furthermore, on a per product basis, cigarettes smoked under the ISO 20778 intense smoking regime delivered higher levels of formaldehyde, acrolein and crotonaldehyde as compared to cigars smoked under the CORESTA regime, while acetaldehyde was found to be higher in mainstream cigar smoke. Given the recent deeming, this work expands upon previously reported work, limited in scope by either number of products or analytes reported, through the analysis of carbonyl delivery found in the mainstream smoke for 12 brands of cigars and cigarillos.

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INTRODUCTION: Many young consumers of non-cigarette tobacco products, such as cigarillos, do not identify as smokers. These "phantom smokers" tend to underestimate risks to health and feel little urgency to quit. This study examines the prevalence and characteristics of phantom smoker status among young cigarillo users. METHODS: An online survey was conducted among 14-28 year olds who smoke at least 2 cigarillos per week. Phantom smoker status was determined by a negative response to "Do you consider yourself a smoker?" Other variables included smoking frequency, group smoking and sharing, and confidence in ability to quit. Associations between smoker identity and these variables were tested using chi square, independent samples t-tests and multivariable logistic regression. RESULTS: Of 1089 respondents, 242 (22%) were identified as phantom smokers. Phantoms smoked half as many cigarillos per week as identified smokers (M = 4.75, SD = 5.11 vs. M = 11.33, SD = 0.88, p < .001) and phantoms were more likely to smoke only when sharing (39.7% vs 21.8%, p < .001). While 59.5% of identified smokers also smoked cigarettes, only 33.5% of phantoms did so (p < .001). Most phantom smokers (83.8%) were unconcerned about addiction. Phantoms also expressed greater confidence in their ability to quit (M = 4.40, SD = 0.98) than did identified smokers (M = 3.72, SD = 1.25, p < .001). CONCLUSIONS: Despite regular cigarillo use, over 20% of respondents did not identify as smokers. Cigarillo smoking, along with non-daily and shared use, should be routinely assessed among youth. Phantom smokers' lack of concern about addiction and high confidence in their ability to quit may render conventional messages about smoking risk ineffective.

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BACKGROUND: Little cigars are growing in popularity in the United States, and Swisher is the market leader. The contexts and experiences associated with the use of Swisher-related products is understudied, but such information is available via publicly available posts on Twitter. OBJECTIVE: This study aimed to analyze Twitter posts to characterize Twitter users' recent experiences with Swisher-related products. METHODS: Twitter posts containing the term "swisher" were analyzed from January 1, 2018, to December 31, 2018. Text classifiers were used to identify topics in posts (n=81,333). RESULTS: The most prevalent topic was Person Tagging (mentioning a Twitter account in a post; 32.77%), followed by Flavors (eg, Grape and Strawberry; 20.96%) and Swisher use (eg, smoke swisher; 17.44%). Additional topics included Cannabis use (eg, blunt, roll, and gut swisher; 6.26%), Appeal (eg, like Swisher; 5.92%), Dislike (eg, posts that showed dissatisfaction with Swisher products; 3.53%), Purchases (eg, buy swisher; 1.90%), and Cigar comparison (eg, mentions of other cigar products including White-owl and Backwoods; 1.64%). CONCLUSIONS: This paper describes common contexts and experiences associated with the use of Swisher little cigars from the population posting on Twitter in 2018. These online messages may have offline consequences for tobacco-related behaviors, indicating the need for countering from public health officials. Findings should inform us about targets for surveillance, policy, and interventions addressing Swisher little cigars as well as communication planning and tobacco product counter messaging on Twitter.

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