A Ban on Flavored Cigars is Long Overdue

A Ban on Flavored Cigars is Long Overdue MAHAM AKBAR PUBLIC POLICY MANAGER APRIL 2018

Overview Background Sales Prevalence Consumer Perceptions Marketing and Promotion Nicotine Dependence Policy Options

Background

Tobacco Control Act

Deeming Rule

FDA Comprehensive Regulatory Plan for Tobacco and Nicotine

Methods Excluded: Not related to cigars Not in English Conducted outside of the US or Canada Related to genetics or tobacco farming Topic Areas: Product Features Health and Safety Consumer Perceptions Patterns of Use Marketing Sales Policies

Flavored cigars: How are sales?

Sales From 1997-2007, little cigar sales 240% and flavored cigars made up about 80% of the market share [VALUE ] Flavored cigars responsible for 75% of the increase in cigar sales 2008-2011 [VAL UE]

Sales DELNEVO CD, ET AL. CHANGES IN THE MASS -MERCHANDISE CIGAR MARKET SINCE THE TOBACCO CONTROL ACT. TOB REG SCI. 2017. 60.0 Share of Flavored Cigars in the Cigar Market, Percentage 50.0 Percentage 43.6 45.0 46.2 48.2 51.5 53.3 53.3 2013 2014 52.1 40.0 30.0 20.0 10.0 0.0 2008 2009 2010 2011 2012 2015

Flavored cigars: Who s smoking them?

Prevalence among youth MONITORING THE FUTURE, 2017 30-Day Prevalence of Tobacco Products Among Youth, Percentage 12 10.1 9.7 10 Percentage 8 6 8th Grade 5.6 5.5 [VALUE].0 4.0 4 [VALUE].0 2.8 2 2.6 1.6 1.9 1.5 0 Flavored Little Cigars or Cigarillos Regular Little Cigars or Cigarillos Large Cigars Cigarettes 10th Grade 12th Grade

Prevalence among youth COREY CG, ET AL. FLAVORED TOBACCO PRODUCT USE AMONG MIDDLE AND HIGH SCHOOL STUDENTS UNITED STATES, 2014. MMW R. 2015. Prevalence of Flavored Tobacco Product Use Among All Middle and High School Students, Percentage 7 5.9 6 Percentage 5 3.9 4 3.5 3.4 3 2.6 2 1 0.5 0 Cigars Cigarettes E-Cigarettes Hookah Smokeless Tobacco Pipe Tobacco

Prevalence among youth COREY CG, ET AL. FLAVORED TOBACCO PRODUCT USE AMONG MIDDLE AND HIGH SCHOOL STUDENTS UNITED STATES, 2014. MMW R. 2015. 70 Prevalence of Flavored Tobacco Product Use Among Current Middle and High School Student Tobacco Product Users, Percentage 63.5 63.3 60.6 60 58.8 53.6 50 Percentage 42.3 40 30 20 10 0 Cigars Cigarettes E-Cigarettes Hookah Smokeless Tobacco Pipe Tobacco

Prevalence among youth COREY CG, ET AL. FLAVORED TOBACCO PRODUCT USE AMONG MIDDLE AND HIGH SCHOOL STUDENTS UNITED STATES, 2014. MMW R. 2015. Among Current Cigar Smokers in Middle and High School, Use of Flavored Cigars by School Type, Percentage 100 90 80 Percentage 70 60 64.7 56.6 50 40 30 20 10 0 Middle School High School

Prevalence among youth COREY CG, ET AL. FLAVORED TOBACCO PRODUCT USE AMONG MIDDLE AND HIGH SCHOOL STUDENTS UNITED STATES, 2014. MMW R. 2015. Among Current Cigar Smokers in Middle and High School, Use of Flavored Cigars by Gender, Percentage 100 90 80 Percentage 70 65.8 58.9 60 50 40 30 20 10 0 Male Female

Prevalence among youth COREY CG, ET AL. FLAVORED TOBACCO PRODUCT USE AMONG MIDDLE AND HIGH SCHOOL STUDENTS UNITED STATES, 2014. MMW R. 2015. Among Current Cigar Smokers in Middle and High School, Use of Flavored Cigars by Race/Ethnicity, Percentage 100 90 80 Percentage 70 70.1 60 67.2 54.8 55.9 Black, non-hispanic Hispanic 50 40 30 20 10 0 White, non-hispanic Other race, non-hispanic

Prevalence among youth AMBROSE BK, ET AL., FLAVORED TOBACCO PRODUCT USE AMONG US YOUTH AGED 12-17 YEARS, 2013-2014. JAMA. 2015 Proportion of Youth Ever Users Reporting First Product Used was Flavored Proportion of Flavored Use Among Past 30Day Youth Tobacco Users Any Cigars 65.4% 71.7% Cigarettes 50.1% 59.5% E-Cigarettes 81.0% 85.3% Hookahs 88.7% 89.0% Smokeless Tobacco (excluding snus) 68.9% 81.0% Snus Pouches 81.2% 80.4%

Prevalence among young adults GLASSER AM, ET AL., CORRELATES OF CIGAR USE BY TYPE AND FLAVOR AMONG US ADULTS: 2011-2015. TOB REG SCI. 2017. 30-Day Prevalence of Flavored Cigar Use Among Current Young Adult Cigar Users, Percentage Did not use flavored cigars 53.2% Used flavored cigars 46.8%

Prevalence among young adults GLASSER AM, ET AL., CORRELATES OF CIGAR USE BY TYPE AND FLAVOR AMONG US ADULTS: 2011-2015. TOB REG SCI. 2017. 60 30-Day Prevalence of Flavored Cigar Use Among Current Young Adult Cigar Users by Age Group, Percentage 56.7 50 40.3 Percentage 40 30 20 10 0 18-24 years 25-34 years

Prevalence among young adults GLASSER AM, ET AL., CORRELATES OF CIGAR USE BY TYPE AND FLAVOR AMONG US ADULTS: 2011-2015. TOB REG SCI. 2017. 70 30-Day Prevalence of Flavored Cigar Use Among Current Young Adult Cigar Users by Gender, Percentage 60.9 60 50 Percentage 40.5 40 30 20 10 0 Male Female

Prevalence among young adults GLASSER AM, ET AL., CORRELATES OF CIGAR USE BY TYPE AND FLAVOR AMONG US ADULTS: 2011-2015. TOB REG SCI. 2017. 70 30-Day Prevalence of Flavored Cigar Use Among Current Young Adult Cigar Users by Race/Ethnicity, Percentage 61.4 60 52.0 Percentage 50 40 46.2 37.8 30 20 10 0 White, non-hispanic Black, non-hispanic Other, non-hispanic Hispanic

Prevalence among young adults GLASSER AM, ET AL., CORRELATES OF CIGAR USE BY TYPE AND FLAVOR AMONG US ADULTS: 2011-2015. TOB REG SCI. 2017. 70 30-Day Prevalence of Flavored Cigar Use Among Current Young Adult Cigar Users by Sexuality, Percentage 60.7 60 Percentage 50 46.8 40 30 20 10 0 Straight/Heterosexual LGB (excludes trans/other)

Prevalence among young adults GLASSER AM, ET AL., CORRELATES OF CIGAR USE BY TYPE AND FLAVOR AMONG US ADULTS: 2011-2015. TOB REG SCI. 2017. 70 30-Day Prevalence of Flavored Cigar Use Among Current Young Adult Cigar Users by Education, Percentage 63.1 60 52.2 Percentage 50 39.3 40 30 20 10 0 Less than high school High school At least some college

Prevalence among adults KING BA, ET AL., FLAVORED CIGAR SMOKING AMONG US ADULTS: FINDINGS FROM THE 2009-2010 NATIONAL ADULT TOBACCO SURVEY. NICOTINE TOB RES. 2012. 30-Day Prevalence of Flavored Cigars among Adults by Age Group, Percentage 10 9.1 9 8 Percentage 7 6 5 4 3.1 3 2 1.4 1 0.2 0 18-24 years 25-44 years 45-64 years 65+ years

Prevalence among adults KING BA, ET AL., FLAVORED CIGAR SMOKING AMONG US ADULTS: FINDINGS FROM THE 2009-2010 NATIONAL ADULT TOBACCO SURVEY. NICOTINE TOB RES. 2012. 30-Day Prevalence of Flavored Cigars among Current Adult Cigar Smokers by Age Group, Percentage 60 57.1 50 43.2 Percentage 40 28.9 30 20 13.4 10 0 18-24 years 25-44 years 45-64 years 65+ years

Preference for flavored cigar brands DELNEVO CD, ET AL., PREFERENCE FOR FLAVOURED CIGAR BRANDS AMONG YOUTH, YOUNG ADULTS AND ADULTS IN THE USA. TOBACCO CONTROL. 2015 100 Among Cigar Smokers, Usual Brand Makes Flavored Cigars by Age Group, Percentage 95.1 88.7 90 80 72.2 70 Percentage 63.2 60 50 40 30 20 10 0 12-17 18-25 Age Group 26-34 35+

Preference for flavored cigar brands DELNEVO CD, ET AL., PREFERENCE FOR FLAVOURED CIGAR BRANDS AMONG YOUTH, YOUNG ADULTS AND ADULTS IN THE USA. TOBACCO CONTROL. 2015 Among Cigar Smokers, Preferred Cigar Brand by Age Group, Percentage 60 50.5 50 42.1 40 Percentage 34.7 Black & Mild 30 Swisher Sweets White Owl [VALUE].0 20 19.4 18.0 15.5 13.8 10 5.9 5.4 3.9 2.5 0 12-17 18-25 Age Group 26-34 35+

Preference for flavored cigar brands DELNEVO CD, ET AL., PREFERENCE FOR FLAVOURED CIGAR BRANDS AMONG YOUTH, YOUNG ADULTS AND ADULTS IN THE USA. TOBACCO CONTROL. 2015 100 Among Cigar Smokers, Usual Brand Makes Flavored Cigars by Gender, Percentage 94.0 90 80 70.6 Percentage 70 60 50 40 30 20 10 0 Male Gender Female

Preference for flavored cigar brands DELNEVO CD, ET AL., PREFERENCE FOR FLAVOURED CIGAR BRANDS AMONG YOUTH, YOUNG ADULTS AND ADULTS IN THE USA. TOBACCO CONTROL. 2015 100 Among Cigar Smokers, Usual Brand Makes Flavored Cigars by Race/Ethnicity, Percentage 94.4 90 80 Percentage 70 74.4 74.3 Hispanic Other 70.4 60 50 40 30 20 10 0 White Black Race/Ethnicity

Flavored cigars: Why are they smoking them?

Consumer perceptions reduce throat irritation

Reasons for cigar use among youth AMBROSE BK, ET AL., FLAVORED TOBACCO PRODUCT USE AMONG US YOUTH AGED 12-17 YEARS, 2013-2014. JAMA. 2015 Leading Reasons for Cigar Use Among Past 30-Day Cigar Users Aged 12-17 Years Reasons for Use Percentage I use cigars because they come in flavors I like. 73.8% I use cigars because they are affordable. 58.2% I use cigars because I like socializing while using them. 57.0% I use cigars because people in the media or other public figures use them. 30.7% I use cigars because they might be less harmful to me than cigarettes. 29.9% I use cigars because people who are important to me use them. 28.4% I use cigars because I can smoke/use them at times when or in places where smoking cigarettes isn t allowed. 10.9% I use cigars because they help people to quit smoking cigarettes. 9.9%

Flavored cigars: How is the industry marketing them?

Marketing and promotion

Flavored cigars: Are they addictive?

Nicotine dependence intentions to quit smoking frequency of smoking

Flavored cigars: What are the policy solutions?

Policy options

Policy options Alaska Hawaii

Policy options 109 cities and local municipalities in MA, including Boston Alaska Hawaii

In Closing Flavoring is the biggest issue when it comes to cigars. Flavored cigar use is higher among youth and young adults than adults. The use of flavors in cigar products makes them more appealing. FDA, states, and localities must ban the sale of flavored cigars.

Thank you makbar@truthinitiative.org