Emerging Tobacco Products:

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• Emerging Tobacco Products
• New Products, Same Targets
• North Carolina Health and Wellness Trust Fund
  Annual Meeting
• October 22, 2009

Amber Thornton-Bullock, MPH, CHES
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Legacy Overview

• The American Legacy Foundation (Legacy) was
  created as the result of the MSA
• 46 States and 5 US Territories are included in
  the MSA
• Celebrating 10 years
• Mission is to build a world where young people
  reject tobacco and anyone can quit
• In addition to public education campaigns, truth
  and EX Legacy seeks to partner with communities
  most impacted by the toll of tobacco
• Restrictions of MSA no lobbying, vilification

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Emerging Products

• Little Cigars and Cigarillos
• Snus and Snuff
• Dissolvables
• Hookah
• New Cigarettes
• E-Cigarettes

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• The Product
• Little Cigars and Cigarillos

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Little Cigars and Cigarillos

• Cigars are defined by the US government as any
  roll of tobacco wrapped in leaf tobacco or in any
  substance containing tobacco.1
• Size Comparison
• Cigarette lt 3 lbs per 1000
• Little Cigar lt 3 lbs per 1000
• Cigar gt 3 lbs per 1000
• (includes cigarillo)

1. USC 5702. Available at http//frwebgate.acces
s.gpo.gov/cgi-bin/getdoc.cgi?dbnamebrowse_uscdoc
idCite26USC5702
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Cigarillos
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Cigarillos

• Often look like smaller versions of traditional
  stogie cigars.
• come in a variety of flavors (cherry, apple,
  menthol, wine, etc.).

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Cigarillos

• Sales of cigarillos increased by almost 150
  between 1997 and 2007.¹
• Phillip Morris now owns Black Mild, the most
  popular brands of cigarillos.

1Maxwell JC. The Maxwell Report Cigar Industry
in 2007. Richmond, VA John C. Maxwell, Jr. 2008
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Where do Cigarillos fit?

• Cigars are divided into two federal tax
  categories based on weight 1) small cigars 2)
  large cigars
• Cigarillos have no current federal tax definition
  
• Cigarillos are included in large cigar category
  despite significant differences in their
  marketing and packaging from that of typical
  large cigars

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Small/Little Cigars
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Little cigars

• available in a variety of flavors (vanilla,
  grape, watermelon, cherry, chocolate, menthol,
  etc).
• include flavors that may appeal to youth and
  young people.

Carpenter CM, et al. New Cigarette Brands with
Flavors that Appeal to Youth Tobacco Marketing
Strategies. Health Affairs, 2005 24(6)
1601-1610.
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Cigar or Cigarette in Disguise???
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Little Cigars

• Sales of little cigars have increased by 240
  between 1997-2007¹.
• A review of formerly-secret tobacco industry
  documents finds that little cigars were intended
  to replace cigarettes as advertising became
  restricted².
• Increase in consumption is frequently attributed
  to increases in tax on cigarettes, as cigars have
  historically been taxed at dramatically lower
  rates.

1Maxwell JC. The Maxwell Report Cigar Industry
in 2007. Richmond, VA John C. Maxwell, Jr.
2008. 2Delnevo CD, Hrywna M. A whole nother
smoke or a cigarette in disguise how RJ
Reynolds reframed the image of little cigars.
American Journal of Public Health, 2007
97(8)1368-75.
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Cigar Tax Rate

• New Federal tax rates as of April 1, 2009
• Small cigars 1.01 per pack of 20 (old rate was
  .04/pack)
• Large cigars 52.75 of manufacturers price
  capped at .40 per cigar (old rate was 20.72 of
  manufacturers price capped at .05 per cigar)

Source 26 USC 5701 as amended by the
Childrens Health Insurance Program
Reauthorization Act (P.L. NO. 111-003)
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• Little Cigar and Cigarillo Research

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Challenges to Data

• No national surveys provide data stratified by
  the three main cigar products (small cigar,
  cigarillo and large cigar).
• Instead, cigar sizes are grouped which results in
  aggregated prevalence estimates that are not
  specific to any one product.
• These various products have unique
  characteristics anecdotal evidence suggests
  they are smoked differently.
• Some tobacco users do not self report as cigar
  users until brands are specified.

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Highlights from Extant Research

• 2000 Rigotti et al. US College Students Use of
  Tobacco Products was assessed as part of the
  ongoing Harvard college Alcohol Survey
• Over 14000 randomly selected students,
• Cigar prevalence 23 used in past year, 8.5
  were current users
• 2005 Delnevo et al. Lower cost of cigar products
  may be influencing youth consumption patterns of
  tobacco
• 2008 Soldz et al. Cigar smoking and brand
  preference in a sample (n 5006) of middle and
  high school students in Massachusetts
• 16 smoked cigars
• Phillies were most popular, followed by Black and
  Mild and Swisher Sweets
• 2008 Jolly Little cigar use at a HBU
• focus groups of college students demonstrated
  that some believe these products to be less
  harmful than cigarette
• 2009 Terchek et al. Current national survey
  items might not adequately measure cigar use,
  need for brand-specific items

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National Study on Descriptive Epidemiology of
Cigar Use

• Methods
• Data Source National Survey on Drug Use or
  Health (NSDUH) conducted by US Substance Abuse
  and Mental Health Services Administration
  (SAMHSA)
• Study Design Annual U.S. annual household
  cross-sectional surveys probability sampling
• Study period 2002-2007 (6 cross-sectional
  surveys)
• Sample population over 60,000 people aged 12
  annually nationally representative.
• Measures/Outcomes prevalence of cigar Ever
  use, Past 30-day use, and frequency of use in
  past 30-days demographics risk behavior
• Mode of Questionnaire administration audio
  computer-assisted self-interview (CATI)
• Statistical analysis Weighted, stratified
  estimates of prevalence over time

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Prevalence in Past 30-Day Cigar Use among for
18-25 year olds
NSDUH 2002-2007
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Prevalence in Cigar Ever Use and Past 30-Day Use
by Age
NSDUH 2002-2007
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Cigar Brand Preferences
NSDUH 2002-2007
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Black Mild brand use by Race
NSDUH 2002-2007
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Summary of Data on Little Cigars and Cigarillos

• Results
• Prevalence and brand preference variation exists
  by age, gender and race/ethnicity.
• Prevalence rates are highest in male adults 18-25
  years.
• The brands most popular to those aged 18-25 are
  ones that represent little cigars and cigarillo
  products.
• NSDUH Data Limitations Potential Solution
• Only people who say they smoke cigars,
  cigarillos, or small cigars were asked the brand
  question. But some youth recognize the brand
  names, only. Surveys should ask about specific
  brands to improve accuracy in self-reported use
  of these products.
• Brand names and/or photographs could be included
  in the initial screener question on survey
  instruments to achieve this.

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Marketing Strategies

• How the industry keeps hooking new customers

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Marketing of Little Cigars and Cigarillos

Magazine Ad in Sports Illustrated , 2001
Magazine Ad in Car and Driver, 2007
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Coupons
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Swisher International
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Advertisement WebsiteRoyal Blunts
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Advertisement WebsiteCaptain Black
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Advertisement Promotions

• Winchester
• An American Sweepstakes
• Royal Blunts
• Discounts available through retailers
• Hunid Racks
• They sell CD singles/DVDs featuring their
  artists B-Legit, Richie Rich, YUKMOUTH and Messy
  Marv
• Link to get a Hunid Racks Debit Card

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Cigarillos on Facebook YouTube

• Some users decided to make Facebook groups and
  YouTube videos for their favorite brands.
• Problem Facebook users are traditionally of a
  younger age bracket.

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Brand Promotion

• Case in point shows the creative lengths the
  industry will go through to promote a brand.

Phillies Adidas product line limited release,
no future plans for full release of product line
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Brand Promotion

• ARI Menthol 10s Shoes
• Made to look like Nike
• Limited release in 2006

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In-Store Placement Eye Level is Buy Level
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In-Store Placement Eye Level is Buy Level
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• Emerging Tobacco
• Products

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Snus and Snuff

• Snus. A spitless tobacco packaged in small
  teabag-like pouches. Modeled after a Swedish
  product
• Marlboro snus tested starting 2007 in plastic
  packs, now in smaller foil packs
• Camel snus   Ads now appear nationally in
  magazines
• Moist Snuff.  Finely ground tobacco packaged in
  cans or pouches, sold moist (placed between the
  lower lip or cheek and gum)
•  Marlboro moist snuff tested starting in 2006,
  discontinued 2009
•  Camel Dip testing starting June 2009
• While overall prevalence of smokeless tobacco use
  has declined in recent years, prevalence of moist
  snuff use is on the rise in men aged 18-44 and
  daily cigarette smokers. (Simard et al., APHA
  135th meeting, 2007)
• While cigarette smoking sales continue to decline
  in the US, moist snuff continues to grow in
  popularity, accounting for 71 of the US
  smokeless market in 2006. (Carpenter et al.,
  Tobacco Control, 20091854-59)

Images Philip Morris, tobaccoproducts.org.
socialbranding.org
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Dissolvable Tobacco

• Three new dissolvable tobacco products made of
  finely milled tobacco, dissolve in the mouth do
  not require spitting. Orbs began test marketing
  in Jan, 2009
• Orbs mint-sized
• Strips appear like Listerine breath strips
• Sticks toothpick-like
• Packaging appearance seems like it may appeal to
  youth

Images Reynolds, Harvard School of Public Health
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Hookah

• Water pipe smoking that hails from Middle
  East
• Water does not filter all the toxic compounds
  and chemicals

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Hookah

• Poses serious health risks to smokers and others
  exposed to smoke.
• A typical one-hour long Hookah session involves
  inhaling 100-200 times the volume of smoke
  inhaled in a single cigarette.

CDC Factsheet
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E-Cigarettes

• Battery-operated devices generally containing
  cartridges filled with nicotine, flavors and
  other chemicals. Vaporized, then inhaled.
• Available in flavors, such as chocolate or mint,
  which may appeal to young people.
• One small sample done by FDA found diethylene
  glycol (a chemical used in antifreeze, toxic to
  humans)
• Other samples FDA analyses detected carcinogens,
  including nitrosamines

Images DSE901 manual, Instead electronic
cigarettes, Journal Star
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New Cigarettes

• Newport M available only in Pennsylvania
• Virginia Slims Superslims introduced late 2008,
  early 2009, come in purse packs, thinner
• public health groups have called them out for
  marketing toward women and younger girls, with
  fashionable colors, and sleek sparkling boxes.
• Camel Crush introduced fall 2008, filter
  contains capsule to be crushed by squeezing,
  releasing menthol flavor
• Marlboro Blend No. 54 introduced summer 2009,
  Mentholated

Images tobaccoproducts.org, tobaccowatch.org
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RYO Vending Machine
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Examples Actions Taken By Others

• Maine- in 2007 banned most flavors of cigars and
  cigarettes, law takes effect July 1, 2009.
• Baltimore City- banned single sales of cheap
  cigars, requiring that they be sold in packs of 5
  to attempt to reduce youth usage.

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Get Involved

• Hold public forums on this issue
• Research gaps This can be addressed by adding
  product/brand specific questions on local surveys
• Educate youth advocates and community at large on
  the issue and that these products are harmful

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Get Involved

• Ensure that materials, campaigns and resources
  for tobacco prevention and control are relevant,
  culturally competent and linguistically
  appropriate
• Tax increases ultimately have public health
  benefits generally less product consumption

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• Questions?

Contact Information abullock_at_americanlegacy.org,
202-454-5591