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The Relative Association of Cigars and Cigarettes
to Adolescent Risk BehaviorMargaret Cox, M.P.H.
Candidate1,2 Elizabeth G. Larkin, M.S.2,3 and
Scott Frank, M.D., M.S.2 Dept. of Family
Medicine, Division of Adolescent Health1 Dept.
of Epidemiology and Biostatistics, Division of
Public Health2 Cuyahoga County Board of
Health3 Case Western Reserve University,
Cleveland, OH
OBJECTIVE To examine health risk behavior
differences among adolescents who do not smoke
tobacco smoke only cigarettes smoke only
cigars and smoke both cigarettes and cigars,
emphasizing on the latter two groups as special
risk categories. BACKGROUND Cigar use is an
underemphasized contributor to adolescent health
risk, often viewed as innocent when compared to
cigarette smoking. Cigar use has been justified
by some users as a measure of harm reduction due
to its decreased frequency of tobacco consumption
compared to cigarette use. Cigar only use and
multiple tobacco product use have not been
examined for similar risk as a gateway to
engagement in other adolescent risk
behaviors. METHODS The Youth Risk Behavior
Survey was administered to 4895 students in a
Midwestern county during 2003 and 2004. Items
assessing current cigarette use and current cigar
use were utilized to categorize students into
cigarette only use, cigar only use, and cigarette
and cigar use. Chi-square analysis explored
variation between groups. Logistic regression
investigated the relationship between use of
various tobacco products and other health risk
behaviors, while controlling for potentially
confounding demographic variables.
TABLE 2 DEMOGRAPHIC CHARACTERISTICS OF SMOKING
GROUPS
Significantly different among groups at the
0.05 level.
RESULTS Current cigar use (20.8) was higher than
current cigarette use (18.5) in this adolescent
survey population. Among participants, 72.1 did
not smoke 7.1 smoked cigarettes only 9.4
smoked cigars only and 11.4 smoked both
cigarettes and cigars. Students reporting either
cigar only use or cigarette only use conferred
many equivalent increased health risk behaviors.
Adolescents engaging in both cigarette and cigar
use reported increased health risk behaviors such
as drinking and driving, weapon carrying,
physical fighting, alcohol use, marijuana use,
and hard drug use. Cigarette and cigar only use
differed regarding mental health items of feeling
sad or hopeless for two or more weeks and
considering suicide in the past
year. CONCLUSIONS While cigar only and cigarette
only users presented similar increased risk,
those smoking both cigarettes and cigars were the
largest group of adolescent tobacco users and
those engaging in the most health risk behaviors.
Higher odds ratios among the cigarette only
group regarding mental health items could be
related to the frequency of self-medication as a
coping mechanism for depression. These findings
may indicate necessary adjustments to current
tobacco prevention and intervention campaigns.