Abstract
Background:
Historically, blunt use constituted tobacco-cannabis co-use based on the products available for creating blunts (e.g., hollowed-out cigars filled with cannabis). With the introduction of tobacco-free blunt wraps (e.g., hemp wraps), blunt use now may constitute tobacco-cannabis co-use or exclusive cannabis use. We examined adolescents’ use of tobacco and tobacco-free blunt products and highlighted how misclassification of tobacco-cannabis co-use versus exclusive cannabis use may occur if products used to make blunts are not assessed.
Methods:
4,855 students from eight Connecticut high schools completed an online survey in 2022. Use of tobacco products for making blunts (e.g., cigarillos, tobacco blunt wraps) and tobacco-free blunt wraps were assessed as was the use of other tobacco products (e.g., e-cigarettes, cigarettes, hookah). The analytic sample comprised 475 students who endorsed lifetime blunt use.
Results:
Tobacco-free blunt wraps (72.6%) were the most popular product for making blunts, followed by cigarillos (56.5%), tobacco blunt wraps (49.2%), and large cigars (13.0%). When classified into mutually exclusive groups, students reported exclusive tobacco-free blunt use (32.3%), exclusive tobacco product blunt use (27.4%), or use of both tobacco product and tobacco-free blunts (40.3%). Among those exclusively using tobacco-free blunts, 13.4% endorsed no tobacco product use.
Conclusions:
Tobacco-free blunt wraps were very popular among high school adolescents, highlighting the importance of assessing products used for making blunts. Assuming that blunts contain tobacco without considering tobacco-free blunts can lead to misclassification of blunt use as tobacco-cannabis co-use when it actually reflects exclusive cannabis use, potentially leading to inflated estimates of tobacco use.
Keywords: cannabis, marijuana, blunts, tobacco, youth, adolescent
1.0. INTRODUCTION
The term “blunt” has multiple meanings for products that consumers smoke. A “blunt” originally referred to a mid-size, cylindrical tobacco cigar with a flat (blunt) tip (cigarcyclopedia.com; 2010). However, by the 1990s in the United States, the term “blunt” began to refer to a tobacco cigar (often an inexpensive tobacco blunt cigar) that had been hollowed out and filled with cannabis (e.g., Golub et al., 2006). Blunt wraps also can be used to make blunts and comprise only the external wrapper for making a blunt. The consumer fills the wrap with cannabis and rolls it up to create the blunt. Initially, all blunt wraps were made of tobacco, so all blunt use (i.e., tobacco-only blunt cigars, hollowed out tobacco cigars filled with cannabis, tobacco blunt wraps filled with cannabis) reflected tobacco-cannabis co-use.
However, in the past several years, tobacco-free blunt wraps entered the market. These wraps are made from non-tobacco sources including hemp, banana leaves, Cordia leaves, and Tendu leaves. Tobacco-free blunt wraps are marketed as a healthier, tobacco-free, and nicotine-free alternative to traditional tobacco blunts (Jordan, 2020) and often carry additional appealing descriptors on product packaging or in product descriptions like “natural,” “no synthetic dyes or colors,” “organic and GMO-free,” and “vegan” (Ghezelbash, 2023). These marketing strategies may appeal to individuals who are opposed to using tobacco, who dislike the effects of nicotine, and/or who dislike the taste of cigars or tobacco blunt wraps but who enjoy the experience of smoking a blunt, which often contains significantly more cannabis than a joint, lasts longer, and is often used in social situations. With the introduction of tobacco-free blunt wraps, blunts can no longer universally be considered tobacco-cannabis co-use; smoking a tobacco-free blunt wrap filled with cannabis constitutes cannabis use only. Therefore, assessing the type of blunt used to smoke cannabis is critical for determining whether use constitutes co-use with tobacco or exclusive cannabis use.
Blunts are particularly popular among youth and young adults (Kong et al., 2018) and often are the first product tried (Mayer et al., 2020). Unfortunately, tobacco-cannabis co-use, including blunts, is associated with many negative outcomes among young people including increased exposure to both cannabis and nicotine (Mayer et al., 2020), which can impede neurological development during this critical period and facilitate the development of nicotine and cannabis dependence (Yuan et al., 2015); increased toxicant exposure including carbon monoxide compared to tobacco or cannabis use alone (Meier & Hatsukami, 2016); concurrent use of cigarettes, cigars, and e-cigarettes (e.g., Camenga et al., 2014; Mayer et al., 2020); poor mental health (Ramo et al., 2012); and engagement is high-risk behaviors like driving after use (Tucker et al., 2019). Given the popularity of blunts among youth and the many associated concerns, we examined high school students’ self-reported use of tobacco and tobacco-free products for making blunts. This allowed us to determine what percentage of blunt use constituted tobacco-cannabis co-use versus exclusive cannabis use. Additionally, we assessed lifetime use of a variety of tobacco products (e.g., e-cigarettes, cigarettes) to determine what percentage of students who endorsed exclusively using tobacco-free blunts reported using tobacco product(s) or not. This allowed us to determine what percentage of students endorsing exclusive tobacco-free blunt use would be accurately or inaccurately classified as engaging in lifetime tobacco product use overall. It is critical to highlight the scope of misclassification given the broader need to establish accurate population-based estimates of tobacco product use.
2.0. MATERIALS AND METHODS
2.1. Participants and Procedures
The Yale University Institutional Review Board approved all procedures. In Fall 2022, 4,855 students from eight Connecticut high schools completed a 20-minute, school-wide, anonymous, online survey. Two weeks before survey administration, each school emailed parents/guardians study information and instructions for opting-out their child (48 children were opted-out). We gave teachers instructions for survey administration, our contact information for any questions, and survey links for their students. The overall response rate was 87.6%. Our analytic sample comprised students who reported lifetime blunt use (defined as ever use of a “cigar, cigarillo, little cigar, or blunt wrap filled with marijuana” and accompanied by images of blunts) and responded to the question about products used to make blunts described below (n = 475 [9.8% of the total sample]; Table 1).
Table 1.
Demographic characteristics of high school students who reported lifetime cannabis blunt use and use of different products for making blunts
| Total Sample |
Blunt Type Known |
|
|---|---|---|
| Sample Size | 475 | 347 |
| Age | 16.00 (1.24) | 16.05 (1.24) |
| Male Sex | 51.4% | 51.0% |
| Hispanic Ethnicity | 41.6% | 41.9% |
| Race | ||
| White | 54.2% | 53.2% |
| Black | 16.1% | 15.9% |
| Multiracial | 11.2% | 12.2% |
| Other | 18.5% | 18.7% |
| Routes of Cannabis Administration | ||
| Blunts | 100.0% | 100.0% |
| Joints, pipes, bongs | 83.0% | 87.8% |
| Edibles | 56.8% | 63.7% |
| Vaping concentrates | 53.6% | 57.9% |
| Vaping flower/bud | 37.3% | 39.6% |
| Dabbing with rig and torch/nail | 22.6% | 26.8% |
| Raw/Juiced | 11.3% | 12.8% |
| Tinctures | 11.3% | 14.6% |
| Topical | 9.7% | 11.0% |
| Blunt-Specific Constructs | ||
| Age of Onset for Blunt Use | 13.63 (2.14) | 13.54 (2.17) |
| Any Past-Month Blunt Use | 54.30% | 62.0% |
| Past-Month Blunt Use (# days)* | 11.60 (11.06) | 12.61 (1.11) |
| All Products Used for Blunting | ||
| Uncertain of Product Used | 26.9% | 0% |
| Tobacco-free Blunt Wraps | 53.1% | 72.6% |
| Any Tobacco Product | 49.5% | 67.7% |
| Cigarillos | 41.2% | 56.5% |
| Tobacco Blunt Wraps | 36.0% | 49.2% |
| Large Cigars | 9.5% | 13.0% |
| Blunt Type | ||
| Tobacco Only | -- | 27.4% |
| Tobacco & Tobacco-Free | -- | 40.3% |
| Tobacco-Free Only | -- | 32.3% |
Note. Data for continuous variables are presented as Mean (Standard Deviation). The 128 students who indicated not knowing the type of blunt they used were excluded from “Blunt Type Known.”
Past-month frequency of blunt use is reported only for those who endorsed any past-month use. The question for assessing “Products Used for Making Blunts” was select all that apply. The categories for “Overall Blunt Type(s) Used” are mutually exclusive. The category “Tobacco & Tobacco-Free” included those who endorsed use of tobacco-free blunt wraps and tobacco blunt wraps, cigarillos, and/or large cigars to make blunts. The category “Tobacco-Free Only” included those who only endorsed using tobacco-free blunt wraps to make blunts. The category “Tobacco Only” included those who endorsed using only tobacco blunt wraps, cigarillos, and/or large cigars to make blunts.
2.2. Measures
2.2.1. Demographics
Participants reported on biological sex (female, male), Hispanic ethnicity (no, yes), and race (all that applied from American Indian or Alaska Native, Asian, Black, Native Hawaiian or Pacific Islander, “Other,” and White).
2.2.2. Blunt Use History
Age of onset of blunt use (in years) and past-30-day frequency of blunt use (number of days) were assessed.
2.2.3. Products Used to Make Blunts
Participants selected all products they had used to make blunts from the following: “Cigarillos or Little Cigars (like Dutch Masters, Entourage, Game, Swisher Sweets, or Black and Milds) that you hollowed out and added marijuana to,” “Large Cigars (like traditional ‘Cuban cigars’) that you hollowed out and added marijuana to,” “Blunt Wraps made from tobacco (like ZigZag or Grapeape) - just the outside wrapper that you filled with marijuana,” and/or “Blunt Wraps made without tobacco (like Twisted Hemp Wraps or King Palm) - just the outside wrapper that you filled with marijuana.” Participants also could indicate “I don’t know,” which was treated as an exclusive answer. A three-level variable was created reflecting exclusive use of tobacco products (only cigarillos, large cigars, and/or tobacco blunt wraps), exclusive use of tobacco-free blunts wraps, or use of both tobacco products and tobacco-free blunt wraps for making blunts.
2.2.4. Other Tobacco Product Use
Participants reported on ever use of e-cigarettes, heated tobacco (e.g., IQOS), cigarettes, hookah, cigarillos (without cannabis), large cigars (without cannabis), smokeless tobacco, and nicotine pouches. Images and descriptions accompanied each product, and participants had to respond “no” or “yes” to indicate ever use of each product.
2.2.5. Analyses
We ran descriptive statistics for all study variables. To get a sense of the popularity of blunt wraps overall, we examined the percentage of students who endorsed using any blunt wrap, tobacco or tobacco-free. We then examined the percentage of students who reported using each individual tobacco product (i.e., cigarillos, large cigars, and/or tobacco blunt wraps) for making blunts versus the percentage who endorsed exclusively using tobacco-free blunt wraps. Finally, we examined how many students who reported exclusively using tobacco-free blunt wraps endorsed using any tobacco product assessed (e.g., e-cigarettes, cigarettes).
3.0. RESULTS
Among the 475 students who endorsed ever using blunts, 73.1% knew what type of blunt(s) they used. Among the 347 students who knew what product(s) they used to make blunts, blunt wraps as a product category (tobacco and/or tobacco-free wraps) were highly endorsed (89.9%). For individual product types, tobacco-free blunt wraps were most endorsed (72.6%), followed by cigarillos (56.5%), tobacco blunt wraps (49.2%), and large cigars (13.0%). Overall, 67.7% reported using a tobacco product to make a blunt.
When we created mutually exclusive groups reflecting blunt type used, 40.3% of students reported using both tobacco products and tobacco-free blunt wraps, 32.3% reported exclusively using tobacco-free blunt wraps, and 27.4% reported exclusively using tobacco products to make blunts.
Of those who reported exclusively using tobacco-free blunt wraps, 86.6% endorsed tobacco product use (i.e., e-cigarettes [93.8%], cigarettes [26.8%], large cigar without cannabis [22.7%], hookah [20.6%], nicotine pouch [14.4%], cigarillo without cannabis [9.3%], smokeless tobacco [7.2%], heated tobacco [3.1%]). However, 13.4% indicated no tobacco product use.
4.0. DISCUSSION
Overall, blunt wraps (tobacco and tobacco-free) were more popular for making blunts within our sample than were traditional cigars and cigarillos. When we examined individual blunt types, tobacco-free blunt wraps were most popular (72.6%), followed by cigarillos (56.5%), tobacco blunt wraps (49.2%), and large cigars (13.0%). Findings suggest that it is critical to assess products used to make blunts to accurately classify blunt use as tobacco-cannabis co-use versus cannabis only; if blunt use was automatically classified as tobacco co-use based on older definitions and products for creating blunts, the 32.3% of students who reported exclusively using tobacco-free blunt wraps in our sample would have been misclassified as using a tobacco blunt.
When we broadened our scope to determine what percentage of students who reported exclusive tobacco-free blunt use also reported lifetime tobacco product use (e.g., e-cigarettes, cigarettes), 13.4% did not endorse any tobacco use. Thus, if these students were assumed to use tobacco products based on their blunt use status, this would inaccurately reflect their tobacco use status and inflate estimates of tobacco use.
Several study limitations must be considered. First, the data were from a convenience sample, which limits generalizability. Second, we relied on self-report, and it was not possible to confirm the use of different product types. Third, our survey assessed lifetime use of different products for making blunts. Thus, future work is needed to assess tobacco-free and tobacco blunt use among those who use blunts regularly (e.g., monthly, daily). Fourth, informed by common terminology used within the cannabis community (e.g., Jaramillo, 2023; Leafly.com; Main, 2022), we defined blunts as a “cigar, cigarillo, little cigar, or blunt wrap filled with marijuana.” However, we did not assess whether students added any other substances, including tobacco, to their blunts. Of note, there is a term used for mixing cannabis and tobacco together, most often in joint - a “spliff’ (Jaramillo, 2023; Leafly.com,;Main, 2022), and spliff use is more common in Europe than in the United States (Jaramillo, 2023; Schauer et al., 2017). Thus, we believe the rate of adding tobacco to tobacco-free blunts likely was low. However, some students who reported exclusively using tobacco-free blunt wraps may have added tobacco to their blunts, which would alter the reported percentages of blunt use constituting tobacco-cannabis co-use versus exclusive cannabis use. Thus, future research should explicitly examine what substances other than cannabis, if any, youth put into their blunts. Finally, we could not report on the exclusive use of tobacco blunt cigars without added cannabis (e.g., Phillies Blunt Cigars) because we assessed tobacco cigar use, which would include blunt cigars, as a broad category. Numerous brands of tobacco blunt cigars continue to be sold, so it will be important to assess the use of blunt cigars without added cannabis to determine whether there also is a problem with misclassifying tobacco-only blunt cigar use as cannabis use.
In sum, there are three key conclusions from this study. To our knowledge, we have highlighted for the first time the tremendous popularity of blunt wraps, especially tobacco-free blunts wraps, among youth who smoke cannabis blunts. Additional research is needed to understand the appeal of blunt wraps to youth - which is likely related to the fact that they come in appealing flavors (e.g., blueberry, mango, sour apple), are inexpensive, and are widely available - as well as other important information like frequency of use relative to other routes of cannabis consumption. Second, the observed popularity of both tobacco-free and tobacco blunt wraps in our sample suggests that current definitions of the term “blunt” (e.g., “a cigar that has been hollowed out and filled with marijuana” [Meriam Webster, 2023]; “a traditional cigar, cigarillo, or filtered cigar with marijuana in it” [United States Department of Health and Human Services, 2020]) should be updated to include blunt wraps so that the definition more accurately captures the full range of products used to make blunts. Finally, it is necessary to query about specific products used to make blunts to accurately classify cannabis blunt use as tobacco-cannabis co-use versus exclusive cannabis use.
Highlights.
Today, cannabis blunt use may reflect tobacco-cannabis co-use or exclusive cannabis use
It is critical to assess tobacco and tobacco-free products used to make blunts
In youth, tobacco-free blunt wraps were most popular; 32.3% endorsed exclusive use
13.4% of those exclusively using tobacco-free blunts did not use any tobacco products
Asking about blunt products used is key for determining cannabis and tobacco use status
Acknowledgements
The authors thank all participants for contributing to this work.
Role of Funding
Efforts by Drs. Morean, Kong, Bold, Davis, and Krishnan-Sarin were supported by grant number U54DA036151 from the National Institute on Drug Abuse of the National Institutes of Health and the Center for Tobacco Products of the U.S. Food and Drug Administration. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the U.S. Food and Drug Administration.
Footnotes
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Conflict of Interest
The authors have no conflicts of interest to declare related to the current study.
Data Availability
Data will be made available upon reasonable request to the corresponding author, Meghan Morean, PhD (meghan.morean@yale.edu).
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data will be made available upon reasonable request to the corresponding author, Meghan Morean, PhD (meghan.morean@yale.edu).