Abstract
Background
Premium cigar use is infrequent compared with the use of other tobacco products, including other cigar types (eg, cigarillos), though current measurement methods for premium cigar use have limitations. Accordingly, prevalence estimates from existing surveillance studies likely underestimate the true prevalence of premium cigar use.
Aims and Methods
Using an online convenience sample of adults (ages 18–45 years) surveyed in February 2022, we examined premium or traditional cigar prevalence and characterized users based on four definitions of use: (1) past-year use, (2) past 30-day use, (3) use every day or some days, and (4) use every day, some days, or rarely, using a novel, one-item measure. We examined demographics, cigar use behaviors, and other tobacco product use for each definition and conducted sensitivity analyses using cigar brands.
Results
Prevalence estimates ranged from 1.8% using Definition 3 to 11.6% using Definition 1. Regardless of definition, premium or traditional cigar users were largely male, white, and aged 25–45 years. A large proportion of users based on Definition 3 were aged 25–34 years, had a regular premium cigar brand, smoked cigars on more than one day in the past month, used cannabis in the past month, and reported perceiving premium cigars as less harmful compared with cigarettes.
Discussion
Prevalence estimates of premium or traditional cigar use varied by more than fivefold based on the definition of use and user characteristics varied by definition. Existing national surveys are likely underestimating the prevalence and patterns of premium cigar use.
Implications
Given that the negative health effects of premium cigars vary based on how the cigars are used (eg, frequency or duration), as well as co-use with other tobacco products and substances (eg, alcohol and cannabis), accurate measurement of these products is important for understanding patterns of use and their impact on public health.
Introduction
There are numerous types of cigar products available to consumers in the United States, which have distinct product and user characteristics. These include cigarillos, filtered (or little) cigars, and traditional cigars, which include premium and non-premium cigars. Although premium, hand-rolled cigars have been the stereotypical product associated with cigar smoking, they make up only 2–3% of the cigar market.1 As such, the majority of research on cigar use in the United States has either focused on inexpensive, mass-produced cigarillos, which make up the majority of cigar sales and are the most widely used cigars,2 or examined cigars as a broad category (ie, does not distinguish between cigar types). Premium cigars, however, have been the focus of legal action and congressional bills aiming to exempt them from oversight.3 Through litigation, trade associations representing premium cigar companies have successfully had regulations overturned that would require premarket approval for premium cigars and health warning statements on all cigar products.4,5 Lack of evidence on premium cigars has impacted these decisions by the court.
In 2021, the National Academies of Sciences, Engineering, and Medicine (NASEM) convened a committee to evaluate the available evidence of the health effects of premium cigar use and to identify research gaps. One of the needs identified by the committee’s report, which was released in March 2022, was ensuring that national surveys (eg, the Population Assessment of Tobacco and Health [PATH] Study) measure both regular use and less frequent patterns of use (eg, past-year use) to capture the full spectrum of people who use premium cigars.6 The NASEM report highlighted that the health effects of premium cigars depend on use patterns, therefore understanding premium cigar patterns of use is critical for estimating their impact on public health.6
Since most research on cigar use in the United States has examined cigars as a broad category or does not distinguish between types of traditional cigars (ie, premium vs. non-premium cigars), people who smoke premium cigars are often not identified. In fact, no national survey in the United States directly measures premium cigar use. The National Survey on Drug Use and Health (NSDUH) and the PATH Study have been used to assess premium cigar use indirectly, via brand and/or price paid.2,7 NSDUH asks about the use of “any type of cigar”. Those who report past 30-day use are then asked what brand they used most often in the past 30 days. Respondents can then be classified as being someone who smokes a certain type of cigar based on their reported brand (eg, users of Macanudo would be categorized as premium cigar smokers).6,7 This method is limited, however, since some brands produce multiple types of cigar products (eg, cigarillos and filtered cigars) and those without a regular brand are not captured. Additionally, this method does not capture the use of multiple cigar types or any use outside of the past 30-day window. The PATH Study measures cigar use by type (ie, cigarillo, filtered cigar, or traditional cigar), but does not directly measure premium cigar use. Rather, those who report traditional cigar use can be further categorized as premium or non-premium cigar users based on their regular brand and price paid per cigar.2,6 As with NSDUH, this has limitations because some brands produce multiple types of cigars. Additionally, if a premium cigar smoker does not identify as a traditional cigar smoker, then they will not be asked the subsequent question about brand and therefore will be misclassified as someone who does not use premium cigars.
Another challenge is that people who smoke premium cigars are likely a small population and not well-represented in current national surveys. The best national estimates from the PATH Study and NSDUH suggest that approximately 0.7–0.9% of U.S. adults smoke premium cigars.2,6 Yet these definitions reflect more regular patterns of use, including those who have ever used fairly regularly, now smoke every day or some days, report using a brand defined as a premium cigar brand,2,6 or those who report using in the past 30 days.6 However, a study using data from the National Adult Tobacco Survey found that among those who usually smoked premium cigars, 3.3% reported “every day” use, 25.6% reported “some day” use, and 71.2% reported using “rarely”.8 Given seasonal patterns in cigar sales,6 the time at which surveys are fielded likely affect prevalence estimates, especially if use is defined within a limited time frame (eg, past 30 days). As such, data from both the PATH Study and NSDUH likely underestimate the true prevalence as they fail to capture infrequent patterns of premium cigar users (eg, past year and rare use). The result is that our understanding of who uses premium cigars (ie, older, white males) may not reflect the true population of users.
By following the recommendations from the NASEM report and expanding the definition of premium cigar use to include less frequent users, prevalence estimates and our understanding of who uses premium cigars may change. Using a novel measure, we estimated the prevalence of traditional cigar use and user characteristics using four definitions of premium or traditional cigar use that vary in terms of frequency and recency of use. We then used brand to further distinguish between those who smoke premium and non-premium cigars.
Methods
Study Sample
Data are from the Rutgers Omnibus study, a quarterly, cross-sectional, web-based mTurk survey of 18–45 year olds in the United States fielded by the Rutgers Center for Tobacco Studies. The study includes people who use and do not use tobacco and nicotine products. Roughly 3000 individuals participate in each wave, about two-thirds of whom are first-time participants while the remainder could have participated in prior waves. For this study, one wave of data was used (February 2022). The total analytic sample included 2988 adults.
Measures
Premium or Traditional Cigar Use
All respondents were asked, “Traditional or premium cigars contain tightly rolled tobacco that is wrapped in a tobacco leaf. Some common brands of cigars include Macanudo, Romeo y Julieta, and Arturo Fuente, but there are many others. Have you ever smoked a traditional or premium cigar, even one time? (yes/no)”. The question was accompanied by an image of a premium cigar. Those who responded yes were asked, “In the past 12 months, have you smoked a traditional or premium cigar? (yes/no)”. All respondents who reported having smoked in the past year were asked to report on how many of the past 30 days they smoked a traditional or premium cigar and whether they currently smoke traditional or premium cigars every day, some days, rarely, or not at all. We created four definitions of premium or traditional cigar use based on these questions: (1) past-year use; (2) past 30-day use; (3) every day or some day use; and (4) every day, some day and rare use. These groups were not mutually exclusive. For example, those who reported use in the past 30 days were also categorized as having used in the past year.
Premium or Traditional Cigar Use Characteristics
Among people who had used traditional or premium cigars in the past year, we asked about the number of days that they used the product in the past 30 days. Those who reported currently smoking premium or traditional cigars every day, some days, or rarely were asked whether they have a regular brand of premium or traditional cigars.
Demographics
We measured age (18–24 years, 25–34 years, and 35–45 years), sex (male, female), race/ethnicity (non-Hispanic White, non-Hispanic Black, non-Hispanic other, and Hispanic), and educational attainment (High school or less, Associates degree or some college, Bachelor’s degree or higher).
Other Tobacco and Substance Use
We measured the past 30-day use of cigarillos, filtered cigars, cigarettes, electronic nicotine delivery systems (ENDS), smokeless tobacco, alcohol, and cannabis.
Premium or Traditional Cigar Perceptions of Harm and Addictiveness Relative to Cigarettes
All respondents were asked, “compared to cigarettes, how harmful do you think the following products are (premium or traditional cigars)?” Answer choices included much less harmful, slightly less harmful, equally harmful, slightly more harmful, and much more harmful. For analyses, we collapsed answer choices such that the categories were less harmful, equally harmful, or more harmful. Respondents were also asked, “compared to cigarettes, how addictive do you think the following products are (premium or traditional cigars)?” Answer choices included much less addictive, slightly less addictive, equally addictive, slightly more addictive, and much more addictive. For analyses, we collapsed answer choices such that the categories were less addictive, equally addictive, or more addictive.
Premium Cigar Use Based on Brand
Again, all respondents who reported having used a traditional or premium cigar every day, some days, or rarely were asked if they have a regular traditional or premium cigar brand (yes/no). Those who said “yes” were asked to report the brand they usually smoke. Answer choices included Macanudo, Romeo y Julieta, Arturo Fuente, Punch, Partagas, Cohiba, Montecristo, Acid, and “other”. Those who selected “other” were asked to write in the brand. Those who reported “no” to having a brand they usually smoke were asked what brand they smoked last and were offered the same answer choices as those with a usual brand. We coded brands (regular and last brand used) as premium or non-premium based on the categorizations used in the NASEM report.6 Non-premium cigars did not include cigarillos or filtered cigars in our analysis, since the use of those products was asked separately in the survey. Rather, non-premium cigars were defined as traditional cigars that were non-premium brands, such as Phillies. Brands written in for the “other” category were manually coded as either premium, non-premium, or unknown. Due to skip patterns and non-response, some individuals either were not asked about brand or did not report brand, and therefore were unable to be classified as those who smoke premium or non-premium cigars. These individuals and those with unknown brands were not classified as smoking premium versus non-premium cigars but were included in the denominator for all prevalence estimates.
Statistical Analysis
We ran cross-tabulations to examine the demographic, tobacco use, and substance use characteristics, as well as product perceptions, of people who smoke premium or traditional cigars. For continuous variables, we reported medians and interquartile ranges. We also conducted sensitivity analyses to identify adults who use premium and non-premium cigars by brand. Based on brand, we calculated the prevalence of premium and non-premium cigar use for each definition, as well as the proportion of users based on each definition who use non-premium and non-premium cigars. Analyses were conducted in Stata/MP 17.0.9
Results
A majority of the sample was female (56.6%), non-Hispanic White (68.2%) and large proportions were ages 25–34 years (45.6%) or 35–45 years (43.6%). About half of the sample reported having a bachelor’s degree or higher (55.3%; Table 1). The prevalence of premium or traditional cigar use was highest using Definition 1 (past-year use; 11.6%), followed by Definition 4 (every day, some day, or rarely; 10.6%), Definition 2 (past 30-day use; 7.0%), and Definition 3 (every day or some days; 1.8%). People who smoke every day or some days (Definition 3) reported smoking on five of the past 30 days, whereas users based on other definitions smoked on one of the past 30 days. A total of 71% of people who smoked every day or some days (Definition 3) reported having a usual premium or traditional cigar brand, whereas 30.5–37.4% of those who smoked according to other definitions reported having a usual premium or traditional cigar brand.
Table 1.
Characteristics of Premium or Traditional Cigar Users, by Definition
| Overall | Definition 1 | Definition 2 | Definition 3 | Definition 4 | |
|---|---|---|---|---|---|
| Past-year use | Past 30-day use | Current use (every day or some days) | Current use (every day, some days, or rarely) | ||
| n (%) | n (%) | n (%) | n (%) | n (%) | |
| Overall prevalence | 2988 (100) | 348 (11.6) | 208 (7.0) | 55 (1.8) | 318 (10.6) |
| Demographics | |||||
| Age | |||||
| 18–24 years | 323 (10.8) | 35 (10.1) | 21 (10.1) | 4 (7.3) | 32 (10.1) |
| 25–34 years | 1363 (45.6) | 185 (53.2) | 106 (51.0) | 28 (50.9) | 166 (52.2) |
| 35–45 years | 1303 (43.6) | 128 (36.8) | 81 (38.9) | 23 (41.8) | 120 (37.7) |
| Sex | |||||
| Male | 1297 (43.4) | 244 (70.1) | 138 (66.3) | 38 (69.1) | 226 (71.1) |
| Female | 1691 (56.6) | 104 (29.9) | 70 (33.6) | 17 (30.9) | 92 (28.9) |
| Race/ethnicity | |||||
| NH White | 1527 (68.2) | 160 (63.0) | 82 (56.2) | 25 (59.5) | 148 (64.3) |
| NH Black | 231 (10.3) | 33 (13.0) | 24 (16.4) | 8 (19.0) | 30 (13.0) |
| NH other | 275 (12.3) | 19 (7.5) | 13 (8.9) | 1 (2.4) | 17 (7.4) |
| Hispanic | 206 (9.2) | 42 (16.5) | 27 (18.5) | 8 (19.0) | 35 (15.2) |
| Educational attainment | |||||
| High school or less | 387 (12.9) | 28 (8.0) | 18 (8.6) | 6 (10.9) | 26 (8.2) |
| Associate’s degree or some college | 947 (31.7) | 116 (33.3) | 74 (35.6) | 22 (40.0) | 105 (33.0) |
| Bachelor’s degree or higher | 1654 (55.3) | 204 (58.6) | 116 (55.8) | 27 (49.1) | 187 (58.8) |
| Premium or traditional cigar use | |||||
| Number of days one used a premium or traditional cigar in past 30 days (median [IQR]) | – | 1 (0–2) | 1 (1–3) | 5 (2–10) | 1 (0–2) |
| Has regular premium or traditional cigar brand (yes)µ | – | 97 (30.5) | 76 (37.4) | 39 (70.9) | 97 (30.5) |
| Other tobacco product use | |||||
| Past 30-day cigarillo use (yes) | 260 (8.7) | 112 (32.2) | 91 (43.7) | 30 (54.5) | 109 (34.3) |
| Past 30-day filtered cigar use (yes) | 87 (2.9) | 35 (10.1) | 28 (13.5) | 11 (20.0) | 33 (10.4) |
| Past 30-day cigarette use (yes) | 1086 (36.3) | 216 (62.1) | 157 (75.5) | 42 (76.4) | 202 (63.5) |
| Past 30-day ENDS use (yes) | 707 (23.7) | 151 (43.4) | 110 (52.9) | 31 (56.4) | 138 (43.4) |
| Past 30-day smokeless tobacco use (yes) | 98 (3.3) | 41 (11.8) | 33 (15.9) | 15 (27.3) | 39 (12.3) |
| Other substance use | |||||
| Past 30-day alcohol use (yes) | 1851 (63.1) | 291 (84.1) | 169 (82.0) | 42 (76.4) | 265 (83.9) |
| Past 30-day cannabis use (yes) | 796 (27.2) | 145 (41.9) | 99 (48.1) | 28 (50.9) | 130 (41.1) |
| Product perceptions | |||||
| Perceived harm of premium or traditional cigars compared with cigarettes | |||||
| Less harmful | 301 (10.1) | 68 (19.6) | 41 (19.8) | 16 (29.1) | 64 (20.2) |
| Equally harmful | 1846 (61.9) | 178 (51.3) | 102 (49.3) | 23 (41.8) | 164 (51.7) |
| More harmful | 835 (28.0) | 101 (29.1) | 64 (30.9) | 16 (29.1) | 89 (28.1) |
| Perceived addictiveness of premium or traditional cigars compared with cigarettes | |||||
| Less addictive | 574 (19.3) | 100 (28.7) | 58 (27.9) | 16 (29.1) | 95 (29.9) |
| Equally addictive | 2036 (68.4) | 203 (58.3) | 119 (57.2) | 28 (50.9) | 180 (56.6) |
| More addictive | 368 (12.4) | 45 (12.9) | 31 (14.9) | 11 (20.0) | 43 (13.5) |
NH = non-Hispanic; IQR= interquartile range; ENDS= electronic nicotine delivery systems.
µAsked only of those who reported currently smoking premium or traditional cigars every day, some days, or rarely. Missing values for this variable by definition are as follows: Definition 1 (n = 30); Definition 2 (n = 5); Definition 3 (n = 0); Definition 4 (n = 0).
Demographics
A total of 42% of adults who smoke every day or some days (Definition 3) were aged 35–45 years, compared with other user definitions (36.8–38.9% ages 35–45 years). About two-thirds of adults who smoked in the past year (Definition 1; 66.7%), smoked every day, some days, or rarely (Definition 4; 68.2%) were non-Hispanic White, compared with those who smoke every day or some days (Definition 3; 57.1%) and in the past 30 days (Definition 2; 56.2%). There were few differences by sex across definitions, with most users being male. About half of the adults who smoke every day or some days (Definition 3) reported having a Bachelor’s degree or higher, compared with those who smoke based on other definitions (55.8–58.8%).
Other Tobacco and Substance Use
Past 30-day use of other tobacco products was common among every day or some day users (Definition 3). Specifically, the prevalence of past 30-day use of cigarillos (54.5%), filtered cigars (20.0%) and smokeless tobacco (27.3%) was high compared with the other user definitions (cigarillos 33.0–44.8%; filtered cigars 10.6–14.8%; smokeless tobacco 13.5–18.9%). Those who smoked in the past 30 days (Definition 2) and every day or some days (Definition 3) reported a high prevalence of past 30-day cigarette (75.5% and 76.4%), ENDS (52.9% and 56.4%), and cannabis (48.1% and 50.9%), respectively, compared with other user definitions (cigarettes 62.1–63.5%; ENDS 43.4% for both; cannabis 40.9–41.7%).
Premium or Traditional Cigar Perceptions of Harm and Addictiveness Relative to Cigarettes
Nearly one-third of adults who smoke every day or some days (Definition 3) reported believing that premium or traditional cigars are less harmful than cigarettes (29.1%), whereas about 20% of those identified by other definitions reported this belief (19.6–20.2%). Perceived addictiveness of premium or traditional cigars compared to cigarettes was similar across user definitions.
Sensitivity Analyses: Premium and Non-Premium Cigar Use, Based on Brand
Table 2 reports the prevalence of premium and non-premium cigar use for each definition based on the participant’s reported regular or last traditional or premium cigar brand. The number of users with missing brand data due to skip patterns are reported for each definition. When identifying those who smoke premium cigars among those who use traditional or premium cigars based on brand, we found that prevalence was highest among those who smoked in the past year (Definition 1) and those who smoke every day, some days, or rarely (Definition 4) at 8.1%. The prevalence estimates for these two definitions are the same due to skip patterns in the survey; however, these groups differed with respect to the number of individuals in each category with missing data (n = 57 for those who smoked in the past year [Definition 1] and n = 27 for those who smoke every day, some days or rarely [Definition 4]. Premium cigar prevalence was 5.3% based on past 30-day use (Definition 2), followed by 1.8% for every day or some day use (Definition 3). Overall, the use of premium cigars was more prevalent than the use of non-premium traditional cigars.
Table 2.
Premium and Non-Premium Cigar Users Based on Brand, by Definition
| Definition 1 | Definition 2 | Definition 3 | Definition 4 | |
|---|---|---|---|---|
| Past-year use | Past 30-day use | Current use (every day or some days) | Current use (every day, some days, or rarely) | |
| n (%) | n (%) | n (%) | n (%) | |
| One-item question | ||||
| Traditional or premium cigar use prevalence | 348 (11.6) | 208 (7.0) | 55 (1.8) | 318 (10.6) |
| Prevalence of premium and non-premium cigar use based on brand | ||||
| Premium cigar use prevalence | 241 (8.1) | 158 (5.3) | 45 (1.5) | 241 (8.1) |
| Non-premium cigar use prevalence | 50 (1.7) | 34 (1.1) | 9 (0.3) | 50 (1.7) |
| Missing | 57 (1.9) | 16 (0.5) | 1 (0.0) | 27 (0.9) |
| Percentage of users reporting premium cigar brand | ||||
| Premium cigar use | 69.2% | 76.0% | 81.8% | 75.8% |
| Non-premium cigar use | 14.4% | 16.3% | 16.4% | 15.7% |
| Missing | 16.4% | 7.7% | 1.8% | 8.5% |
Discussion
Prevalence estimates for premium or traditional cigar use using a novel question varied more than fivefold based on the definition of use, ranging from 1.8% based on every day or some day use (Definition 3) to 11.6% for past-year use (Definition 1). After accounting for cigar brand, estimates ranged from 1.5% for every day or some day use (Definition 3) to 8.1% when including “rarely” (Definition 4). Findings from our main analyses and sensitivity analyses including brand suggest higher premium cigar use prevalence than reported in national surveys, including the PATH Study reported by Corey et al6 (1.5% for traditional cigars [i.e. premium, and non-premium combined]) and from NSDUH as reported in the NASEM report (0.9%). This is likely due to differences in sampling and study design, as well as differences in the survey items used to derive definitions of premium cigar use. The Rutgers Omnibus study is a convenience sample of 18–45 year olds collected in 2022, while the PATH Study data used by Corey et al (2016–2017) and NSDUH data (pooled data from 2010 to 2019) included adults 18 years and older and utilized stratified address-based, area-probability sampling approaches. Indeed, convenience samples like MTurk tend to produce higher prevalence estimates of tobacco use compared with probability-based samples.10 Furthermore, the definition of premium cigar use in Corey et al’s paper and in NSDUH are different than our definition. The definition of traditional cigar use in Corey et al was (1) having ever used fairly regularly and (2) now using some days or every day. Traditional cigar users were then further classified as premium or non-premium cigar smokers based on brand and price paid per cigar.2 NSDUH analyses in the NASEM report defined premium cigar use as having used cigars in the past 30 days and reporting regular use of a premium cigar brand.6 Including “premium cigar” in the survey item wording in the Rutgers Omnibus resulted in higher prevalence estimates of premium cigar use in our sample of U.S. adults aged 18–45 years and these estimates remained higher than those reported in other national surveys after incorporating brand into our definitions.
Our findings suggest that there are two categories of premium and traditional cigar users those who smoke more frequently and have more established cigar smoking patterns (Definition 3), and those who use premium cigars less frequently (Definitions 1, 2, and 4). Those with more established patterns of use, who are typically captured in large national studies (eg, PATH Study), reported smoking on more days in the past 30 days and a large proportion reported having a regular premium cigar brand—especially when compared to those who smoked in the past year (Definition 1) and those who smoke every day, some days, or rarely users (Definition 4). Across all definitions, approximately 60% of those who smoke premium or traditional cigars were aged 18–34 years compared with 43% in the PATH Study.2 Of note, the highest prevalence of premium cigar use in other studies is typically found in those aged 35–54 years and our sample did not include participants over the age of 45 years. We also found that those with more established patterns of use (Definition 3) reported low relative harm perceptions of premium cigars compared with cigarettes. Research shows that cigars are often perceived as less harmful than cigarettes,6 but it is noteworthy that there is variation among premium cigar smokers in these perceptions. These data are cross-sectional and therefore we cannot determine if lower harm perceptions lead to more frequent premium cigar use or vice versa, but these findings are still concerning given that premium cigars contain many of the same harmful and potentially harmful constituents as cigarettes.6
This study has limitations. First, it used a convenience sample and therefore findings may not be generalizable to the U.S. population. Additionally, our sample was limited to adults between the ages of 18–45 years. Given that premium cigar smokers skew older,6 our findings are likely to underestimate the true prevalence of premium cigar use among U.S. adults. Lastly, skip patterns in our survey limited our ability to use brand to categorize all premium or traditional cigar users as premium or non-premium users but was still more inclusive than many national surveys.
Overall, our findings suggest that current survey efforts, including major national surveys, are not capturing a category of people who use premium or traditional cigars infrequently and, thus, the prevalence of premium and traditional cigar use is underestimated. Those who use infrequently in our study engage in risky behaviors, including a high prevalence of poly tobacco and poly substance use, and are therefore an important population for tobacco control research. Our findings also highlight that premium or traditional cigar use occurs in young adults, with about 7–10% of those who smoke premium or traditional cigars being young adults across definitions, which is similar to findings from the PATH Study reported in the NASEM report.6 Given that the negative health effects of premium cigars vary based on how the cigars are used (eg, frequency or duration), as well as co-use with other tobacco products and substances (eg, alcohol and cannabis), accurate measurement of these products is important for understanding patterns of use and their impact on public health. Findings from our study show that there is great variation in prevalence estimates and user characteristics based on how premium or traditional cigar use is asked on surveys and subsequently operationalized. Future survey efforts should capture the full spectrum of premium cigar users in order to more accurately inform public health efforts related to cigars.6
Supplement Sponsorship
This article appears as part of the supplement “Regulatory Research Advances on Premium Cigars,” sponsored by the Center for Coordination of Analytics, Science, Enhancement, and Logistics (CASEL) in Tobacco Regulatory Science (5U54DA046060) from the National Institute on Drug Abuse at NIH and FDA’s Center for Tobacco Products.
Contributor Information
Ollie Ganz, Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ, 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
Andrea C Villanti, Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ, 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
William J Young, Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ, 08901, USA.
Darren Mays, Department of Internal Medicine, Wexner Medical Center, Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Starling-Loving Hall, 320 W 10th Ave b302, Columbus, OH 43210, USA.
Michelle T Bover Manderski, Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ, 08901, USA; Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
Cristine D Delnevo, Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, Suite 500, New Brunswick, NJ, 08901, USA; Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ 08854, USA.
Funding
Research reported in this publication was supported by the Rutgers Center for Tobacco Studies. Author effort was also supported by the National Cancer Institute of the NIH and the US Food and Drug Administration (FDA) Center for Tobacco Products (award number: U54CA229973). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH or the FDA.
Declaration of Interests
The authors have no competing interests to report.
Data Availability
Data are not available in a repository. Since we didn’t specify in the online consent that the data could be used for secondary data analyses, we are not able to make the data public. A restricted dataset may be requested from Cristine Delnevo (ORCID 0000-0001-9597-4307, delnevo@cts.rutgers.edu) and should include a plan for its use. Data may be made available to qualified researchers after the main findings are published in a peer-reviewed journal. All data sharing will comply with local, state, and federal laws and regulations and may be subject to appropriate human subjects institutional review board approvals.
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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 are not available in a repository. Since we didn’t specify in the online consent that the data could be used for secondary data analyses, we are not able to make the data public. A restricted dataset may be requested from Cristine Delnevo (ORCID 0000-0001-9597-4307, delnevo@cts.rutgers.edu) and should include a plan for its use. Data may be made available to qualified researchers after the main findings are published in a peer-reviewed journal. All data sharing will comply with local, state, and federal laws and regulations and may be subject to appropriate human subjects institutional review board approvals.