The Language of Cigar Use: Focus Group Findings on Cigar Product Terminology

Abstract

Introduction

The consumption of cigar products has increased since 2000. The multiple product types within this category, combined with the varied language with which consumers refer to them, present challenges for accurately assessing the prevalence of cigar product use. Surveillance is also complicated by the fact that these products can be used to smoke marijuana, as “blunts”— cigars in which the tobacco is removed and replaced with marijuana. Few studies exist regarding the language and terminology used to describe these products.

Methods

Sixteen focus groups were conducted in fi cities in the United States between March and May of 2014. Participants (N = 123) included adults who had used cigars, cigarillos, or little cigars in the past 30 days. A semi-structured moderator guide was used to gather data on the terms used to identify cigar product subtypes and the language used to describe the products and their use.

Results

Participants used a variety of terms for each product subtype. Brand names were often used, as well as slang terms, including terms describing cigars modified for marijuana use. Some subtypes were less likely than others to be considered “cigars.” Participants had mixed opinions about whether users of cigar products are “smokers.”

Conclusions

Users of cigar products may classify or label products differently from researchers and policy makers, and many refer to their product by brand name or a slang term. These fi have implications for future research, instrument design, and public health messaging about cigar products.

Implications

This study adds to the body of evidence highlighting the challenges for measurement and surveillance of non-cigarette tobacco products, including cigars. Findings illustrate the myriad terms used by consumers to describe their use of cigar product subtypes, as well as the complexity of distinguishing between use of cigar products as intended, versus as a vehicle for smoking marijuana. Future research aimed to enhance specifi of cigar use measures will enable policy-makers and public health practitioners to more fully characterize prevalence and patterns of use by cigar subtype.

Introduction

Although cigarette use has declined over the last decade, the consumption of cigar products has doubled.¹ The increase in cigar product use has been attributed to the lower cost of cigars relative to cigarettes,² a lower perceived health risk of cigars,^3–5 and the rise in availability of a large variety of cigar products, including little cigars and flavored cigar products.^2,6

The cigar product category comprises a considerable variety of products, which can differ along a number of dimensions including: size, presence of a filter or tip, presence of added characterizing flavors, price, and manufacturing (hand rolled vs. machine made). Commonly-used categories include large/traditional cigars, cigaril- los/other mass market cigars, and little cigars. Traditional cigars are typically larger than cigarillos; some are considered premium cigars, which are hand rolled with whole leaf wrapper and binder, and are typically more expensive. Cigarillos are typically smaller than traditional cigars and sometimes have a wood or plastic tip. Little cigars, also referred to as little filtered cigars, are generally machine-made, contain a filter, and are similar in size to a cigarette.

The multiple product types within the cigar category present challenges for ascertaining who is using them and how they are being used. Most national surveys have asked about cigar use in general terms, rather than by specific product subtype or brand. The 2012–2013 National Adult Tobacco Survey (NATS)⁷ was among the first national surveys to characterize cigar smokers by usual product subtype; data revealed marked differences in prevalence by subtype. Moreover, these data revealed that prevalence of use for each cigar product subtype varied across demographic characteristics including sex, age, race/ethnicity, census region, education, income and sexual orientation. These variations highlight the importance of precisely measuring cigar use by product subtype.⁷

Precise measurement of cigar product use requires that survey items enable participants to accurately report their behavior—including how they identify products they use. Data suggest that the inclusion of brand name examples in survey items may be particularly relevant for this product category. Qualitative studies have suggested that many cigar users refer only to brand names when referring to their use of cigar products.^3,4,8 Likewise, Corey et al.⁹ examined changes in reported cigar smoking among middle and high school students following the addition of brand examples to cigar questions on the 2012 National Youth Tobacco Survey. Results revealed pronounced differences in prevalence rates between 2011 and 2012: In particular, prevalence increased among African-American students, suggesting the possibility that in previous surveys, the absence of brand name examples led to underreporting of cigar use. Similarly, in 2004, when the cigar item on a Youth Risk Behavior Survey was modified to include a brand-specific example (Black and Mild), the percentage of students reporting cigar use nearly doubled compared to the percentage reporting cigar use in 2002 (from 12.9% to 20.7%).¹⁰

Accurate assessment of cigar product use prevalence is also complicated by the fact that these products are known to be used as “blunts”—cigars in which the tobacco is replaced with marijuana. It is unclear if “blunt” users report their behavior as cigar use when survey questions ask about cigar use, in general. Likewise, if survey questions do not differentiate between blunt use and use of cigars with tobacco (ie, as they are sold), it is difficult to draw conclusions about the prevalence and health effects of these behaviors.

In April 2014, the Food and Drug Administration (FDA) released a proposed rule to extend its jurisdictional authorities to other tobacco products, including cigar products.¹¹ Under the proposed rule, FDA would have the authority to regulate the manufacturing, marketing, and distribution of cigar products. When evaluating tobacco products, FDA is required to assess the impact of the product and its marketing on population health. Such assessments can be informed by research studies involving cigar users, including largescale national surveillance data. However, as described above, the quality of these data requires careful measurement of product use. Therefore, research is needed to explore the language and terminology that consumers use when referring to cigar products, how they differentiate among products, and to better understand differences in tobacco use behaviors related to cigar products.

Few studies in the scientific literature focus on how consumers describe various types of cigar products and their use, and studies that include diverse populations are lacking. This study employed qualitative methods to explore the language and terminology with which adult cigar users describe these products and their use. A series of focus groups was conducted with current users of cigar products to address the following research questions: (1) How do adult cigar users identify various cigar products?; (2) How do adult cigar users describe the language and terminology specific to cigar use and people who use cigar products?; and (3) How do adult cigar users describe the language and terminology specific to use of cigar products for smoking marijuana?

Methods

Setting and Participants

Focus group participants were recruited as part of a broader qualitative study focusing on language, beliefs, and behaviors related to “other tobacco products” (e-cigarettes, hookah, and cigars). The study was sponsored by FDA’s Center for Tobacco Products and was conducted by RTI International. In this article, we examine data from the cigar focus groups.

A series of 16 focus groups (N = 123 participants) was conducted between March and May of 2014 with current cigar users in five cities in the United States: Washington, District of Columbia; Richmond, Virginia; Providence, Rhode Island; Orlando, Florida; and Los Angeles, California. Available data on prevalence were used to identify locations appropriate for all three products of interest in the broader study. To be eligible, participants in the cigar focus groups had to have used a cigar product in the past 30 days. Participants were first asked: “Have you ever tried smoking cigars, cigarillos, or little cigars (such as Black and Milds, Swisher Sweets, Dutch Masters, White Owl, or Phillies Blunts), even one or two puffs?”¹² Those who said “yes” were then asked if, during the past 30 days, they smoked cigars, cigarillos, or little cigars “every day,” “some days,” or “not at all.” Those who said “every day” or “some days” were eligible for the study. Focus groups were segmented by age (young adults aged 18 to 24 and older adults aged 25 to 65), gender, and, for male groups, race/ ethnicity (black/African American, Hispanic, and white/other). All groups comprised a mix of individuals with regard to education level. Table 1 shows the segmentation for the focus groups.

Table 1.

Cigars Focus Group Segmentation (N = 16)

City	Segmentation
Los Angeles (n = 6).  Originally scheduled four  groups but increased  because of recruitment  issues in Orlando	2 adult (25–65) groups:1 femalea  (segment#1) 1 Hispanic male  (segment #2)
	4 young adult (18–24)b groups:  2 femalea (segment #3) 1  Hispanic male (segment #4), 1  white/otherc male (segment #5)
Orlando (n = 2). Originally  scheduled four groups  but reduced because of  recruitment issues	2 adult (25–65) groups: 1 African  American male (segment #6); 1  white/otherc male (segment #7)
Providence (n = 3)	2 adult (25–65) groups: 1 female  (segment #8); 1 Hispanic male  (segment #9)
	1 young adult (18–24) group: 1  Hispanic male (segment #10)
Richmond (n = 4)	2 adult (25–65) groups: 1 African  American male (segment #11);  1 white/otherc male (segment  #12)
	2 young adult (18–24) groups:  1 African American male  (segment #13); 1 white/otherc  male (segment #14)
Washington, DC (n = 1)	1 young adult (18–24) group:  African American male  (segment #15)

^aThe use requirement for the female groups was expanded to the past 60 days (from 30 days) for Los Angeles, because of recruitment problems at the focus group facility.

^bThe young adult age group was expanded to ages 18–30 for Los Angeles, because of recruitment problems at the focus group facility.

^cThe term “other” refers to non-white, non-black and non-Hispanic.

Local market research fi provided facilities and recruitment services for the focus groups. These fi used convenience sampling to recruit study participants from their databases who met the requirements for inclusion in the specifi segments using a screener developed by study investigators. In addition to the criteria above, to be eligible, focus group participants had to be able to read, understand, and speak English. Individuals were ineligible if they had other characteristics that could potentially bias responses (eg, connections to the tobacco industry; employed by the federal government) or if they had participated in market research in the past 6 months. All study procedures were approved by the Institutional Review Boards at FDA and RTI International and by the Offi of Management and Budget.

Focus Group Procedures

Upon arrival, participants provided informed consent and were rescreened to confirm eligibility. Experienced moderators conducted the focus group discussions using a semi-structured moderator guide. To clarify participants’ understanding of cigar products, at the beginning of each discussion, the moderator presented a handout that had an (unlabeled) image of the following four product types: (1) little cigar, (2) tipped cigarillo, (3) untipped cigarillo, and (4) large/traditional cigar. The moderator asked participants to identify each of these products. After hearing from the participants, the moderator provided terms for each product (Table 2), to establish common terminology that would be used during the discussion. The moderator explained that, for convenience, he/she would use the terms “cigars” or “cigar products” when referring to all four product types.

Table 2.

Identification of Cigar Products

Picture	Term used in this article	Focus group participants’ identification of producta		Moderator’s identification of product
	Product #1—  little cigar	Cigarette	Clipper	Little cigar
		Clove/clove cigarette	Filtered cigar
		E-cigarette	Filtered pipe tobacco
		Cigarillo	Little cigar
		Jack	Prime Time
		Stogie	Roll-up
		Flavored cigarette	Square
		Black	Stick
		Cancer stick	Turkish-flavored Camel
		Capone	Black and Milk
		Cheyenne	Roll-up
		Small cigarillo	Cigar-wrapped cigarette
		Cigar cigarette
	Product #2—  tipped  cigarillo	Black and Milk	Blackstone	Cigarillo
		Black	Blicky
		Cigarillo	Cigar mixed with cigarillo
		Tiparillo	Milton
		Cigar	Portable pipe/disposable  pipe
		Wood-tip/wood-tip  cigar/tipped cigar	Tip
			White
		Blunt	Dutch Master
		Philly blunt	Swisher Sweet
		Corona	Gansta
	Product #3—  untipped  cigarillo	Cigarillo	ACID	Cigarillo
		Swisher	L
		Blunt	Mini-blunt
		Dutch	Mini-cigar
		Cigar	Papers
		Rillo	Petit
		Roll-up	Philly
		Mini-Dutch	Krush
		Blunt wrap	White Owl
		Wrap	Wrap
		J	Little cigar
		Black Cigar
	Product #4—Large/  traditional cigar	Cigar	Fat Boy	Cigar
		Churchill	L
		Cuban	Tony
		Blunt	Torpedo
		Stogie	Garcia Vega
		Phillies Blunt	Godfather
		Dutch	Romeo y Julieta
		Cohiba

Photo credit: Truth Initiative, http://truthinitiative.org/.

^aFor each product, the names/terms mentioned by participants are ordered by frequency from top to bottom in columns.

At the beginning of each discussion, the moderator explicitly acknowledged that users sometimes modify cigarillos by replacing the tobacco fi with marijuana and asked participants to specify when they were discussing a product that was fi with a substance other than tobacco.

The moderator guide included questions about cigar use and behavior; access to cigar products; identifi of cigar products; language used to refer to cigar product users; and knowledge, attitudes, and beliefs about cigar products. At the end of the discussion, participants received a monetary incentive of $75. All focus groups lasted approxi- mately 1 hour and were audio-recorded and professionally transcribed.

Data Analysis

Verbatim transcripts from the focus group sessions were coded using NVivo version 10 software.¹³ Study investigators reviewed the transcripts to become familiar with the text and began a thematic analysis by searching for common themes. An initial set of codes was created corresponding to each topic of interest identifi for the study. Using a phenomenological approach,¹⁴ additional codes were created for emergent themes and patterns were identifi during the coding process; codes were then consolidated as necessary. All codes in the dictionary were given operational defi to enhance reliability and validity and aid in the coding process. The investigators discussed initial codes, as well as changes, additions, and iterations to the codes to strengthen the reliability of the coding process. The primary investigator completed all coding of focus group transcripts and a second investigator then reviewed the coding in a random sample of 25% of the transcripts to verify coding accuracy according to the agreed-upon operational defi All coding disagreements were discussed until the research team reached consensus. Queries in the software were used to gather data by multiple codes. For example, word frequency queries and text search queries were used to locate and quantify commonly used words and phrases. Results were examined across all focus groups, as well as by age group, gender, and race/ethnicity.

Results

Sample Characteristics

Participant characteristics are provided in Table 3. Approximately half of participants were young adults and half were adults; the average age of all participants was 32.5 years (SD = 11.5; range = 18–62). Seventy- fi percent of participants were male. Participants were most likely to have some college education (n = 62, 50%) or a college degree (n = 29, 24%). Forty-nine (40%) participants identifi as white, 43 (35%) identifi as black/African American, 28 (23%) identifi as Hispanic, two (2%) identifi as Asian, and one (1%) identifi as “other.”

Table 3.

Participant Characteristics by City (N = 123)^a

	Overall		District of Columbia		Los Angeles		Orlando		Providence		Richmond
	n	%	n	%	n	%	n	%	n	%	n	%
City
Total	123		8	7	45	37	14	11	20	16	36	29
Age cohort
Adult	66	54	0	0	16	36	14	100	18	90	18	50
Young adult	57	46	8	100	29	64	0	0	2	10	18	50
Average age (SD)	32.5 (11.5)		21.0 (2.4)		30.4 (8.5)		34.6 (6.3)		40.0 (12.5)		32.7 (14.2)
Gender
Female	31	25	0	0	22	49	0	0	9	45	0	0
Male	92	75	8	100	23	51	14	100	11	55	36	100
Race
American Indian—Native Alaskan	0	0	0	0	0	0	0	0	0	0	0	0
Asian	2	2	0	0	2	4	0	0	0	0	0	0
Black or African American	43	35	8	100	8	18	9	64	0	0	18	50
Filipino/Pacific Islander	0	0	0	0	0	0	0	0	0	0	0	0
Hispanic	28	23	0	0	16	36	0	0	11	55	1	3
Other	1	1	0	0	1	2	0	0	0	0	0	0
White	49	40	0	0	18	40	5	36	9	45	17	47
Education
Less than high school	3	2	1	13	1	2	0	0	1	5	0	0
High school or GED	24	20	3	38	5	11	5	36	5	25	6	17
Some college or 2-year degree	62	50	4	50	23	51	5	36	9	45	21	58
College degree	29	24	0	0	14	31	3	21	5	25	7	19
Postgraduate degree	5	4	0	0	2	4	1	7	0	0	2	6

^aPercentages may not total 100% because of rounding.

Findings for each of the research questions are presented below. Quotations are provided to illustrate themes but are not representative of all participants’ opinions or experiences. The segment number is cited for quoted participants (see Table 1 for demographic/ geographic segments).

Research Question #1: How do Adult Cigar Users Identify Cigar Products?

Table 2 presents participants’ identification of each product (in order of frequency of mention). Participants used a variety of terms for each product and used some terms for multiple products. Brand names were often used, as well as slang terms, including terms describing cigars that have been modified for marijuana use.

A key finding from this discussion was that the little cigar was almost always misidentified. In almost every group, at least one participant identified it as a cigarette, and in most groups this was the most common response. It was also commonly identified as a “clove” or “clove cigarette.” “Little cigar” was only mentioned in one of the 16 groups. When the moderator provided the term “little cigar” to describe the product, one participant noted a distinguishing characteristic: “Yeah, the brown papers as opposed to the white, like regular cigarettes” (segment #3). Others had not heard the term “little cigar” or had not heard this product referred to as a “little cigar.” The tipped cigarillo was most often referred to by brand name (eg, “Black and Mild,” “Black”). Some participants had not heard this product referred to as a “cigarillo.”

The untipped cigarillo was often called a “cigarillo” but also commonly called a “Swisher” or a “blunt.” The term “blunt” was the most common way of referring to a cigarillo that had been modified such that the tobacco was removed and replaced with marijuana. Participants mentioned a range of other brand names and slang terms, including “Dutch,” “Rillo,” “Roll-up,” “Mini-Dutch,” “Blunt wrap,” “Wrap,” and “J” (Table 2).

The large/traditional cigar was identified as a “cigar” in almost every group. However, there were also many references to brand names and some references to “blunts,” indicating that large/traditional cigars were also sometimes used for smoking marijuana.

Research Question #2: How do Adult Cigar Users Describe the Language and Terminology Specific to Cigar Use and People Who Use Cigar Products?

Terms for Cigar Products

The names, brands, and terms that participants most frequently used spontaneously when discussing cigar products are presented in Table 4 (in approximate order of frequency of mention). Some cigar product users did not consider products #1, #2, and #3 to be “cigars.” Many participants commonly referred to these products using popular brand names such as “Black and Mild” or “Swisher Sweets.” Language regarding how consumers refer to products did not tend to vary across geographic locations.

Table 4.

Terms Used Spontaneously for Cigar Products^a

Cigar

Black and Mild/Black

Cigarillo

Swisher/Swisher Sweets

Blunt

Dutch/Dutch Masters

Al Capone/Capone

Cuban/Cuban cigar

Garcia Y Vega

Phillies

White Owl

Backwoods

Churchill

Montecristo

Prime Time cigarillo

^aThe names/terms mentioned spontaneously by participants throughout the discussion are ordered by frequency from top to bottom.

Terms to Describe Users of Cigar Products

When asked if they would consider cigar users “smokers,” participants had mixed opinions. The majority of respondents indicated they would, though some preferred the term “cigar smoker” and others indicated that it would depend on the frequency of use. For some participants, the term “smoker” or “cigar smoker” could only be applied if the user smoked cigars at least several times per week or daily: “Well … in the instance where they only smoke once a week or twice a week or as a social smoker, I would not call them a smoker” (segment #1). A participant voiced a fairly common opinion that daily smoking is a requirement for calling someone a “smoker”: “I think somebody that smokes every day is a smoker. If somebody, let’s just say, smokes when they drink, I don’t really see them as a smoker” (segment #7). Others considered a person who smokes infrequently or who is a “recreational smoker” to be a smoker. One participant associated habitual smoking with the definition of “smoker.”

Participants saw little cigars and cigarillos as being more common, daily-use products than large/traditional cigars, which were viewed as something to smoke during leisure time or special occasions, such as during a birthday party, backyard barbecue, camping trip, or beach trip. Participants were less likely to view users of large/ traditional cigars as “smokers”: “They’re just sitting out having a Cuban, they’re really not a smoker.” (segment #6).

In one group, participants discussed whether someone is a smoker if he/she does not inhale: “If you inhale the smoke, you’re a smoker” (segment #4). Participants had mixed opinions on whether cigar products were inhaled. One participant noted that large/traditional cigars are not intended to be inhaled: “Personally, the only “cigar” I see is number 4 [large/traditional cigar]. I just take number 4 as a cigar … you want to just sit back and puff, not necessarily inhale… me, personally, that’s what I call a cigar. The rest of these, no” (segment #11).

Some participants also said the term “smoker” carries negative connotations associated with cigarette use. Many participants high- lighted the stigma surrounding cigarettes in contrast to all forms of cigars: “I think there used to be more of a stigma to cigars and now you’re getting more of a stigma with cigarettes” (segment #12).

Similarly, participants had mixed opinions about the definition of a “regular cigar user,” including that cigar use must be “constant,” “weekly,”“daily,”“2–3 times per week,”“a routine,” and “several times a week.” Some participants said that consistency was key: “Once a week, twice a week, as long as you’re consistent with it” (segment #6).

Research Question #3: How do Adult Cigar Users Describe the Language and Terminology Specific to Use of Cigar Products for Smoking Marijuana?

Words used to refer to cigarillos and other cigar products that have been modified for smoking marijuana include “blunt,”“Phillies blunt,” “blunt wrap,” “mini blunt,” “Dutch” or “rolled up Dutch,” “L,” “J,” “primo” (a cigar with both marijuana and cocaine), “modified cigar,” “rollup,”“joint,” and “papers.” The term “blunt” was overwhelmingly the most common term and was mentioned in all 16 groups.

The act of modifying cigar products for use with marijuana was referred to as “splitting a blunt,” “rolling a blunt,” “splitting it/ them” (referring to cigar products), “splitting tobacco,” “modifying a blunt,” and “blowing up a Dutch.”

In one group, all participants agreed that the term “smoker” applies to someone who uses cigars to smoke marijuana. In fact, some participants first assumed that the term “smoker” refers to marijuana rather than tobacco products: “Someone tells me they’re a smoker, I’m going to automatically assume weed or marijuana. I’m not going to assume tobacco” (segment #3).

Participants discussed using tipped and untipped cigarillos and large/traditional cigars for marijuana use, although untipped cigarillos (product #3) were mentioned most frequently. Although some participants who used product #3 used them for tobacco only, the majority stated that they used them for both marijuana and tobacco. One participant noted: “I honestly do not know one person in my social circle who smokes number 3 [untipped cigarillo] that does not have weed in it” (segment #3). This type of use was mentioned or implied by both male and female participants and by young adults and adults.

Discussion

Our research revealed that users of cigar products may classify or label cigar products differently from researchers and policy makers. In particular, cigar users commonly refer to their product by brand name or a slang term, rather than the generic term “cigar.” Brand names and other terms were more common than the term “cigar” in reference to cigarillos. In fact, the term “Black and Mild” was mentioned more often than the term “cigarillo” in reference to the tipped cigarillo. Our findings were consistent with focus group data gathered by Yerger et al.,⁸ who found that African American youth considered only large/traditional cigars to be “cigars,” whereas other types of cigar products were referred to by brand names. We also found that very few users could identify the little cigar as a “cigar,” which is consistent with evidence from focus groups with young adult African-American little cigar or cigarillo users, who found that the term “little cigar” was confusing and “weird.”¹⁵ Together, these findings add to the growing body of evidence that the language con- sumers use to identify and differentiate cigar subtypes is extremely varied; and in the case of little cigars, consumers may not even identify these products as cigars.

Our findings also revealed that marijuana plays a fundamental role in cigar product use for many users. This is consistent with recent findings from Sterling et al.¹⁶ and Stephens et al.¹⁵ who conducted focus groups with users of little cigars and cigarillos, and concluded that flavored little cigars and cigarillos are primarily used as a vehicle to smoke marijuana. In the present study, we found users have specific terms for cigars used for smoking marijuana, consistent with research showing that many blunt users do not necessarily recognize themselves as cigar users.^8,17–20 Indeed, the language and terms related to cigar products, in many cases, is inextricable from the use of cigars to smoke marijuana. For instance, many participants indicated they perceive cigarillos as primarily meant for use with marijuana; as such, the predominant label used for that product was “blunt.” This suggests the possibility that the term blunt is used to refer to a cigarillo (and potentially other cigar subtypes), regardless of whether it has been modified. Similarly, participants often used brand names such as “Philly,”“Dutch,” and “Swisher” when referring to cigars modified for marijuana use. The term “blunt” is closely associated with the brand “Phillies Blunt,” causing further ambiguity.

Finally, the current findings contribute to growing evidence underscoring the distinctions between cigar product subtypes, and reinforce the importance of measurement to distinguish among the three main types of products.^21,22 Such distinctions have important implications to the extent that these subtypes may be associated with different user groups and different patterns of use. For instance, whereas cigarillos were commonly referred to as blunts and discussed in the context of marijuana, in contrast, little cigars were not identified as cigars by the majority of our participants; and other evidence suggests little cigars may be more likely to be used by cigarette smokers,⁷ mistaken for cigarettes, and perceived as substitutes for cigarettes.²³

Specific and reliable measurement of cigar product use is compli- cated by at least two interdependent challenges highlighted by these findings: (1) distinguishing between the cigar subtypes and (2) disam- biguating use of cigars as they are sold versus modified for use with marijuana. This study substantiates proposed strategies to improve respondents’ understanding of questions, including use of brand names^4,9,10,21,22 and product images alongside survey questions, as done in the Population Assessment of Tobacco and Health Study.^24,25 Depending on the study aims, researchers may want to also consider including explicit questions to differentiate between use of cigars as they are sold (with tobacco) versus use as a vehicle for smoking marijuana. Additional research, including qualitative work, can continue to refine measures to ensure specific and reliable data on cigar products. Product-level information can inform FDA’s evaluation of tobacco products based on the population health standard, which involves understanding who is using which products, and how.

Limitations

As with all qualitative research methods, results are not generalizable to wider populations. Care was taken to include a cross-section of young adult and adult cigar users from multiple racial/ethnic groups and both genders, and to select five diverse geographic locations for the focus groups.

Although the moderator instructed participants to be specific when discussing a particular type of product, ascertaining which product participants were discussing was often difficult. Indeed, this was an inherent limitation to conducting groups including users of different cigar products. Rather than referring to products by name, participants often cited the product number from the handout (eg, “product #3”); however, because participants frequently misidenti- fied products on the handout, confirming their meaning was often challenging. Future qualitative studies that segment groups by discrete product subtypes would address this limitation and would be beneficial for obtaining a more focused assessment of terminology and use for each subtype.

Another study limitation is that discussion of little cigars was minimal. Very few participants specifically reported use of little cigars. This could account for the relatively sparse mention of little cigars during the discussion, and could be why most participants were unable to identify product #1 on the handout as a “little cigar.”

An additional complicating factor was that the discussion often centered on using cigar products as a means of smoking marijuana. Although the moderator asked participants to clarify whether they were discussing a product that was filled with a substance other than tobacco, they often did not directly specify whether they were talking about tobacco or marijuana use. However, investigators inferred through participants’ tone, intimation, laughter, and other references that the majority of the cigarillo use discussion referred to modifying the cigarillos to smoke marijuana.

Conclusion

Few studies have qualitatively explored the language and terminology surrounding different types of cigar products. This study provides a detailed analysis of cigar product users’ language and terminology related to various cigar products. Findings have implications for future research and instrument design. Specifically, additional research can identify best practices for collecting data on cigar product use by subtype, as well as differentiating between cigars used as intended and as a vehicle for smoking marijuana. Continued efforts to understand the best way to ask questions about these products are important to identify which products are being used and how they are being used. These data can help to inform regulations and public health messaging.