Transcript Slide 1

Emerging Tobacco Products:
“New Products, Same Targets”
North Carolina Health and Wellness Trust Fund Annual Meeting
October 22, 2009
Amber Thornton-Bullock, MPH, CHES
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
Emerging Products
• Little Cigars and Cigarillos
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Snus and Snuff
Dissolvables
Hookah
New Cigarettes
E-Cigarettes
The Product:
Little Cigars and
Cigarillos
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 < 3 lbs per 1000
– Little Cigar < 3 lbs per 1000
– Cigar > 3 lbs per 1000
(includes cigarillo)
1. USC 5702. Available at: http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=browse_usc&docid=Cite:+26USC5702
Cigarillos
Cigarillos…
…Often look like smaller versions of traditional
stogie cigars.
…come in a variety of flavors (cherry, apple,
menthol, wine, etc.).
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
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
Small/Little Cigars
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.
Cigar or Cigarette in Disguise???
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.
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 manufacturer’s price
capped at $.40 per cigar (old rate was 20.72% of
manufacturer’s price capped at $.05 per cigar)
Source: 26 USC 5701 – as amended by the Children’s Health Insurance Program Reauthorization Act (P.L. NO. 111-003)
Little Cigar and Cigarillo
Research
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.
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
National Study on Descriptive
Epidemiology of Cigar Use
Methods:
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Data Source: National Survey on Drug Use or Health (NSDUH) conducted by US Substance
Abuse and Mental Health Services Administration (SAMHSA)
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Study Design: Annual U.S. annual household cross-sectional surveys; probability sampling
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Study period: 2002-2007 (6 cross-sectional surveys)
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Sample population: over 60,000 people aged 12+ annually; nationally representative.
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Measures/Outcomes: prevalence of cigar “Ever use”, “Past 30-day use”, and frequency of use
in past 30-days; demographics; risk behavior
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Mode of Questionnaire administration: audio computer-assisted self-interview (CATI)
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Statistical analysis: Weighted, stratified estimates of prevalence over time
Prevalence in Past 30-Day Cigar Use
among for 18-25 year olds
NSDUH 2002-2007
Prevalence in Cigar Ever Use and Past 30Day Use by Age
Cigar Ever Use & Used in Past 30 days by Age
50.0%
Cigar Ever Used 12-17
40.0%
Cigar Ever Used 18-25
Cigar Ever Used 26-34
30.0%
Cigar Used in Past 30 days 12-17
Cigar Used in Past 30 days 18-25
20.0%
Cigar Used in Past 30 days 26-34
10.0%
0.0%
2002
NSDUH 2002-2007
2003
2004
2005
2006
2007
Cigar Brand Preferences
Cigar Brand Used Most Often in Past 30
Days
30.0%
20.0%
10.0%
0.0%
2002
Black & Mild
NSDUH 2002-2007
2003
Swisher Sweets
2004
Phillies
2005
2006
Dutch Masters
2007
White Owl
Black & Mild brand use by Race
Past 30-Day Use of Black & Mild by
Race/Ethnicity
for Ages 18-25
90.0%
80.0%
70.0%
60.0%
50.0%
40.0%
30.0%
20.0%
10.0%
0.0%
2002
2003
White, Non-Hispanic
NSDUH 2002-2007
2004
2005
Black, Non-Hispanic
2006
Hispanic
2007
Other
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.
Marketing Strategies
How the industry keeps hooking new
customers
Marketing of Little Cigars and Cigarillos
Magazine Ad in Sports Illustrated , 2001
Magazine Ad in Car and Driver, 2007
Coupons
Swisher International
Advertisement: Website
Royal Blunts
Advertisement: Website
Captain Black
Advertisement: Promotions
• Winchester
– An American Sweepstakes
• Royal Blunts
– Discounts available
through retailers
• Hunid Racks
– They sell CD singles/DVD’s
featuring their artists BLegit, Richie Rich,
YUKMOUTH and Messy
Marv
– Link to get a “Hunid Racks
Debit Card”
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.
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
Brand Promotion
ARI Menthol 10’s Shoes
• Made to look like Nike
• Limited release in 2006
In-Store Placement: Eye Level is Buy Level
In-Store Placement: Eye Level is Buy Level
Emerging Tobacco
Products
Snus and Snuff
Snus. A spitless tobacco packaged in small teabag-like pouches. Modeled after a Swedish product
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Marlboro snus – tested starting 2007 in plastic packs, now in smaller foil packs
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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)
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Marlboro moist snuff: tested starting in 2006, discontinued 2009
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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, 2009;18:54-59)
Images: Philip Morris, tobaccoproducts.org. socialbranding.org
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
Hookah
• Water pipe smoking that hails
from Middle East
• Water does not “filter” all the
toxic compounds and chemicals
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
E-Cigarettes
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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
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
RYO Vending Machine
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.
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
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
Questions?
Contact Information: [email protected],
202-454-5591