Paper: Examining the influence of cigar and cannabis co-marketing on packaging perceptions: An experiment with a sample of US youth

In 2023, cigars were one of the most commonly used tobacco products among youth, with around 280,000 high school students reporting past 30-day cigar use (Birdsey, 2023). One of the most common ways in which young people use cigars is by removing some or all of the tobacco and replacing it with cannabis, often referred to as “blunts.” In a study of high school students, nearly two-thirds of youth who reported using cigars modified the cigars to make blunts (Trapl et al., 2018). Similarly, in a qualitative study of high school students, youth more commonly reported modifying cigarillos to smoke blunts than using unmodified cigarillos (Kong et al., 2017). Indeed, many young people explicitly report that cigarillos are purposefully made to be used as blunts (Giovenco, Miller Lo, Lewis, & Delnevo, 2017). Importantly, some people who use blunts also do not think of themselves as “cigar users” (C.D Delnevo, Bover-Manderski, & Hrywna, 2011) so some estimates of blunt use may be underreported if blunt use is only asked among those reporting cigar use.

Because blunts are smoked, the health risks associated with cigar and blunt use are likely similar to those of using combustible cannabis products and potentially other combustible tobacco products, like cigars. However, the harms of cannabis and tobacco co-use are largely unknown given challenges in measuring co-use and disentangling health effects between tobacco and cannabis. Nevertheless, blunts can expose people to nicotine even if tobacco filler is completely removed (Peters, Schauer, Rosenberry, & Pickworth, 2016) since the wrapper can contain tobacco. As such, blunt use is associated with both nicotine and cannabis dependence (Schauer, Rosenberry, & Peters, 2017). For youth, in particular, use of blunts is also associated with subsequent cigar use (Audrain-McGovern, Rodriguez, Alexander, Pianin, & Sterling, 2019) and other tobacco product use (e.g., cigarettes) (Fairman et al., 2023, Mayer et al., 2020).

Cigars are co-marketed with cannabis in different ways, including product descriptors connoting cannabis-related flavors (e.g., Cali Green, Kush, Purple Haze) and brand names (e.g., Swisher Sweets Blunts). For instance, in a study of tobacco retailers near middle and high schools in California, approximately 62 % of stores sold cigars with at least one form of cannabis co-marketing (Henriksen, Schleicher, Ababseh, Johnson, & Fortmann, 2018). In particular, 26.0 % of stores sold cigar products, such as blunt wraps and cigarillos, with a cannabis-related flavor and 27.2 % sold cigarillos marketed as blunts—either with the brand name or product label (e.g., Swisher Sweets Blunt) (Henriksen et al., 2018). In another study relying on 2016 sales data, almost 30 million cigars and 56 million cigar wraps sold in 2016 had cannabis co-marketing in the flavor and/or brand name (representing 4.3 % and 4.9% of the dollar and unit share, respectively, of the cigar market), and most that did have cannabis-related flavors also used cannabis terminology in the brand name (Delnevo, Giovenco, Kurti, & Al-Shujairi, 2020). Importantly, both of these studies revealed disparities in how and where cannabis co-marketing is displayed. Cannabis co-marketing was more prevalent in neighborhoods with a lower median household income (Henriksen et al., 2018), and cannabis-related flavored cigars were cheaper, on average, than cigars without cannabis-related flavors (Delnevo et al., 2020).

Cigars with cannabis co-marketing can be advertised anywhere in the US and are not restricted to those states where cannabis is legal. In particular, cigarillos, which are often used to make blunts and contain cannabis co-marketing, are most commonly purchased in convenience stores or gas stations (Edwards et al., 2023). Even in states where cannabis is legal, cannabis retailers often cannot sell tobacco products, such as cigars or cigar wraps. For instance, both Washington (Washington State Liquor and Cannabis Board, 2023) and California (Public Health Law Center, 2023) state law prohibit cannabis retailers from selling tobacco products and tobacco retailers from selling cannabis. Therefore, blunts are often not commercially sold in the US but cigars are still marketed with cannabis-related references. As such, cigars with cannabis co-marketing are subject to regulations from the Food and Drug Administration’s Center for Tobacco products, which has regulatory authority over tobacco products in the US.

While research has shown that cigar and cannabis co-use is common, no research to our knowledge has occurred on testing the impact of co-marketing on product packages among youth. As such, the goal of this study was to examine how cigar and cannabis co-marketing on packages is associated with product perceptions. We hypothesized that cigar and cannabis co-marketing would decrease perceptions of product harm and increase perceptions that the cigars contain cannabis, appeal, susceptibility to using the product shown, and purchase intentions. We also hypothesized significant interactions between co-marketing and blunt use, such that effects would be strongest among youth reporting blunt use.