An Ecological Momentary Assessment of Cigarette and Cigar Dual Use Among African American Young Adults

Abstract

IntroductionThe dual use of cigarettes and cigars among African American young adults is a significant public health issue. Patterns of and reasons for dual use are difficult to capture using traditional self-report methods. This study used ecological momentary assessment (EMA) to characterize patterns of dual smoking and examine the personal and environmental predictors of cigarette and cigar smoking among African American young adult dual users (ages 18–29) in real-time.MethodsFor 14 days, 64 participants smoked ad libitum and were prompted four times daily to record their smoking, craving, emotions, social smoking, and environment via text message on their mobile phones. The odds of single product and dual use were examined using adjusted generalized estimating equations.ResultsParticipants smoked an average of 7.9 cigarettes and 4.2 cigars per day. Cigarettes and cigars were smoked as frequently during periods of dual use as they were during periods of single product use. Cigarette craving was positively associated with cigarette-only smoking (OR: 1.07), whereas cigar craving was positively associated with cigar-only smoking (OR: 1.43) and dual use (OR: 1.08). Cigars had the greatest odds of dual use when with others (OR: 4.69) and in others’ homes (OR: 4.33). Cigarettes had the greatest odds of being smoked while alone (OR: 1.57).ConclusionsEMA was useful for capturing variable smoking patterns and predictors. In this study population, cigarettes and cigars appeared to be smoked additively, and cigars smoked socially. These findings can inform future interventions addressing dual use in this high priority population.ImplicationsThis is the first study to use EMA to examine naturalistic patterns and predictors of multiple tobacco use in real-time. African American young adults smoked cigarettes and cigars during periods of dual use as frequently as during periods of single product use. This suggests that most use was additive (one product smoked in addition to another) and less often as substitution (one product smoked instead of another). Social smoking and craving were strongly associated with cigar smoking in single and dual use periods. This study suggests the need for cessation messaging specifically targeted to reduce dual use in this population.

Ecological momentary assessment of various tobacco product use among young adults

“…In relation to the former, substance use events were assessed using a dynamic-interval "coverage" survey strategy as this strategy is designed to ensure that all behavioral events of interest are documented with fidelity, as well as ensure that reports for all behaviors are balanced over the course of every day for every participant. [103][104][105][106] Specifically, participants were asked to report their usual sleep schedule, which anchored the timing of each assessment (i.e., the first assessment was four hours after waking and then three times more every four hours thereafter). At the end of each window, participants were asked, "Since last assessment, how many of each have you used: cigarettes, little cigars or cigarillos, puffs of an e-cigarette or vape pen, puffs of a hookah, puffs of marijuana (vaporized or smoked), a mix of tobacco and marijuana, and servings of alcohol."…”

“…Combined in succession, these coverage reports produce near-complete and consistent use reports over relatively extended periods, partly because they require only seconds for participants to complete. [103][104][105][106] Complementing the behavioral use reports collected at the close of each coverage window, randomly prompted momentary assessments, roughly one-to-two minutes each, were used to assess cravings, affect, and social context, within each four-hour window to assess ebbs and flows randomly during the day. 104 Cravings for tobacco were assessed on a ten-point scale.…”

Patterns and Correlates of Multiple Tobacco Product Use in the United States

“… 16 Mead et al used ecological momentary assessments to investigate reasons for dual use of cigarettes and cigars among African American young adults. 17 The authors found that cigars and cigarettes are smoked additively, rather than by substitution. Moreover, cigars (used exclusively or with cigarettes) are more likely to be used with others and inside others’ homes, whereas cigarettes are more likely to be smoked while alone.…”

“…Moreover, cigars (used exclusively or with cigarettes) are more likely to be used with others and inside others’ homes, whereas cigarettes are more likely to be smoked while alone. 17 Studying youth in North Carolina (NC), Osman et al found variation in single, dual, and polytobacco use by race/ethnicity over three time points from 2011 to 2015, including variation in the types of tobacco products and combinations used. 18 White and Hispanic youth were found to have higher relative risk for dual and polytobacco use than Black youth; and although types of tobacco products used varied by year and race, in 2015 e-cigarettes were the most commonly used product among single product users from all racial groups in this NC youth sample.…”

“… 24 , 25 The remaining two papers do not fit into these categories as one does not define use because they studied the products themselves 27 and the other used ecological momentary assessment methods to assess frequency (days smoked) and amount (products smoked per day). 17 As definitions and analytic approaches evolve, results across studies should reveal whether definitions such as concurrent past 30-day use are the most appropriate measures to fully understand the impact of polytobacco use on nicotine dependence, smoking cessation, individual-level health effects, and net population health impact.…”