title: Cigar Product Modification Among High School Youth.
abstract: Prevalence of cigar use has been increasing among youth. Research indicates that youth are modifying cigar products either by "freaking" (ie, removing the filter paper) or "blunting" (removing the tobacco and supplementing or replacing with marijuana), yet little is known about youth who engage in this behavior. Thus, this study examines demographic and concurrent substance use behaviors of youth who modify cigars.
  
  
  
  Data from the 2013 Cuyahoga County Youth Risk Behavior survey were examined (n = 16 855). The survey collected data on demographics, cigar product use, cigar modification behaviors, and current cigarette, hookah and marijuana use. Responses to cigar product use items were used to create a composite to classify youth in one of eight unique user categories. Univariate and bivariate statistics were calculated using SPSS complex samples procedures.
  
  
  
  Overall, 15.2% reported current cigar product use, 11.0% reported current freaking, and 18.5% reported current blunt use; taken together, 25.3% of respondents reported any current use of a cigar product. When examined by user category, of those who endorsed any cigar product use, cigars, cigarillos, and little cigars use only was most endorsed (26.3%), followed by Blunt only (25.2%) and all three (ie, cigars, cigarillos, and little cigars, freaking, and blunting; 17.4%).
  
  
  
  A substantial proportion of high school youth who report using cigar products are modifying them in some way, with nearly half freaking and nearly two-thirds blunting. Given the FDA Center for Tobacco products recent extension of its regulatory authority to include cigar products, it is imperative to understand more about the prevalence of and reasons for cigar modification behaviors.
  
  
  
  Although the FDA has recently enacted regulatory authority over cigar products, little is known about cigar product modification. This is the first study to concurrently examine two unique cigar modification behaviors, "freaking" (ie, removing the filter paper) and "blunting" (removing the tobacco and supplementing or replacing with marijuana). A significant proportion of high school youth are modifying cigar products to be used as a tobacco product and as a mechanism to smoke marijuana. More research is needed to understand these behaviors to prevent and reduce the use of cigar products among youth.
authors.affiliation: Prevention Research Center for Healthy Neighborhoods, Department of Epidemiology and Biostatistics Case, Western Reserve University, Cleveland, OH.
authors.forename: Erika S
authors.initials: ES
authors.lastname: Trapl
authors.affiliation: Prevention Research Center for Healthy Neighborhoods, Department of Epidemiology and Biostatistics Case, Western Reserve University, Cleveland, OH.
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: Koopman Gonzalez
authors.affiliation: Gillings School of Global Public Health, Department of Health Behavior, University of North Carolina, Chapel Hill, NC.
authors.forename: Leslie
authors.initials: L
authors.lastname: Cofie
authors.affiliation: Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI.
authors.forename: Laura D
authors.initials: LD
authors.lastname: Yoder
authors.affiliation: Prevention Research Center for Healthy Neighborhoods, Department of Epidemiology and Biostatistics Case, Western Reserve University, Cleveland, OH.
authors.forename: Jean
authors.initials: J
authors.lastname: Frank
authors.affiliation: Division of Health Promotion and Behavior, School of Public Health, Georgia State University, Atlanta, GA.
authors.forename: Kymberle L
authors.initials: KL
authors.lastname: Sterling
mesh_terms: D000293:Adolescent; D000073863:Cigar Smoking / Q000453:epidemiology / Q000523:psychology / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008385:Marijuana Smoking / Q000453:epidemiology / Q000523:psychology / Q000639:trends*; D015995:Prevalence; D012574:Schools / Q000639:trends*; D013334:Students / Q000523:psychology; D011795:Surveys and Questionnaires; D062789:Tobacco Products