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Longitudinal pathways of exclusive and polytobacco cigar use among youth, young adults and adults in the USA: findings from the PATH Study Waves 1–3 (2013–2016)
  1. Kathryn C Edwards1,
  2. Eva Sharma1,
  3. Michael J Halenar1,
  4. Kristie A Taylor1,
  5. Karin A Kasza2,
  6. Hannah Day3,
  7. Hoda T Hammad3,
  8. Gabriella Anic3,
  9. Maansi Bansal-Travers2,
  10. Jean Limpert3,
  11. Lisa D Gardner3,
  12. Nicolette Borek3,
  13. Heather L Kimmel4,
  14. Wilson M Compton4,
  15. Andrew Hyland2,
  16. Cassandra A Stanton1,5
  1. 1 Behavioral Health and Health Policy Practice, Westat, Rockville, MD, USA
  2. 2 Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, NY, United States
  3. 3 Office of Science, Center for Tobacco Products, Food and Drug Administration, Silver Spring, MD, United States
  4. 4 National Institute on Drug Abuse, National Institutes of Health, Bethesda, MD, United States
  5. 5 Department of Oncology, Georgetown University Medical Center, Washington, DC, United States
  1. Correspondence to Dr Kathryn C Edwards, Behavioral Health and Health Policy, Westat, Rockville, MD 20852, USA; KatyEdwards{at}


Objective The goal of this study is to examine the cross-sectional prevalence of use and 3-year longitudinal pathways of cigar use in US youth (12-17 years), young adults (18-24 years), and adults 25+ (25 years or older).

Design Data were drawn from the first three waves (2013–2016) of the Population Assessment of Tobacco and Health Study, a nationally representative, longitudinal cohort study of US youth and adults. Respondents with data at all three waves (youth, n=11 046; young adults, n=6478; adults 25+, n=17 188) were included in longitudinal analyses.

Results Weighted cross-sectional prevalence of past 30-day (P30D) use was stable for adults 25+ (~6%), but decreased in youth (Wave 1 (W1) to Wave 3 (W3)=2.5% to 1.2%) and young adults (W1 to W3=15.7% to 14.0%). Among W1 P30D cigar users, over 50% discontinued cigar use (irrespective of other tobacco use) by Wave 2 (W2) or W3. Across age groups, over 70% of W1 P30D cigar users also indicated P30D use of another tobacco product, predominantly cigar polytobacco use with cigarettes. Discontinuing all tobacco use by W2 or W3 was greater in adult exclusive P30D cigar users compared with polytobacco cigar users.

Conclusions Although the majority of P30D cigar users discontinued use by W3, adult polytobacco users of cigars were less likely to discontinue all tobacco use than were exclusive cigar users. Tracking patterns of cigar use will allow further assessment of the population health impact of cigars.

  • surveillance and monitoring
  • non-cigarette tobacco products
  • prevention
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  • Contributors KCE and CAS led the conceptual design. KCE drafted the initial manuscript and all authors critically revised it. ES and MJH conducted the statistical analysis and all authors contributed to interpretation of results. All authors approved the work for journal publication and agree to be accountable for all aspects of the work.

  • Funding This manuscript is supported with federal funds from the National Institute on Drug Abuse, National Institutes of Health, and the Center for Tobacco Products, Food and Drug Administration, Department of Health and Human Services, under a contract to Westat (contract number HHSN271201100027C).

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the US Department of Health and Human Services or any of its affiliated institutions or agencies.

  • Competing interests WMC reports long-term stock holdings in General Electric Company, 3M Company, and Pfizer Incorporated, unrelated to this manuscript. No financial disclosures were reported by the other authors of this paper.

  • Patient consent for publication Not required.

  • Ethics approval The study was conducted by Westat and approved by the Westat Institutional Review Board. All participants aged 18 and older provided informed consent, with youth participants aged 12–17 providing assent while their parent/legal guardian provided consent.

  • Provenance and peer review Not commissioned; internally peer reviewed.

  • Data availability statement Data from the PATH Study Wave 1 to Wave 3 are available for download as Public Use Files in a public, open access repository ( Conditions of use are available at the website above.

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