Objective: To examine public health implications of adolescent use of cigars only, cigarettes only, and both cigarettes and cigars.
Methods: A cross-sectional health risk survey was administered to a random sample of 4486 high school students in a Midwestern county.
Results: More adolescents reported using both cigarettes and cigars (10.6%) than cigar-only (7.4%) or cigarette-only (6.4%). Product of initiation was associated with current product use. Dual use was associated with more frequent use of both products, high stress, and susceptibility to future cigarette use.
Conclusion: Assessing cigarette use without examining cigar use overlooks a critical dimension of adolescent tobacco use.