Substance Use
Intersectional patterns in cigar use with cigarettes and e-cigarettes by race and ethnicity, education, and sex: Insights from 10-Years of PATH data James Buszkiewicz* James Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz Buszkiewicz University of Michigan School of Public Health
Background: Few studies have examined US cigar use disparities at the intersection of race and ethnicity, education, and sex, and none have documented intersectional trends—work critical to designing tailored tobacco control strategies.
Methods: Using nationally representative Population Assessment of Tobacco and Health data, Waves 1 (2013–2014) to 7 (2022–2023), we examined current cigar use prevalence trends at the intersection of race and ethnicity (Hispanic, non-Hispanic Black, non-Hispanic White, non-Hispanic other), education (high school degree, General Educational Development (GED), or less; some college; or college degree or more), and sex among US adults aged 25 or older. We also examined current dual and polytobacco use with cigarettes and e-cigarettes. For all trends, we estimated average annual percentage changes (AAPC) using segmented log-linear regression.
Results: Among non-Hispanic White adults, cigar use declined among females (AAPC = -7.0%; 95% CI = -13.3%, -0.2%) and males (AAPC = -1.2%; 95% CI, -1.5% to -0.9%) with some college education, and among females with a college degree or more (AAPC = -11.8%, 95% CI = -20.9%, -1.6%), but increased among males with a college degree or more (AAPC = 4.1%; 95% CI, 2.3%, 5.9%). Among non-Hispanic White adults with a college degree or more, exclusive cigar use (AAPC = 4.0% 95% CI = 2.0%, 6.1%) and dual e-cigarette use (AAPC = 10.6%, 95% CI = 4.7, 17.0%) increased. Current dual cigarette use decreased or remained stable for all subgroups. Polytobacco use increased among non-Hispanic Black adults with a high school degree, GED, or less (AAPC = 16.8%, 95% CI = 3.5%, 31.8%) and a college degree or more (AAPC = 24.5%, 95% CI = 1.8%, 52.8%).
Conclusion: We documented persistent intersectional cigar use disparities and new emerging trends in dual and polytobacco use with cigarettes and e-cigarettes, highlighting the need for equity-focused interventions addressing intersectional determinants of US adult cigar use.