Freak'em, Blunt'em, & Smoke'em: Adolescent use of modified cigar products

Background: Local community members and health experts have expressed concerns regarding adolescents' misperception of modified cigar products as a safer form of smoking. Some adolescents believe that removing the filter paper from cigars (“freaking”), or replacing the tobacco content – usually with marijuana (“blunting”), reduces the adverse health effects of smoking. Research is limited on adolescent freaking and blunting behaviors. Therefore, we examined the use of modified cigar products among high school students in a diverse, Mid-Western county. Methods: We used the 2011 High School Cuyahoga County Youth Risk Behavior Surveillance System data (N=12737) to examine demographic characteristics, lifetime and current (past 30 day) blunting and freaking behaviors, as well as cigarette, cigar (including little and flavored cigars and cigarillos), and marijuana use. Results: Compared with current cigarette (11.4%) and cigar (17.0%) use, marijuana use was the highest (22.1%). In the past 30 days, 9.7% of high school students had freaked a cigar and 16.4% had blunted a cigar. Among current cigar users, 45.4% freaked, 65.9% blunted, 35.6% both freaked and blunted a cigar in the past 30 days. Among current marijuana users, 68.1% of students had blunted a cigar. High rates of blunting among current cigar and marijuana users persist in all races and regions of the county. Conclusions: Numerous studies demonstrate the importance of including cigar products in prevention and cessation programs. However, assessing rates, characteristics, and beliefs of adolescents using modified cigar products is a critical addition to the body of knowledge informing appropriate interventions for this growing problem.