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.