Age of initiation of cigarillo use among young adults: Findings from the Population Assessment of Tobacco and Health (PATH) study, 2013-2017.

Significance: Young adults, especially those who identify as racial/ethnic minorities, are legal targets of the tobacco industry. Cigarillo initiation is a risk among these vulnerable groups. Estimating the age of initiation of cigarillo use among young adults may inform the timing of prevention interventions.

Methods: Weighted interval-censored survival analyses of the Population Assessment of Tobacco and Health (PATH) young adult (ages 18-24 at their first wave of adult participation) annual datasets were conducted (2013-2017). Young adult never cigarillo users (n = 7,101; represents N = 24,023,488) at their first wave of adult participation (2013-2016) were followed-up through 2014-2017 to estimate the age of initiation of ever, past 30-day and fairly regular cigarillo use outcomes. Differences by sex and by race/ethnicity, accounting for previous use of other tobacco products and marijuana and blunt use, were assessed using weighted interval-censored Cox proportional hazards models.

Results: Among PATH young adults, by age 21, 5.8% initiated ever cigarillo use, 4.1% initiated past 30-day cigarillo use, and 1.4% initiated fairly regular cigarillo use. By age 26, 15% initiated ever cigarillo use, and 10.4% initiated past 30-day cigarillo use. Males had higher risk of initiating ever (AHR: 1.63, 95% CI: 1.37-1.95) and past 30-day cigarillo use (AHR: 1.65, 95% CI: 1.32-2.06) at earlier ages than females. Non-Hispanic Blacks had higher risk of initiating ever (AHR: 2.81, 95% CI: 2.26-3.50), past 30-day (AHR: 4.88, 95% CI: 2.95-5.09) and fairly regular cigarillo use (AHR: 4.62, 95% CI: 2.70-7.93) at earlier ages than non-Hispanic Whites. Hispanics had higher risk of initiating past 30-day cigarillo use at earlier ages than non-Hispanic Whites (AHR: 1.51, 95% CI: 1.12-2.03). Non-Hispanic Other race (i.e., Asian, multiracial, etc.) had lower risk of initiating ever (AHR: 0.43, 95% CI: 0.28-0.65) and past 30-day cigarillo use (AHR: 0.40, 95% CI: 0.26-0.63) at earlier ages than Non-Hispanic Whites.

Conclusion: Along with those aged 21 and younger, interventions should target young adults over the age of 21, specifically males, non-Hispanic Black and Hispanic young adults, to stall initiation and progression of cigarillo use behaviors.