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Epidemiology of Cigar, Cigarillo and Little Cigar Use among Youth and Young Adults
close up image of little cigars
Much of the PRCHN's tobacco prevention and cessation research is led by Associate Director Erika Trapl, PhD. Dr. Trapl uses a classical epidemiological approach to youth tobacco use. Using quantitative data from the Youth Risk Behavior Survey (YRBS) and qualitative interview data, she aims to understand the characteristics, correlates, and associated risk factors of cigar, cigarillo, and little cigar users in a local context.
 
 
Past Tobacco Use Studies
Split Sample Study Measuring Use of Cigar Products among Adolescents
Led by Associate Director Erika Trapl, PhD, this 2011 study found that adding brand examples to traditional surveillance items increased cigar product use among African American youth by roughly 45%. The study was replicated by the Centers for Disease Control and Prevention at the national level, leading to a language change in the cigar product prevalence item in the National Youth Tobacco Survey. It has now become more standard practice in national cigar product surveillance to add brand names to improve estimates.  
Behaviors Related to Modification of Cigar Products
Ongoing research into adolescent and young adult cigar use by Associate Director Erika Trapl, PhD, has identified behaviors related to the modification of cigar products, such as removing the filter paper (i.e., freaking) or adding marijuana to the cigar (i.e., blunting). This issue informed the development of items implemented in the Cuyahoga County Youth Risk Behavior Survey (YRBS). Dr. Trapl has presented her work on measurement of these sub-type behaviors at the national meeting of the Society for Research on Nicotine and Tobacco.  
CTSC Core Utilization Grant
Associate Director Erika Trapl, PhD, received a 2011 core utilization grant from the Clinical & Translational Science Collaborative (CTSC) to
1) Conduct interviews with young adult, African-American males who used cigar products and
2) Integrate additional cigar-related items into the Cuyahoga County Youth Risk Behavior Survey (YRBS)

The results from this work have informed several other PRCHN grant applications, including the NIH-funded Little Cigar Study to develop a measure of nicotine dependence for cigar product users, led by Associate Director Sue Flocke, PhD, as well as a number of publications. 
Public Health Policy Implications
Cigar products are not currently regulated by the US Food and Drug Administration’s Center for Tobacco Products (CTP), however, the agency has proposed a rule to enact their regulatory authority. Alternative cigar products have been popularly used since 1995, but the overwhelming majority of tobacco control literature focuses exclusively on cigarettes. Should CTP choose to enact regulatory authority over cigar products, it will require hard data to inform any regulations adopted, making the PRCHN’s research in the area of cigar product use of great value.

Dr. Trapl’s work has already been used to inform policy interventions in the City of Cleveland.