"I just use it for weed": The modification of little cigars and cigarillos by young adult African American male users.

Little cigar and cigarillo (LCC) use has received increased attention, but research on their modification is limited. Qualitative interviews with 17 young adult African American male LCC users investigated tobacco use behaviors and patterns, including LCC modification. The modification of LCCs for use as blunts emerged as a very prominent aspect of LCC users' tobacco use. Four subthemes regarding marijuana and blunt use are explored in this article, including participants' explanations of how blunts are made and used, concurrent use of marijuana and tobacco, perceptions and reasons for smoking marijuana and blunts, and perceptions of the risks of blunt use.

Keywords: Blunts; cigarillos; little cigars; marijuana

Little cigar and cigarillo (LCC) use has received increased attention in research in the past decade as rates of LCC use rise (Centers for Disease Control and Prevention, [5]; Cullen et al., [8]). LCCs have been shown to be common among African American men (Borawski et al., [3]; Cullen et al., [8]; Montgomery, [22]) and among youth and young adults (Arrazola et al., [1]; Richardson, Rath, Ganz, Xiao, & Vallone, [27]). However, some research has shown that LCCs are used for smoking marijuana.

"Blunts" are defined as cigar shells (large cigar, little cigar, or cigarillo) filled with marijuana after some or all of the tobacco has been removed (Dunlap, Benoit, Sifaneck, & Johnson, [11]; Ramo, Liu, & Prochaska, [24]; Sifaneck, Johnson, & Dunlap, [30]; Timberlake, [37]; Yerger, Pearson, & Malone, [41]). Blunt users are more likely to be African American, male, and living in metropolitan areas (Delnevo & Hrywna, [10]; Golub, Johnson, & Dunlap, [13]; Soldz, Huyser, & Dorsey, [33]).

Quantitative and qualitative evidence on blunt use includes use trajectories and patterns of use. Research among rural African American young adult men found that 69.7% of those who used blunts reported cigarettes as their first product smoked (Sinclair, Foushee, Pevear, & Scarinci, [31]). Conversely, in a qualitative study among adolescent and young adult urban Southeast Asian Americans, many participants reported using marijuana and blunts as products of smoking initiation prior to tobacco use (Lee, Battle, Lipton, & Soller, [19]). Qualitatively, blunt use has also been explored within the context of social behavior in which participants often used blunts in a group setting with smokers of other tobacco products as well as other blunt users (Dunlap et al., [11]; Dunlap, Johnson, Benoit, & Sifaneck, [12]; Lee et al., [19]; Soller & Lee, [34]). Smoking in groups also affected how blunts were used when alone. Dunlap et al. ([12]) noted how participants continue group use practices even when smoking alone by smoking a little and then putting the blunt out.

The literature on tobacco and marijuana use suggests that there are varying perceptions about blunt use and its associated risks. Blunt use is generally considered marijuana use by smokers, but a few studies suggest otherwise (Delnevo, Bover-Manderski, & Hrywna, [9]; Dunlap et al., [11]; Lee et al., [19]; Golub et al., [12]). For example, in a study on adolescents (12–17 years old) using the National Survey on Drug Use and Health (NSDUH) data from 1979 to 2003, Golub et al. ([13]) determined that participants often do not consider blunt use to be marijuana use. Their findings revealed that prevalence rates of past 30 days marijuana use from NSDUH increased by 16%, and lifetime prevalence of marijuana use increased by 7%, after combining the rates of marijuana and blunt use. In addition, evidence suggests that blunt use may not be considered cigar or tobacco use (Delnevo et al., [9]; Golub et al., [13]; Lee et al., [19]). In their analysis of NSDUH data from 2007, Delnevo et al. ([9]) found that only one-third of adolescent and young adult blunt users considered their use as cigar use. In addition, Dunlap et al. ([10]) demonstrated that among blunt and cannabis users in New York City, participants' understanding of the content of blunts seems to affect their risk perceptions. When participants recognized blunts as tobacco use, they perceived the tobacco as addictive.

In some studies, smokers were shown to concurrently use tobacco products (including cigarettes, little cigars, or cigarillos) and marijuana (Cullen et al., [8]; Dunlap et al., [11]; Sinclair et al., [31]). Research has demonstrated that smokers believe that tobacco products increase the effects of marijuana (Jolly, [15]; Lee et al., [19]; Sifaneck et al., [12]; Yerger et al., [41]). Blunt use can also be considered concurrent use because of the tobacco in the shell, exposing users to both marijuana and tobacco, and inherently nicotine (Dunlap et al., [11]; Lipperman-Kreda, Lee, Morrison, & Freisthler, [20]). Although addictiveness of blunts may be debated by individuals, there are risks associated with blunt use. Timberlake ([37], [38]) found that blunt users were more likely to be dependent on cannabis and nicotine than those who had never used blunts or those who use other marijuana products.

Research has looked at the social aspects of blunt use, the trajectory of use, the content of blunts, as well as risk perceptions of blunt and marijuana users. These studies were conducted with a sample from the general population as well as specified subpopulations, but these patterns have not been widely examined among LCC users despite the relationship between LCCs and marijuana (Cohn et al., [6]; Schuster, Hertel, & Mermelstein, [29]; Sterling, Berg, Thomas, Glantz, & Ahluwalia, 2013; Stoltz & Sanders, [36]). The objective of the overall study was to understand the risk perceptions, patterns of use, purchasing practices, and initiation of tobacco use among young adult African American male LCC users. This article examines one pattern of use, the modification of tobacco products. Specifically, the modification of LCCs for the use of marijuana in the form of blunts emerged as a prominent aspect of tobacco use among this population. The attitudes and behaviors regarding marijuana and blunts among this population are further explored in this article.

Participants were recruited using purposive sampling, a nonprobability sampling strategy in which sample characteristics were preselected (Bernard, [2]; Miles & Huberman, [21]; Patton, [23]): African American, male, between 18 and 29 years old, and current or former (past three years) user of LCCs (e.g., Black & Milds, Phillies, Swisher Sweets). Both current and former LCC users were included to examine patterns regarding quitting tobacco products. The sample consisted of respondents to flyers posted in a public health center and those posted at bus and train stations in an urban area of the city. The demographics of the 17 participants who made up the sample are shown in Table 1.

Table 1. Sample demographics (N = 17).

Researchers conducted semistructured individual interviews using a guide developed from a review of the literature and input from a research working group (Tramble et al., 2011), which included academic and community partners as well as community residents. The interviews lasted an average of 40 minutes and took place at the public health center where participants were recruited.

Interviews included the identification of four images: cigarettes; plastic-tipped and nontipped cigarillos; large cigars; and small cigars. The images were used to frame the conversation around tobacco products to create a common ground for all participants and researchers. Identification allowed researchers to understand what terms were being used for each tobacco product. For example, participants were shown an image and asked the following questions: "What do you call this product?"; "Are there other names it may be called?"; and "Tell me about anything else that comes to mind when you see this tobacco picture." The first two participants could not identify small cigars (i.e., cigars that are the size and shape of a cigarette but are brown in appearance), so only the first three images were used with subsequent participants. For a card sort activity to elicit rank orders (Bernard, [2]) of the three images, participants were asked to arrange the images by danger to health, addictiveness, popularity, price, ease of access, and flavor. After arranging the cards, participants were asked to explain their ordering.

Semistructured questions regarding initiation to smoking tobacco products, trajectory of tobacco use, current use context and habits, the benefits and consequences of smoking, and tobacco availability and popularity were asked, and probing was used to elicit more-detailed explanations from participants. For example, participants were asked the following: "I am interested in your use of cigarillos. Do you smoke them as they are when you buy them, or do you modify them?" Participants were then probed about how and why they, as well as other people, modify these LCCs.

Participants received a $20 gift card for participating. Audio recordings of interviews were transcribed and analyzed in NVivo (Richards, [25]). The study protocol was approved by Case Western Reserve University's Institutional Review Board.

A codebook of themes was developed through both inductive and a priori approaches (Miles & Huberman, [21]; Patton, [23]; Ryan & Bernard, [28]) to include emergent themes as well as those from the interview guide to understand the attitudes and perceptions of LCC initiation, use, and purchasing practices among young adult African American men. Interviews were coded and analyzed throughout data collection so that subsequent interviews could be guided by emergent themes. Themes were identified through reviewing interview notes and transcripts. After data collection, transcripts were used to identify any additional themes. Examples of codes included product identification, product preference, product modifications, and tobacco use descriptions for cigarettes, cigars, and cigarillos. Coded segments from transcripts were analyzed to identify congruencies and differences among the narratives. This article reports the findings from one emergent theme, marijuana use, particularly as it relates to participants' modification of LCC products.

This qualitative inquiry yielded four subthemes related to marijuana use. These included the identification of blunts, concurrent marijuana and tobacco use, participant use perceptions, and the perceived risks of blunt use (see Table 2). Each subtheme is expanded upon below.

Table 2. Marijuana use subthemes.

To begin the interview, participants were shown product images, and all participants identified the plastic-tipped cigarillo as a Black and Mild and the nontipped cigarillo as something different, using the terms cigarillo, Swisher, blunt, shell, cigar, or miniature cigar; both images were on the same card. This differentiation occurred without provocation or probing. When the interviewer referred to "Black and Milds" as cigarillos in one interview, the participant responded, "No. For cigarillos I got Swisher Sweets. Black and Milds and cigarillos are two different things" (Participant 1, age 20–24). Participants not only differentiated between the two, but most (76.5%) immediately described how the nontipped cigarillo is used as a blunt to smoke marijuana. This understanding of the term "cigarillo" was made not only by those who had used nontipped cigarillos as blunts (referred to as "cigarillo blunts" for the remainder of this paper) in their lifetime, but also by participants who did not report blunt use. One participant said during the identification section of the interview

Okay, I know those as either Swishers or miniature cigars, and that product I've always known for I've never seen nobody actually smoke them really like normally, or just take out the insides and use them for paraphernalia and for use of controlled substance. For that matter I've never used one of them, but I've seen it happen a couple of times. (Participant 6, age 18–19)

Even in this early identification section of the interview, participants expressed that these products are altered for marijuana use in their communities.

Marijuana use in general and the use of cigarillo blunts emerged as salient themes for participants. Several participants described marijuana use as being popular in their community among young people. As for the use of cigarillo blunts, participants described this as common in their communities. One participant explained, "Around my area, everybody's doing either Black and Mild or they're smoking weed out of cigarillos nowadays instead of papers" (Participant 17, age 20–24). All but one participant identified the nontipped cigarillo as a vehicle for using marijuana during the course of the interview. Nontipped cigarillos were often described as being used exclusively to smoke marijuana. Some participants also indicated they had never heard of anyone smoking nontipped cigarillos without modifications; as described by one participant, "No, I've never actually seen anybody smoke a cigarillo. I've never seen anybody use it for nothing else other than marijuana" (Participant 4, age 20–24). It is of note that three participants did discuss seeing others smoke nontipped cigarillos as sold, and two have done this themselves. When probed about the use of nontipped cigarillos as blunts, one participant said, "I'm not sure like how somebody else would do anything with it. I just consider it a cigar, like you smoke a cigar, like cigar smoke, that's how I think of it. That's all it is to me" (Participant 15, age 20–24). This participant not only had smoked nontipped cigarillos as sold, but also was the only participant who did not relate nontipped cigarillos to marijuana.

In general, participants described the process of converting a nontipped cigarillo into a blunt as removing all of the tobacco inside of the nontipped cigarillo and replacing it with marijuana before rolling it back together. This process is exemplified by one participant who explained

So once you, you lick the shell and you break it down. You've got a straight split down the middle and you take all the tobacco out. You fill it with weed and then you roll it, and you lick it together. I'd have to show you, but you lick it together and then you light it up and then you smoke it." (Participant 3, age 20–24)

In describing the process of modifying nontipped cigarillos for the use of marijuana, none of the participants use the word "blunting" even though this is a term that has been used in literature describing this process (e.g., Cullen et al., [8]; Delnevo et al., [9]; Delnevo & Hrywna, [10]; Soldz, Huyser, & Dorsey, [32]; Sterling et al., [35]). In fact, no specific term for the process of modifying tobacco products to make a blunt was given by any of the participants. The term "blunt," though, was used by some participants for the final product containing the marijuana, and the term "shell" was used by over half of the participants, signifying that the outer wrapping of the nontipped cigarillo is the part that is used. As articulated by one participant, "Then you've got a cigarillo, which is a shell. It's like say you took all the lead out this pencil, but you still got the pencil. That's like a shell" (Participant 2, age 18–19). From these interviews, it was apparent that "blunt" and "shell" were recognized terms in this community, while "blunting" was not.

Although the majority of this article deals with the use of nontipped cigarillos for smoking marijuana, some participants identified other tobacco products as being used as blunts. Both plastic-tipped cigarillos and large cigars were described by a few participants as being used as blunts, although two of them did not equate this practice with the current local scene. One of these participants used to smoke marijuana in this manner while living in Louisiana and described how nontipped cigarillos would not be marketable in Louisiana because of the prevalence of large cigars as blunts. The other participant who discussed this practice said that it is something that used to happen in the past: "Back in the day, people used to take the cigars, the big cigars like the ones right here (points to card with image of cigar), and they'll put the marijuana in them too, but we don't really do that no more. They usually use cigarillos" (Participant 17, age 20–24). While most participants discussed nontipped cigarillos as blunts, these participants demonstrated that the term "blunt" can refer to the modification of other tobacco products as a vehicle for marijuana use.

Twelve participants reported that they had smoked marijuana by using nontipped cigarillos, and over half were still smoking them at the time of the interview, some on a daily basis. A trend among all participants was the use of multiple types of tobacco products. Among the seven who were using cigarillo blunts at the time of the interview, five were also smoking cigarettes and about a third were using plastic-tipped cigarillos. The use of multiple tobacco products, including cigarillo blunts, can also be seen in the smoking history of participants. For participants who had smoked a cigarillo blunt in their lifetimes, other tobacco products, not blunts, were their initiation to smoking. Of the 12 participants who reported smoking cigarillo blunts, eight started with cigarettes, three with plastic-tipped cigarillos, and one did not report the first product smoked. Participants also discussed when they began using different tobacco products, with four describing the use of cigarillo blunts before ever using plastic-tipped cigarillos, and three discussed using plastic-tipped cigarillos before using blunts. The use of cigarillo blunts was common, and among participants who used cigarillo blunts, many also used cigarettes and plastic-tipped cigarillos in their use histories.

Six participants said that they prefer smoking marijuana to other tobacco products. The reasons for smoking marijuana included not having other things to do (e.g., a job), helping them deal with problems, smoking marijuana because women like marijuana, and the effects of the product, which included relaxation and the feeling of the high. Three participants also listed cigarillo blunts as the best tasting product during the card sort activity. Another reason for smoking cigarillo blunts is the perception that the tobacco inside of the nontipped cigarillo is of low quality and thus needs to be replaced, as exemplified when one participant said, "The tobacco is not meant to be smoked and is meant to be thrown in the garbage. That's how I'll put it. I just use it for weed" (Participant 7, age 20–24). One participant even thought that the tobacco inside of this product will "kill you" (Participant 2, age 18–19). Some participants also suggested that tobacco companies use low quality tobacco because they know that the product is being used for blunts. This understanding is exemplified by one participant who said, "cause now that they know people use these for weed, the cigarillos, they changed the tobacco" (Participant 11, age 25–29). Since these participants think that tobacco companies are using poorer quality tobacco in nontipped cigarillos, it perpetuates the need to replace the tobacco with marijuana.

There were varying ideas regarding the risks associated with smoking cigarillo blunts. Participants expressed different views of the makeup of the shell, which related to their understanding of the risks. By replacing the tobacco in nontipped cigarillos with marijuana, some participants felt that the product was less harmful and addictive since the harmful element, the loose tobacco, was being removed. One participant explained

The Swisher, this is the same thing as that. It's the same thing. That's smoking cigars. A Swisher is a cigar for real. It's just people smoke it 'cause you break it down though. But the only thing that give you cancer is tobacco though. The paper, that don't give you cancer, 'cause if it did, then we would get cancer off weed then. (Participant 8, age 18–19)

For this participant, when the tobacco from the nontipped cigarillo was removed and replaced with marijuana, it eliminated the risk of cancer. Other participants felt that the shell of the nontipped cigarillo could pose risks, including being addictive and harmful to their health because of the tobacco it contains, although this was expressed by fewer participants.

Participants also had differing views of the potential risks of the marijuana element of the blunt. Two participants described how the marijuana itself is not addictive. Conversely, one participant felt that marijuana itself is addictive because he would use it in any form, not just in nontipped cigarillos.

Even for the participants who thought that some part of the cigarillo blunt is harmful, there were also some perceived benefits. One participant explained this contradiction of cigarillo blunt use when he said

So you're inhaling more or less some type of chemical, whether it's your marijuana or not. It's still this cigarillo, this shell, whatever that is made of, you're still inhaling it, but it could be beneficial to some people. I believe for me it's beneficial as far as taking a lot of stuff off my chest. (Participant 5, age 20–24)

Although there may be some harm and risk perceived by the participants, cigarillo blunts are a way that participants use marijuana. Several participants expressed their reasons for using marijuana ranging from its physical (i.e., feeling high) and psychological (e.g., stress relief) effects to a preference for its flavor over tobacco.

While blunts are defined as being made with cigar or cigarillo shells in the literature (Dunlap et al., [11]; Ramo et al., [24]; Sifaneck et al., [12]; Yerger et al., [41]), our data show that for the majority of participants, a blunt is made with a nontipped cigarillo, and other types of blunts (i.e., made from large cigars or plastic-tipped cigarillos) are not common in the local scene; however, there may be larger regional variation. Moreover, in our findings, the words "blunt" and "shell" were used by participants in association with cigarillo blunt use, while the term "blunting" was not. These findings suggest that appropriate terminology may be important in surveillance of these products to ensure more-accurate responses. Furthermore, our data support the splitting of cigarillos into multiple subcategories as suggested by Kozlowski, Dollar, and Giovino ([17]). At least two categories can be found from our data—plastic-tipped cigarillos and nontipped cigarillos—because of their different uses (i.e., different ways of modifying the product) as well as the perceived differences in their contents. Further research is needed to see whether this differentiation is found in other populations and geographical regions.

Participants in this study reported multiple intersections between marijuana and tobacco use. In our data, participants who had used cigarillo blunts tended to have smoked tobacco products (both cigarettes and plastic-tipped cigarillos) prior to ever using marijuana. All participants who were using cigarillo blunts at the time of the interview were also concurrently using other tobacco products, including immediately after smoking marijuana and blunts.

There are limitations to this study. This was a qualitative study of young adult male African American LCC users. Since the sample consisted of one ethnicity and one gender in a particular urban geographic location, it may not be representative of the broader young adult LCC-using population. The primary focus of the interview guide was on tobacco use behaviors and attitudes, which included questions regarding the modification of LCCs. The modification of nontipped cigarillos for the use of marijuana emerged as a very prominent theme from the data but was not the focus of deeper probing or modification of the interview guide. Nonetheless, this corpus of data generated very rich information with which to conduct the analysis reported in this manuscript. However, additional data on participant preferences regarding cigarillo blunts compared with other methods of using marijuana and the specific context of blunt use and use trajectories need to be further explored among this population.

Understanding cigarillo blunt use can have implications for both tobacco and marijuana control efforts since blunt use is an area that brings both tobacco and drug use behaviors together. At the time of submission of this manuscript and at the time of data collection, marijuana was illegal in Ohio, where our study was conducted. Thus, limiting access to LCCs may also affect marijuana use. LCCs, as compared to cigarettes, have lower taxes and prices (Cantrell et al., [4]; Connolly & Alpert, [7]). This has particularly been the case in African American communities, which have also received targeted LCC advertisement (Cantrell et al., [4]; Kostygina, Glantz, & Ling, [16]; Kwate & Lee, [18]; Richardson, Ganz, & Vallone, [26]). As suggested by research with cigarettes (Tworek et al., [40]), an increase in price, including tax increases, may minimize access to LCCs as well. Furthermore, the United States Food and Drug Administration (FDA) is the regulatory body of tobacco products but currently does not regulate cigar products. If brought under the authority of the FDA, marketing regulations as well as inclusion in the FDA's educational campaigns have the possibility of limiting both LCC and marijuana use by making LCCs less accessible.

If cigars continue to be a significant method for smoking marijuana with legalization, this may increase the smoking-related health disparities and risks among African Americans (Haiman et al., [14]). Our data corroborate findings from the literature that show variability regarding whether blunt use is considered marijuana or tobacco use, the addictiveness of blunts, as well as their health consequences (Dunlap et al., [11]; Jolly, [15]). Some participants in our study felt that blunts were less harmful and less addictive because they replaced the tobacco in the product with marijuana, while other participants expressed that the shell and marijuana in the blunt are harmful and addictive. Research has demonstrated the negative effects of blunt use, including an increased dependence to both nicotine and cannabis (Timberlake, [37], [38]). These health effects along with the participants' ambiguity regarding the consequences of blunt use highlight the need for education efforts regarding the implications of blunt use.

Our data suggest that more than health education may be needed. Although some participants acknowledged the health risks of cigarillo blunt use, they also had other reasons for continuing their use. A reason given by participants for modifying nontipped cigarillos is the perception that the tobacco is bad and of low quality. There is also the perception by some participants that tobacco companies know that nontipped cigarillos are being used as blunts and therefore put poor quality tobacco in the product. If this perception is widespread, it may play a role in why almost all of the participants discussed the almost exclusive use of nontipped cigarillos as blunts in their communities. Even if FDA regulation and tax equalization do not come to pass, understanding the reasons participants use tobacco products even when knowing about health risks is important for developing campaigns and interventions to counter them. Further research should focus on the reasons for blunt use in this population and explore strategies to reduce and prevent LCC and blunt use.

This publication was made possible by the Cooperative Agreement #1-U48-DP-001930 from the Centers for Disease Control and Prevention and the Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences (NCATS) component of the National Institutes of Health, and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention, the NIH, or other funders.