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.