Health Behavior Branch, Division of Intramural Population Health, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD.
Department of Epidemiology and Biostatistics, Michigan State University, East Lansing, MI.
Nicotine Tob Res. 2018 Feb 7;20(3):355-361. doi: 10.1093/ntr/ntx015.
Among United States teens during the 1990s, increasing cigar use coincided with increasing use of tobacco cigar shells filled with cannabis, called "blunts." Cigar smokers are more likely to use cannabis, and we hypothesized that starting to smoke cigars might be a probabilistic "trigger" of blunt smoking. We turned to the case-crossover approach to evaluate this hypothesis.
Within US National Surveys on Drug Use and Health, 2009-2013, we identified a nationally representative sample of newly incident blunt smokers aged 12- to 21-years-old (n = 4868) and compared month-of-onsets for smoking of cigars and blunts. Using the subjects-as-their-own-controls case-crossover design, we specified the first month prior to blunt use as a "hazard interval" and the second month prior to blunt use as a "control interval." We used Mantel-Haenszel (MH) estimators to estimate the matched-pairs odds ratio (OR).
The MH OR estimate was 1.7 (95% CI = 1.3, 2.3), with excess odds of cigar onsets during the hazard interval relative to the control interval. Two alternative control interval specifications yielded congruent estimates (OR = 2.7 and 2.9, respectively).
A short interval right after starting to smoke cigars may be one of increased risk of starting to smoke blunts. We discuss cigar, cigarillo, and "blunt wraps" control approaches that might reduce both tobacco and cannabis-related harms.
If this evidence is correct, increased market-targeting to promote youthful cigar and cigarillo smoking might be followed by increased rates of blunt smoking in a vulnerable population. As noted by others, enhanced risk of smoking-attributable harms might be a consequence of mixed tobacco-cannabis formulations.
在 20 世纪 90 年代的美国青少年中，雪茄烟的使用量不断增加，同时使用大麻填充的烟草雪茄烟也在增加，被称为“blunts”。雪茄烟民更有可能使用大麻，我们假设开始抽雪茄可能是吸食“blunts”的概率“触发因素”。我们采用病例交叉研究方法来评估这一假设。
在 2009 年至 2013 年的美国国家药物使用和健康调查中，我们确定了一个具有全国代表性的新吸烟的 12 至 21 岁青少年（n=4868）的样本，比较了吸烟雪茄和“blunts”的起始月份。使用以个体自身为对照的病例交叉设计，我们将使用“blunts”前的第一个月定义为“危险间隔”，将使用“blunts”前的第二个月定义为“对照间隔”。我们使用 Mantel-Haenszel（MH）估计量来估计匹配对的比值比（OR）。
MH 估计值为 1.7（95%CI=1.3，2.3），在危险间隔期内吸烟雪茄的几率相对于对照间隔期内吸烟雪茄的几率较高。两种替代的对照间隔期规格得出了一致的估计值（OR=2.7 和 2.9）。
在开始吸烟雪茄后的短时间内，可能会增加开始吸食“blunts”的风险。我们讨论了控制雪茄、小雪茄和“blunt wraps”的方法，这些方法可能会减少烟草和大麻相关的危害。
如果这一证据是正确的，增加针对年轻人群体推广雪茄和小雪茄的市场推广活动，可能会导致易受影响人群中吸食“blunts”的比例增加。正如其他人所指出的，吸烟相关危害增加可能是混合烟草-大麻配方的结果。
