Cigarillo Flavor in Context: Qualitative Analysis of the Social-Ecological Factors Influencing Cigarillo and Cannabis Co-Use Among Young Adults.

Co-use of cannabis and cigarillos ("co-use") is prevalent among young adults. The United States Food and Drug Administration proposed a rule to ban flavored cigars, which could impact co-use, particularly blunt use (removing tobacco from cigar and mixing or replacing with cannabis). We sought to explore the impact of cigarillo flavor on cannabis/cigarillo co-use. The sample included 38 young adults (21-28) who smoked cigarillos and cannabis in the past month recruited from a non-probability sample of participants in the Cigarillos Flavor and Abuse Liability, Attention, and Substitution (C-FLASH) Study. Semi-structured phone interviews were conducted, double-coded, and analyzed for emergent themes. Most participants believed cigarillo flavor enhances the co-use experience, but participants mostly felt that a cigar flavor ban would not impact their cannabis use. They would continue using unflavored cigarillos to roll blunts or migrate to another method of consuming cannabis. Other influential cigarillo characteristics (e.g., burn time) and social-contextual factors (e.g., management of mental health, easy access) emerged. Banning flavored cigars may have a neutral to positive impact on co-users. To reduce co-use, policymakers should consider approaches to address psychosocial and structural determinants of use.