Using Comparative Health Perceptions of Cigarettes to Prevent New and Emerging Tobacco Use Among Black Youth and Young Adults

Background: Comprehensive tobacco prevention programs have been largely successful in preventing cigarette uptake and escalation of use among youth. However, the use of new and emerging tobacco products is now on the rise. Traditional tobacco products have shown to have disproportionate and significant negative health impact on the Black community. Yet, information on the use and perception of these non-cigarette products (NCP) by Black youth and young adults are lacking. This study aims to understand how Black youth and young adults perceive harms of these NCP relative to cigarettes to better form targeted messages.

Methods: Individual in-person interviews were conducted among a sample of continuation high school and vocational school students in southern California. Participation was limited to those who had ever tried at least one tobacco product, self-identified as Black/African American, and were between the ages of 14-26 (n=28). Qualitative methods were used to analyze themes related to harm perceptions of new and emerging tobacco products relative to cigarettes.

Results: Respondents held strong negative cigarette health and named outcomes like cancer, addiction, and bad teeth. For NCP, health perceptions were mixed and depended on the similarities drawn between the two types of products. If respondents understood the product to have “nicotine” or “tobacco” in the product, then they were more likely to draw similar health perceptions as those for cigarettes. Modification of cigars/cigarillos with marijuana produced split perceptions on health, where those who believed taking out the tobacco was a healthy option compared to those who thought they were swapping one drug for another so it then would have equal or worse health outcomes. Similarly, some viewed hookah as less harmful than cigarettes based on whether they believed it had nicotine or tobacco in it, while others believed it to be more harmful if they viewed it as just a different way of smoking the same chemicals. Vapes and e-cigarettes were most frequently seen as a safer alternative to cigarettes. This was often attributed to the ability to moderate the “hit” (i.e., harshness). Vaping was often seen as healthier than both hookah and cigarettes because of the lack of nicotine and tobacco.

Conclusions and Implications: The overall perception that both tobacco and nicotine were harmful presents a possible pathway for developing new messages to prevent uptake of new and emerging tobacco products, particularly among Black youth and young adults. Making the connection between these new products and cigarettes, nicotine, and/or tobacco will be an efficient means of transferring current health beliefs and capitalizing off the successes of earlier tobacco prevention and control efforts.