A qualitative exploration of cigar smoking beliefs by type among U.S. susceptible Black young adults

Abstract

Background

Cigar smoking is associated with cancer and pulmonary and cardiovascular diseases. Black young adults have the highest prevalence of cigarillo and little filtered cigar smoking. Little is known about Black young adults’ beliefs about each cigar type, which helps understand behaviors and informs prevention strategies.

Methods

We conducted belief elicitation interviews with 30 Black young adults interested in cigar smoking from April 2022-January 2024 to explore their behavioral, normative, and control beliefs by cigar type. We used thematic analysis to code emergent themes by belief category and cigar type.

Results

Participants mentioned more positive behavioral beliefs for cigarillos and large cigars than for little filtered cigars. There was less variation across cigar types for negative behavioral beliefs. Friends were mentioned as referents (i.e., individuals whose opinions or behaviors influence one’s attitudes or decisions) supportive of cigar smoking, particularly for cigarillos. Family members were mentioned as referents unsupportive of cigar smoking. While easy- and difficult- to-smoke beliefs emerged across cigar types, participants mentioned more easy-to-smoke beliefs for large cigars and more difficult-to-smoke beliefs for cigarillos and little filtered cigars. Cigarillos were characterized by outcome expectations of stress relief and use within social contexts; little filtered cigars were characterized by expectations of nicotine-related physical effects and relaxation; and large cigars were characterized as symbolizing high social status and social positions of power.

Discussion

Salient beliefs by cigar type support the need for cigar-specific prevention messaging for Black young adults. Future research should test the utility of modifying these beliefs in prevention messaging.