Perceived Tobacco Accessibility and Cigar Initiation: Exploring Racial and Ethnic Differences.

Cigar initiation among youth is a public health hazard. The current study examines the relationship between perceived tobacco accessibility and cigar initiation, with a focus on exploring racial differences in this association. We studied a longitudinal cohort of 5399 youth aged 12-17 who had never used cigars (cigar-naïve) and were surveyed as part of the nationally representative Population Assessment of Tobacco and Health Study. Using multivariable regression and marginal effects, we modeled cigar initiation within 1-year after the measurement of the perceived tobacco accessibility (very easy/somewhat easy vs somewhat difficult/very difficult). We then explored the interaction between accessibility and race and ethnicity. We additionally used multivariable logistic regression to model changes in perceived accessibility. Approximately 4% of youth started smoking cigars by 1 year later. In our final adjusted model, perceiving tobacco accessibility as very easy/somewhat easy increased the estimated risk of initiating cigars by 59% (OR = 1.59; 95% CI: [1.18, 2.16]). The probability of cigar initiation also increased with each higher level of perceived accessibility. Compared to Non-Hispanic White youth who perceived tobacco to be inaccessible, Hispanic youth who perceived tobacco as accessible were 2 times (OR = 2.01; 95% CI: [1.09, 3.71]) more likely to initiate cigar use by 1 year later. Youth who believe they have easy access to tobacco are at an increased risk of starting to smoke cigars with the risk possibly higher among Hispanic groups. Multi-level approaches focused on reducing tobacco accessibility are needed to successfully reduce cigar initiation among all youth.