Density of medical marijuana dispensaries and delivery services per city, however, was negatively and strongly associated with greater availability of these products at places where tobacco products are typically sold. The current study examined social factors associated with availability of tobacco products for blunts. Other studies have shown that the tobacco industry aggressively markets specific products, such as menthol cigarettes, in low-income communities and communities of color . This may not be the case for blunts and blunt wrappers. Results of our study indicate, that for the most part, availability of tobacco products associated with blunts was similar in neighborhoods with different socioeconomic status and racial and ethnic composition. Focusing on socioeconomic status, these results are less expected given the associations between some low socioeconomic indicators and use of blunts . Our results regarding racial and ethnic composition are consistent with recent findings that blunt smoking appears to be practiced among a growing number of racial/ethnic groups . Moreover, our finding about the positive association between percent of Whites and availability of cigars at the store is consistent with results of a recent study that cigar use including big cigars, cigarillos, and little cigars has increased among White non-Hispanic men aged 18 to 25 years . Additionally, our findings suggest that convenience stores, smoke/tobacco shops and liquor stores may provide greater availability of tobacco products associated with blunts than do other types of stores that sell tobacco. Because previous studies have shown that exposure to and availability of drugs increase drug use and abuse , policies that limit young people retail access to these products may help to reduce use of blunts and therefore related problems such as growing indoor cannabis and tobacco dependence and smoking-related diseases . Interestingly, all three community-level factors related to marijuana use and access to medical marijuana were found associated with availability of tobacco products associated with blunts. Specifically, higher prevalence of marijuana/hashish use and policy that permits medical marijuana dispensaries and private cultivation were positively associated with availability of tobacco products for blunts in tobacco outlets.
Density of medical marijuana dispensaries and/or delivery services, however, reduced odds of availability of these products. Possible explanations of these results include considering community norms and physical demand. Focusing on the associations between medical marijuana policy and availability, it is possible that community norms that support marijuana use may affect medical marijuana policy which in turn may increase availability of tobacco products associated with blunts. Using structural equations modeling, our previous studies indicated that community norms were directly related to tobacco and alcohol policies . Community-level prevalence of adult marijuana/hashish use was another important factor.In this case, higher rates of marijuana use contribute to more acceptability of marijuana which affects policy and availability. However, it is also possible that increased acceptability of marijuana affects policy and access to marijuana which in turn increases rates of marijuana/hashish users in the community. A recent study found higher odds of marijuana use in states that legalized medical marijuana . The cross-sectional design of the current study limits our understanding of these relationships. Future studies should explore these potential mediation effects and its relationships to youth and adults marijuana and blunts use. We also found that greater density of medical marijuana dispensaries and delivery services reduced odds of availability of tobacco products associated with blunts. These relationships may be explained by economic equilibrium theory . That is, tobacco stores may service demand for products associated with marijuana use when supply through medical marijuana dispensaries and delivery services is low. Also, tobacco stores that sell products associated with blunts and medical marijuana dispensaries and delivery services may serve different types of marijuana users and therefore emerge in different types of business. Some research suggests that blunts use is a distinct sub-cultural formation associated with hip hop or rap music and with distinct configuration of rituals, jargon, and drug use norms .
Results of this study should be considered in light of several limitations. First, the cross sectional design of the study limited our ability to make directional inferences about relationships between the community-level factors and availability. For example, prevalence of adult marijuana/hashish use can be a proxy of community norms or it can be a result of availability of marijuana and marijuana products through density of medical marijuana dispensaries and delivery services. Also, the study included only selected tobacco outlets in midsized cities. Including rural communities and a larger sample of tobacco outlets may help to more closely explore the relationships between neighborhood demographics and availability. Third, it is possible that our community-level measures do not capture societal level influences related to normalization of marijuana use comprehensively. Other studies should include other variables related to popular culture and more direct measures of adult beliefs. Finally, information about individuals’ blunts use in these communities was not available for the study. Prevalence of blunt smoking in regions of California is unknown. Such information is only available from of a qualitative study of Southeast Asian Americans in two communities in San Francisco Bay Area. In that study, 62% of youth and young adults and 10% of adults reported lifetime blunts use . This limits our understanding of the relationships among community norms, medical marijuana policy, availability of tobacco products associated with blunts and actual blunts use. Despite these limitations, results of this study suggest the important role that community norms that support marijuana use or legalization of medical marijuana and medical marijuana policy may play in increasing availability of tobacco products associated with blunts. Since blunts have become popular over time and expanded into growing number of racial/ethnic groups , these results may be of particular importance to different communities in California and elsewhere. Tobacco and marijuana policymakers should be aware of the larger social contexts of blunts use and availability and the importance of considering societal-level influences related to normalization of marijuana use to reduce blunts use and/or other forms of concurrent use of tobacco and marijuana.
Similarly, results of this study also suggest the importance of studying blunts use and availability within the larger social contexts of marijuana use, related policies and community norms to better inform policies to reduce blunts use and/or other forms of concurrent use of tobacco and marijuana.In January 2020, the United States Food and Drug Administration finalized a policy to prioritize enforcement against cartridge-based e-cigarettes in flavors other than tobacco and menthol, effective February 1, 2020 . At the time,indoor cannabis growing no e-cigarette product was authorized for sale in the United States, meaning that no e-cigarette was being sold with legal authorization. However, the FDA had exercised enforcement discretion to defer authorization requirements, effectively allowing all e-cigarettes into the marketplace. The FDA announcement cited “epidemic levels” of youth e-cigarette use , particularly use of mint and fruit flavors and cartridge-based systems , such as those sold under the JUUL brand, in which single-use cartridges, or pods, are swapped in and out of a reusable device. The policy goal was to focus on products most attractive to youth. Companies that did not cease manufacture, distribution and sale of prioritized products within 30 days “risked FDA enforcement actions ,” but those enforcement actions were not delineated. The policy was criticized for vague product definitions and for excepting menthol, refillable, and disposable e-cigarette products increasingly popular among youth . The policy was defended as providing flexibility to pursue action against any e-cigarette company selling products that target youth . E-cigarettes are the most commonly consumed tobacco product among adolescents . Flavors in e-cigarettes and other tobacco products and a cooling sensation from added menthol may increase product appeal and mask harshness, motivating youth experimentation and continued use . Fruit flavors and sweet/ dessert flavors are considered particularly popular among young e-cigarette users; however, combination fruit-ice flavors and mint flavors are also used commonly . While recent surveillance indicates a possible decline in e-cigarette use prevalence among adolescents, 80% of e-cigarette users report using flavored products . Emerging data also suggest that flavored and pod-based product use continued to be normative among young e-cigarette users in the months following the FDA enforcement prioritization policy. The 2020 National Youth Tobacco Survey , conducted from January to March , demonstrated that high school e-cigarette users most commonly used pod devices and fruit , mint , menthol , or sweet flavors.
In a May 2020 national online survey of adolescents and young adults, reusable pod/cartridge e-cigarettes and disposable e-cigarettes, such as those sold under the Puff Bar brand, were the most used devices, and mint, menthol, or ice was the most used class of flavors among both reusable and disposable users . Barshaped “fifth-generation” disposable devices, sometimes called “podmods” , do not actually contain pods, are not modifiable, and differ from first-generation “cigalike” disposable devices. This manuscript uses “modern disposable” to refer to these disposables and “reusable pod” to refer to reusable systems with single-use cartridges .The present study characterizes device type and flavor behaviors among young e-cigarette users approximately one year after the FDA policy announcement, allowing time for regulators, sellers, and users to adjust to the new policy. As the main goal of this study was descriptive, no numerical hypothesis was defined. Data are from a national online panel of e-cigarette repeated ever-users ages 14–20 years, conducted from March to April 2021. The investigation also examines participants’ e-cigarette flavor preferences and perceived access to flavors that they like. Finally, using latent class analysis , we classify participants according to their flavor preferences and examine how flavor preferences relate to sociodemographic characteristics, e-cigarette and other tobacco use behaviors, and reasons for e-cigarette use. Examining e-cigarette flavor preferences, rather than use behaviors alone, may help inform assumptions about how youth may respond to potential policies. Results are based on a national cross-sectional online survey of adolescents and young adults who reported e-cigarette ever use . Participants were recruited from existing, actively managed market research panels aggregated by a third-party vendor . Online research panels have gained wide use in behavioral health sciences research, including tobacco control research and with youth specifically . While panel members may not represent the general population, participants reflect a range of geography, age, income levels, and racial/ ethnic groups. For this investigation, panel members residing in the United States whose demographic profiles potentially matched study eligibility criteria were invited to complete a screener questionnaire to confirm their age and lifetime e-cigarettes use . A threshold of ≥3 times was set as an inclusion criterion to help assure that the study population included participants familiar with e-cigarettes from repeated use. Of 8860 completed screener questionnaires, 2712 participants met eligibility criteria and 2253 of these completed the survey. Surveys were administered from March 18 to April 25, 2021. Median completion time was 9 min. Participant incentives varied by panel but typically consisted of points redeemable toward merchandise, travel, or other awards. Before beginning the survey, potential participants were provided information stating that the survey was a research study and were informed of the study goals, its voluntary nature, and were asked to complete two items to confirm their comprehension. Signed informed consent was not collected to preserve anonymity. The University of California San Francisco Institutional Review Board approved all study procedures. All participants were provided with a list of 9 different tobacco products , 6 types of e-cigarette devices , marijuana, and alcohol and asked to endorse all of the products listed that they had ever used . The list included photographs and example brands. For each product ever used, participants reported how many days in the past 30 days they used that product . Past 30-day e-cigarette users were asked to endorse which e-cigarette flavors they had used in the past 30 days from a list . All participants, including e-cigarette non-users were asked, “Right now, how difficult or easy is it to find e-cigarettes or vapes in flavors that you like?” with 4 options . Participants were then asked how it is to find each of 8 specific e-cigarette flavors and how it is to find fruit, candy, fruit-ice, and/or dessert e-cigarette flavors from 5 specific sources . All participants were asked to respond to the prompt, “How much do you like the following flavors for e-cigarettes or vapes?” for 8 flavors .