DESCRIPTION (provided by applicant): Between 2000 and 2012 cigar, cigarillo, and little cigar (CCLC) use has increased 124%. Adolescents and young adults are the most prevalent users. For some states and urban school districts, including Cleveland, Ohio, the use of CCLC among adolescents now exceeds the use of cigarettes. Despite the increase in CCLC use among youth, attention to potential nicotine dependence (ND) among users of these products has been largely ignored. Recent evidence shows that users of CCLC do inhale when smoking and that, when compared to cigarettes, CCLC products contain as much if not more of the highly addictive chemical nicotine. Therefore, assessing ND among CCLC users is an important step to inform the extent to which these products are causing harm among users and thus, should be subjected to the same regulations as cigarettes. Patterns of use and the speed and method with which nicotine is physically received differ by tobacco product; because of this Fagerstrom and colleagues suggest that product-specific measures are needed to more precisely assess the level of ND among users. To our knowledge no measure of ND has been adapted for CCLC users nor has there been a new measure created for this purpose. This represents a significant gap in research we aim to address by establishing a measure of ND symptoms that is relevant, valid and reliable for adolescents and young adult CCLC users. Using an array of rigorous methods including qualitative in-depth interviews, Rasch modeling for measure development, and survey and biomarker data, the proposed project will contribute to the reliable and valid measurement of ND among CCLC users. The final CCLC ND measure will be administered to large samples of adolescents using the Youth Risk Behavior Survey (YRBS) to assess the prevalence of ND symptoms among CCLC users. The findings from this study will guide decisions regarding the appropriate implementation and scope of CCLC product regulation that is parallel to cigarettes with regard to warning labels, harmful constituent reporting, and regulation of other aspects that have been shown to influence youth access to and consumption of tobacco projects including packaging and product placement for sale.

PUBLIC HEALTH RELEVANCE: The use of cigarillos, cigars and little cigars (CCLC) has increased dramatically especially among adolescents and young adults. To date, instruments to measure nicotine dependence among tobacco users have not been developed or adapted for CCLC users. This project will use rigorous methods to develop a measure of nicotine dependence that is valid and reliable for CCLC users. This work will inform whether these products are causing nicotine dependence and harm to users and thus, should be subjected to the same regulations as cigarettes. Inequitable regulation with regard to reporting contents, labeling, flavoring and packaging make CCLC products highly attractive and accessible to adolescents.