Problem/Objective: Before the 1990's, cigar use was rarely included in tobacco use surveillance efforts and survey items were often limited to large cigars, neglecting the rising popularity of cigars and little cigars. While rates of cigarette use are in decline, little cigar use represents an underappreciated threat. Moreover, patterns of tobacco use and multiple product use are not well understood, in part due to limited measurement in national surveys.

Methods: Between 2003 and 2006, 5,301 individuals in northeast Ohio were randomly selected and surveyed by telephone and completed the Behavior Risk Factor Surveillance System, which was expanded to include items assessing little cigar use with reference to common brands. Data were weighted to reflect the demographics of the county.

Results: Cigarette, cigar, and little cigar users have distinct demographic profiles and patterns of use. While cigarette and cigar use has been widely studied, little cigar use has remained unexamined. Little cigar users are more likely to be African Americans, male, lower income, less educated and more likely to use multiple tobacco products. More striking is that nearly 80% of current little cigar users also smoke, on average, ½ pack of cigarettes and 1 cigar per day.

Conclusions: Our findings suggest that little cigar users represent a special population with an increased health risk due to greatly increased exposure. The results highlight the importance of the inclusion of alternative tobacco product use in epidemiological surveillance.