Potential Impact of a Flavored Cigar Ban in Young Adults Who Dual Use: A Randomized Clinical Trial

INTRODUCTION: Flavored tobacco bans decrease tobacco use, but the impact in young adults who use multiple products is unclear. This study evaluated how availability of flavored cigarillos affects (a) cigarillo demand and smoking and (b) cigarette demand and smoking in young adults who dual use cigars and cigarettes. Results may inform tobacco use behaviors under a ban. METHODS: In this 2-week randomized crossover trial (collected 2018-2020, analyzed 2024-2025), dual-using young adults (18-34 years) completed 1-week (each) flavored and tobacco-flavored study cigarillo assignment in random order. Outcomes were: demand for study cigarillos and own-brand cigarettes (hypothetical consumption at increasing prices measured using a purchase task), smoking behaviors, and product dependence. Fifty-three participants completed all study visits (77% male, 45% non-Hispanic white). RESULTS: Hypothetical consumption of tobacco-flavored cigarillos decreased more as prices increased compared to flavored cigarillo purchasing (Beta=0.07, 95% Credible Interval=0.01,0.12), indicating greater overall demand for flavored cigarillos. Tobacco-flavored cigarillos were less satisfying [Beta =-0.45, 95% Confidence Interval (CI)=-0.82,-0.09], reduced cravings less (Beta=-0.48, 95% CI=-0.95,-0.01), and relieved negative affect less (Beta=-0.40, 95% CI=-0.76,-0.05) than flavored cigarillos. However, smoking behaviors did not differ for flavored vs. tobacco-flavored study cigarillos. Cigarillo condition had no effect on cigarette demand, consumption, or dependence. CONCLUSIONS: Dual-using young adults preferred flavored cigarillos, with no evidence of increased preference for cigarettes when flavored cigarillos were unavailable. A cigar flavor ban might encourage dual-using young people to reduce or quit cigars without increasing cigarette smoking, but additional measures may help encourage cessation. TRIAL REGISTRATION: The study is registered at www. CLINICALTRIALS: gov NCT03496077.