The document discusses tobacco product usage among teens and provides the following key points: 1. Approximately 1 in 6 teens reported smoking cigarettes in the past 30 days according to a 2009 Massachusetts survey. 2. Youth who smoke cigarettes are more likely to use alcohol, marijuana, and cocaine. The earlier one starts smoking, the more likely they are to use other drugs. 3. While cigarette smoking is declining among teens, the use of other tobacco products like cigars and smokeless tobacco is increasing according to Massachusetts data from 1999-2009.

1. Gateways to Drugs
CURRENT CIGARETTE USE BY GRADE LEVEL
MA 2009
Teens are still smoking.
In a 2009 survey, approximately 1 in 6 teens reported having 25
21%
smoked in the past 30 days. Why is this important?
20
18%
15%
Youth aged 12-17 who smoke are: 15
• 4x more likely to abuse alcohol 11%
• 4x more likely to smoke marijuana 10
7%
• 26x more likely to use cocaine
4%
5
The earlier in life people use tobacco, the more likely they 2%
are to have tried cocaine, heroin, or other drugs, and the more
0
likely they are to become regular drug users as adults. 6th 7th 8th 9th 10th 11th 12th
Heavy smokers or heavy users of smokeless tobacco are Sources: Massachusetts Youth Health Survey, 2009.
Massachusetts Youth Risk Behavior Survey, 2009.
much more likely to abuse marijuana or harder drugs.
CIGARETTE SMOKING STATUS AND DRUG USE AMONG HIGH SCHOOL STUDENTS | MA 2009
80
69.2
70 non-cigarette
smokers
60
current cigarette
smokers
50
March 2010
40
30
20.1 19.9
20 14.1
8.0 8.5
10 6.8
4.8
1.5 0.3 0.4 0.2 2.2 0.5
0
current ever used current ever used current ever used current
marijuana use cocaine cocaine use crack crack use oxycontin oxycontin use
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2. Blunt and Tipped Cigars T I P C I gArS
What are blunts?
Small cigars, with or without filters, in a variety of flavors, often
used with marijuana.
Health
Like all smoking tobacco. Unfiltered cigars are worse for health
when inhaled. Blunts are strongly associated with marijuana use. B LUNT C I gArS
Common Brands
Phillies, Black & Mild, White Owl, Swisher Sweets, Black Max,
Prince Albert, Happy Hour, Prime Time
Common Varieties
BLUNTS
Short, flavored cigars, often emptied and filled with marijuana
LITTLe CIgArS, CIgArILLOS, MINI CIgArS C I gArI L LOS
Smaller cigars with or without filters
TIP CIgArS, PIPe TOBACCO CIgArS
Cigars with plastic or wood-tip filters. Black & Mild is most popular brand.
What’s the selling point?
• Blunts are mentioned in songs and music videos, usually
associated with marijuana.
• Little cigars look ‘classier’ than cigarettes, though they’re
mostly identical.
Some Flavors: Appletini, Banana, Bellini, Berry, Cherry,
• Seductive flavors with names evoking candy, fruit, and Chocolate, Chocomint, Cinnamon, Coconut, Coffee,
alcoholic drinks. Cognac, Cosmo, Grape, Honey, Mango, Menthol, Peach,
Pina Colada, Raspberry, Rum, Sizzurp, Sour Apple,
Spearmint, Strawberry, Sugarillos, Sweet Vanilla, Tequila,
Watermelon, Wine…
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3. Blunt Wraps B LUNT W rAP S
What are blunt wraps?
Leaf tobacco processed to form a hard, hollow tube.
Filled with loose tobacco or marijuana.
Health
Most have no filters, effects of smoking are much worse
than cigarettes. Strongly associated with marijuana use.
Common Brands
True Blunt, royal Blunt are most common. Also Juicy Blunt,
Blunt Wrap USA, Bluntville, Cyclones (cone-shaped)
What’s the selling point?
• Mentioned in songs and music videos, usually associated
with marijuana.
• Seductive flavors with names evoking candy, fruit, and
alcoholic drinks.
• Notice: If a store sells these, do they also sell loose tobacco?
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4. Roll Your Own (RYO) rOLL YOUr OWN
What is “roll your own”?
Product sold to make your own cigarettes using loose tobacco.
Often used for marijuana.
Health
Most have no filters, effects of smoking are much worse than
cigarettes. Strongly associated with marijuana use.
Related Products
ALUMINUM CIgAreTTeS Or ‘BATS’
Metal tubes about the size and shape of a cigarette. Also called
“one-hitter” or “pinch hitter.”
‘DUgOUT’
Wooden box for storing a ‘bat’ and marijuana.
rOLLINg PAPerS Or CIgAreTTe TUBeS
Now with machines to roll for you.
What’s the selling point?
• Discreet way to smoke marijuana while pretending to smoke tobacco.
• Sold at head shops, popular among ‘stoners’.
• With loose tobacco, can be cheaper alternative to pre-made cigarettes.
• Notice: If a store sells these, do they also sell loose tobacco?
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5. Hookah / Shisha H OOK AH
What is a hookah?
A water pipe. Sweetened tobacco is burned with charcoal, bubbled
through water, and inhaled through a hose and mouthpiece.
Health
• Because smoke is cooler and sweeter, users think smoke is
less dangerous, or that water removes anything dangerous.
• Hookah smoke has same chemicals as cigarette smoke, but
in higher concentrations, especially “tar.” Charcoal contains
chemicals and lighter fluid.
• Deep inhales are needed to burn moist tobacco. Smoking
hookah for an hour will inhale as much tar and nicotine as from
a pack of cigarettes.
• Shared mouthpiece and water can transmit TB, herpes, mono,
hepatitis, flu.
• Highly addictive, leading to strong correlation with cigarette
smoking.
• Could be used to smoke marijuana, hashish, opium.
Common Varieties
• Flavors: apple, apricot, mint, banana
• Water in bowl can be mixed with wine, ice, fruit juice, etc.
• Pipes and tobacco available online. More often, smoked
at restaurants or hookah bars. Found in towns with colleges
or many young adults.
What’s the selling point?
• exotic, trendy, communal alternative to cigarettes.
• Water cools smoke, making it ‘smoother.’
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6. Snus S NUS
What is snus?
Moist snuff in small teabag-like pouches. Used like snuff, but
no spitting.
Health
• Similar risks to chewing tobacco.
• Needs refrigeration, or carcinogenic nitrosamines build up.
• Could lead to use of regular snuff and chewing tobacco and
cigarettes.
Common Brands and Varieties
CAMeL SNUS Mellow, robust, Frost and Winterchill
MArLBOrO SNUS rich, Mild, Peppermint and Spearmint
TrIUMPH (Swedish Brand)
Other common snuff brands as a ‘pouch’ variety.
What’s the selling point?
• No smoke or spitting; can be used where smoking or
regular chewing tobacco is prohibited.
• Burns cheek less than chewing tobacco.
• Flavors mask the tobacco taste.
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7. Dissolvable Tobacco DI S S OLVAB L e
What is dissolvable tobacco?
Fine-milled tobacco in a dissolvable candy-like base.
Dissolves completely in mouth.
Health
• except for nicotine amounts, unknown and untested for safety.
• Full package may contain enough nicotine to kill a small child, if
chewed or swallowed all at once.
• Visual and taste similarity to candy could lead to first use of tobacco
by minors.
• Clerks may not even realize it is tobacco, and may sell to minors.
Common Brands and Varieties
CAMeL OrBS, STICKS, AND STrIPS Fresh and Mellow
ArIVA AND STONeWALL Wintergreen and Java
What’s the selling point?
• No spitting, no smoke, no leftovers.
• Burns cheek less than chewing tobacco.
• “Anytime, Anywhere”: can be used where smoking is prohibited,
like an office (or a classroom).
• Celebrities Lindsay Lohan, Paris Hilton have promoted Ariva for
smoking cessation.
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8. Electronic Cigarettes e L eCT rONI C
What are electronic cigarettes?
Metal device resembling a cigarette, but does not use tobacco.
electricity vaporizes liquid nicotine solution, vapor is inhaled.
Health
• Unknown, very limited testing. Contains propylene glycol, which is
untested for direct inhaling. FDA has found toxic diethylene glycol
and carcinogenic nitrosamines in some samples.
• Liquid contains up to 18 mg of nicotine, enough to kill a young child
if accidentally swallowed.
• Widespread use could send a social message that smoking is
once again a norm. even though illegal for import, available online
and at malls.
Common Brands and Varieties
• gamucci, Smokingeverywhere.com, Jaunty and NJoy
• Different brands have different volumes of liquid
• Different nicotine strengths available
What’s the selling point?
• Manufacturer claims does not cause cancer. Also claims no risk to
others from ‘second-hand vapor’. No research to prove either claim.
• No tar, carbon monoxide, or other effects of burning tobacco.
• Theoretically can be used in public places where smoking is banned.
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9. Tobacco in Disguise
> mints or tobacco?
> lip ba
lm
or tobac
co?
> packaging
makes tobacco
seem fashionable
or attractive.
> pretty
in pink?
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10. Other Tobacco Product Usage
Cigarette smoking is declining among youth.
However, cigar smoking and smokeless tobacco use is on the rise.
OTHER TOBACCO PRODUCT USE* AMONG HIGH SCHOOL STUDENTS: | MA 1999 - 2009
40%
OT H e r
TO B A C C O
P rODUCTS
C I gAre T T eS
30%
Source:
Youth Risk Behavior
Survey 1993-2009
P erC eNT OF ST U D eNTS
* Used one or more days
during the past 30 days.
20% 17.2% 17.6%
16.8%
15.1%
15.0%
13.3%
16.0%
10%
0%
1999 2001 2003 2005 2007 2009
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