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And among today's teens and young adults, there is a worrisome, unhealthy trend. Sales of little cigars are on the rise. NPR's Patti Neighmond reports.
PATTI NEIGHMOND, BYLINE: Cigarette sales are down by about a third over the past decade. Not so for little cigars and cigarillos. Their sales more than doubled, particularly among teenagers and 20-somethings. One reason? They're flavored - sort of like candy. Jennifer Cantrell directs research at the anti-tobacco Legacy Foundation.
JENNIFER CANTRELL: We're seeing chocolate, cherry, wild cherry, strawberry, grape - pretty much every flavor you can think of that you might see in a gum or a candy product, we're' seeing in little cigars and cigarillos.
NEIGHMOND: To examine how heavily companies market to young people, Cantrell sent field researchers out to about 750 small grocery and convenience stores in Washington, D.C. She found stores in areas dominated by young people had far more ads for little cigars. They were outside the store, and they were clearly targeted to a youthful eye.
CANTRELL: They're almost indistinguishable from candy packaging. Some ads that we've seen on the outside of stores, it almost looks like a big box of colorful crayons.
NEIGHMOND: And the price is right, too. Unlike cigarettes, which cost about $6.50 a pack and can't be sold individually, little cigars are wrapped in packages of one, two or three and average about 99 cents per cigar. The Altria Co., which makes one of the most popular cigarillos, says they market to adult tobacco smokers, not to children. Even so, Mayo Clinic researcher and public health advocate Mignonne Guy says little cigars are easier for kids to access than cigarettes, but no less harmful.
MIGNONNE GUY: The average cigarette has approx 8 milligrams of nicotine in it. The average cigar can range anywhere from 100 to 200 milligrams of nicotine.
NEIGHMOND: That's a lot more nicotine than in a cigarette. And the problem is today's teens and young adults don't just puff, like in the old days. They inhale.
GUY: They're treating it like a cigarette, and they're using them like cigarettes. They will say, "I'll use them when I'm really stressed out," after a test, or after a long day's worth of work.
NEIGHMOND: Guy says kids as young as middle-schoolers are trying little cigars. And evidence shows the earlier in life people start using tobacco products, the harder it is to quit.
GUY: We've done a great job in communicating to the general public about the dangers of cigarettes, but we have not done a great job of communicating the harm - and the risk and the danger - of little cigars and cigarillos.
NEIGHMOND: About four years ago, the FDA expanded oversight of cigarettes, restricting advertising and banning most flavors. The agency is now considering whether to take a similar strict stance when it comes to regulating little cigars and cigarillos.
Patti Neighmond, NPR News.
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