The United States Food and Drug Administration (FDA) announced in June of 2022 that plans to implement a reduced-nicotine standard for combustible cigarettes will move forward [1]. By reducing the nicotine content of cigarettes—and therefore their addictiveness—this policy aims to reduce smoking rates, make smoking cessation easier, and prevent tobacco initiation among youth and young adults [2]. The FDA is considering how broadly this policy should be implemented, as focusing solely on cigarettes may encourage people who smoke cigarettes to shift to other combustible tobacco products or engage in the dual use of cigarettes and other products, reducing the policy’s effectiveness [3]. Therefore, there are sound public health reasons to include other combustible tobacco products in the policy.

In the US, cigars, including both large cigars and little cigars and cigarillos (LCCs), are the third most used tobacco products after cigarettes and e-cigarettes. In 2020, 12.5% of US adults used cigarettes and 3.5% used cigars [4]. Rates of cigarette and cigar use are similar in Canada [5]. In the UK, cigar use is less common; however, a number of people who smoke report concurrent cigar use [6]. Amid the declining trend of cigarette consumption in recent years, cigar consumption has increased, with rates more than doubling from 2000 to 2011 [7]. Recent years also have witnessed an increase in cigar promotion on social media, which might lead to more LCC consumption [8].

Smoking LCCs puts individuals at risk for the same adverse health effects as smoking cigarettes, including cancer, lung disease, heart disease, and gum disease [9]. Indeed, smoking LCCs can deliver more tobacco-specific nitrosamines, carbon monoxide, and nitrogen oxide than smoking a cigarette due to their larger size [10]. Furthermore, nicotine delivery from LCCs is similar to cigarettes [11]. Despite their similarities, cigar products are taxed at lower rates than cigarettes in both the US and UK, resulting in lower prices [12,13]. In the US, weaker advertising restrictions apply to products labeled as cigars than to cigarettes [14]. Therefore, while some cigars look similar to cigarettes, they meet the legal definition of cigars, and tobacco manufacturers label them as LCCs to avoid the more stringent regulations of cigarettes and exploit the policy [12,14,15].

There are several important distinctions between the patterns of cigarette and LCC use. While cigarette smoking rates are similar between US whites and African Americans, cigar use prevalence is much higher among African Americans [16]. Additionally, males and people with lower incomes are more likely to use LCCs than their counterparts [17]. Another distinction between cigarette and cigar use concerns the patterns and contexts of use. Overall, LCCs are commonly used in infrequent social occasions rather than daily [18]. LCCs also come in many flavors that are banned in cigarettes [19], and flavors are a primary reason people cite for using LCCs [20]. Many LCCs are designed to be modified by the user, such as emptying out the tobacco and using the LCC wrapper to hold marijuana, which is very common [21].

As the tobacco industry has successfully marketed LCCs as different from cigarettes, they have also succeeded in fostering misperceptions. People falsely believe that cigars are less addictive than cigarettes [17], and many people who use LCCs do not consider themselves addicted [20]. If a reduced nicotine policy was implemented for LCCs and the initiative was communicated to the public, misbeliefs about LCCs might reduce public understanding about the policy. Research shows that anti-smoking communication campaigns that target people who use LCCs should be differentiated from anti-smoking campaigns that target people who use cigarettes. For example, a study aiming to develop a health communication campaign to discourage cigarillo use found that given that individuals who use these products tend to be younger and misperceive them to be less harmful than traditional cigarettes, messages targeting people who use cigarillos should correct those misperceptions and focus on the harmful constituents of LCCs [22]. To help understand the potential for reduced nicotine LCCs to lower the population harm from the use of these products and inform communication efforts about the policy, we conducted a qualitative study of people who use LCCs to provide an in-depth examination of their perceptions of nicotine and addiction related to LCC use.