The issue of smoking on college campuses has seen much debate.

According to the activist group Americans for Nonsmokers’ Rights, 1,137 college campuses in the United States are currently tobacco-free. However, a cultural shift has occurred tobacco use to marijuana use, and several researchers at Case Western Reserve University are currently exploring the social factors that influence smoking tendences.

Elizabeth Antognoli, a medical anthropologist working in the Center for Common Health Integration, specializes in qualitative research on cancer prevention. She obtained a doctorate in medical anthropology and her master’s in public health from CWRU. Most recently, she completed a study in which she interviewed cigarillo smokers and compiled information on their social behaviors.

The study, which is based on a larger evaluation conducted by Susan S. Locke, seeks to develop and measure nicotine dependence among cigarillo smokers. Cigarillos, which are tobacco products similar to cigarettes and cigars, differ in terms of the amount of nicotine found within and in terms of how they’re used—the interaction between smoker and nicotine product varies based on the product’s characteristics and features. Most importantly, however, the behavioral interactions differ as well. To understand these behavioral differences, Antognoli’s manuscript was split into several phases.

“Phase 1, on which the interviews of this manuscript were based, was to understand how these products were used,” said Antognoli. “We wanted to explore what the individual’s behaviors were and how their attitudes differed, based upon preferences in regards to smoking.”

Their findings offered an intriguing glimpse into smoking behavior.

“One of the main things we found was that people prefer to smoke in groups of two or more people,” she said. “When that happens, the products are repeatedly passed back and forth. This is how people begin smoking in the first place, with a product passed to them.”

As it turns out, this passing is a common way for tobacco smoking to be initiated.

Additionally, as detailed by the second part of the manuscript, Antognoli found that individuals who purchase cigarillos tend to use them not just for tobacco, but for marijuana as well. Because of this, there has been an underreporting of cigarillo use: People usually refrain from using the term “cigarillo” to describe what it is they’re smoking, and instead use brand names (like “Milds”). Interestingly, when cigarillos are employed for marijuana use, tobacco is still being inhaled because the leaf is used as the “shell”.

According to a series of national surveys by the University of Michigan’s “Monitoring the Future” study in 2015, daily marijuana use amongst college students is the highest it has been since 1980, surpassing even tobacco use. This presents a health problem for both smokers and non-smokers alike.

“There’s a lot of miscommunication about what exactly is being smoked,” said Antognoli. “What’s really interesting is that cigarillos and marijuana blunts make up 83 percent of our sample—people use both products together, to create blunts with both tobacco and marijuana.”

Antognoli also detailed a similarity in setting, mentioning that “the most common practice is to chase the marijuana blunt after the cigarillo to extend the high.”

Even if an individual is intending only to smoke marijuana, they end up smoking the cigarillo as well; Antognoli’s research aimed to explore both how and why this co-product use was happening. Because marijuana is not always readily available for smokers, cigarillos were found to be a substitute for the marijuana blunt.

“The co-use of the product has a lot of implications for initiating, continuing and increasing tobacco use,” said Antognoli.

To continue tobacco use in recreational activities is to continue behaviors that lead to cancer, and Antognoli is seeking to understand the social behaviors involved in these practices so that preventative measures can be taken.

University Health and Counseling Services offers information for students regarding drug dependency on their website.