Is Cigar Smoking on the Rise?

Cigar smoking is currently a fad in the United States, especially among young men and women. It is fueled in part by the efforts of the tobacco industry to glamorize cigars and the willingness of movie stars to be photographed smoking cigars. Especially for women, the industry seems to have tapped into an impulse among some to be slightly outrageous, to do something a little over the line, to be liberated from old restrictions and stereotypes. Teenagers and young adults may be particularly vulnerable because of the mistaken idea that cigars are safer than cigarettes.

From 1973 to 1993 cigar smoking had been on the decline. Since 1993 however, cigar use in this country has increased nearly 50%. Use of small cigars has gone up about 13% while consumption of large cigars has risen nearly 70% during this time period. Sales of premium cigars, most of which are hand-made and imported, has increased even more--an estimated 250%.

Most of this increase appears to be among teenagers and young men who smoke less than daily. Surveys show that the current level of cigar smoking among adolescents and teenagers is higher than that of smokeless tobacco use. A 1996 survey of Massachusetts students in grades six to 12 showed that cigar use ranged from 3.2% in the sixth grade to as high as 30% in high school. The same survey showed that 6% to 7% of girls in grades nine to 11 reported they had used cigars in the past month. The Centers for Disease Control and Prevention’s 1997 Youth Risk Behavior Survey reported that among US high school students, 42.7% used cigarettes, smokeless tobacco, or cigars during the 30 days before the survey. Current cigar use was reported by 22% of the students. Boys were more likely to use cigars (31.2%) than were girls (10.8%).

The greatest increase in adult cigar smoking is among young and middle-aged white men (ages 18 to 44) with higher than average incomes and education. There is a boom in the popularity of premium cigars that parallels the interest in gourmet coffee and micro brewery beers. The health risks of cigar smoking are, of course, ignored in this effort at glamorization.

How Are Cigars Different from Cigarettes?

A cigar is defined, for tax purposes, as "any roll of tobacco wrapped in leaf tobacco or in any substance containing tobacco," while a cigarette is "any roll of tobacco wrapped in paper or any substance not containing tobacco."

Cigars come in different sizes, some as small as a cigarette, others much larger. Large cigars typically contain between 5 and 17 grams of tobacco. It is not unusual for some premium brands to have as much tobacco in one cigar as in a whole pack of cigarettes. Large cigars can take between one and two hours to smoke.

Most cigars are made up of a single air-cured or dried burley tobacco. Cigar tobacco leaves are first aged for about a year and then fermented in a multi-step process that can take from three to five months. Fermentation causes chemical and bacterial reactions that change the tobacco and give cigars a different taste and smell from cigarettes.

Do Cigars Cause Health Problems?

Smoking as little as one cigar per day can increase the risk of several cancers, including cancer of the oral cavity (lip, tongue, mouth, throat), esophagus, larynx, and lung. Cigar smoking may be linked to cancer of the pancreas as well.

Daily cigar smoking, especially for people who inhale, also increases the risk of heart disease and a type of lung disease known as chronic obstructive pulmonary disease or COPD. Smoking one or two cigars a day doubles the risk for oral cancers and esophageal cancer compared to someone who has never smoked. And someone smoking as few as one or two cigars daily increases the risk of cancer of the voice box (larynx) by more than six times that of a nonsmoker.

The risks from cigar smoking increase with the number of cigars smoked per day. Smoking three to four cigars per day increases the risk of oral cancer to 8 and a half times that of a nonsmoker, and smoking more than five cigars daily raises the oral cancer risk to 16 times that of nonsmokers.

Does Inhaling Affect the Risks?

While almost all cigarette smokers inhale, most cigar smokers do not. But cigar smokers and cigarette smokers still have similar levels of risk for oral, throat, and esophageal cancers. For example, the risk of oral cancers among daily cigar smokers who do not inhale is seven times greater than for nonsmokers; the risk of cancer of the larynx is more than 10 times greater than that of nonsmokers. Although the risk of lung cancer is lower for cigar smokers compared to cigarette smokers, it is still double that of nonsmokers.

For cigar smokers who inhale, the risks are even greater. Compared to nonsmokers, cigar smokers who inhale deeply have 27 times the risk of oral cancer, 15 times the risk of esophageal cancer, and 53 times the risk of cancer of the larynx. The lung cancer risk for cigar smokers (five cigars per day) who inhale moderately is about the same as that of a one-pack-a-day cigarette smoker.The risk of heart and lung disease among cigar smokers who inhale approaches that of cigarette smokers.

Cigar smokers who have a history of cigarette smoking are more likely to inhale cigar smoke. For these smokers, the disease risks are uniformly higher than for other cigar smokers.

What About Secondhand Cigar Smoke?

Because cigars have more tobacco than cigarettes, and because they often burn for much longer, they give off greater amounts of secondhand smoke--also known as environmental tobacco smoke (ETS) or passive smoke. Secondhand smoke includes both the smoke from the end of the cigar and the smoke exhaled by the smoker.

In general, secondhand smoke from cigars contains many of the same poisons (toxins) and cancer-causing agents (carcinogens) as does cigarette smoke but in higher concentrations. Some of the toxins or irritants in cigar smoke include:

• carbon monoxide
• nicotine
• hydrogen cyanide
• ammonia
• volatile aldehydes

Carcinogens in cigar smoke include the following:

• benzene
• aromatic amines (especially carcinogens such as 2-naphthylamine and 4-minobiphenyl)
• vinyl chloride
• ethylene oxide
• arsenic
• chromium
• cadmium
• nitrosamines
• polynuclear aromatic hydrocarbons

There are some differences between cigar and cigarette smoke, though. These differences are due to the long aging and fermentation process used for cigar tobacco and to the fact that the cigar wrapper is not as porous as cigarette paper. Cigar tobacco has a high concentration of nitrogen compounds (nitrates and nitrites). During fermentation and smoking, these compounds give rise to several tobacco-specific nitrosamines, some of the most potent human carcinogens known. Also, because the cigar wrapper is less porous than cigarette paper, the tobacco doesn’t burn as completely. The result is a higher concentration of nitrogen oxides, ammonia, carbon monoxide and tar--all very harmful.

In a recent study, researchers found that the concentrations of carbon monoxide at two cigar social events in San Francisco were higher than the levels found on a busy California freeway. Had these indoor exposures lasted eight hours, they would have exceeded the National Ambient Air Quality Standards for outdoor air established by the Environmental Protection Agency. In another study, smoke from a single large cigar that burned inside a house took five hours to dissipate. While no studies have been done to prove the health effects on nonsmokers at cigar social events, there is clearly an increased risk of lung cancer from secondhand smoke.

Are Cigars Addictive?

Nicotine is the substance in tobacco that causes addiction. Most cigars have as much nicotine as several cigarettes. When cigar smokers inhale, nicotine is absorbed as rapidly as it is with cigarettes. For those who do not inhale, it is absorbed, more slowly through the lining of the mouth. People who use smokeless tobacco absorb nicotine the same way. Both inhaled and non-inhaled nicotine are highly addictive.

Are There Federal Laws Regulating Cigars?

Cigars fall under fewer federal regulations than do cigarettes and smokeless tobacco. In 1996, the Food and Drug Administration (FDA) exercised its right to regulate cigarettes and smokeless tobacco products as drugs. Cigars, however, were not included.

One result is that while health warnings are required on cigarettes and smokeless tobacco labels, none are required on cigars. Cigars are also exempt from regulations that restrict youth access and limit advertising. However, all 50 states and the District of Columbia have laws which either specifically address youth access to cigars or limit youth access to all tobacco products.

Since the mid-1960’s, the Federal Trade Commission has overseen a testing program to report yield of tar, nicotine, and carbon monoxide for most brands of cigarettes. Cigars, however, are not included and makers of cigar do not have to report such levels to any federal agency.

Cigarettes and smokeless tobacco products cannot be advertised on television, radio, or any other form of electronic communication regulated by the Federal Communications Commission. However, the ban does not include cigars. Finally, federal tax rates are such that the highest tax on a cigar is 3 cents per cigar, regardless of the price of the cigar.

References

Centers for Disease Control and Prevention (CDC) Tobacco Use Among High School Students-US, 1997. MMWR, 1998; (No. 12):229-233.

National Cancer Institute (NCI). Cigars: Health Effects and Trends. Monograph #9. 1998. http://rex.nci.nih.gov/nci.monographs/index.htm.

Shopland DR. US Cigar Consumption, 1950-1996. JNCI. 89 (14): 999.

US Department of Health and Human Services. Reducing the Health Consequences of Smoking: 25 Years of Progress. A Report of the Surgeon General. US Department of Health and Human Services, Public Health Service Centers for Disease Control, Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health. DHHS Publication No. (CDC) 89-8411, 1989.

US Department of Health and Human Services. The Health Consequences of Smoking: Nicotine Addiction: A Report of the Surgeon General, US DHHS, PHS, CDC. Office on Smoking and Health. DHHS Publ# (CDC) 88-8406, 1988.

REVISED: 8/10/98