THE RISE OF CIGARS AND CIGAR-SMOKING HARMS

Despite increases in cigar smoking, especially among youth, cigars are often overlooked by legislators and other policymakers who mistakenly believe that cigars are “not that harmful” compared to cigarettes and deserve special treatment. But cigars are addictive and deadly – causing lung cancer, other cancers, heart attacks and more – and they are often marketed in a wide variety of kid-friendly flavors. Cigar smokers also produce more secondhand smoke than cigarette smokers, and secondhand cigar smoke is often even more harmful and deadly than secondhand cigarette smoke. Health Harms to Users from Cigar Smoking Like cigarettes, cigars are smoked and contain the same toxic and carcinogenic compounds. 1 While many believe that cigars are safer than cigarettes because cigar smoke is not inhaled, studies have shown that cigar smokers actually do inhale – even when smoking large premium cigars – thereby absorbing smoke into their lungs and bloodstream, and depositing cigarette smoke particles in their lungs and even in their stomachs and digestive tract. Because large cigars do not have filters, smokers are exposed to more tobacco smoke and, especially, more toxins in the smoke. 2 Moreover, many youth and other smokers are now consuming cigars, especially smaller ones, just like cigarettes, with full inhalation. Accordingly, smoking cigars causes the same kinds of serious health consequences and premature death as cigarette smoking. For example: > > > Cigar smokers have much higher rates of lung cancer, heart disease, and heart attacks than nonsmokers. 3 Cigar smoking increases the risk for chronic obstructive pulmonary disease (COPD). 4 Cigarette and cigar smokers have similarly increased risk of oral and esophageal cancers; and male cigar smokers are up to eight times more likely to die from oral cancer and ten times more likely to die from laryngeal cancers than nonsmokers. 5 Cigar smokers can spend up to an hour smoking a single cigar, often consuming as much tobacco as in a full pack of cigarettes. 6

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Harms from Secondhand Cigar Smoke A person smoking a regular cigar creates much more air pollution than a cigarette smoker; but even in equal amounts, cigar smoke contains substantially higher levels of carbon monoxide and other toxins than cigarette smoke. For example, because most cigars are larger than cigarettes, a burning cigar produces more smoke than a burning cigarette. Similarly, to the extent that cigar smoke is not inhaled as deeply as cigarette smoke, secondhand cigar smoke is less “filtered” than secondhand cigarette smoke before bystanders are exposed to it. 7 Recent Increases in Cigar Smoking, Interest Among Youth Although cigarette smoking has been slowly declining in the United States, cigar consumption has increased dramatically since 1993. Between 2000 and 2006, for example, cigarette consumption declined by 13 percent, but cigar smoking increased by more than 37 percent. 8 Similarly, while youth cigarette smoking rates are declining, youth cigar smoking rates have remained steady. 9
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Cigar smoking is the second most common form of tobacco use among youth. The most recent data available show that 13.6 percent of high school students currently smoke cigars (19.4% among boys; 7.6% among girls). 10 Each day, more than 3,500 additional kids under 18 years old try cigar smoking for the first time – almost as many as those who try cigarettes for the first time each day (roughly 3,800). 11 In some states, cigar smoking among some youth groups is even more popular than cigarette smoking. In New Hampshire, for example, 20.6 percent of high school boys currently smoke cigarettes, but 27.2 percent smoke cigars. 12 Similarly, a recent study in Ohio found cigars to be the most popular tobacco product among high school students. 13 A 2008 study found that adolescents who started smoking cigars were more susceptible to smoking cigarettes, and those who smoked both cigars and cigarettes were more likely to be frequent dual users. 14

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Part of the reason youth cigar smoking rates are relatively high is due to cigars being marketed in a range of kid-attracting flavors, such as such as candy, fruit and chocolate. 15 As a cigar retailer commented, “The flavors attract customers.” 16 But the inaccurate belief that cigars are much less harmful than cigarettes is also part of the problem. Interviews with college students, for example, found that some smoked little cigars because they believed they were less addictive and less harmful than cigarettes. 17 The federal government and almost all of the states compound these problems by sharply undertaxing cigars compared to cigarettes, often making small cigars a less-expensive alternative to cigarettes. In addition, many laws and restrictions pertaining to cigarettes or cigarette marketing do not apply to cigars. For example, federal law now prohibits cigarettes from having flavors that attract kids, but does not yet prohibit even small cigars from having such kid-attracting flavors – and only one state restricts cigar flavorings that attract kids.
Campaign for Tobacco-Free Kids, March 5, 2010 / Ann Boonn & Eric Lindblom National Cancer Institute (NCI), Cigars: Health Effects and Trends, Smoking and Tobacco Control Monograph No. 9, 1998, http://cancercontrol.cancer.gov/tcrb/monographs/9/index.html. 2 See, e.g., Rodriguez, J, et al., “The Association of Pipe and Cigar Use with Cotinine Levels, Lung Funnction, and Airflow Obstruction: A Cross-sectional Study,” Annals of Internal Medicine 152:201-210, 2010; McDonald, LJ, et al, “Deposition of Cigar Smoke Particles in the Lung: Evaluation with Ventilation Scan Using 99mTc-Labeled Sulfur Colloid Particles,” Journal of Nuclear Medicine 43:1591-1595, 2002. 3 Baker, F, et al., “Health Risks Associated with Cigar Smoking,” Journal of the American Medical Association 284(6):735-740, 2000; NCI, Cigars: Health Effects and Trends, 1998. 4 Rodriguez, J, et al., Annals of Internal Medicine 152:201-210, 2010. 5 NCI, Cigars: Health Effects and Trends, 1998. 6 NCI, Cigars: Health Effects and Trends, 1998. 7 NCI, Cigars: Health Effects and Trends, 1998 at chapters 3 and 5. Rodriguez, J, et al., Annals of Internal Medicine 152:201-210, 2010. 8 USDA Economic Research Service, Tobacco Briefing Room, Tables 1 and 3, April 2007. 9 Substance Abuse and Mental Health Services Administration (SAMHSA), Results from the 2008 National Survey on Drug Use and Health: National Findings, DHHS Publication No. SMA 09-4434, 2009. 10 U.S. Centers for Disease Control & Prevention (CDC), “Youth Risk Behavior Surveillance, United States, 2007,” Morbidity and Mortality Weekly Report (MMWR) 55(SS-4), June 6, 2008. 11 SAMHSA, Results from the 2008 National Survey on Drug Use and Health: National Findings, 2009. 12 CDC, MMWR 57(SS-4), June 6, 2008. Delnevo, C, et al., “Trading Tobacco: Are Youths Choosing Cigars Over Cigarettes?” American Journal of Public Health 95(12), 2005. 13 Brooks, A, et al., “Cigars, Cigarettes, and Adolescents,” American Journal of Health Behavior 32(6):640-649, 2008. 14 Brooks, A, et al., “Cigars, Cigarettes, and Adolescents,” American Journal of Health Behavior 32(6):640-649, 2008. 15 See, e.g., Lewis, M, et al., “Dealing with an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands,” American Journal of Public Health 96(2), February 2006. 16 Koch, W, “Small Cigars Making Big Gains,” USA Today, February 20, 2008. 17 Jolly, DH, "Exploring the use of little cigars by students at a historically black university," Preventing Chronic Disease 5(3):1-9, July 2008, http://www.cdc.gov/pcd/issues/2008/jul/07_0157.htm.
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