Cigar smoking is increasing in the United
States, mainly in young and middle-aged men, but also among teenagers and women. In some
circles it has even achieved a certain social status. It may be people think that cigar
smoking is a safer alternative to cigarettes. This is not the case - the practice is known
to be a risk factor for cancer of the mouth, throat, larynx, gullet (esophagus) and lung,
and also and for a troublesome breathing condition - chronic obstructive pulmonary disease
So far it was not known whether
it carried an increased risk of cardiovascular disease, but a recent study has provided
evidence to that effect.
Over 17,500 men aged 30 to 85 were enrolled in
the Kaiser Permanente Medical Care Program between 1964 and 1973. They had never smoked
cigarettes, and were not currently pipe smokers. Their health was carefully followed from
1971 through 1996, using hospitalization discharge records and local tumor registries.
There were over 1,500 cigar smokers at entry -
about 9% of the total - and their subsequent health records were compared with those of
the 91% non-smokers. The analyses took into account the health information collected at
enrollment, medical history, alcohol consumption, and any exposure to occupational hazards
such as solvents, pesticides, asbestos and silica.
The cigar smokers were slightly older, more
obese, had higher blood pressure, higher cholesterol levels and were more likely to have
diabetes, than non-cigar smokers; also, they consumed more alcohol than non-smokers. Most
of them smoked less than 5 cigars a day.
After adjusting for age, it was found that
cigar smokers were 1.27 times more likely to develop coronary heart disease, and 1.45
times more likely to develop COPD, than non-smokers. There was no evidence that cigar
smokers were more likely to have a stroke or disease of the leg arteries than non-smokers.
Cigar smokers had about twice the risk of
cancer of the throat, larynx, esophagus and lung as non-smokers. The risks were greater
among those who smoked 5 or more cigars daily, compared with those who smoked fewer than
5. Alcohol consumption seemed to increase the risk for these cancers (except cancer of the
lung) still further. Cigar smoking was not associated with an increased risk of cancer of
the pancreas, kidney, bladder, colon or rectum.
Obviously, these findings must be compared
with those for cigarette smoking. Various studies have shown that cigarette smoking by men
causes a 1.5 to 3 times likelihood of coronary heart disease, 9 to 25 times the risk of
COPD, 8 to 24 times the risk for lung cancer and 4 to 12 times the risk for mouth/throat
cancer. However, as about half the cigar smokers in the Kaiser Permanente study said that
they quit smoking within the first 8 years after enrollment, the actual effects of cigar
smoking may have been underestimated. Cigar smoke is not usually deeply inhaled, which may
explain the lowered risks of COPD and lung cancer among cigar smokers, compared with
The resurgence of cigar smoking in the United
States in recent years is worrying, in view of the findings of this, and other, studies.
Older persons, even if non-smokers themselves, can play an effective role by advising
their children (and grandchildren) about the risks of all forms of tobacco.
Cigars and Your Health
Debora J. Orrick, M.A., LCDC, CTAC-ACP
The old lie that smoking is cool is rearing its ugly head
again. While going to swank cigar bars becomes a part of the night life across the
country, a message is being sent that cigar smoking is trendy, sophisticated and safe.
Many cigar smokers erroneously believe that cigars are not as hazardous to their health as
cigarettes because they are smoked differently. The fashion of smoking cigars has been
fueled by the promotion of cigar smoking by all types of celebrities and public figures,
such as President Clinton, Luciano Pavarotti, Wayne Gretzky, Sylvester Stallone and Salma
Hyak. Cigars have reached such high popularity that cigar stores, salons and bars are
opening all over the United States; there is even a cigar magazine for the connoisseur,
whose cover has been graced by super models, super stars and super powers.
Unfortunately, most new cigar smokers are poorly informed
about the major health risks associated with daily cigar smoking; and new smokers in
general greatly underestimate the potential health effects of smoking and often regret
their naivete after they have become dependent to the drug and the habit. Seventy percent
of regular smokers wish they could stop and wish that they had never started in the first
Cigar smoking has increased dramatically in the United
States in the 1990s, especially among women and teen-agers. Between 1993 and 1997, cigar
sales jumped 50 percent. Current usage levels are the highest in 20 years. Since 1993,
cigar and cigarillo use has increased by 45 percent, and the use of premium cigars (which
can cost more than $10 each) has increased a dramatic 250 percent. By 1997, more than 10
million Americans smoked cigars; that is three million more than in 1994, which represents
an incredible increase in just three years! The greatest increase in cigar use has been
with young and middle-aged Caucasian adults with higher-than-average incomes and
education. Adult men are eight times more likely than women to use cigars. More teen-agers
use cigars than smokeless tobacco. One out of every four teen-agers reports having smoked
a cigar at least once, and as many as 30 percent of teens report having smoked a cigar in
the last month.
Research shows that three-quarters of cigar smokers smoke
occasionally and that 76 percent of them smoke fewer than five cigars a day. Occasional
cigar smoking (once or twice a month) is considered to be of minimal health risk unless
you have special or hereditary factors that would place you at higher risk for
tobacco-related illnesses or tobacco addiction. If you have parents or grandparents who
are or were addicted to tobacco, if you grew up in a home with one or more chronic smokers
and high levels of second-hand smoke, or if there have been unusually high levels or many
types of cancers in your family (particularly in your parents and grandparents), you may
be at a higher risk.
Cigar vs. Cigarette Use
One of the main thrusts behind cigars' popularity is the belief that they are a safe
alternative to cigarettes because the smoke is not inhaled, and because cigars are
commonly used only occasionally and not daily. Traditionally, cigar smokers hold the smoke
in their mouth and throat, allowing nicotine and other chemical compounds to be absorbed
through the mucous lining of the mouth and throat, rather than inhaling the smoke into
A smoker can spend more than an hour puffing on a cigar,
which has the equivalent risk of oral cancers as smoking a pack of cigarettes a day. Daily
cigarette smokers and daily cigar smokers have similar levels of risk for oral cancers.
Smokers who smoke more than five cigars per day have lung cancer risks comparable to
smoking a pack of cigarettes a day.
The real difference between cigar and cigarette smoking is
the type of cancers that cigar smokers develop, which is usually a head or neck cancer
instead of the lung cancer so common among cigarette smokers. Unfortunately, people who
switch from using cigarettes to cigars tend to smoke cigars the way they smoked
cigarettes: by inhaling deeply and smoking often. Inhalation seems to raise the health
risks of cigars so that the smoker will face the same health risks as with cigarette
Unlike cigarettes, cigars do not have filters to reduce
their tar and nicotine content. Cigar packages do not carry the Surgeon General's health
warnings that are required on other tobacco products. Like cigarettes, the additives in
cigars are not regulated by any consumer or governmental agency and do not have to be
reported or put on the label.
Cigar Smoke and Nicotine Content
Researchers currently believe that as few as five milligrams of nicotine a day is enough
to cause addiction to the drug. The average cigarette has around one milligram of nicotine
in it, and cigars have much higher levels of nicotine -- up to 400 milligrams in large,
long cigars. This means that one cigar a day may be enough to cause addictive changes in
your brain cells. Tobacco smoke contains more than 4,000 chemical compounds, including the
following substances, which are also contained in household products with warning labels
telling you to avoid inhaling them:
Other cigar smoke contents include the following
- carbon monoxide
- hydrogen cyanide
- vinyl chloride
- ethylene oxide
- other volatile aldehydes
- radioactive polonium 210
Because of the long aging and fermentation process for
cigar leaves, because of the larger size of cigars and because of the toxic way it burns
due to cigars' nonporous wrappers, cigar smoke has 20 times more ammonia than cigarettes
and 80 to 90 times the number of highly carcinogenic, tobacco-specific nitrosamines. Cigar
smoke also contains 30 times more carbon monoxide than cigarette smoke.
Cigars and Your Health
The National Cancer Institute of the National Institute of Health has determined that
cigars are not safe alternatives to cigarettes and may cause addiction to nicotine.
Regular cigar smoking increases risks for heart disease, lung disease and cancers of the
mouth, throat and lung. Daily cigar smokers who do not inhale have a 27 percent higher
risk of heart disease than nonsmokers, and a 45 percent higher risk of chronic obstructive
pulmonary disease (COPD), a blanket term for emphysema and chronic bronchitis. Cigar
smokers who inhale have a 53 times greater risk of larynx cancer, 27 times greater risk of
oral cancer and 23 percent greater risk of heart disease. Drinking three or more alcoholic
beverages a day with your cigar increases your average risk of mouth and throat cancers,
because alcohol is extremely effective in dissolving the carcinogens from the smoke into
Overall, cancer death rates of cigar smokers are 34 percent
higher than those of nonsmokers, and cigar smokers are three to five times more likely to
die of lung cancer than are nonsmokers. One study found that 90 percent of cigar smokers
have precancerous changes in the cells of their voice box. There are also strong links
between cigar smoking and cancer of the pancreas and the very rare male breast cancer.
Second-Hand Cigar Smoke
The second-hand smoke from a single cigar burned in a home can take five hours to
dissipate. Secondhand cigar smoke contains the same 4,000 chemical compounds found in
other tobacco products. Many of these compounds occur in much higher quantities in cigars
than in cigarettes. These include unusually high amounts of ammonia, carbon monoxide,
nitrosamines and easily inhaled particles -- all potent carcinogens!
No studies have been conducted to determine the health
effects of nonsmokers who frequent cigar social events and clubs, but a significant body
of evidence clearly demonstrates an increased risk of lung cancer, asthma and other lung
diseases from secondhand cigarette smoke. Research conducted at two cigar events in San
Francisco found carbon monoxide levels were higher than the levels found on a busy
California freeway. Had these exposures lasted more than eight hours, they would have
exceeded the National Ambient Air Quality Standards for outdoor air, which were
established by the Environmental Protection Agency.
Recommendations About Cigars
Because the health risks are so high, U.S. Surgeon General David Satcher and the American
Cancer Society have made the following recommendations regarding cigars:
- Adopt measures identical to those employed in the fight
against cigarette smoking.
- Raise taxes on all tobacco products.
- Require health warning labels.
- Increase public education programs about the risks of cigar
smoking, especially for children and teen-agers.
- Adopt laws limiting access to all tobacco products by
children and teens.