The harms of cigarette smoking are well-reported, but those of cigar smoking are discussed less often. Here Cindy M. Chang of the U.S. Food and Drug Administration (FDA), tells us more about her systematic review on cigar smoking and mortality risk, recently published in BMC Public Health.
In 2012, an estimated 10.1 billion cigars were sold in the U.S. An analysis of the 2012-2013 National Adult Tobacco Survey found that more than one in 20 U.S. adults smoke cigars every day, some days, or rarely. The National Youth Tobacco Survey found that while the overall prevalence of cigar smoking declined from 2011 to 2014 (11.6% to 8.2%) among high school students, cigars continued to be the most frequently used tobacco product among U.S. African American high school students, with one in eleven reporting using cigars in the past 30 days.
There are many harmful chemicals present in both cigar and cigarette smoke, including nitrosamines, that cause cancers such as lung and oral cancer. A 2014 study estimated that regular cigar smoking causes 9,000 premature deaths annually in the U.S.
Given the public health harm caused by smoking, we conducted a systematic review of information currently available on the mortality risks of cigar smokers compared to those who had never smoked tobacco or used any form of tobacco. We reviewed 22 studies and found that regular cigar smoking increases the risk of dying from many of the same diseases caused by cigarette smoking, including cancer and heart disease.
We also found that when cigar smokers reported not inhaling cigar smoke, they were still three to ten times more likely to die from oral, laryngeal, or esophageal cancer than someone who never used tobacco. Research has shown that whether cigar smokers realize it, they are likely to inhale some tobacco smoke. Cigar smokers also absorb nicotine and harmful substances from cigar smoke through their mouths. Our study reinforces the fact that cigar smoking poses significant health risks to users.
The findings are not surprising, given that cigar smokers are exposed to the same harmful chemicals as cigarette smokers, because both cigars and cigarettes are burned tobacco products. A 2014 study found that nitrosamine levels as measured in the urine of daily cigar smokers were comparable with those in daily cigarette smokers.
There is a strong body of evidence that clearly demonstrates the health risks of cigar smoking. Because the cigar marketplace has changed over time with different sizes, flavors, and packaging, as well as changes in patterns of cigar smoking, additional studies would help inform our scientific knowledge of this changing product.
In order to add to the scientific evidence base, future studies could examine the risks associated with cigar smoking in a range of populations that use the various types of cigars (e.g. cigarillos, little cigars). Incorporating biomarkers of tobacco exposure and potential harm could serve as short-term markers that reflect long-term disease outcomes.
The Food and Drug Administration’s (FDA) and National Institute of Health’s Population Assessment of Tobacco and Health (PATH) Study, is a large, nationally representative, cohort study of tobacco use, exposure and health. This will be able to address some of the questions above.
The PATH Study, along with other research supported by FDA, will contribute to the evidence base on the public health impacts of cigar use. It is clear that, given the harmful impacts of their use, cigars continue to be a public health concern.