The mortality risks of cigar smoking

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.

A 2014 study estimated that regular cigar smoking causes 9,000 premature deaths annually in the U.S.

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.

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There is no new information presented here by Dr. Chang that has not been previously put out by the FDA and other anti-tobacco zealots. The PR machine of the FDA is in full swing in anticipation of their attack on cigars and their continued want to encroach on American’s personal freedoms.

Dr. Chang acknowledges that this information is nothing more than a meta-analysis
of old data and extrapolated to meet the FDA’s pre-drawn conclusion that they should indeed regulate cigars. What Dr. Chang does not tell you is that her own agency does not view meta-analysis and combining data from studies using different populations and methodoligies to support conclusions as appropriate or definitive. Only prospective studies with primary outcomes clearly outlined can be used to support a conclusion.

Now, do I need a large prospective trial to tell me cigars are bad for me? No, I am not that naive, but I also don’t need a PhD to tell me that smoking 2-3 cigars a month poses the same risks as a two pack a day cigarette smoker.

The recent arguments that we must protect kids from the dangers of premium cigar smoking is ludicrous. There is no tobacconist in America that is going to jeopardize his business by selling a child a premium cigar. That of course assumes a child can afford the cost of a premium cigar. (Note I cannot and will not defend what happens in some gas station convenience store selling cheap flavored cigars.)

The current fall back argument that second hand smoke from premium cigars affects non-smokers civil liberties is also an antiquated point since most nanny state and local governments have outlawed smoking just about everywhere in public. Oh, and I know that this is a moot point, but enacting laws to protect the civil liberties of one group (non-smokers) usually involves taking the rights away from some other group of Americans.

The public should be should be concerned about this, because once cigars are taken care what will they want to control next. Soda, potato chips, Hershey bars? Does that sound far fetched? If so take a look at NYC. And while I’m on the subject of junk food and Hershey bars, why is that people praise CVS for removing tobacco from its stores, but no one has complained about their checkout areas filled with nothing but junk food and candy? Isn’t obesiety and diabetes one of the toughest issues facing America right now? But, that’s a rant for a different day.


Good point regarding CVS, David. I also mentioned their hypocrisy to CVS management about their getting rid of all tobacco items a couple of years ago while continuing to sell all of the junk food they still sell today. The response I got from CVS management over and over again was, “those things are all right in moderation”. Pretty good, huh? Actually, I was told just recently by a CVS management person that the real reason CVS ditched all of the tobacco was that, in order to land the very lucrative CAREMARK deal they now have, FedGov required that they be a tobacco-free operation. CVS makes a lot more money from CAREMARK than they ever did by selling cigarettes and cigars. At least that explanation makes more sense than the self-righteous ‘smoking is bad for you’ rationale offered by CVS when they pulled all of the tobacco off their shelves.

Rance Lee

9000 premature deaths from a population of 320 million that is a 0.00028125% possibility. I will take my chances.


This “study” looks suspect to the point of humorous. The CDC Tobacco Fact Sheet on cigars estimates 12.4 million American cigar smokers. In 2011 there were 278 million hand made cigars imported into the USA. That’s about one box of cigars per person per year, about 2 cigars per month. Dr. Chang claims “10.1 billion” cigars SOLD in the US in 2012. Um, that would be 831 cigars for every cigar smoker in this country, which is 16 cigars to smoke for every weekend of the year! I’ve smoked cigars for decades and this describes exactly nobody I ever heard of except perhaps Dr. Sigmund Freud, who did finally die of mouth cancer at age 83 after 60 years of very heavy smoking. Dr Chang talks about “regular cigar smoking” without defining the term, though her study offers the cryptic claim that “more than one in 20 U.S. adults smoke cigars every day, some days, or rarely.” Gee, thanks for that. This… article isn’t science, and it isn’t scientific, and it isn’t even a study in any meaningful sense of the word. Why all the bogeyman stories, and why no semblance of rational data??

Fred Mertz

if you smoke one or less cigars a day like most cigar smokers do the risk is miniscule.

Dr. Jack Davidson

Going through the details of the meta-analysis, there is no statistically significant increase in risk for those who smoke 1-2 cigars a day, have not previously smoked cigarettes, and do not inhale.

And since the vast majority of cigar smokers are in this category, the correct conclusion from this meta-analysis should be “infrequent cigar smoking without inhaling is associated with minimal increase in risk (if any), in comparison to non-smokers”.

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