THE BLOG
07/18/2013 05:24 pm ET | Updated Sep 17, 2013

9 Things to Think About When Thinking About Cigars -- Little or Big

1. Cigars can be as deadly as cigarettes -- especially for former cigarette smokers.

Smokers know that there is no safe way to smoke, but they often believe there are safer ways to smoke. Many cigars smokers are former cigarette smokers who switched, hoping for a safer smoke.

A scientist who worked for a national anti-cancer organization once told me that her father was a cigarette smoker who had switched to cigars to be safer. She thought he had done himself a favor and added that he had recently switched to little cigars, finding them very cigarette-like and still believing he was better off. Unfortunately, such smokers are still smoking very dangerously.

2. For some, cigars can be safer than cigarettes.

Although cigars can be safer than cigarettes, many cigar smokers enjoy little to no decrease in risk.

Based on the existing research, the landmark 1964 surgeon general's report on smoking and health pointed to the dangers of cigarettes and excused cigars and pipes as much less dangerous than cigarettes. A statement at the press conference noted, ''Cigar and pipe smoking were found to have little significance in comparison with cigarettes.'' Even Consumer Reports magazine and the head of the American Medical Association recommended in 1964 that cigarette smokers, if they couldn't quit entirely, should switch to cigars or pipes as less dangerous products. Many cigar or pipe smokers in these early studies were not former cigarette smokers. The story would be different for cigarette smokers who switched to cigars or pipes.

Websites and media coverage also spread the word that cigars were safer than cigarettes.

3. Cigarette smokers switched to cigars to reduce risks, but kept on inhaling.

The early studies were based largely on cigar smokers who started out smoking cigars and had not been cigarette smokers. Such "primary" cigar smokers tended to not inhale smoke -- they took it into their mouths and not into their lungs.

Because of its chemical makeup, cigars can send nicotine to the brain even if the smoke isn't inhaled. In contrast, cigarettes mostly need to be inhaled to send nicotine to the brain. Cigarette smokers who switched to cigars often kept on inhaling smoke, and they also often smoked more cigars per day than cigar smokers who never smoked cigarettes. Cigarette smokers who switch to daily cigar smoking (or pipe smoking) and who inhale, should not expect to cut their health risks.

4. Know if you inhale and know its danger.

If you ask smokers how deeply they inhale, they are not very good at knowing depth of inhalation. But they know if they inhale or not. Cigar smokers should be mindful of inhaling and not think they are "safer" if they inhale cigar smoke. Don't make the excuse of thinking you don't inhale deeply. The perception of any inhalation points to significant inhalation.

5. Smaller and filtered cigars are like cigarettes.

Smaller cigars (little cigars, filtered cigars, cigarillos) can be very dangerous. Smokers who have switched to nearly cigarette-sized or filtered cigars should not think that they have cut their risks of smoking-caused diseases, especially if they smoke many per day. And, even for those who never smoked cigarettes, they are easier to inhale than big cigars.

6. Bigger doses = bigger danger.

Regular doses of inhaled tobacco smoke are the main carrier of the health damage (heart disease, cancers, lung disease). Daily smoking of inhaled cigars, especially several each day, should be seen as a major cause of death and disability. While cigar-only smoking can be less dangerous than cigarette-only smoking, it is more dangerous than not smoking. With inhalation and increasing daily use of cigars, the health risks of cigars become more and more like cigarettes. (The same principles, including increased inhalation by former cigarette smokers, apply to pipe smokers.)

7. If you won't quit, consider avoiding smoke.

As a rule of thumb, non-burned tobacco or nicotine products are less risky than burned tobacco products. Vapor-based electronic nicotine delivery systems (ENDS), such as e-cigarettes or e-cigars; nicotine replacement products; and smokeless tobacco products, especially low-nitrosamine tobacco (LN-SLT) products, are less dangerous than cigarettes. (See this related blog for some discussion of issues related to e-cigarettes.)

8. Price also drives sales.

The market for "little cigars" collapsed when taxes were increased on them to make them cost more like cigarettes. Cigar makers could dodge the increased tax by making little cigars just a bit bigger, which put them in a different tax bracket. Cheaper "filtered cigars," rapidly outsold little cigars. This demonstrates how important costs are. It also shows that differential taxation -- according to product risk -- could push consumers to different products.

9. Tell somebody.

When a product switch is spurred by a false belief in something that seems safer, it is important to try to correct the error.

Many cigar smokers are not thinking about health issues at the present time. Nevertheless, they and others might help spread the word about greater risks for former cigarette smokers, for those who smoke smaller cigars, for those who inhale cigars and for those who smoke cigars several times a day. You never know who does not realize these risks.

Don't expect grateful words and a quick promise to quit from, say, a pack-a-day inhaling smoker of filtered cigars. Rarely is there just one reason for doing anything, and nobody likes to be told what to do. (A warning about cigar risks can seem a bit like "telling people what to do.") But you never know who might appreciate the heads-up and consider a change.

For more by Lynn T. Kozlowski, Ph.D., click here.

For more on personal health, click here.

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