Premium Cigar Ingredients as Harmful as Cigars and Cigarettes; Health Effects Depend on Frequency, Patterns of Use

[El Presidente]

https://www.nationalacademies.org/news/2022/03/premium-cigar-ingredients-as-harmful-as-cigars-and-cigarettes-health-effects-depend-on-frequency-patterns-of-use

 

 

News Release | March 10, 2022

WASHINGTON — The ingredients in premium cigars make them inherently as harmful as cigarettes and other types of cigars, says a new report from the National Academies of Sciences, Engineering, and Medicine. But, because the majority of premium cigar smokers are nondaily or occasional users, and because they are less likely to inhale the smoke, the population health effects are currently modest.

Premium Cigars: Patterns of Use, Marketing, and Health Effects contains 13 conclusions related to health risks, addiction potential, and secondhand smoke exposure associated with premium cigars. It also provides recommendations to inform federal research on premium cigars.

 

No single characteristic differentiates premium cigars from other cigars, says the report. To guide its work, the committee that wrote the report defined a premium cigar as having all of the following six characteristics: handmade, composed of at least 50 percent natural long-leaf filler tobacco, wrapped in whole leaf tobacco, weighs at least 6 pounds per 1,000 units, has no filters or tips, and has no characterizing flavor other than tobacco. While the committee provided a working definition of premium cigars, it was not charged with recommending a regulatory definition or whether the U.S. Food and Drug Administration (FDA) should regulate premium cigars.

The toxicants and carcinogens in premium cigar smoke are nearly identical to those in cigarette smoke, and they are capable of causing heart disease, cancers (lung, oral, head, and neck), respiratory diseases, and other adverse health effects, the report concludes. One’s actual health risks from smoking premium cigars, though, will be determined by smoking behavior — including frequency of use, the pattern and duration of smoking, and how deeply the smoke is inhaled. These conclusions are based on epidemiologic studies of cigars in general and biological mechanisms, as no currently available studies distinguish premium from other cigar types.

About 1 percent of the U.S. adult population smokes premium cigars, and this percentage has remained stable over time, the report says.

Premium cigar smokers are overwhelmingly male, older, white, and with higher income and education levels, and use is extremely rare among youth. However, the report concludes, should flavorings be added to premium cigars, it could result in increased popularity of the product, greater appeal to nonusers, and more frequent use — leading to increased nicotine intake, addiction potential, and exposure to harmful and potentially harmful chemicals.

Due to lack of data, there is insufficient evidence to determine if secondhand exposure to premium cigar smoke specifically is associated with health risks, the report concludes. There is plausible concern that people with underlying heart disease could be particularly vulnerable to secondhand premium cigar smoke. The location where premium cigars are used is a consideration with determining secondhand exposure risks (for example, outdoors versus indoors).

“One of the biggest research challenges we found is there isn’t a consistent definition of a premium cigar or other cigar types — a common definition is needed for future research,” said Steven M. Teutsch, adjunct professor at the Fielding School of Public Health, University of California, Los Angeles, and chair of the committee that wrote the report. “Although premium cigars are not currently widely used, patterns of use could shift based on changes in price, marketing practices, or regulatory changes. Therefore, the research agenda recommended by the committee is needed to provide an understanding of premium cigar use, consumer awareness and perceptions, and health effects over time.”

Marketing and Risk Perceptions
Cigar lifestyle magazines, festivals, and social media sites have become popular forums for the tobacco industry to market premium cigars. Across these forums, the evidence is strongly suggestive that premium cigars are marketed as a product with benefits that outweigh their adverse health effects. Some content within lifestyle magazines implies the health effects of premium cigar use is lower compared to cigarette use, and that premium cigars are a safe substitution for cigarettes. Moreover, as social media platforms evolve, tobacco companies’ marketing practices will likely evolve, too. Future studies need to keep up with these changing trends, says the report, and research on consumer knowledge of premium cigars, including the definition and whether consumers distinguish premium cigars from other cigars, is needed.

Priority Research Areas
FDA, in consultation with other federal agencies, should develop formal categories and definitions for cigars to be used for research to ensure consistency among studies. Using common definitions of cigar types, the FDA, the National Institutes of Health, and other federal agencies should support research on the health effects of premium cigars, compared to other large cigars, little cigars, or cigarillos. Research should also evaluate how various premium cigar characteristics (such as size, shape, type of tobacco, flavor, and moisture) affect puffing duration and volume.

The report also recommends the U.S. Department of Health and Human Services, in partnership with the Alcohol and Tobacco Tax and Trade Bureau and the Federal Trade Commission, develop surveillance and evaluation systems that regularly monitor patterns of cigar use, product characteristics, and consumer knowledge and perceptions by cigar type. These systems should also track exposure to cigar smoke and related health outcomes; monitor tobacco industry marketing and promotion strategies and sales; and track cigar prices by cigar type. In addition, the agency should ensure that the tobacco research it already supports, such as the Population Assessment of Tobacco and Health, surveys participants about premium cigar use.

The study — undertaken by the Committee on Patterns of Use and Health Effects of “Premium Cigars” and Priority Research — was sponsored by the U.S. Food and Drug Administration and the National Institutes of Health. The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

Contact:
Stephanie Miceli, Media Officer
Office of News and Public Information
202-334-2138; e-mail [email protected]

[canadianbeaver]

Interesting. Thanks for sharing. If the word Premium is the factor to determine the cigar, this is where we are messed up. Brandy dipped Gurkha for example.

CB

 

[NSXCIGAR]

This is like saying the ingredients in steak make it just as harmful as hamburgers. 

A government funded study no doubt.

[Cigar Surgeon]

This was the session I mentioned in the other NASEM thread that was going to occur this morning. I haven't had an opportunity to write up my thoughts as I've been slammed at work but here are two quick takeaway slides from the session.

I think using their own research, the health claims can easily be reframed.

• The vast majority of cigar smokers are non-daily smokers. 
• The vast majority of cigar smokers are not former cigarette smokers.
• The vast majority of cigar smokers are not current dual tobacco users (cigarettes and premium cigars).

I found the claims about harmful constituents to be odd, as there was data presented in the 2021 session that cadmium and other heavy metals would vary dramatically depending on the area that the tobacco was grown in. That alone tells me that some tobacco grown in certain areas could potentially be more harmful than others.

Based on their research, and this will shock you, cigar smokers were 7-9 years older than other tobacco users. This to be was a no brainer, and should be consistently used to fight against the nonsense notion of underage premium cigar smoking. Advocate groups have and will continue to use underage smoking as a wedge issue in the US, just like they did in Canada.

[SGD316]

I don't have any doubt there is harm from cigars. It certainly isnt zero. I'm be curious to see a more detailed study over time of their use depending on various factors such how often, what kind size/length wise, etc. 

@Cigar Surgeon  thanks doc. nobody has their first drink as straight scotch. 

[El Presidente]

23 minutes ago, SGD316 said:

@Cigar Surgeon  thanks doc. nobody has their first drink as straight scotch. 

My son Tom did. 

Never a big drinker.....he skipped beer and wine and went straight to Scotch at 19. He has stayed there. 

I will admit Tom is unique 

[Cigar Surgeon]

5 minutes ago, El Presidente said:

My son Tom did. 

Never a big drinker.....he skipped beer and wine and went straight to Scotch at 19. He has stayed there. 

I will admit Tom is unique 

19 isn't 15 though!

I was just discussing with my wife that I would feel confident laying a couple hundred dollarydoos that they could not find 5 teenagers in an entire high school that had smoked a true premium cigar in the past 30 days.  I might even be willing to lower than threshold to 2.

 

[SGD316]

Hope my boy aspires to this legendary status 

[teamrandr]

All this tells me is that I need to not worry about smoking cigars.

[Edicion]

I'm just waiting for the first "organic" cigars to come. 

[Fuzz]

3 hours ago, SGD316 said:

@Cigar Surgeon  thanks doc. nobody has their first drink as straight scotch. 

My first alcoholic drink was scotch. An uncle thought I'd be funny to let me have a big sip when I was 5.

My first time I chose the drink, it was cognac and I was 16.

 

[MrBirdman]

As one of the members helping to fund that research I can only shake my head. We basically know nothing more about the health effects of premium cigars than we did yesterday. 

Long term studies on cigars are, admittedly, far more complicated than those on cigarettes. The difference in size, composition, and even the definition of what constitutes a premium cigar would presumably make a controlled long-term study extremely difficult.

4 hours ago, Cigar Surgeon said:

there was data presented in the 2021 session that cadmium and other heavy metals would vary dramatically depending on the area that the tobacco was grown in.

I would be surprised if that *wasn’t* true given that heavy metal levels vary in different soils. But studying that would have limited value presumably except for puros. One wonders how Cuba would fare on that score compared to, say, Nicaragua. Heavy metals are mostly poorly absorbed through the skin or mouth, whereas they are readily absorbed through the lungs. Some incidental inhalation with cigar smoking is unavoidable for the most part, though. 

Smoking cigars is not good for you. No surprise there. Luckily they seem to dissuade overuse on their own, at least for me. If I smoke multiple cigars for two or more days in a row, I can pretty much count on some kind of sore or other oral discomfort. 

[NSXCIGAR]

8 hours ago, SGD316 said:

@Cigar Surgeon  thanks doc. nobody has their first drink as straight scotch. 

Well, technically the first hard liquor I ever tried was Jim Beam when I was about 7. Just a taste to the lips. Tasted like paint thinner. Didn't touch alcohol again until I was 19 and still can't stand Jim Beam. 

8 hours ago, SGD316 said:

I don't have any doubt there is harm from cigars.

I'm sure there is but since basically everything except water and raw vegetables is harmful to some degree the question is how harmful. If something is as harmful as a Big Mac that is pretty insignificant and to this point the preponderance of the evidence points to moderate cigar smoking being about that harmful. 

8 hours ago, Cigar Surgeon said:

I think using their own research, the health claims can easily be reframed.

I think there's a fundamental error in the ability to classify cigar smokers by amount of cigars smoked and to separate out premium cigar smokers. As you point out, the vast majority of premium cigar smokers do not smoke daily. And those who are smoking 3+ cigars a day are not smoking premium cigars (except me) and may in fact be in a group that is more likely to engage in other poor lifestyle choices. 

In other words, it may be very difficult to isolate the effects of premium cigars on those smokers. I cannot imagine smoking the 1-3 cigars per week that the average premium cigar smoker smokes could even possibly be statistically significant.

3 hours ago, MrBirdman said:

Smoking cigars is not good for you.

As I pointed out above, I have no doubt that's true but it is a useless statement. Just about everything is sub-optimal to some degree. If it doesn't pass the worse-than-a-Big Mac test I really don't think it can be singled out for harm. 

Virtually every piece of data I've seen on tobacco and smoke in the last 25 years indicates the level of harm is dose-dependent. That's why second-hand smoke isn't harmful and the typical smoking of premium cigars isn't particularly harmful. 

[Edicion]

47 minutes ago, MrBirdman said:

Smoking cigars is not good for you. No surprise there. Luckily they seem to dissuade overuse on their own, at least for me. If I smoke multiple cigars for two or more days in a row, I can pretty much count on some kind of sore or other oral discomfort. 

I think you raise a good point and I don't mean to be a downer here, but I would say regular health check-ups are important so I do recommend everyone to go yearly or even every 6 months. Given that our interest is cigars we could also look at seeing specialists like ENT doctors as part of our health routine, I don't go for advice, I go for checking that everything is alright. Personally I also use a neti pot , ayurveda nasal cleansing (sounds horrific but it's actually excellent and zero discomfort prob the opposite). If it helps anyone, then great.

Plus having a healthish diet, active lifestyle also helps. And a drink.

[Cigar Surgeon]

2 hours ago, MrBirdman said:

Smoking cigars is not good for you. No surprise there. Luckily they seem to dissuade overuse on their own, at least for me. If I smoke multiple cigars for two or more days in a row, I can pretty much count on some kind of sore or other oral discomfort. 

I don't disagree with you here, but much of the information provided seems to reinforce earlier studies which made it clear that there was a direct dose based response. The question becomes is the earlier studies of 1-3 cigars a day poses minimal risks still true.

2 hours ago, MrBirdman said:

I would be surprised if that *wasn’t* true given that heavy metal levels vary in different soils. But studying that would have limited value presumably except for puros. 

Well it came up in one of the sessions that the FDA could potentially have jurisdiction to do soil sample testing in areas where tobacco is grown (Nicaragua, Dominican, Honduras). I think it also goes a long way to showing that one cigar is not in fact the same as another; which for the record is an absurd notion from the panel and shows that they really did not get a good source of information regarding cigar tobacco. I posed a question that was never asked to the panel about the nicotine range measured from 98mg to just under 700mg in premium cigars that were sampled.

That's a massive difference. 

[Ryan]

The study calls for a consistent definition of "premium cigar".

If that ever happens, cigarette manufacturers will immediately put out products that will fall under the definition to exploit any regulatory or tax exemptions. Of course this will "spoil it for everyone", to use a term.

That has already happened in plenty of other markets. It's one of the reasons that cigar producers and even regulatory bodies are so slow to come up with a definition of what a premium cigar is.

[Puros Y Vino]

5 hours ago, Ryan said:

The study calls for a consistent definition of "premium cigar".

If that ever happens, cigarette manufacturers will immediately put out products that will fall under the definition to exploit any regulatory or tax exemptions. Of course this will "spoil it for everyone", to use a term.

That has already happened in plenty of other markets. It's one of the reasons that cigar producers and even regulatory bodies are so slow to come up with a definition of what a premium cigar is.

Doesn't the ingredients list suffice to define what a "premium cigar" is?

Cigar ingredients: Rolled tobacco leaves.

Cigarette ingredients: barely discernible tobacco bits and a 3000 ingredient chemical cocktail 😁

[Ryan]

2 hours ago, Puros Y Vino said:

Doesn't the ingredients list suffice to define what a "premium cigar" is?

Cigar ingredients: Rolled tobacco leaves.

Cigarette ingredients: barely discernible tobacco bits and a 3000 ingredient chemical cocktail 😁

For example. A company in Poland about 15 years ago introduced what they called a "party cigar". 

There was an outer wrapper leaf. If that was removed, inside were 10 individual smoking sticks, about cigarette sized.

Having a single outer wrapper made it a single product, and put it over a minimum weight requirement for a "premium cigar" in that market at the time.

Clever, but these efforts to skirt the rules mean regulators are slow to approve any allowances for "premium cigars". Skirting the rules becomes much easier when the rules are defined.

Cigar industry people get regular phone calls from the cigarette industry asking for the definition of a "premium cigar".

Edit. I found a picture on an old drive of mine. Not much about these anymore on Google. Hard to make out in that picture but the individual minis are inside that tobacco wrapper outer.

[djrey]

Has anyone ever realized that the old timers of the industry tend to die in their 80's or 90's? These guys were practically born smoking and worked with leaf there whole life. Many claimed to have smoked 10 plus a day. Jose Padron, 91. Carolos Fuente, 81. Arsenio Ramos, 83. Not in the industry but Winston Churchill started smoking in his teens and again, said to have smoked upwards of 10 per day. Lived to 90. I know this doesn't really prove anything but they are data points imo and it certainly goes against the far reaching claims of govt studies that say premium cigars are no different than cigs and are death sticks. 

There is enough evidence out there to give me the firm opinion that moderate (even possibly heavy) cigar smoking has very little impact on ones health. Tomorrow is never guaranteed. Choose some things that make you happy and go for it. The only guarantee in life is death. People that get worked up about cigars or alcohol use could be in a car wreck tomorrow.  

On a side note, my absolute favorite are the people who are obese and haven't been to a gym in their life and eat like shit telling me about the hazards of cigar smoking. But that's another rant. 

[joeypots]

21 hours ago, El Presidente said:

because the majority of premium cigar smokers are nondaily or occasional users, and because they are less likely to inhale the smoke, the population health effects are currently modest.

It's as simple as this. Moderate cigar smoking? Not so bad. Heavy cigar smoking? Not so good. So it's like my mother said, "Strive for moderation in all things and you'll be ok."

[Focal_Banger]

14 minutes ago, djrey said:

Has anyone ever realized that the old timers of the industry tend to die in their 80's or 90's? These guys were practically born smoking and worked with leaf there whole life. Many claimed to have smoked 10 plus a day. Jose Padron, 91. Carolos Fuente, 81. Arsenio Ramos, 83. Not in the industry but Winston Churchill started smoking in his teens at again, said to have smoked upwards of 10 per day. Lived to 90. I know this doesn't really prove anything but they are data points imo and it certainly goes against the far reaching claims of govt studies that say premium cigars are no different than cigs and are death sticks. 

There is enough evidence out there to give me the firm opinion that moderate (even possibly heavy) cigar smoking has very little impact on ones health. Tomorrow is never guaranteed. Choose some things that make you happy and go for it. The only guarantee in life is death. People that get worked up about cigars or alcohol use could be in a car wreck tomorrow.  

On a side note, my absolute favorite are the people who are obese and haven't been to a gym in their life and eat like shit telling me about the hazards of cigar smoking. But that's another rant. 

But my D.A.R.E. teacher told me smoking is bad and that I would be constantly offered and peer pressured into smoking.

No...stop... don't...I will not smoke that Cohiba Siglo VI. You can't make me. 

[Puros Y Vino]

1 hour ago, Ryan said:

For example. A company in Poland about 15 years ago introduced what they called a "party cigar". 

There was an outer wrapper leaf. If that was removed, inside were 10 individual smoking sticks, about cigarette sized.

Having a single outer wrapper made it a single product, and put it over a minimum weight requirement for a "premium cigar" in that market at the time.

Clever, but these efforts to skirt the rules mean regulators are slow to approve any allowances for "premium cigars". Skirting the rules becomes much easier when the rules are defined.

Cigar industry people get regular phone calls from the cigarette industry asking for the definition of a "premium cigar".

Edit. I found a picture on an old drive of mine. Not much about these anymore on Google. Hard to make out in that picture but the individual minis are inside that tobacco wrapper outer.

 

So, this in an interesting point.  Cigarette makers would ride on that definition to skirt the laws.  Cigar manufacturers really can't distance themselves from cigarette makers as they tend to fall under the same ownership structures at the end of the day. "Big Tobacco" if you will. AFAIK, there are no "pure" cigar manufacturers.(ie they only make cigars, not cigarettes, not owned by "Big Tobacco" etc).  So, they're hesitant to define it as regulators know cigarette manufacturers will pull a fast one on them and the cigar makers will end up pissing off the ownership structure above them if they do help define it to a point where there is little wriggle room for cigarette peddlars..  I dont know for sure, but I assume global cigarette sales are greater than global cigar sales? 

[MrBirdman]

I think it’s pretty clear that, unless you inhale, moderate consumption (certainly if you’re averaging 1 or fewer a day) does not carry a substantial risk, certainly not on the order of cigarette smoking. Studies have been limited and the results for most cancers mixed. The one area with a pretty conclusive positive, moderately dose-dependent correlation regardless of inhalation are ENT cancers, which is hardly surprising since all smoke is full of carcinogens. 

As with most long term health risks, your luck and genetics are the jokers in the pack. My best friend underwent an orchiectomy last Friday for testicular cancer, chemo starts next week. He doesn’t smoke, barely drinks, and is generally a hypochondriac about his health. Just had crap luck. 

The one thing we can be certain about is that none of us will live forever even if we do everything the FDA tells us.

[joeypots]

52 minutes ago, MrBirdman said:

The one thing we can be certain about is that none of us will live forever even if we do everything the FDA tells us.

And everything that's fun is dangerous.

[El Presidente]

From Drew Newman 

 

“The National Academies have confirmed what we all know to be true – that premium cigars are distinct from all other tobacco products.

“Today’s report found that children do not smoke premium cigars and that adults enjoy premium cigars in moderation. The report explained that premium cigars are typically not inhaled, largely because the pH level of premium cigar tobacco is much higher than cigarette tobacco. Because of this, the report concluded that health effects of premium cigars are different from cigarettes and mass-market products. Indeed, the chair of the committee stated today that the overall effect of premium cigars is ‘probably modest.’”

“When FDA decided to regulate premium cigars in 2016, it took a one-size-fits-all approach and applied the massive and expensive regulatory scheme developed for cigarettes to all other tobacco products, including premium cigars. Since then, we have been urging policymakers to recognize that premium cigars are different and should be treated differently. The National Academies report agrees and urges the government to create a formal definition of ‘premium cigar’ as a distinct class of products so that they are not grouped together with mass-market products.

“Today’s report will support our continued efforts in Washington to seek regulatory relief for premium cigars. I am very grateful to the National Academies and its committee of scientists for their work.”