Research Articles
Cigar smoking in California: 1990–1996

https://doi.org/10.1016/S0749-3797(98)00092-0Get rights and content

Abstract

Background: Cigars have been heavily promoted in recent years. The nature and extent of the resultant increase in cigar smoking needs to be understood before the public health implications can be assessed.

Methods: Data are from population-based surveys conducted in California adults (≥18 years) in 1990 (n = 24,296) and 1996 (n = 24,266). Trends in current (every day or some days) cigar use are described for demographic subgroups and by cigarette smoking status.

Results: Current cigar use has doubled in California, from 2.5% in 1990 to 4.9% in 1996. In 1996, fewer than 5% of cigar smokers smoked cigars daily; essentially all of the increase was from nondaily use in those under 45 years of age of both genders, particularly in 18- to 24-year-olds. Among males, increased cigar use was observed in all racial/ethnic groups except Asians, and was observed in those with higher educational attainment and higher incomes. In both years, current and former cigarette smokers had higher rates of cigar use than never smokers, but the increase in current cigar smoking was observed regardless of cigarette smoking status. In 1996, daily cigar smokers were more likely to be former cigarette smokers than nondaily cigar smokers.

Conclusion: If more people begin to smoke cigars daily, or if cigar use leads young people to initiate cigarette smoking or leads former cigarette smokers to relapse to cigarette smoking, the recent trends in cigar use may have public health implications.

Introduction

In the 1990s, cigar smoking is being heavily promoted by the cigar industry in the United States, and cigar sales have increased dramatically.1, 2 Previously, cigar smoking was seen as the purview of the powerful, or would-be powerful male.3, 4 Because only a small segment of the population smoked them, cigars were not perceived to be a serious public health concern. Instead, the public health focus has been to discourage cigarette smoking. To gain some understanding of what implications the recent cigar fashion has for future public health, it is important to examine the nature and extent of recent trends in cigar smoking.

Earlier studies of cigar smokers showed that the risk of lung cancer and cardiovascular and chronic pulmonary disease was lower than in cigarette smokers, although the risk was still significantly greater than for nonsmokers.2, 5, 6, 7, 8 Also, cigar smokers have elevated risks of oral, laryngeal, esophageal, and pancreatic cancers when compared to cigarette smokers and nonsmokers.2, 9, 10, 11, 12, 13 Much of the quantification of these risks was based on males who smoked cigars in the 1920s to 1970s, when smokers tended to smoke cigars daily. The evidence indicated that the more cigars smoked per day, the higher were the health risks. Assessment of these risks was complicated by the subjects’ current and former cigarette smoking history.2, 14

The concentration of nicotine in cigar tobacco is comparable to that in a cigarette, but cigars generally contain much more tobacco. Also, the alkalinity of cigar tobacco makes it more readily absorbable through nasal and oral mucosa.15, 16 Cigars vary considerably in the amount of tobacco they contain and the pH of the tobacco, but smoking the average cigar is probably equivalent to smoking approximately 10 cigarettes.17, 18 A typical cigar also delivers about 10 times more tar and carbon monoxide than a cigarette.17 Many large cigars deliver much more nicotine, tar, and carbon monoxide than the overall cigar average.16, 17

Cigarette smokers inhale to most efficiently extract the nicotine from cigarette smoke, while most cigar smokers get their nicotine through the oral mucosa. Some studies have suggested that cigarette smokers or former cigarette smokers are more likely to inhale than cigar smokers who never smoked cigarettes.18, 19 However, high levels of expired carbon monoxide, an indication of consumption, appear to be related more to the number of cigars smoked per day than to the extent of inhalation or to cigarette smoking history.14 Former cigarette smokers may be using cigars to maintain a nicotine addiction, and they also may be more vulnerable to relapse to cigarette smoking than other former cigarette smokers.

There are no health warnings on cigar wrappings, packaging, or advertisements, and many cigar smokers probably feel that the health risks involved with having an occasional cigar are minimal. However, if there is escalation of use, not only is there more exposure to the harmful effects of cigars, but as with all tobacco products, there is always the risk of developing nicotine dependence. Once this happens, some cigar smokers may turn to cigarettes as a more convenient way to support their nicotine addiction.

The present study examines changes in the pattern of adult cigar use in California. Data are from large population-based surveys conducted in 1990 and 1996. We examine changes in the prevalence of cigar use overall and for different demographic subgroups of the population. Finally, we characterize the cigar smokers in 1996 and comment on the public health implications of our findings.

Section snippets

Surveys

The data for this analysis come from the 1990 and 1996 California Tobacco Surveys.20, 21, 22 These surveys are part of a series of random-digit-dialed population surveys that are conducted periodically to evaluate the California Tobacco Control Programs.23 There were 32,135 households contacted in 1990 and 39,674 contacted in 1996. In both survey years, all household members were enumerated in a screener interview, and some adults (≥ 18 years) were randomly selected to answer an extended

Changes in adult cigar use: 1990–1996

In the tables and figures described below, current cigar users were those who answered either “every day” or “some days” to the question about current cigar use. It is of interest to note that 9.0% of current cigar smokers reported daily cigar use in 1990, but this percentage dropped to just 4.5% in 1996.

Between 1990 and 1996, the overall percentage of adults who reported they had ever smoked a cigar has declined significantly, from 24.6% to 20.1% (Table 1). This decline was significant for

Discussion

Between 1990 and 1996, current cigar smoking doubled in California. Most of the increase was in those under 45 years of age, particularly in 18- to 24-year-olds. Although cigar smoking is still a predominately male activity, there are indications that younger females, especially current cigarette smokers, are starting to smoke cigars at appreciable rates. Among males, increased current cigar use was observed for all racial/ethnic groups except Asians. Additionally, males with higher educational

Acknowledgements

Data were collected under Contract 95-23211 from the California Department of Health Services, Tobacco Control Section, Sacramento, California. Preparation of this article was supported by funding from the Cancer Prevention Research Unit NIH Grant # CA72092, funded by the National Cancer Institute, Bethesda, Maryland. Dr. Pierce is supported in part by an Established Investigator Award from the American Heart Association.

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