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Use of large premium cigars (hereafter ‘large cigars’) has steadily increased over the past 30 years in the USA.1 2 The health risks associated with cigar smoking depend on the type and number of cigars smoked and the amount of smoke inhaled.3 Per gram of tobacco smoked, cigars contain a higher amount of tar (ie, particulate matter) than cigarettes.3 Even among individuals who do not inhale cigar smoke, the pH of the smoke may be sufficiently basic to allow for nicotine absorption through the buccal mucosa.4 Despite the well-documented health risks associated with cigar smoking,5 6 fewer marketing and sales restrictions apply to large cigars than for cigarettes and small cigars.7–9 Additionally, key government policies (eg, levying taxes and tariffs) are underused. If these policies are applied judiciously, they could reduce usage of large cigars.
The number of large cigars domestically produced and taxed (ie, excluding tax exempt) in the USA increased from 4.8 billion in 2008 to a peak level of 9.9 billion in 2011. Subsequently, US production decreased to 4.7 billion in 2019 (figure 1). In contrast, the number of large cigars imported in the USA increased steadily from 1.0 billion in 2008 to 8.5 billion in 2019. Since 2015, more large cigars were imported than domestically produced in the USA. In 2019, 65% of large cigars were imported. A similar pattern did not occur for other …
Contributors SS and CM were involved in study design, data collection, statistical analysis and preparation of the article. SF was involved in study design and preparation of the article.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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