TY - JOUR T1 - Growth in imported large premium cigar sales, USA 2008–2019 JF - Tobacco Control JO - Tob Control DO - 10.1136/tobaccocontrol-2020-056230 SP - tobaccocontrol-2020-056230 AU - Samir Soneji AU - Caroline Mann AU - Sina Fong Y1 - 2021/02/04 UR - http://tobaccocontrol.bmj.com/content/early/2021/02/04/tobaccocontrol-2020-056230.abstract N2 - 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 … ER -