By David Diaz, Ed.D.
Introduction
This past year, at the annual board of directors meeting, the membership of the Retail Tobacco Dealers of America (RTDA) decided to change the name of the organization. The membership voted to adopt the name International Premium Cigar and Pipe Retailers association or, the IPCPR. Recognizing the reality and strength of the current anti-tobacco movement, the organization felt it was necessary to better represent the focus of the organization and make clear its distance from cigarettes and even machine-made cigars. After 75 years of existence, the organization conceded that the generic reference to “Tobacco” in the name of the organization could refer to any type of tobacco and was too closely associated with, or better, maligned by, cigarette tobacco.
There are, indeed, many differences between premium cigars and cigarettes. The main purpose of this article is to compare cigarettes and cigars with respect to construction and contents. In describing the fundamental differences between cigarettes and cigars, I also hope to elucidate how these differences are related to the potential for addiction, toxicity, and disease, and to describe how we as cigar smokers might lower our risk for all kinds of health conditions, diseases and early death.
Historical Sketch
Public interest in the dangers of cigar smoking has been spurred by many scientific publications, but none were more historic or groundbreaking than the first report to the U.S. Surgeon General on smoking and health (U.S. Public Health Service, 1964). The Surgeon General’s report portrayed moderate cigar smoking (less than 5 cigars per day) as having nearly the same low risk of early death as for non-smokers and started a debate that still rages to this day.
Cigar consumption had languished since the introduction of modern blended cigarettes in 1913 and suffered further negative effects due to the Great Depression and World War I (National Cancer Institute, 2000). The Surgeon General’s 1964 report warned of the disease risks associated with smoking cigarettes and probably did much to encourage the increased consumption of cigars. What was written about cigars in the report was positive: “The death rates for men smoking less than 5 cigars a day are about the same as for non-smokers. For men smoking more than 5 cigars daily, death rates are slightly higher.” Given these remarks, cigars were likely viewed as a safer alternative to cigarettes.
Encouraged by the favorable remarks regarding cigars in the Surgeon General’s report and favored by a loop-hole in the 1969 law that banned cigarette (but not cigar) advertising, the cigar industry began television advertising for small cigars (i.e., cigarillo’s). The sales of cigars increased dramatically until 1973 when a subsequent T.V. advertising ban restricted the advertising of cigars. This started a decline in the popularity of cigars that lasted 20 years. However, in 1993, fueled by a public interest in wealth, success and the finer things in life, Cigar Aficionado magazine hit the newsstands and created even more interest in cigars and cigar smoking and helped pave the way to the “cigar boom” of the mid-1990s.
This modern popularity of cigars has prompted government and related health organizations to ask and investigate several important health questions related to cigars: Who is using cigars? What are the health risks of cigar smoking? Are premium cigars less hazardous than regular cigars? What are the risks if you don't inhale the smoke? What are the health implications of being around a cigar smoker?
Intense scientific scrutiny of cigars has led to the appearance of countless studies and published papers and has shaped current public opinion. Subsequent research has not been as favorable toward cigar smoking as was the first Surgeon General’s report. Cigars have now been lumped together with cigarettes and other tobacco products with regards to disease risk and have suffered similar fates with respect to anti-smoking legislation. But is this really a fair assessment?
Cigars and Health
First let me say that cigar smoking is not a healthy activity. Anybody who thinks it is probably missed out on the common sense gene. We don’t smoke cigars because they’re healthy. We do it because we personally enjoy them, because smoking cigars with friends and acquaintances is a great social or celebratory activity, and because collecting cigars and their accoutrements can be a fun and interesting hobby. That said; cigar smoking doesn’t necessarily have to translate into high risk for morbidity or mortality.
Cigar smoking is a lot like eating food and drinking alcohol. The risk of eventual disease is related not only to what you consume, but how much you consume. Eating a hamburger with French fries and a Soda is unlikely to lead to disease. What leads to poor health and eventual disease is eating that same meal every day for a period of many years. So, for example, while heavy alcohol consumption can give rise to various diseases, moderate alcohol consumption may have no effects, or even beneficial effects on health. Those who smoke 1-2 cigars per day will likely experience lesser negative effects than those who smoke 4-5 cigars per day. Plus, many cigar smokers report that sitting and enjoying a fine premium cigar provides them opportunities for regular diversion from the stresses of life, time to reflect and refocus, relaxed social activity with friends and family, and a satisfying intellectual activity consistent with an engaging hobby. Such activities have been shown to reduce stress and improve overall health.
The process of assessing the risk of suffering from a disease as a result of cigar smoking is often based on some form of odds ratio that may, or may not, successfully predict an outcome. For those of you who play poker, you would probably realize that, even though the odds favor you if you hold a straight, you might still lose to a person who holds a straight flush. On the other hand, you may only hold a pair of 10s, and still win. There are way too many factors, in both poker and health, to accurately predict how every situation will turn out. That is why most research on the effects of smoking and health report their conclusions in terms of averages and probabilities.
Differences Between Cigars and Cigarettes
Processing differences
For the purpose of our discussion, when I talk about a cigar, I am referring to a premium cigar. A premium cigar is one that uses 100% tobacco and does not contain, non-tobacco products like reconstituted tobacco. I will not be referring to short filler or machine rolled cigars, only to long-filler cigars whose tobaccos have been fermented and aged naturally (i.e., without additives) and are totally hand-made products.
A cigarette can be defined as “a tobacco product that is wrapped in paper or other substance that does not contain tobacco” (NCI, 2000). The typical US-made cigarette contains a blend of heat-cured and air-cured tobaccos, but the tobaccos are not fermented. This is one of the fundamental differences between cigarettes and premium cigars. Premium cigars are air-cured and undergo an extensive fermentation process.
Above: Inside of a cigar tobacco curing barn
The tobacco curing process involves hanging green leaf tobacco inside temperature and humidity-controlled barns. This will eventually dry the tobacco leaves and turn their color from green to brown. Subsequent to curing, cigar tobaccos are fermented. Fermentation involves stacking the tobacco leaves in large piles called, “pilones,” which are repeatedly torn down and restacked until the leaves have achieved the proper state of flavor and aroma. The tobaccos are basically “cooked” in the pilones, which are carefully monitored for temperature. It is during fermentation (“sweating”) that cigar tobacco is reduced in protein, sugars, phytosterols and polyphenols (Baker, F., et al. 2000). Fermented tobacco is also reduced in nicotine by about a third and ends up slightly alkaline (i.e., with high pH). Cigarette tobacco, which is not fermented, loses some of its nicotine during curing, but doesn’t lose the extra nicotine that cigar tobacco loses during the fermentation stage.
Above: a large “Pilón” being assembled in the fermentation warehouse
The process of fermentation is not completely beneficial, however. Although fermentation does serve to reduce the amount of nicotine in the tobacco, this benefit is partially offset by the introduction of some toxic and carcinogenic compounds that are formed during fermentation. The high nitrate levels in cigar tobacco eventually form nitrosamines (nitrites are reduced to N-nitrosating nitrite, which then reacts with amines to form nitrosamines). Two other tobacco-specific carcinogens (NNN and NNK) are also formed during fermentation (Baker, 2000).
Manufacturing differences
Major differences also exist between cigarettes and cigars at the manufacturing level (Figure 1). A finished US cigarette contains only 50% tobacco, which is treated with sugar to mask bitterness and enhance absorption. Another 30% is reconstituted tobacco (RECON), which is made from stems and tobacco from factory leftovers. RECON is shredded, emulsified and sprayed on a paper substance that is finely chopped before being added to the cigarette blend. A final 20% consists of expanded tobacco (tobacco product that has been expanded with carbon dioxide) and reclaim (cigarettes that have passed their prime and are sent back to the factory). The cigarettes are then rolled into paper and most (97%) are fitted with a filter made of cellulose acetate.
Figure 1. Comparison of contents of cigarettes vs. premium cigars (Tobacco, 2006)
It is well known that flavor additives are used in cigarettes to reduce bitterness. Plasticizers, like glyceryl triacetate and triethylene glycol triacetate, are also added to the filters of cigarettes, where they function to reduce nicotine delivery and improve the mechanical efficiency of the filter.
Potential for toxicity and abuse
The chemistry of cigar tobacco is not as established as that of cigarettes. Depending on whom you are referencing, processed tobacco contains between 3000-4000 different compounds. Most of these compounds are present in green tobacco leaf, but some are also formed during curing, fermentation and aging. (NCI, 2000). Though only a portion of these compounds have been identified in cigar tobacco, it is likely that, prior to processing, the contents found in cigar and cigarette tobacco are similar (Baker, 2000). What have not been adequately reported are the different levels of concentrations of compounds present in cigar and cigarette tobacco, and the difference in chemical additives used while growing and processing the plants.
Wald and Watt (1997), in a study of the effects of switching from cigarettes to cigars or pipes, noted that regular cigarette smokers consumed a greater total volume of tobacco than regular cigar smokers. They also concluded that the total volume of tobacco smoked by subjects in their study was the most significant factor responsible for the increased risk of dying from heart disease, lung cancer and chronic obstructive lung disease (COPD). While cigarette smokers have been shown to increase their consumption of cigarettes over time, cigar smokers “maintain patterns of intermittent use and smoke fewer cigars per day than is seen in cigarette smokers” (NCI, 2000). Thus, based on the risk factor of total consumption of tobacco, cigar smokers are most likely at lower risk for heart and lung disease than cigarette smokers.
Nicotine is the primary psychoactive ingredient in tobacco and represents the component most likely to be abused. Though the nicotine levels in cigar tobacco are lower than in cigarette tobacco when measured per gram of tobacco (possibly due to the effects of extended fermentation), the total nicotine in any given cigar can vary from an amount equivalent to a single cigarette, to the quantity generated by a pack of cigarettes, or more (Blake, 2000), depending on the size of the cigar. Today’s trend is toward larger cigars, which likely contain the nicotine equivalent of several cigarettes.
Another important factor in the delivery of nicotine, as well as the delivery of other toxins and cancer-causing agents, is the manner in which a person smokes. The difference in composition of cigarette versus cigar tobacco is likely the cause of the differences in smoking patterns. Cigar smoke is alkaline (i.e., has a higher pH relative to cigarette smoke) and as a result is difficult to inhale without severely irritating the respiratory airways. The nicotine produced in a high pH environment is termed “free nicotine” and is a type that more readily absorbs through the mucous membranes of the mouth. Thus, cigar smokers can deliver a substantial amount of nicotine to the brain via transport through the oral mucosa. However, the rate of delivery is slower.
Cigarette smoke, on the other hand, is mildly acidic, making it much easier to inhale and produces a type of nicotine that is termed “protonated.” Protonated nicotine is not readily absorbed through the oral mucosa and must be inhaled to produce substantial nicotine delivery.
The practice of inhaling smoke has been shown to increase the rate of delivery of nicotine to the brain. On the other hand, nicotine absorption to the brain is slower when nicotine is absorbed through oral mucosa. The ability of any drug to bring on addiction appears to be related to the speed with which its messages are delivered to the brain. The more quickly the brain feels the effects of what the body takes in, the more easily it is able to connect/associate this action with the reaction of pleasure. Though both cigarette and cigar smoking can deliver substantial amounts of nicotine to the brain, if the speed of ingestion is a more important factor when it comes to nicotine addiction, then cigar smokers who do not inhale will be at a lower risk of suffering nicotine dependence.
Furthermore, while the vast majority of cigarette smokers report that they inhale the smoke into their lungs, the majority of cigar smokers who have never smoked cigarettes say that they never inhale (NCI, 2000). Cigar smoke is often partially inhaled by current and former cigarette smokers (Baker, 2000) who seem to be unable to break themselves of the habit of inhaling. Cigar smokers who inhale, particularly those who smoke several cigars per day, have a higher risk of suffering from several diseases. However, non-inhaling cigar smokers tend to have lower rates of coronary heart disease, COPD and lung cancer, than either inhaling cigar smokers or cigarette smokers (NCI, 2000).
Mainstream smoke, which is the smoke pulled through the burning cigar or cigarette and taken into the mouth and lungs, delivers its constituents directly to the oral mucosa and the lungs (if inhaled). In most cases, cigarettes filter the contents of mainstream smoke, before they make contact with the mucous membranes and the lungs. However, cigar smokers have more direct contact with the tobacco. Since there is no filter on a premium cigar, the moistening of the tobacco with saliva found on the lips and tongue, facilitates the extraction of nicotine into the oral mucosa. Further, the tars in cigar tobacco tend to concentrate toward the head of the cigar as the smoke progresses, accumulating more tar at the point of entry into the mouth.
The lungs and oral mucosa of cigarette and cigar smokers serve as filters, in a sense, since a certain portion of the constituents of the tar and particulate matter of smoke remain in the body. Some of these chemicals affect the mouth and tongue directly, some are swallowed and affect the esophagus and stomach, and the rest is inhaled and exhaled where it will affect the lungs and nasal mucosa. No matter what pattern of smoking one chooses, the body will absorb and filter some of the constituents of cigar smoke.
Besides nicotine, carbon monoxide, benzene, benzo(a)pyrene and ammonia are found in high quantities in both cigarette and cigar smoke. However, these chemicals are most dangerous when inhaled into the lungs as a part of mainstream or sidestream smoke.
Another factor that should be considered by cigar smokers is the type of tobacco used in making a cigar. Tobacco that comes from the highest part of the plant is called ligero. The ligero stays on the plant longer before it is primed (systematically removed), thereby increasing its exposure to nutrients from the soil. As a result, ligero tobacco is more full in flavor and possesses more nicotine. Cigar-makers, who want to blend a stronger cigar, will often use more ligero in the blend.
Non-inhaling cigar smokers receive high smoke exposure to the mouth and tongue. There is also particulate matter in their saliva, which they swallow. Thus, cigar smokers, even though they do not inhale, may have increased risk of cancers of the mouth and esophagus.
Environmental Toxicity
As noted earlier, tobacco smoke produced by cigar and cigarette tobacco is likely to have the same or similar toxic and cancer-producing chemicals. Besides the potential danger associated with ingesting the constituents of tobacco smoke via mucous membranes and/or directly into the lungs when smoking, there is also a potential toxicity through breathing or rebreathing the pollutants in the environment. A good deal of research supports the notion that regular, sustained exposure to environmental tobacco smoke (ETS) poses a danger not only to the smoker, but also to non-smokers who are exposed to the same environment.
The major difference in the contribution to environmental toxicity between cigars and cigarettes is size. A standard US-made cigarette usually has less than one gram of tobacco and is smoked within 7-8 minutes. A large cigar, depending on the length and ring gauge, may contain between 5-17 grams of tobacco and is smoked over the course of 60-90 minutes. Though cigars may produce similar ETS per minute compared with cigarettes, they continue producing ETS over a longer period of time. The contribution of ETS by a single cigar will be much higher than by a single cigarette.
There are two primary sources that contribute to ETS. Sidestream smoke (i.e., that which comes off the burning end of the cigar or cigarette) is the major contributor. Exhaled smoke, whether it is first inhaled or simply taken into the mouth or retrohaled, is the second contributor to ETS. Given the earlier discussion of the effects of inhaling cigar or cigarette smoke, it would seem prudent to avoid regular and/or sustained environments where ETS is high.
Conclusions
Cigar smoking will always carry some level of risk. But there is also risk associated with many of our daily activities; from eating and drinking to driving and flying, there are many things that we do that could potentially kill us. On the other hand, cigar smoking can be enjoyed with only a low to moderate level of risk, if one observes some or all of the following recommendations:
Smoke premium, handmade cigars that have been well cured, fermented and aged. The best premium smokes have gone through extensive fermentation and aging and are not laced with harmful additives. The fermentation process has been shown to reduce nicotine and other harmful chemicals.
Smoke in moderation. The total volume of tobacco consumed has been shown to be the most important factor contributing to the risk of disease. Therefore, it would be wise to moderate the total number of cigars that you smoke to no more than 1-2 per day. Smoke less, but better.
Don’t inhale. Inhaling mainstream smoke will likely increase your risk of nicotine addiction and will increase your risk of suffering from coronary heart disease, lung cancer and COPD.
Don’t chew your cigars. Chewing will cause a higher level of accumulated tars to pass into the mouth where they can more substantially affect the oral mucosa and esophagus.
Smoke outdoors or in well-ventilated areas. Cigar “Smokers,” “Herfs,” and special events should provide opportunity for inducing fresh air into the environment, or removing smoke-filled air, or both. My personal practice has been to smoke outside whenever possible. However, those who must smoke indoors should provide plenty of air circulation. The use of fans, open windows, air-ventilation systems and/or air purifiers should help to reduce the concentration of ETS.
References
Baker, F., Ainsworth, S., Dye, J., Crammer, C., Thun, M., Hoffmann, D., Repace, J., Henningfield, J., Slade, J., Pinney, J., Shanks, T., Burns, D., Connolly, G., and Shopland, D. (2000) Health risks associated with cigar smoking. JAMA, 2000; 284: 735-740.
National Cancer Institute (July 7, 2000). Cigars: Health effects and trends. Bethesda, MD: US Dept of Health and Human Services. Public Health Service. Smoking and Tobacco Control Monograph No. 9. NIH Publication 98-4302
Tobacco. Writer, Sean Dash. Nov 8, 2006. DVD. The History Channel, 2007.
U.S. Public Health Service (1964). Smoking and Health: Report of the Advisory Committee to the Surgeon General of the Public Health Service. PHS Publication No. 1103. Rockville, MD: US Department of Health Education and Welfare, Public Health Service, Centers for Disease Control.
Wald, N. J., and Watt, H. C. (1997). Prospective study of effect of switching from cigarettes to pipes or cigars on mortality from three smoking related diseases. BMJ 1997;314:1860 (28 June).
David Diaz is the president of Stogie Fresh and the editor of the Stogie Fresh Cigar Journal. He has served as an educator, researcher and writer and has taught in the Health Education and Health Science field for nearly 30 years. He possesses an earned doctorate from Nova Southeastern University.
By Rob Gray, Ph.D.
