Evaluation of Flavored Cigar Products As They Relate To Questions of Public Health

Background: Flavors in tobacco products is a subject of public health debate and increasing regulatory attention. There is interest in gaining an in-depth understanding of flavored cigar smoking prevalence and behaviors to address the use of flavors in cigars and questions of public health.Methods: Seven publicly available data resources that assess flavored cigar use were analyzed. Two focus on youth tobacco use (NYTS, MTF), four focus on adult tobacco use (HINTS-FDA, NATS, TPRPS, TUS-CPS), and one on both groups (PATH). Available data (2011-2019) were analyzed to assess usage trends over time. In addition, longitudinal analysis of PATH adult data examined whether flavored cigar use was associated with future use of cigarettes or increased use of cigars.Results: Youth past 30-day estimates of cigar use ranged from 2%-10% for both flavored and non-flavored cigars, slightly higher in high school vs. middle school age subpopulations. These estimates have been stable or declined across all survey years within the respective surveys. Consistent trends were observed regarding frequency of use; most youth using cigars do so 1-2 days per month. Similar findings were observed for adult cigar users, with five surveys indicating less than 10% currently use cigars. Flavored cigar use is at less than 5% across all data sources. These overarching use estimates were essentially flat over time. Frequency of youth cigar use remained consistent over time, with most youth reporting cigar use on 1-2 days per month. In addition, multivariable modeling of PATH adult data did not identify an association between flavored cigar use and future use of cigarettes or increased use of cigars.Conclusions: No evidence was found of increased use or different usage patterns, among either youth or adults, of flavored cigars vs. non-flavored cigars. While these trends should continue to be monitored, there is no indication of existing or emerging public health concerns related to flavored cigars within the seven large, nationally representative, US government-funded epidemiologic databases examined.

Cigar-Smoking-Cessation Interest and Experience among Black Young Adults: A Semi-Structured In-Depth Interview Investigation

Although Black/African American populations have high cigar-smoking prevalence, little is known about cigar-smoking cessation among this group. This study explored the perceptions and experiences of cigar-smoking cessation and assistance received from healthcare providers among forty Black young-adult cigar smokers (ages 21–29). Semi-structured in-depth phone interviews were transcribed and coded. Qualitative data were analyzed by using thematic analysis. Participants mostly smoked cigarillos, large cigars, and blunts. Overall, many regular cigarillo smokers reported interest in quitting eventually, while large-cigar and blunt smokers shared less interest in quitting because they perceived low harm from smoking these products. The reasons for cigar-smoking cessation were health concerns and financial constraints. Most of the participants who attempted to quit cigars did not use any cessation aids. The reasons for relapse included nicotine withdrawal, stress, and easy access. Additionally, most participants reported their healthcare providers did not ask whether they smoked cigars, and even when they knew, little assistance for cigar-smoking cessation was provided. Informing Black cigar smokers of the harm of cigar smoking and encouraging healthcare providers to screen for and assist with cigar-smoking cessation may alleviate the health burden of cigar smoking in this population.

Mortality among male cigar and cigarette smokers in the USA

Background Cigars and cigarettes are both smoked, but much less is known about the former’s long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys. Purpose We conducted a follow-up mortality study of cigar-smoking men age 40–79 years in National Health Interview Surveys (NHIS). Methods We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases. Results There were 14,657 deaths from all causes, including 3426 never tobacco users, 3276 exclusive cigarette smokers and 176 exclusive cigar users. The latter had no statistically significant evidence of increased mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, smoking-related diseases or other causes. In contrast, the mortality experience of dual users of cigars and cigarettes and cigar smokers who formerly used cigarettes is similar to exclusive cigarette smokers. Conclusions This study provides evidence that male cigar smokers age 40 + years had elevated mortality risks. However, after accounting for cigarette smoking and other confounding variables, we found significantly increased mortality only among dual and former users of cigarettes.

Mortality Among Male Cigar and Cigarette Smokers in the U.S.

Background. Cigars and cigarettes are both smoked, but much less is known about the former’s long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys. Purpose. We conducted a follow-up mortality study of cigar-smoking men age 40-79 years in National Health Interview Surveys (NHIS). Methods. We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases. Results. There were 14,657 deaths from all causes, including 3,426 never tobacco users, 3,276 exclusive cigarette smokers, and 176 exclusive cigar users. The latter had no statistically significant evidence of increased mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, smoking related diseases or other causes. In contrast, the mortality experience of dual users of cigars and cigarettes and cigar smokers who formerly used cigarettes is similar to exclusive cigarette smokers. Conclusions. This study provides evidence that male cigar smokers age 40+ years had elevated mortality risks. However, after accounting for cigarette smoking and other confounding variables, we found significantly increased mortality only among dual and former users of cigarettes.

Mortality Among Male Cigar and Cigarette Smokers in the U.S.

Background. Cigars and cigarettes are both smoked, but much less is known about the former’s long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys. Purpose. We conducted a follow-up mortality study of cigar-smoking men age 40-79 years in National Health Interview Surveys (NHIS). Methods. We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income, health status, body mass index, and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases. Results. There were 14,628 deaths from all causes, including 3,420 never tobacco users, 3,266 exclusive cigarette smokers, and 176 exclusive cigar users. The latter had no statistically significant evidence of increased mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, smoking related diseases or other causes. In contrast, the mortality experience of dual users of cigars and cigarettes and cigar smokers who formerly used cigarettes is similar to exclusive cigarette smokers. Conclusions. This study provides evidence that male cigar smokers age 40+ years had elevated mortality risks. However, after accounting for cigarette smoking and other confounding variables, we found significantly increased mortality only among dual and former users of cigarettes.

On Coffee-Houses, Smoking, and the English Essay Tradition

The Romantic essayist James Henry Leigh Hunt, in two essays saturated with nostalgia for a lost world of Enlightenment coffee-house sociability, registers a shift in the cultural place of the literary essay in the 1820s—the era of the cigar-smoking George IV—from an urban public sphere dominated by Mr Spectator and his pipe, to more suburban cubicles of domestic privacy. Through the medium of Hunt’s self-reflective essays on the English periodical essay tradition, this chapter reveals the fate of the literary periodical essay to be linked to a fading amateur culture of belles-lettres and ornamental arts. Hunt blames the early essayists for the result of the civilizing process: the cultivation of a taste for polite literature that has isolated readers and emptied Covent Garden of its intellectual life. The reveries, dreams, and visions of the literary essay made possible by the Orientalized cigar divan (Romantic successor to the coffee-house) reflect the complicated reality of London in an age of global imperialism.

Mortality Among Male Cigar and Cigarette Smokers in the U.S.

Background. Cigars and cigarettes are both smoked, but much less is known about the former’s long-term health effects, due to its low prevalence and infrequent collection of cigar information in national surveys. Purpose. We conducted a follow-up mortality study of cigar-smoking men age 40-79 years in National Health Interview Surveys (NHIS). We utilized Methods. We used pooled NHIS files linked to the National Death Index to obtain follow-up from year of interview to year of death or December 31, 2015. We developed categories of cigarette and cigar smoking that accommodate dual and former use of both products. We used Cox proportional hazards models, adjusted for age, race/ethnicity, marital status, education, income, health status, body mass index, and region to estimate hazard ratios (HRs, 95% confidence intervals, CI) for mortality from all causes, heart diseases, malignant neoplasms, cerebrovascular disease, chronic lower respiratory diseases and two mutually exclusive categories: smoking-related and other diseases.Results. There were 14,628 deaths from all causes, including 3,420 never tobacco users, 3,266 exclusive smokers, and 176 exclusive cigar users. The latter had significantly increased mortality only from chronic lower respiratory diseases (HR = 2.60, CI = 1.04 – 6.50), which was based on 6 deaths. We found no statistically significant evidence among exclusive cigar smokers of increased mortality from any other cause.Conclusions. This study provides evidence that male cigar smokers had elevated mortality risks. However, after accounting for cigarette smoking, we found significantly increased mortality only for chronic lower respiratory diseases.