Cigars, cigarettes and cigarillos: How each affects health

Despite all the known health hazards of smoking – cancer and respiratory and heart disease high among them – cigars are making a quiet comeback. In recent years, the U.S. has seen a startling shift in tobacco product consumption. Even as cigarette smoking declined by 40 percent in the general population between 2000 and 2015, cigar consumption doubled, according to the Campaign for Tobacco-Free Kids.

What's more, a 2015 nationwide survey found nearly 1.3 million high school students and about 180,000 middle-school students said they had smoked a cigar within the past month. For African-American high school students, cigars were the most common tobacco product used.

Whether cigars represent a more or less hazardous choice among tobacco products is uncertain. What is known is that, as with cigarettes, the only health benefit of cigar use comes from quitting. Below, health experts clear the air around the health risks of smoking cigars.

[See: 17 Ways Heart Health Varies in Women and Men.]

Large cigars pose large risks.

Cigarettes and the various cigar types differ in size, fermentation type, tobacco content, wrapping and speed of smoking. According to the National Cancer Institute, cigarettes, which are wrapped in paper, contain less than 1 gram of tobacco and take less than 10 minutes to smoke. Cigars, by contrast, have tobacco-leaf wrappers, and large cigars, measuring 7 inches or so, hold between 5 and 20 grams of tobacco. It can take up to two hours to smoke a large cigar, the NCI notes, with some premium cigars containing the tobacco equivalent of a full pack of cigarettes.

Cigarillos, a midway size, hold about 3 grams of tobacco. Little cigars closely resemble cigarettes in tobacco quantity, shape and size, and some have filters.

"Large cigars can deliver as much as 10 times the nicotine, two times the tar and more than five times the carbon monoxide of a filtered cigarette," according to a fact sheet from the U.S. Food and Drug Administration. Harmful chemicals found in both cigar and cigarette smoke include nitrosamines that lead to the development of lung and oral cancers.

It's not just cancer. Heart disease, chronic obstructive pulmonary disease, or COPD, and aortic aneurysm risk are all increased for cigar smokers. So what's the attraction?

"Smoking cigars has all kinds of social connotations," says Dr. Norman Edelman, senior scientific advisor for the American Lung Association. "It's a pretty macho thing to do if you smoke a big, fat Cuban cigar."

Long ago in his personal life, Edelman tried to justify smoking a pipe on a relative-health level. "I said, 'Oh, well, this has to be safer than cigarettes,'" he recalls. Nonetheless, he says, he developed a smoking-related cancer: bladder cancer.

"You swallow all that stuff, and the carcinogens get excreted in the urine," Edelman says. "And over the years, they increase the risk of bladder cancer." The upper airway and throat are the other major cancer sites related to cigar smoking, he adds.

[See: 7 Things You Didn't Know About Lung Cancer.]

Inhalation matters.

Whether people inhale cigar smoke is a big key to how much their health is affected, says Dr. Stanton Glantz, a professor at the University of California–San Francisco's Center for Tobacco Control Research and Education. "The sort of classic use of cigars a long time ago was people didn't inhale too much, so they tended to generate more mouth and neck cancers and less lung cancer than a cigarette does," he says. "But people have increasingly inhaled them – and when you inhale them, you get all the same effects as a cigarette, except that you're taking in and burning a lot more tobacco."

Cigarillos and other adaptations blur the line between cigars and cigarettes. "Smaller cigars are designed now, today, much more like cigarettes," Glantz says. "The way they're manufactured, the usage of additives, menthol – things like that are designed to promote inhalation. Because if you inhale the smoke, you get a much faster, stronger nicotine hit than if you keep it in your mouth."

Small cigars find younger smokers.

With the opening of Cuban-U.S. trade, smokers who can afford pricey imports will have easier access to large, fancy cigars. But the real rising U.S. market is in cheaper little cigars and cigarillos, with their flavoring, packaging and prices aimed squarely at younger adults and kids.

Small cigars are reaching consumers who probably wouldn't puff on traditional, premium cigars. At the highest end, a single Havana cigar can cost between $15 and $29 online – and a luxury-seeking buyer could easily spend $450 for a box of 25. Small cigars, however, can cost as little as $33 for a box of 40.

As people grow older, their preference for flavored products fades. But for smokers at their youngest and most impressionable, candy-, fruit- and chocolate-flavored tobacco products are the most popular. And these are widely marketed in local convenience stores as well as online.

"In recent years, we've seen a proliferation of small cigars that are sold in candy and food flavors like watermelon, grape and chocolate, and they're often very cheap," says Vince Willmore, vice president of communications with the Campaign for Tobacco-Free Kids. "Two or three for less than a dollar. So these cheap, sweet-flavored cigars definitely appeal to kids."

A small study in the May 2016 issue of the journal Nicotine & Tobacco Research looked at beliefs among young adults who had recently smoked some type of cigar. Many participants thought of flavored small cigars as devices for smoking marijuana, or "blunts." Overall, "the most concerning was participants' perception of reduced harm of little cigars and cigarillos (smoked with its tobacco inside) compared to cigarettes," researchers concluded.

"Basically, a lot of people think cigars are safer than cigarettes – but they're just different," Glantz says. Among young people, he says, the latest pattern for tobacco use is mixing and matching cigars, cigarettes and little cigars.

[See: 10 Concerns Parents Have About Their Kids' Health.]

There has been progress in industry oversight, Willmore notes. This year, the Food and Drug Administration increased its regulatory authority to cover cigars, although accessories such as lighters and cutters were excluded. Manufacture, import, packaging, labeling, advertising, sale, promotion and distribution of cigars now fall under FDA regulation.

Copyright 2016 U.S. News & World Report