Cigars just as damaging to health as cigarettes, study finds

Researchers from Harvard University have carried out the first study of cigar smoking among college students.

The study is based on responses from a representative sample of 14,138 students who were surveyed in 1999. It is the first study to look beyond cigarette smoking and to include other forms of tobacco use, such as cigars and smokeless tobacco.

Of those responding to the survey, 46 per cent reported using tobacco products in the previous year, and of these, 23 per cent had used cigars. The "past year use" of cigars among female smokers is 13.6 per cent.

Current use, defined as "the smoking of a cigar in the previous 30 days", was found to have a prevalence of 16 per cent among male college students.

College students who smoke cigars are putting themselves at risk of a lifelong addiction to nicotine, according to lead author Dr Nancy Rigotti, Director of Tobacco Research and Treatment at Massachusetts General Hospital and Harvard Medical School.

"Young people who are smoking cigars may not think that they are at risk of getting hooked, but they are. Repeated exposure to any tobacco product puts students at increased danger of becoming addicted to nicotine," she said.

Total tobacco use was much higher among male college students, at 38 per cent, than among females (30 per cent). The study shows that this difference is almost entirely due to males' much higher use of cigars. Over half of the males and a quarter of the females studied had tried cigar smoking.

Cigar smoking was primarily confined to older men prior to the early 1990s, according to the authors. However, this pattern changed dramatically after cigar manufacturers stepped up their promotional activities. Cigar consumption increased by 50 per cent between 1993 and 1998, the study finds. Cigar use is increasing most rapidly among young adults and is more common among individuals with higher education and income.

More than half of respondents used more than one type of tobacco product in the last year. Cigars and cigarettes are the most frequent combination.

Tobacco use is particularly high among students whose priorities are social rather than educational or athletic, researchers discovered. Other significant associations were usage of alcohol and marijuana and being white.

The authors recommended making all college buildings smoke-free zones. The are especially keen to see smoke-free dormitories, which they say will discourage new students from taking up smoking.

The Harvard research is published today in the Journal of the American Medical Association, in an edition devoted to an anti-tobacco theme. The same journal carries a special report summarising the health risks associated with cigar smoking.

Cigar tobacco is rich in nitrates compared to cigarette tobacco. This leads to the formation of nitrosamines which are highly carcinogenic substances. Carbon monoxide and ammonia are also produced in greater quantities in cigars.

Cigar users have an increased risk of oral, oesophageal (gullet) and laryngeal (voice box) cancers. Lung cancer risk is less strongly associated with cigar smoking than with cigarette smoking, but the risk increases with the number of cigars smoked per day and with the depth of inhalation.

"This study provides strong support for an increased risk for cancers of the lung, oesophagus, larynx and mouth. The increase in risk appears to be roughly proportional to the degree of exposure to the cigar smoke," the authors say.

They found that the cancer risk associated with cigars is greater for the mouth and voice box than for the gullet.

The report concludes by saying that switching from cigarette to cigar smoking will not reduce the risk of nicotine addiction. Neither will smoking cigars rather than cigarettes reduce the risk of death from a tobacco-related illness.