Cigars pose a real danger to the long-term health of all Americans – and to young people especially – yet government regulation of cigars lags behind that of cigarettes and e-cigarettes. In January 2020, the FDA prohibited the sale of most flavors in cartridge-based e-cigarettes.[1] Flavored cigarettes, except for menthol, have been largely illegal since 2009. However, similar regulations do not exist for flavored cigars, something that has helped the cigar industry stay attractive to younger customers. The FDA announced its intention to prohibit flavors in cigars and menthol in cigarettes, but no regulation is currently in effect. Similarly, cigars are not always taxed at the same rate as cigarettes. Excluding cigars from evidence-based tobacco control measures provides opportunity for the tobacco industry to take advantage of and aggressively market their deadly products to youth. In addition, some groups, such as Black middle and high school students, experience a disproportionate impact, exacerbating existing health disparities.[2]
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What Defines a Cigar? |
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A cigar is usually defined, for tax purposes, as any roll of tobacco wrapped in leaf tobacco or in any substance containing tobacco. Cigars sold in the United States include large cigars, cigarillos, and little cigars. Large cigars usually contain at least a half an ounce of tobacco, while cigarillos tend to be shorter and contain 3 grams or less of tobacco.[1] Some cigarillos and little cigars are similar in size and shape to cigarettes. Unsurprisingly, these cigarette-like cigars are appealing to youth. |
An estimated 380,000 U.S. students were current cigar users in 2021, making cigars the second most popular tobacco product among youth.[3] In addition, 3.5 percent of U.S. adults reported current cigar use in 2020, including 4.6 percent of non-Hispanic Black adults.[4]
According to CDC data, Black students are more than twice as likely to use cigars than their peers. In 2021, 3.1 percent of surveyed Black middle and high school students reported using cigars in the past 30 days, compared to 1.4 percent among all students.[5] Cigars are currently the second most popular tobacco product among Black youth, behind e-cigarettes. Male high school students are also more likely than female high school students to be current cigar users (2.6 percent vs 1.5 percent). Clearly, the issue of youth cigar use is also an issue of health equity.
Cigars, cigarillos, and little cigars are all sold in many flavors that are appealing to young people, such as banana, mango, chocolate, and grape. These flavored products are commonly sold by cigarette retailers, such as convenience stores, but, unlike cigarettes, are not required to be placed behind the countertop.[6],[7] This practice may make flavored cigars and cigarillos more appealing and accessible to young people.
Flavored cigars are very popular among children and young adults. A 2015 study found that 74 percent of youth who used cigars reported flavoring as a primary reason for using them.[8],[9] In 2021, 44.4 percent of students who currently use cigars reported using flavored cigars in the past 30 days (41.1% for high school students and 59.9% for middle school students.)[10]
Importantly, flavored cigars can also serve as a gateway for new tobacco users. A 2019 longitudinal study found that, among youth aged 12-17 who began using cigars during the study period, 45.2 percent reported that their first product was flavored.[11] This same study found that young adults aged 18-24 who start with flavored cigars are more likely to become regular users compared to those who start with unflavored cigars.
Regular cigar smoking increases the risk of cancers of the lung, oral cavity, larynx, and esophagus.[12] In fact, cigar smokers are four to ten times more likely to die from laryngeal, oral or esophageal cancers than non-smokers.[13] Heavy cigar smoking also increases the risk of developing lung diseases, such as emphysema and chronic bronchitis.[14] Cigars also produce secondhand smoke that is dangerous for non-smokers.
All tobacco products, including cigars, contain nicotine, which may induce dependence and harm health.[15] And unfortunately, young people who use tobacco products are more likely to become addicted than adults.[16]
Regulation of cigars is part of ACS CAN’s comprehensive approach to reducing tobacco use and exposure to secondhand smoke in the United States. Excluding cigars from comprehensive tobacco control laws provides the tobacco industry with an opening to target youth, who may be especially drawn to flavored products. ACS CAN makes the following policy recommendations with respect to cigars:
Updated April 2022
[1] FDA Finalizes enforcement policy on unauthorized flavored cartridge-based e-cigarettes that appeal to children, including fruit and mint. U.S. Food and Drug Administration. Published January 2, 2020. Accessed December 9, 2020. https://www.fda.gov/news-events/press-announcements/fda-finalizes-enforcement-policy-unauthorized-flavored-cartridge-based-e-cigarettes-appeal-children
[2] Odani S, Armour BS, Agaku IT. Racial/Ethnic Disparities in Tobacco Product Use Among Middle and High School Students — United States, 2014–2017. MMWR Morb Mortal Wkly Rep. 2018;67(34):952-957. doi:10.15585/mmwr.mm6734a3
[3] Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1–29.
[4] Cornelius ME, Loretan CG, Wang TW, Jamal A, Homa DM. Tobacco Product Use Among Adults — United States, 2020. MMWR Morb Mortal Wkly Rep 2022;71:397–405. DOI: http://dx.doi.org/10.15585/mmwr.mm7111a1
[5] Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1–29. DOI: http://dx.doi.org/10.15585/mmwr.ss7105a1
[6] Kong AY, Queen TL, Golden SD, Ribisl KM. Neighborhood Disparities in the Availability, Advertising, Promotion, and Youth Appeal of Little Cigars and Cigarillos, United States, 2015. Nicotine & Tobacco Research. Published online January 9, 2020. doi:10.1093/ntr/ntaa005
[7] The Truth about Tobacco Industry Retail Practices. Truth Initiative; 2017. https://truthinitiative.org/sites/default/files/media/files/2019/03/Point-of-Sale-10-2017.pdf
[8] Flavors. Truth Initiative; 2018. https://truthinitiative.org/sites/default/files/media/files/2019/03/Truth-Flavors-Fact-Sheet.pdf
[9] Ambrose BK, Day HR, Rostron B, et al. Flavored Tobacco Product Use Among US Youth Aged 12-17 Years, 2013-2014. JAMA. 2015;314(17):1871. doi:10.1001/jama.2015.13802
[10] Gentzke AS, Wang TW, Cornelius M, et al. Tobacco Product Use and Associated Factors Among Middle and High School Students — National Youth Tobacco Survey, United States, 2021. MMWR Surveill Summ 2022;71(No. SS-5):1–29.
[11] Villanti AC, Johnson AL, Glasser AM, et al. Association of Flavored Tobacco Use With Tobacco Initiation and Subsequent Use Among US Youth and Adults, 2013-2015. JAMA Netw Open. 2019;2(10):e1913804. doi:10.1001/jamanetworkopen.2019.13804
[12] Cancer Facts and Figures. American Cancer Society; 2017. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2017.html
[13] Oral Cancer and Tobacco. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/oral-cancer-and-tobacco#:~:text=Smokers%20are%20also%20at%20a,60%20known%20cancer%2Dcausing%20agents.
[14] Cigars. Centers for Disease Control and Prevention. https://www.cdc.gov/tobacco/data_statistics/fact_sheets/tobacco_industry/cigars/index.htm
[15] The Health Consequences of Smoking - 50 Years of Progress. U.S. Department of Health and Human Services; 2014. https://pubmed.ncbi.nlm.nih.gov/24455788/
[16] A Report of the Surgeon General: Preventing Tobacco Use Among Youth and Young Adults. Centers for Disease Control and Prevention Office on Smoking and Health; 2012. https://www.cdc.gov/tobacco/data_statistics/sgr/2012/consumer_booklet/pdfs/consumer.pdf
