WASHINGTONCigars should carry health warning labels
similar to those on cigarettes and other tobacco products, the
inspector general (IG) of the Department of Health and Human Services
(HHS) has concluded. Inspector General June Gibbs Brown also urged
the federal government to develop a public awareness campaign aimed
specifically at explaining the adverse health effects of cigar smoking.
The recommendations came with the release of two studies conducted by
Ms. Browns office. One study examined the patterns of cigar use
among teenagers and found that 19% acknowledged smoking at least one
cigar in the previous 30 days. The second study found generally lax
state enforcement of laws governing the sale of cigars to minors.
These findings are of profound concern and require our
immediate action to inform the public about the health risks
associated with cigar smoking, Ms. Brown said. There is a
great need for additional research on cigars, including prevalence,
patterns of use, developmental effects, the addictive potential of
cigars, and blunting. In teen talk, a blunt is a
cigar that has had some of its core tobacco removed and replaced with
marijuana (see box ).
A Disturbing Trend
One particularly disturbing trend noted in the
The students reported that blunting is common at weekend parties, and
Using cigars as a vehicle for smoking marijuana is increasingly
The call for warning labels on cigars won strong endorsement from
Surgeon General David Satcher, MD. We should require the same
sort of warning labels on cigars that we already require on packages
of cigarettes and spit tobacco, he said. The absence of
such a warning on cigars could lead consumers to erroneously conclude
that cigars do not carry health risks.
Currently, only cigars sold in California are required to carry a
warning label. It states that cigars contain and produce chemicals
known to the state of California to cause cancer and birth defects
and other reproductive harm. The warning, however, appears only on
cigar boxes and packages and not on the wrappers of individual cigars.
The IGs office carried out the two studies at the request of
the Office on Smoking and Health at the Centers for Disease Control
and Prevention (CDC). The request resulted, in part, from the release
1 year ago of a report by the National Cancer Institute (NCI) called
Cigars: Health Effects and Trends. That monograph
concluded that cigar smokers face substantial health risks because,
although they inhale less smoke, the smoke they inhale contains
greater concentrations of toxic chemicals than does cigarette smoke.
According to the NCI, smoking a large cigar emits up to 20 times more
ammonia, 5 to 10 times more cadmium and methyl-ethylnitrosamine, and
up to 90 times more highly carcinogenic tobacco-specific nitrosamines
than smoking a cigarette.
Usage data is far less well established for cigars than it is for
cigarettes. The HHS, for example, only recently began to look at
cigar use among young people. Both CDC and the Substance Abuse and
Mental Health Services Administration (SAMHSA) added questions about
youth cigar smoking to their annual surveys only in 1997.
Using different methodologies, SAMHSA estimates that 5% of teenagers
have smoked cigars while the CDCs data suggest that 22% of
teens have smoked a cigar in the past 30 days.
In one of its studies, the IG office convened 18 focus groups
consisting of 227 young males and females, both cigar users and
nonsmokers, to explore the patterns of cigar use among the
participants and their peers. Thirteen of the groups were made up of
high school students; four used junior high students; and one
consisted solely of college students.
Of these students, 54% said they had smoked a cigar sometime in their
life. Not only did 19% acknowledge smoking cigars in the month prior
to their focus session, half of these said they expected to smoke
cigars 5 years in the future in spite of their awareness of the
dangers of smoking. Among the 82 students who said they had smoked a
cigar in the past 12 months, 60% reported they also smoked
cigarettes, and 16% said they had used snuff or chewable tobacco.
Forty percent of the focus group participants said that cigar smoking
was gaining in popularity among their peers. In general, the students
said they believed that cigars were socially more acceptable among
teens and adults than cigarettes.
Teens most often buy cigars at gas stations or convenience stores,
typically smoke them at parties (frequently along with drinking
alcohol), and prefer manufactured to premium cigars because of their
lower cost, sweeter flavors, and pleasant aromas, the students reported.
Report on Enforcement
In the second report on enforcement and regulation, the IGs
office noted that all 50 states ban the sale of cigars to minors.
However, it said, enforcement of these laws is uneven, it is
generally given a lower priority than laws regulating the sales of
cigarettes and chewable tobacco products, and half the states are
unaware of how easy it is for teens to obtain cigars.
The enforcement report suggested that the growing popularity of
cigars among teens stems in part from their ready availability.
Cigars may be more easily available because they do not receive the
same degree of regulation and oversight accorded other tobacco products.
The report also noted that cigars, except for little cigars that
resemble cigarettes, are not subject to restrictions on television
and radio advertising. The only federal oversight for cigars is a
requirement that states conduct yearly, random, unannounced
inspections of vendors to measure tobacco sales to minors.