Those Crazy Kids and Their Cigars

A letter to the American Journal of Public Health that wonders whether teenagers are "choosing cigars over cigarettes" is the latest excuse for anti-smoking activists to mislead the public about the relative hazards of these two forms of tobacco. John Banzhaf of Action on Smoking and Health tells HealthDay "it's hard to make a direct comparison" between the risks posed by cigars and the risks posed by cigarettes "because it depends on how often one smokes each product, the extent to which the cigar smoke is inhaled, and which cancers we focus on." It's true that frequency and inhalation matter. If the typical cigar smoker went through 10 stogies a day and inhaled the smoke, his risks might resemble those of the typical cigarette smoker. But he doesn't, and they don't.

Cigar smokers face much smaller risks than cigarette smokers do, precisely because they smoke less often and are less apt to inhale. They are therefore much less prone to lung cancer, heart disease, and emphysema--the three major smoking-related causes of death--and much less likely to die as a result of their habit. Given these facts, it is more than a little misleading to say the comparison depends on "which cancers we focus on," as if there were no clear overall difference in risk. Banzhaf moves from misdirection to outright prevarication when he says "most experts would agree that cigar smoking is clearly not less dangerous than cigarette smoking."

The HealthDay story directs readers to the Web site of the American Cancer Society for more information "about the risks of cigar smoking." There you will find an article with a headline claiming it's a "false notion" that cigars are "safer than cigarettes." In fact, says the ACS, "cigars are as deadly as cigarettes," a point "supported by the National Cancer Institute." It immediately contrradicts itself by citing a 1998 NCI report that found "regular cigar smokers have a similar risk of developing oral and esophagus cancer, but less chance of developing lung and larynx cancers, coronary heart disease, and chronic obstructive pulmonary disease than cigarette smokers" (emphasis added). As I said, the latter diseases include the major cigarette-related killers, and the upshot is a lower overall risk.

There is some evidence that cigar smoking among teenagers is rising while cigarette smoking is declining. The AJPH letter cites data from the 2004 New Jersey Youth Tobacco Survey indicating that "for the first time ever, more high school boys reported currently smoking cigars (17.2%) than cigarettes (15.9%)." ("Current" smoking is defined as at least once in the previous month. Oddly, the letter does not say whether cigar smoking was more common in 2004 than in the previous survey.) The corresponding numbers from the National Youth Tobacco Survey were 18.4 percent for cigars (up from 16.9 percent in 2002) and 21.6 percent for cigarettes (down from 23.9 percent in 2002). But if it's true that teenagers are "choosing cigars over cigarettes," the result (assuming they continue the habits into adulthood) is likely to be less smoking-related illness.