Public Health

Just a Cigar

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Two years ago, The New York Times claimed that cigars pose "higher risks" than cigarettes. Last year it reported that "smoking cigars can be just as deadly as smoking cigarettes." This month it said "the disease risks are not as high as they are for cigarette smokers because cigar smokers usually do not inhale the smoke."

Are cigars getting safer? No, but reporters may be getting smarter.

Once easily misled by the scare tactics of public health officials and anti-smoking activists, the mainstream press is starting to acknowledge something that medical studies have been finding for decades: The typical cigar smoker faces hazards far less serious than the typical cigarette smoker does.

This pattern, clear from the data compiled by the National Cancer Institute in its 1998 monograph on cigars, was confirmed once again in a study recently published by The New England Journal of Medicine. And this time, reporters paid closer attention.

In the study, researchers led by Carlos Iribarren, an epidemiologist with the Kaiser Permanente Medical Care Program in California, tracked about 18,000 men–1,546 cigar smokers and 16,228 nonsmokers–from 1971 through 1995. Overall, the cigar smokers were about twice as likely to develop cancers of the mouth, throat, and lungs; 45 percent more likely to develop chronic obstructive lung disease; and 27 percent more likely to develop coronary heart disease.

As Iribarren and his colleagues noted, these risks are modest compared to those seen in cigarette smokers. Depending upon the study, cigarette smokers are four to 12 times as likely as nonsmokers to develop mouth and throat cancers; eight to 24 times as likely to develop lung cancer; nine to 25 times as likely to develop chronic obstructive lung disease; and 1.5 to three times as likely to develop coronary heart disease.

Furthermore, smoking-related diseases were concentrated among the heaviest cigar smokers in the Kaiser Permanente study. For those smoking fewer than five cigars a day–76 percent of the sample–only the difference in heart disease risk (20 percent) was statistically significant.

Iribarren et al. did not ask the subjects about inhalation, which has been linked to higher risks in other studies, and they did not consider men who smoke a few cigars a month as a separate category. According to last year's NCI report, "as many as three-quarters of cigar smokers smoke only occasionally," and "the health risks of occasional cigar smokers…are not known."

Given the news media's track record in this area, I expected reporters to hype the hazards found by the Kaiser Permanente study and ignore the clear differences between cigars and cigarettes. But for the most part, the coverage was much more accurate and responsible (though less conspicuous) than the stories that followed the NCI report (one of which was headlined, "Cancer Institute's Warning on Cigars: Just As Bad As Cigarettes").

The Associated Press, whose story was picked up by several major newspapers, was careful to put the hazards of cigars in perspective. The Washington Post, which only last year said it was "probably a misconception" that "cigars are healthier than cigarettes because smoke is not inhaled to the same degree," this time correctly cited that factor as the most likely explanation for the comparatively low risks found among cigar smokers.

My favorite story ran in The Hartford Courant under the appropriately reassuring headline, "Cigars' Dangers Relatively Low/Moderate Users Face Only Slightly More Health Risks Than Nonsmokers." The article quoted a local cardiologist who said: "If someone tells me they're smoking one cigar a day, it would be hard for me to jump up and down and say you're killing yourself and be intellectually honest. You are increasing your risk a little bit."

Some reporters still don't get it. "New findings give more weight to warnings that cigars can be at least as hazardous as cigarettes," United Press International announced. If UPI's science correspondent often leaps to such conclusions, she might do well in the long jump, but not in reading comprehension.

To be charitable, it's not surprising that reporters continue to make such mistakes, since public health officials are still pushing the false equation between cigars and cigarettes. Surgeon General David Satcher, who wants to see federal warnings on cigars "analogous to the labels on cigarettes," says "the absence of labels implies cigars are different and don't carry the same risk." They are, and they don't.