Cigarettes and cigars

ROC STATUS: Known human carcinogen since 2000

ALSO KNOWN AS: Smoking tobacco

DEFINITION: Cigarettes and cigars are made from dried tobacco leaves. Manufacturers add hundreds of substances to enhance flavor and other properties. The primary difference between cigars and cigarettes is that cigars are wrapped in leaf tobacco or other substances that contain tobacco. In contrast, cigarettes are wrapped in paper or other substances that do not contain tobacco. Additionally, cigars typically do not have filters. According to the American Cancer Society, a single large cigar can contain as much tobacco as an entire pack of cigarettes.

Tobacco and tobacco smoke contain more than 4,000 chemicals, of which as many as 250 are known to be toxic or carcinogenic. The composition of smoke varies depending on the product, tobacco blend, chemical additives, and other factors. Some of the toxic compounds found in tobacco smoke include ammonia, tar, cyanide, carbon monoxide, and the carcinogens benzene, aromatic amines, arsenic, and chromium. Sidestreamsecondhandsmoke contains many of the same carcinogens as mainstream smoke, sometimes in higher concentrations. Because cigars contain more tobacco than cigarettes and usually burn longer, they give off more sidestream smoke with higher concentrations of carcinogens.

Related cancers: Cancers of the lung, oral cavity, larynx, pharynx, esophagus, bladder, stomach

Exposure routes: Inhalation is the primary route of exposure to the carcinogens found in cigarettes and cigars. Smoking tobacco produces mainstream smoke that the smoker inhales. Secondhand exposure via sidestream smokealso called secondhand smoke, passive smoke, or environmental tobacco smokecan also occur. Cigarettes are the primary source of tobacco smoke exposure; cigars are less common. Direct exposure through the mouth, gums, and swallowed saliva can also occur during smoking.

Where found: Legally sold in the form of cigarettes and cigars.

At risk: All users of smoking tobacco are at risk of developing cancer. As of 2021, the US Centers for Disease Control and Prevention (CDC) estimated 28.3 million adults in the United States were smokers. This, however, was down from 40 million adults in 2017. In 2021, 11.5% of U.S. adults consumed cigarettes. Similar numbers from 2015 showed that about 15.1 percent of all U.S. adults smoked, which was down from 20.9 percent in 2005. The use of tobacco products varies with gender, age, and racial and ethnic background. More men smoke (13.1%) than women (10.1 %). Smoking is less common among adults ages eighteen to twenty-four (5.3%), twenty-five to forty-four (12.6 %), and forty-five to sixty-four (14.9%) than among those over age sixty-five (8.3%). Overall smoking rates are highest among non-Hispanic American Indians and Alaska natives (14.9%), non-Hispanic multiple-race individuals (12.9% ), non-Hispanic blacks (11.7%), and non-Hispanic whites (14.9%). Smoking rates are also higher among those with a graduate education degree certificate (GED) or no high school diploma than those with any higher education level. In addition, people living below the poverty level, people with a disability or limitation, and LGBTQ individuals all experience higher rates of tobacco smoking.

Smoking is consistently the most significant cause of preventable death and disease in the United States. Each year, over 480,000 people in the United States die prematurely from smoking or sidestream smoke exposureone of every five deathsaccording to the CDC. Approximately 16 million Americans suffer from smoking-related illnesses. Cancer was among the first diseases causally linked to smoking, and cigarette smoking is the primary cause of cancer mortality in the United Statesresponsible for at least 30 percent of all cancer deaths. It is the leading risk factor for lung cancer and causes approximately 90 percent of lung cancer deaths in men and almost 80 percent in women. Smoking so-called light cigarettes or those with less tar does not substantially reduce lung cancer risk.

Inhalation of sidestream smoke also increases cancer risk. More than 126 million nonsmoking Americans, including children, are regularly exposed to secondhand smoke, and more than 34,000 nonsmoking American adults and approximately 400 infants die each year due to factors associated with secondhand smoke.

Cigar smoking is a popular habit in the United States. Rates more than doubled in the 1990s, and Americans consumed approximately 5.1 billion cigars in 2005. By 2023, cigars were the third most commonly used tobacco product in U.S. middle and high school. In 2021, about 3.5 percent of all U.S. adults6.2% of men and 1.0% of womenwere current cigar smokers. Cigar smoking is most common among men ages thirty-five to sixty-four who have higher incomes and educational backgrounds. Most new cigar users are teenagers and younger malesages eighteen to twenty-four. In addition, in 2021, about 2.0% percent of male high school studentsgrades nine to twelvesmoked at least one cigar in the past thirty days.

Etiology and symptoms of associated cancers: Toxic ingredients in cigarette smoke travel throughout the body, causing damage in several different ways. Some carcinogens in tobacco smoke produce epoxides when they undergo oxidation, or burning. These epoxides bind to and damage the deoxyribonucleic acid (DNA) in cells, causing them to grow abnormally or divide quickly and uncontrollably, resulting in tumor development. Although nicotine is not considered carcinogenic, it can inhibit cell death, thereby promoting tumor development. Symptoms vary with the type of cancer.

History: Based on the findings of hundreds of scientific articles, the U.S. Surgeon General first reported a causal association between cigarette smoking and cancer in 1964. The U.S. Surgeon General first published health risks associated with sidestream smoke in 1972. The cigarettes are subject to several state and federal regulations. The 1964 Surgeon General's report led to laws requiring warning labels on tobacco products. However, those laws were only applied to cigars much later. Television advertising of cigarettes has been prohibited since 1971 and has since been expanded to include advertising on radio and other electronic media; these regulations do extend to cigar advertising. Cigarettes and cigars are also subject to taxes, which vary from state to state. In addition, it is currently illegal to sell tobacco products to minors, and in many states, it is unlawful for a minor to possess any form of tobacco. Many states also prohibit smoking in restaurants and some public places.

Beginning in 2007, the introduction of electronic cigarettes (e-cigarettes) to the U.S. market had a substantial impact on the smoking industry. Since 2014, e-cigarettes have been the tobacco product of choice for young Americans. By 2023, ten percent of high school students reported consuming an e-cigarette in the previous month, with 4.6 percent of middle school students indicating likewise. Advocates of the technology, which distributes nicotine, flavoring, and other chemicals through vapor, have argued that it has fewer health risks than tobacco smoking and can help smokers quit. However, most health organizations refrained from endorsing such claims due to the lack of research, especially on the long-term effects of e-cigarettes or "vaping." Critics of the technology also argue that the liquids used in "vape" devices are unregulated and can contain many harmful chemicals and that e-cigarettes can act as a gateway drug to traditional tobacco use. Vaping is particularly impactful for youth as tobacco use typically begins in adolescence. 90% of adult smokers first started before the age of 18. Many major tobacco companiesBig Tobaccoquickly introduced their e-cigarettes and other vape products, taking market share from smaller independent businesses.  

In the mid-2020s, anti-tobacco efforts expanded to limit the availability of methanol cigarettes. In mid-2024, expectations loomed that the U.S. federal government would issue a nationwide ban on menthol cigarettes and cigars. Several states, such as California and Massachusetts, already had such bans in place.

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