Smokers' Choice: What Explains the Steady Growth of Cigar Use in the U.S.?

After decades of stagnant use, cigar smoking surged during the 1990s, coinciding with increased cigar marketing, most notably the use of cigars by celebrities.¹ Consequently, initiation of cigar smoking in the United States has exceeded initiation of cigarette smoking since the mid 1990s and both adolescents (younger than age 18) and females constitute an increasing proportion of the number of new cigar smokers.² The rapid rise in cigar use in the mid 1990s garnered much attention from the public health and lay community, but interest in cigar use as a public health and tobacco control problem quickly waned. In fact, some surveys suggest that the cigar boom, specically the rapid increase in prevalence, may be over.^3,4

However, other data suggest the contrary—cigar use continues to rise. The National Survey on Drug Use and Health (NSDUH, formerly known as the National Household Survey on Drug Abuse), shows that in the United States, lifetime and past-month cigar use has signicantly increased among adults. Specically, past-month cigar use increased from 4.8% (60.2) in 2000⁵ to 5.5% (60.3) in 2003.² Signicant increases were also noted among females (1.3%60.2% in 2000 to 1.9%60.2% in 2003) and adults aged 18–25 (10.4%60.5% to 11.6%60.6%). The highest rates of past-month cigar use were reported among young adults aged 18 to 25 (11.6%60.6% in 2003), particularly among white (18.5%61.3%) and black (20.3%63.0%) males, aged 18–25.⁶

A more disconcerting picture emerges when data from the U.S. Department of Agriculture (USDA) are examined. The most recent USDA data indicate that cigar consumption shows small but steady increases from year to year (see Table).^8,9 The fastest growing product from 1993 to 1998 was large cigars, increasing in consumption by 73%. However, since 1998, small cigars have become the fastest growing segment of the market, increasing in consumption by 76% from 1998 to 2004 compared to large cigars, which increased by 34%. In addition, while USDA consumption data on large cigars incorporate imports, the estimate for small cigars does not and imports of these products have grown substantially. From 1997 to 2004, imports of small cigars into the U.S. increased from 34 million pieces to 215 million pieces, an increase of more than 500%.⁹ In contrast, imports of large cigars have remained fairly stable over this time (i.e., approximately 500 million cigars annually).⁸ Likewise, trade magazines point to a rapid increase in both the importation and sales of small cigars.¹⁰ Small cigars are specically referred to as “viable, growing products that were virtually nonexistent before the boom.”¹¹ Total consumption in 2004 was estimated at 2.9 billion small cigars and 4.9 billion large cigars. Although large cigars remain the market leader, the 2004 market share for small cigars (37%) rivals that of 1973 (38%), when small cigar consumption soared as a result of a loophole in the federal law banning cigarette ads on TV and radio.¹

Table.

Consumption of large and small cigarsin the United States: 1993-2004

SOURCE:Department of Agriculture (US). Tobacco situation and outlook yearbook. Washington: U.S. Department of Agriculture, Economic Research Service; 2004. (TBS-2004)

^aData on imports of small cigars are from TTB.

By denition, small cigars weigh no more than three pounds per thousand cigars. But small cigars have other characteristics that set them apart from large cigars, most notably features that are also common to cigarettes, such as shape, size (length 70 to 100 mm), and frequent use of filter tips. The wrapper on a small cigar is sometimes cigarette paper that contains tobacco or tobacco extract.¹ In addition, marketing strategies have given rise to shared attributes between small cigars and cigarettes. The packaging and marketing of small cigar products often mimic those of cigarettes (e.g., small cigars packaged in the traditional 20-cigarette soft pack). From the early 1970s to today, marketing of small cigars has capitalized on these visual similarities. Indeed, a 1973 advertisement for A–C little cigars included the tagline, “The Great Impostor. It is not a cigarette. Nor is it everybody's idea of a cigar.” A 2004 advertisement for Smoking Joe's Small Cigars reads “the perfect everyday smoke.” Thirty years separate these ads, but the message is clear: smoke these (small cigars) instead of your usual cigarettes.

The distinction between large and small cigars is made federally for taxation purposes. But there is a marked disparity between the rates of cigarette and cigar excise taxes. In 2004, the U.S. federal tax rate for small cigars was $.04 per pack of 20 and $.05 per each large cigar, while the rate for cigarettes was $.39 per pack of 20.¹² Furthermore, whereas all 50 states impose a tax on cigarettes, only 45 states impose a tax on cigars.¹³ Nearly all states impose a considerably lower excise tax on cigars compared to cigarettes and few states differentiate between small and large cigars for taxation.¹³

Disparities in tobacco taxes create the potential for product switching (e.g., from cigarettes to cigars).^14,15 The tobacco industry has not only taken notice, but once proposed to capitalize on it. A Phillip Morris document argues for the development of cigarillos because “European tax legislation forsees a considerably lower taxation for cigars/cigarillos than for manufactured cigarettes” and thus a cigarillo-type product should be developed that is “acceptable tastewise for usual cigarette smokers.”¹⁶

The price disparity between cigarettes and other tobacco products in the United States is likely to widen, or at least persist for some time. Since January 2002, more than two-thirds of states increased their cigarette excise taxes, including several states that instituted consecutive tax increases. New Jersey instituted three consecutive tax increases and currently has the second highest cigarette excise tax in the United States at $2.40.¹⁷ To illustrate the appeal of small cigars with regard to both product and price, a pack of Winchester Little Cigars was purchased in July 2004 for $2.87 at a chain pharmacy in New Jersey, and a pack of Doral cigarettes (considered a value brand) was purchased for $5.99. Based on cost alone, these small cigars are a feasible alternative product to cigarettes and are widely available. The cigar industry is well aware of its position in the tobacco market, as observed by Barton Laws, COO of Cincinnati-based American Western Cigars, quoted in the April 2004 issue of Tobacco Retailer Magazine:

“Increased prices on manufactured cigarettes have caused the ‘little cigar' business to blossom,” said Laws. “Consumers are constantly searching for lower cost alternatives to cigarettes, and they have found such an alternative in little cigars.”¹⁸

Do small cigar users see themselves as cigarette smokers, simply seeking “cheaper smokes?” In the 2003 NSDUH, when smokers were asked what brand of cigarette they currently smoked, some participants actually reported cigars, specically Black – Mild, Captain Black, Phillies, Swisher Sweets, Winchester, Al Capone, and Corona.⁶ While they comprise less than 1% of cigarette smokers, it raises questions about how tobacco users perceive their tobacco product. Indeed, some research suggests that cigar users sometimes identify their products by the brand name and so respondents may not recognize their product as a cigar or tobacco.^19,20 Again, trade magazines are tracking similar smoking behaviors: “Reformed cigarette smokers seem more attracted to small cigars than large ones, maybe because they look and feel more like cigarettes.”¹¹

The increase in small and large cigar consumption is a concern because cigar use is often dismissed as a health issue. Indeed, some former cigarette smokers incorrectly perceive cigars as safe alternatives to cigarettes.³ However, even moderate cigar use carries signicant health risks, including increased risk for heart and lung disease and cancer, including but not limited to oral, esophageal, larynx, and lung cancer, compared to non-smokers.¹ And while the risks for lung and laryngeal cancers are lower for cigar smokers compared to cigarette smokers, oral and esophageal cancer risks are similar in both cigar smokers and cigarette smokers. As with other carcinogenic products, risk increases with consumption (i.e., number of cigars smoked) and depth of inhalation.²¹ Smokers who quit cigarettes but substitute cigars will continue to face risks for tobacco-caused diseases. Of particular concern is that former cigarette smokers typically inhale when smoking cigars, and thus are at higher risk for tobacco-caused diseases than cigar smokers who have never smoked cigarettes.¹ Since 2001, cigars marketed and sold in the United States are required to display one of five health warnings on a rotating basis.²²

Given the decline in cigarette consumption, steady growth in cigar consumption,⁸ the disparity between taxation of cigars and cigarettes, innovative cigar marketing,¹ and the expansion of available cigar products,^10,11 the threat posed by cigars is real and deserves attention.

It is important that we remain vigilant and responsive to emerging trends. Surveillance and monitoring of tobacco products is a critical first step. Such monitoring can and should be done at many levels. For example, trade magazines and specialty shops offer public health, and in particular, tobacco control professionals, a unique glimpse of what may come and can function as our “canary in the coal mine.” Data such as that reported by the USDA (e.g., imports, exports, taxation) can track national shifts in production, sales, and consumption. Finally, our behavioral surveillance systems (i.e., surveys) are critical to understanding the epidemiology of cigar use and identifying at-risk populations. Researchers who worked on the 1998 National Cancer Institute monograph on cigars highlighted numerous differences in both survey methodology and measurement, and subsequently recommended inclusion of cigar questions in surveys designed to measure tobacco use, as well as standardization of cigar survey questions.¹

Despite the call for improvements, current tobacco surveillance systems have not adequately addressed these recommendations. Only the National Survey on Drug Use and Health collects cigar use data annually. The Figure, which summarizes cigar use questions from four commonly used tobacco control surveillance systems, highlights additional problems with question standardization. Perhaps most problematic is the optional tobacco module of the 2004 Behavioral Risk Factor Surveillance System (BRFSS), which now includes only one question to measure all tobacco products other than cigarettes and smokeless tobacco. Consequently, it is no longer possible to estimate current cigar use at the state level with BRFSS.

Figure.

Cigar smoking survey questions by key tobacco surveillance systems, 2000–2004

^a In 2004, the BRFSS dropped specific questions on cigars. This new combination question is preceded by a question on smokeless tobacco.

Although cigarette consumption⁸ and prevalence²³ among adults has demonstrated small declines nationally over the past few years, we should remain cautious and target our tobacco control efforts (including monitoring) to include all forms of tobacco use. Quite simply, greater product and brand variety supplies the public with more opportunities to use, which may increase overall incidence and prevalence of tobacco use. Policy approaches at the state, federal, and international level need to impose equivalent taxes on all tobacco products to avoid substitution.^24,25 Cessation of all tobacco products should be promoted for the best public health outcome.²⁶