The early to mid-1990s saw a large surge in U.S. cigar consumption, including premium cigars. Based on recent import data, premium cigar use may be increasing, though they currently make up a small percent of the total U.S. cigar market. Premium cigars have also been the subject of legal and regulatory efforts for the past decade. In 1998, the National Cancer Institute undertook a comprehensive review of available knowledge about cigars — the only one to date. The resulting research recommendations have largely not been addressed, and many of the identified information gaps persist. Furthermore, there is no single, consistent definition of premium cigars, making research challenging. In response, the Food and Drug Administration (FDA) and the National Institutes of Health commissioned the National Academies of Sciences, Engineering, and Medicine to convene a committee of experts to address this issue. The resulting report, Premium Cigars: Patterns of Use, Marketing, and Health Effects, includes 13 findings, 24 conclusions, and nine priority research recommendations and assesses the state of evidence on premium cigar characteristics, current patterns of use, marketing and perceptions of the product, and short- long-term health effects.

Contents

• The National Academies of SCIENCES • ENGINEERING • MEDICINE
• COMMITTEE ON PATTERNS OF USE AND HEALTH EFFECTS OF “PREMIUM CIGARS” AND PRIORITY RESEARCH
• Reviewers
• Acknowledgments
• Acronyms and Abbreviations
• Abstract
• Summary
  • INTRODUCTION AND DEFINITIONS
  • CONTEXT
  • STUDY PROCESS
  • FINDINGS AND CONCLUSIONS
  • PATTERNS OF USE
  • MARKETING AND PERCEPTIONS
  • HEALTH EFFECTS
  • PRIORITY RESEARCH
  • CONCLUDING REMARKS
• 1. Context and Methods
  • BACKGROUND AND LANDSCAPE
  • THE COMMITTEE'S CHARGE
  • STUDY CONTEXT AND APPROACH
  • THE COMMITTEE'S APPROACH
  • REPORT OVERVIEW
  • CONCLUDING OBSERVATIONS
  • REFERENCES
  • Chapter 1 Annex. Premium Cigar Definitions
• 2. Characteristics of Cigars
  • PHYSICAL CHARACTERISTICS OF CIGARS
  • CIGAR CHEMISTRY
  • BIOMARKERS
  • INHALATION PATTERNS
  • FLAVORS
  • CONCLUDING OBSERVATIONS
  • REFERENCES
• 3. Patterns of Use and Prevalence of Cigars
  • CIGAR CONSUMPTION OVER TIME
  • PREVALENCE AND TRENDS OF PREMIUM CIGARS VERSUS OTHER CIGAR TYPES AND CIGARETTES
  • CO-USE OF PREMIUM CIGARS WITH OTHER TOBACCO PRODUCTS OR SUBSTANCES
  • TRANSITIONS IN CIGAR USE AND OTHER TOBACCO PRODUCTS
  • KEY RESEARCH GAPS AND FINDINGS
  • REFERENCES
• 4. Cigar Marketing and Perceptions
  • HISTORICAL CONTEXT
  • CONCEPT OF “PREMIUM”
  • MARKETING
  • SALES
  • AWARENESS, KNOWLEDGE, AND BELIEFS
  • CONCLUDING OBSERVATIONS
  • REFERENCES
  • Chapter 4 Annex. Evidence Tables
• 5. Health Effects of Premium Cigars
  • INTRODUCTION
  • HEALTH EFFECTS OF EXPOSURE TO HARMFUL AND POTENTIALLY HARMFUL CONSTITUENTS OF CIGAR SMOKE
  • HEALTH EFFECTS OF PREMIUM CIGARS
  • CARDIOVASCULAR DISEASE
  • LUNG CANCER AND RESPIRATORY DISEASE
  • PERIODONTAL DISEASES AND CANCERS OF THE ORAL CAVITY, HEAD, AND NECK
  • OTHER CANCERS
  • OTHER HEALTH CONDITIONS
  • HEALTH EFFECTS: SUMMARY AND CONCLUSIONS
  • DIFFERENCES BY SOCIODEMOGRAPHIC CHARACTERISTICS
  • POTENTIAL HEALTH IMPLICATIONS OF FLAVORINGS IN PREMIUM CIGARS
  • HEALTH EFFECTS OF SECONDHAND CIGAR SMOKE
  • ADDICTION POTENTIAL
  • RESEARCH GAPS
  • REFERENCES
  • Chapter 5 Annex. Health Effects Evidence Tables
• 6. Priority Research Needs
  • INTRODUCTION
  • PRIORITIZATION CONSIDERATIONS
  • HIGH-PRIORITY RECOMMENDATIONS
  • ADDITIONAL PRIORITY RECOMMENDATIONS
  • CONCLUDING COMMENTS
  • REFERENCES
• Appendix A. Research Questions
• Appendix B. Overview of Literature Search
• Appendix C. Cross-Sectional Patterns of Cigar Use by Type in the National Survey on Drug Use and Health
  Michelle T. Bover Manderski, Ollie Ganz, and Julia Chen-Sankey.
• Appendix D. Cross-Sectional Patterns and Longitudinal Transitions of Cigar Use by Type in the PATH Study
  Jihyoun Jeon and Yoonseo Mok.
  Published: September 2021.
• Appendix E. Cigar Brands from PATH and NSDUH Analyses
• Appendix F. Cigar Physical Characteristics
  Sundos Yassin, Jeremy Giberson, and Michelle Page.
• Appendix G. Exploratory Spatial Analyses of the Locations of 2019–2021 Premium Cigar Association Retailers, United States
  Amanda Y. Kong.
• Appendix H. Public Meeting Agendas
• Appendix I. Committee Member and Staff Biographies

Suggested citation:

National Academies of Sciences, Engineering, and Medicine. 2022. Premium cigars: Patterns of use, marketing, and health effects. Washington, DC: The National Academies Press. https://doi.org/10.17226/26421.

Digital Object Identifier: https://doi.org/10.17226/26421

Library of Congress Catalog Number: 2022935876

Additional copies of this publication are available from the National Academies Press, 500 Fifth Street, NW, Keck 360, Washington, DC 20001; (800) 624-6242 or (202) 334-3313; http://www.nap.edu.

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