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The National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Patterns of Use and Health Effects of "Premium Cigars" and Priority Research; Mead AM, Geller AB, Teutsch SM, editors. Premium Cigars: Patterns of Use, Marketing, and Health Effects. Washington (DC): National Academies Press (US); 2022 Mar 10.
Premium Cigars: Patterns of Use, Marketing, and Health Effects.
Show detailsThis chapter summarizes what is known about cigar1 marketing and promotion, including for “premium”2 cigars, and consumers' perceptions. The Food and Drug Administration (FDA) charged the committee to examine the health effects of premium cigars. This chapter recognizes the highly effective nature of tobacco advertising and promotion on use behaviors that in turn affect the health consequences of cigars. The chapter begins with the historical context of premium cigar marketing and promotion, followed by an overview of premium cigar marketing; sales; and awareness, knowledge, and beliefs. Box 4-1 presents terminology used in the chapter.
BOX 4-1
Terminology.
HISTORICAL CONTEXT
The committee is not the first to examine the health effects or marketing and promotion of premium cigars. A comprehensive review of these topics was conducted and reported in the 1998 National Cancer Institute (NCI) Tobacco Control Monograph 9, Cigars: Health Effects and Trends. The 2008 NCI Monograph 19, The Role of the Media in Promotingand Reducing Tobacco Use, synthesized data to demonstrate a causal relationship between tobacco advertising and promotion and increased use (NCI, 2008). Surgeon General reports on tobacco have underscored that “advertising and promotional activities by the tobacco companies cause the onset and continuation of smoking among adolescents and young adults” (HHS, 2012, 2014). The committee found no evidence to suggest that the effects of advertising and promotion of premium cigars would differ from that of other tobacco products. This chapter summarizes and identifies the unique literature related to premium cigars and cigars in general, which builds on the conclusions in Monographs 9 and 19.
Cigar use, including of premium cigars, began to increase in 1993 when promotional activities increased (NCI, 1998). Prior to 1993, cigar smoking had declined by 66 percent, a trend that began in the mid-1960s (NCI, 1998). However, as the promotion and sales of large cigars expanded, cigar use grew rapidly between 1993 and 1997, with premium consumption increasing by nearly 50 percent (NCI, 1998). Consolidated Cigar, General Cigar, and Swisher International were major premium cigar companies whose media spending increased during this period (NCI, 1998). Premium cigars (as a percentage of total cigar consumption) decreased from 4.1 percent in 1999 to 2.2 percent in 2012 (Maxwell, 2006, 2013), and has remained relatively constant through 2020 (see Table 3-1 in Chapter 3). Given this sharp reversal, NCI initiated a monograph to explore various aspects of cigar use, including marketing (NCI, 2008).
Because marketing and promotion play a critical role in increasing the demand for cigars, Monograph 9 included a chapter on the commercial history of cigars, sales patterns, advertising, and promotion. The authors concluded that the promotional activities increased the visibility of cigar consumption, normalized use, and broke down barriers to use among new users, such as children and women, and in new settings (NCI, 1998). In fact, the cigar market was fairly stagnant until the release of Cigar Aficionado in the fall of 1992; the magazine's founder, Marvin Shanken, said that it was launched in response to an increase in premium cigar use (NCI, 1998). Cigar Aficionado expanded the popularity of cigars, helped launch new magazines, and promoted premium cigars in news stories and at social events.
When Monograph 9 was published, evidence was sufficient to conclude that cigar use increased after Cigar Aficionado was launched but insufficient to state that the advertisements and promotion of premium cigars were causally linked to their use, as quantitative and longitudinal data were limited. Ten years later, Monograph 19 concluded that “the total weight of [the] evidence—from multiple types of studies, conducted by investigators from different disciplines, and using data from many countries—demonstrates a causal relationship between tobacco advertising and promotion and increased use of tobacco as manifested by increased smoking initiation and increased per capita tobacco consumption in the population” (NCI, 2008, pp. 11-12).
Factors that supported this strong conclusion were studies that showed that
- 1.
Brief exposure to tobacco advertising influences adolescents' attitudes and perceptions about smoking and adolescents' intentions to smoke; and
- 2.
A temporal relationship exists between exposure to advertising and adolescent initiation of smoking and subsequent regular smoking (NCI, 2008).
Marketing and promotion of tobacco products is a critical component of sales strategies and still influence their sale and use.
Furthermore, decreasing consumption of any tobacco product can decrease adverse health effects and health care costs. False advertising can lead consumers to have beliefs about a product that are incorrect. Deceptive health claims by manufacturers and distributors can mislead consumers about the harms of a product. Advertising and promotion can influence consumer risk perceptions, which can affect tobacco use.
CONCEPT OF “PREMIUM”
As discussed in Chapter 1, the definition of premium cigars has not been consistent, thus complicating the committee's assessment of their marketing and promotional activities. “Premiumization” is a marketing strategy that has been used by tobacco companies to encourage consumers to use more expensive brands by purporting that they are better quality and less harmful than mid-priced or discount brands (Xu et al., 2019). Although studies specific to the word “premium” in cigar marketing are limited, research indicates that consumers perceive premium products to be linked to rewarding experiences, exclusive fun, endowed status, or superior craftsmanship (Gofman et al., 2010). Buying them may elicit emotional reactions, including making consumers feel good or more confident (Nielsen, 2016). The definition of premium cigars as “handrolled” may also induce positive perceptions, as “handmade” products are perceived to be of higher quality and thus more attractive (Fuchs et al., 2015). In the context of tobacco products, similar descriptors that convey a positive aspect, such as cigarettes marketed as “organic,” “natural,” or “additive-free,” have previously been associated with reduced harm perceptions, intentions to use, and use (Agaku et al., 2015; Gratale et al., 2018; O'Connor et al., 2017; Pearson et al., 2016; Sanders-Jackson et al., 2018). “Natural,” “organic,” “additive-free,” and “premium” have also been used for brand differentiation in the cigarette market (Dewhirst, 2021; Xu et al., 2019). Consistent with research on cigarettes (Agaku et al., 2015; Pearson et al., 2017, 2019), these terms may impact harm perceptions, intentions, and use of premium cigars.
MARKETING
Tobacco marketing, which includes a range of strategies used by the industry to promote its brands and products, is central to how the industry develops positive perceptions to persuade nonusers to initiate use and current users to continue (NCI, 2008). A strong body of literature shows that tobacco marketing plays a powerful role in shaping positive perceptions of tobacco products and lower risk of harm and in influencing tobacco use behaviors, including initiation, continued use, and decreased cessation (HHS, 2001, 2014; Lovato et al., 2011; NCI, 2008). Tobacco marketing is often tailored and targeted to specific populations, such as youth, women, and racialized and ethnic groups, particularly African American/Black communities (HHS, 1998, 2001, 2012; NCI, 2008). Sufficient evidence indicates that the tobacco industry does not self-regulate its marketing practices for any product and that restrictions on tobacco advertising and promotion can influence health consequences, including addiction and decreasing exposure among targeted populations and the deceptive or misleading nature of marketing (NCI, 2008).
Regulations
Federal regulations aim to restrict tobacco marketing. For example, the Master Settlement Agreement and the Tobacco Control Act3 of 2009 prohibit tobacco marketing in traditional media (e.g., television, radio), billboards, transit stations, and events (e.g., sporting events, concerts) (FDA, 2020; National Association of Attorneys General, n.d.). Despite these restrictions, the cigarette and smokeless tobacco industry spends billions of dollars each year on marketing (FTC, 2021). Premium cigars (along with other tobacco products, such as nonpremium cigars, hookah, pipe tobacco, and electronic cigarettes [e-cigarettes]) are not included in these provisions of the agreement or the act. The most recent federal data on marketing expenditures of cigars, including premium cigars, document a nearly 300 percent increase ($1.1 million to $4 million) between 1994 and 1996 (NCI, 1998).
FDA has authority under the Tobacco Control Act to regulate certain types of marketing content for premium cigars (FDA, 2020, 2021); its rules for premium cigars include prohibiting
- 1.
The sale of tobacco products to minors;
- 2.
The sale and distribution of tobacco products with unsubstantiated modified risk tobacco product (MRTP)4 health claims or false or misleading claims on labeling or advertising;
- 3.
The use of modified risk descriptors (e.g., “light,” “low,” and “mild”), unless authorized by FDA; and
- 4.
The distribution of free samples of tobacco products.
FDA also requires health warnings to be displayed on packaging and advertisements of cigarettes, smokeless tobacco, and e-cigarettes (FDA, 2016). However, on September 11, 2020, the United States District Court ruled that premium cigars, as well as other cigar products and pipe tobacco, should be excluded from this rule (FDA, 2020). Scientific evidence is ample to suggest that a health warning is warranted on any tobacco product because no level of tobacco consumption is safe (Hammond, 2011; HHS, 2020). Despite this scientific evidence, the court ruled to exclude cigars and pipe tobacco, including premium cigars, from this rule.
Presence of Marketing
Monograph 9 (NCI, 1998) reported that only a small number of cigar companies engaged in conventional advertising. Despite limited measurement of cigar advertisements, media advertisement expenditures of cigar brands, which included premium brands, such as Macanudo, Davidoff, and H-Upmann, rapidly increased between 1994 and 1996 (NCI, 1998). However, since that time (NCI, 1998), data on premium cigars' marketing practices have been limited.
Since tobacco marketing strongly influences perceptions and use behaviors (HHS, 2001, 2014; Lovato et al., 2011; NCI, 2008), the committee reviewed the literature on premium cigar marketing, specifically summarizing articles that were not included in Monograph 9, and conducted primary data collection to elucidate the marketing practices of these companies.
The committee could not identify recent published data on how much premium cigar companies spend on marketing.
Marketing in Print Media
Premium cigars have been presented to the public through promotional and marketing activities in print media, which includes direct mailers, magazines, and newspapers. Premium cigars are widely promoted in print and, in recent years, digital cigar lifestyle magazines (e.g., Cigar Aficionado, Cigar Journal, Cigar Snob) devoted to promoting them. After Cigar Aficionado began, other magazines were launched, including Smoke in 1996 by tobacco trade publisher Lockwood (NCI, 1998, p. 206) and Cigar Snob, a bimonthly publication that claims to bring “a fresh approach to the old, stuffy take on cigars with stunning photography, impactful editorial, and honest, easy to read cigar ratings” (Cigar Snob Magazine, n.d.). Other lifestyle magazines also include premium cigar advertising. One study examined selling propositions of print tobacco ads between 2012 and 2013 in consumer magazines, local magazines, Sunday magazines, and magazines targeting Latino/Latina/Hispanic readers: out of 1,122 tobacco ads, 87 were for premium cigars (Shen et al., 2017).
Premium Cigar Companies' Print and Electronic Media Advertising
Given the limited amount of published data on the use of print media, including direct-to-consumer (DTC) advertisements and direct mail to promote premium cigar use, the committee obtained data5 from Mintel Comperemedia (Mintel) to assess premium cigar advertising expenditures from print advertising, direct mail, and e-mail received by a national panel of consumers between June 2018 and September 2021. Mintel tracks all three advertising channels in the United States using a nationally representative sample of panelists comprising 67,000 households and an additional e-mail panel of about 1,300 households who forward paper mail and e-mails to Mintel on a weekly basis (Ganz et al., 2016). Although Mintel does not capture premium cigar advertisements as their own category, the Mintel database was searched for premium cigar brand names as identified in Corey et al. (2018).
The Mintel data consist of advertisement image and associated meta-data, which includes (1) company name; (2) the month/year in which the ad was received; (3) estimated dollar amount spent on the ad (direct mail only); and (4) estimated direct mail volume (direct mail only).
Mintel data provided to the committee had two separate paid ad spreads (see Figure 4-1) from a single premium cigar brand in a free in-flight magazine of a major U.S. airline. These ads featured themes of history, culture, and family, and the rate spent for them was $159,000 and $53,100, respectively.
FIGURE 4-1
Paid advertisement spreads from a single premium cigar brand in a major U.S. airline's in-flight magazine. NOTE: All images reproduced with permission from Mintel Comperemedia SOURCE: Mintel Comperemedia, 2021 (available in the project's public access (more...)
One premium cigar brand, Drew Estate, had several e-mail ads (see Figure 4-2) that promoted an in-person entertainment event/festival to celebrate its 25th anniversary and “The Rebirth of Cigars Movement,” promoting branded items, new cigars, and live music featuring rock and hip-hop. These ads used graffiti images with a logo of the Manhattan Bridge and pictures of musical artists who would be featured at the festival; these DJs and musicians gained popularity from the 1990s through mid-2000s. Some of these e-mail ads featured only the brand logo with an image and a description of DJs and musicians without the mention of any premium cigar products. These promotional efforts that highlighted DJs and musicians were part of a larger tobacco industry movement to use music to appeal to consumers. This same strategy was used for menthol cigarettes and the Kool Mix Campaigns and Newport music festivals.
FIGURE 4-2
Email advertisement promoting an in-person entertainment event. NOTE: All images reproduced with permission from Mintel Comperemedia SOURCE: Mintel Comperemedia, 2021 (available in the project's public access file and upon request from the National Academies (more...)
The committee did not identify any premium cigar advertising in direct mail but did observe that cigarillo brands (i.e., Black & Mild, Swisher Sweets, Night Owl, and Havana Honey Cigars) and little cigar brands (i.e., Talon) used direct mail (Rutgers Center for Tobacco Studies, n.d.) with strategies including coupons,6 discounts, rewards and free gifts for purchasing, sweepstakes entry, invitation to visit the brand website or their social media accounts, and links to visit their website for non-cigar-related topics (e.g., a new episode of a reality show featuring a new singer, recipes, concerts).
DTC advertisement is a common source of tobacco advertising and has been used widely by the cigarette and smokeless tobacco industries (FTC, 2021). The Mintel data suggest that cigarillo and little cigar brands are using direct mail with multiple discount strategies, as well as nontobacco-related events and promotional items, to a variety of populations across the majority of U.S. states. With higher price points associated with premium cigars, these may be marketed in other venues not obtained through DTC advertisements. For example, they are advertised in inflight magazines, which are often associated with luxury and travel.
However, third-party retailers are also using DTC to market premium cigar products. An example is Thompson Cigar,7 which started out as a mail-order cigar company in 1915 (it was sold to Scandinavia Tobacco Group in 2018) and continues to sell premium cigars through mail catalogues, e-mails, and its website (Danielson, 2019). When the Mintel database was searched for terms (including “premium,” “small batch,” “limited edition,” “limited refill,” “hand rolled,” “reserve,” and “long leaf”) related to how premium cigars could be used in DTC ads, third-party retailers were found that primarily sell premium cigars using e-mail coupons, catalogs, and subscription services (e.g., “get five premium cigars each month”). The e-mails featured coupons (e.g., $10 off, free lighter/wallet with purchase, time-limited sales) for premium cigars, and some e-mail ads advertised a specific brand. The ads described premium cigars as “highly rated,” from a “renowned” brand, and “exclusive” cigars, alluding to a higher class of product.
Although premium cigar brands are generally not using DTC ads, evidence suggests that they are using similar marketing strategies as other cigar brands, such as e-mails to promote non-cigar-specific themes that appeal to young people—music festivals, urban lifestyle, and hip-hop and rock music. Additional evidence indicates that third-party retailers that primarily sell premium cigars are using DTC to market these products using discount strategies similar to those used by the nonpremium cigar industry, and also alluding to premium cigars as a higher-class product.
Summary and Conclusion
To assess premium cigar marketing, the committee conducted primary data collection, given the extremely limited literature, to reach its conclusions. It examined:
- 1.
Data obtained from Mintel Comperemedia, which collects DTC advertisements using mail and e-mail sent to a national panel of consumers, as well as print advertising (June 2018 and September 2021);
- 2.
Content from cigar lifestyle magazines (i.e., Cigar Aficionado, Cigar Journal, and Cigar Snob) published in 2021; and
- 3.
Content from social media platforms and company-owned websites of premium cigar brands.
The committee's analysis of Mintel data showed that third-party retailers are using DTC advertisements of premium cigars using coupons, catalogs, and subscription services. These strategies were also commonly used by cigarillo brands, as also observed from the dataset. These observations led the committee to conclude that there is conclusive evidence that third-party cigar retailers are using DTC methods to market premium cigars similar to strategies used by the nonpremium cigar industry. Based on its review of print and electronic media advertising data, the committee concludes:
Conclusion 4-1: Based on the committee's primary data collection, there is conclusive evidence that third-party cigar retailers use direct-to-consumer methods to market premium cigars using similar strategies as the nonpremium cigar industry.
Content Analysis of Cigar Lifestyle Magazines
In the early years of Cigar Aficionado, celebrities were featured. The magazine launched a line of clothing and men's fragrance and promoted cigar-centered dining and entertainment worldwide. In addition, the number of cigar smoking clubs and bars, which featured premium brands (e.g., Club Macanudo in Chicago), grew (NCI, 1998, pp. 209–210). In 1996, other magazines, such as Smoke and Cigar Monthly, joined the magazine market, and news stories and newspaper articles about premium cigars increased as well (NCI, 1998). Few studies exist that examine the content or practices of current cigar lifestyle magazines.
The committee analyzed8 magazine covers, articles, and advertisements from eight issues of three popular cigar lifestyle magazines: Cigar Aficionado (March/April 2021, May/June 2021, and July/August 2021), Cigar Journal (Summer 2021 and Autumn 2021), and Cigar Snob (March/April 2021, May/June 2021, and July/August 2021) to examine a snapshot of recent content. The magazine covers (n = 9, which includes one additional cover featuring a Whisky Advocate special edition included on the back of the May/June 2021 edition of Cigar Aficionado), every fifth article (n = 28), and every fifth ad (n = 61) of each issue were coded for major themes outlined in the literature (DeSantis and Morgan, 2003; Falit, 1997; Shen et al., 2017; Wenger et al., 2001a,b) and of interest to the committee: (1) health risk and benefit related to premium cigars, (2) new cigar trends (e.g., changes to premium products, including industry practices), (3) enjoyable social activity, (4) luxury, (5) product quality, (6) success, (7) masculinity, (8) sex appeal, (9) taste, and (10) other substance (i.e., alcohol, cannabis).
Article Analysis
Nineteen (68 percent) of the 28 articles sampled had content related to premium cigars, including ratings and reviews; pairing of cigars with alcohol; interviews with celebrities and people in the cigar industry to discuss topics related to cigars; cigar history and information (e.g., about Premium Cigar Association [PCA]); and a gift guide (e.g., featuring cigar products, such as accessories). One article featured rankings of cigar-related Twitter accounts that had the most followers by cigar-related organizations, radio stations, companies, and retailers. Nine (32 percent) of the articles that included non-cigar-related topics had travel guides and reviews of vehicles, alcohol, and coffee. See Table 4-1 for the themes in the articles.
TABLE 4-1Themes from Cigar Lifestyle Magazine Articles Sampled (n = 28)
| Theme | Examples | N (%) |
|---|---|---|
| Quality | Use of superior processes and materials in making a product | 25 (89%) |
| Luxury | Fancy packaging (premium cigars); fine art, expensive cars/clothes (nonpremium cigars) | 15 (54%) |
| Social images that show people having fun with other people | People laughing with each other | 9 (32%) |
| Success | Achieving wealth, respect, or fame | 13 (46%) |
| Alcohol | Pairing premium cigars with alcohol, such as whisky or wine | 12 (43%) |
| Masculinity | Hunting, cowboys | 11 (39%) |
| Describing the taste of premium cigars using language similar to how the taste of wine is described | “Core of earth, red pepper, and chocolate accompanied by a touch of ripe fruit sweetness” | 7 (5%) |
| New cigar trends and innovations | Changes to premium cigars, such as the size, tobacco source, wrapping techniques, or new blends of tobacco | 5 (18%) |
SOURCE: Commissioned magazine analysis (data available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu).
No articles mentioned health risks related to premium cigars; two (7 percent) mentioned positive health effects (i.e., using premium cigar as stress relief, such as Rush Limbaugh's interview stating, “Cigars relax me. They help me to think”). Based on studies documenting that certain words used in tobacco marketing, such as “natural” and “organic” allude to lower harm and result in lower perceived harm among cigarette smokers and nonsmokers (Baig et al., 2019), the committee also conducted a search of “lower-harm” terms in all digital versions of the magazines, which included three issues each of Cigar Snob and Cigar Aficionado. The search function was used to check for the presence of terms relating to “lower harm,” including “organic,” “healthy,” “clean,” “pure,” “natural,” “fresh,” and “light.” Forty-six mentions of lower-harm words were found, approximately 7.7 mentions per issue. For example, some of the product names contained these lower-harm terms (e.g., “Churchill Natural”), and the taste, smoke, and wrapper were described as “fresh,” “light,” and “clean.”
Eighteen celebrities were featured in 18 percent of the articles; two articles featured multiple individuals (e.g., celebrities talking about their favorite premium cigar brands; see Table 4-2 for their demographics).
Ad Analysis
Forty-four (72 percent) of the 61 ads assessed had content related to premium cigars (i.e., brands, retail shops, magazines, events). The frequency of each theme did not differ between ads that featured premium cigars and noncigar products, so the findings present the overall frequency in which these themes appeared (Table 4-3). Three (5 percent) of the ads included an image of a celebrity; similar to findings from the article analysis (Table 4-2); these were middle-aged to older men, and their professions were musician, sports figure, and owner of a premium cigar brand.
Six ads (10 percent) featured large-scale events that included festivals hosted by premium cigar brands and cigar magazines targeting consumers and trade partners. These events had premium cigars, food, alcohol, and music. Some festivals specifically featured a combination of premium cigars and alcohol (e.g., “Big Smoke meets WhiskyFest”). Nonpremium cigar festivals included a food and wine festival hosted by the Food Network.
Cover Analysis
Eighty-nine percent of the magazine covers (nine total covers) had at least one theme related to premium cigars (covers were coded for both text and images). The only one that did not was the additional cover of the Whisky Advocate special edition. The content featured on the covers included five (56 percent) interviews, four (44 percent) photo shoots (e.g., scantily dressed young female models posing on a beach or a pool with cigars), three (33 percent) travel tips, two (22 percent) cigar reviews, one (11 percent) alcohol-related content, and 35 percent “other” articles (e.g., social media rankings of cigar-related Twitter accounts, editorials related to premium cigars/industry).
TABLE 4-2Demographics of Celebrities (n = 18) Featured in Cigar Lifestyle Magazine Articles Sampled
| Demographics | Categories | N (%) |
|---|---|---|
| Profession | Sports figure | 6 (33%) |
| Actor | 3 (17%) | |
| Other (e.g., notable military figures, pundits, writers, CEOs of premium cigar brands) | 9 (50%) | |
| Sex | Male | 18 (100%) |
| Female | 0 (0%) | |
| Nonbinary | 0 (0%) | |
| American Indian or Alaska Native | 0 (0%) | |
| Race | Asian | 0 (0%) |
| Black | 3 (17%) | |
| Hispanic or Latino | 0 (0%) | |
| Native Hawaiian or Other Pacific Islander | 0 (0%) | |
| White | 15 (83%) | |
| Other/Unknown | 0 (0%) | |
| Age | 18–30 years old | 0 (0%) |
| 31–50 years old | 3 (17%) | |
| 51–65 years old | 9 (50%) | |
| 65 years or older | 6 (33%) |
SOURCE: Commissioned magazine analysis (data available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu).
Seven of the nine covers (78 percent) included the image of a celebrity; one magazine had two. The celebrities were models/social media influencers, sports figures, and actors; four (50 percent) were male and four (50 percent) were female, representing diverse age ranges: three (38 percent) 18–30, three (38 percent) 31–50, one (13 percent) 51–65, and one (13 percent) 65 or older. Six (75 percent) of the celebrities were coded as white, one (13 percent) as Black, and one (13 percent) as other (Indian/British).
TABLE 4-3Themes from Cigar Lifestyle Magazine Advertisements Sampled (n = 61)
| Themes | Examples | N (%) |
|---|---|---|
| High quality | Using words such as “hand-crafted,” “quality” | 46 (75%) |
| Social images that show people having fun with other people | People laughing with each other | 18 (30%) |
| Masculinity | Image of a cowboy, words such as “adventure” | 16 (26%) |
| Luxury | Images of expensive cars, clothes, use of words such as “finest” | 14 (23%) |
| Success | Images of executive chairs and a business meeting room | 12 (20%) |
| Taste | Description of taste of cigar | 6 (10%) |
| New cigar trends and innovations | Ads of new blends of tobacco. Images of a newer technology, such as an image of a tablet to advertise digital cigar magazines | 4 (7%) |
| Included an image of a celebrity | 3 (5%) | |
| Featuring a cigar lounge | 2 (3%) | |
| Sex appeal | Scantily dressed women | 1 (2%) |
SOURCE: Commissioned magazine analysis (data available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu).
In summary, premium cigar lifestyle magazines primarily featured such cigars throughout, including the cover, articles, and ads. The premium cigar industry is shown positively, with virtually no mention of negative health concerns. However, positive benefits, such as using premium cigars to reduce stress and words that allude to lower harm, such as “light,” “clean,” and “natural,” were mentioned multiple times within a single issue.
Based on the articles, advertisements, and covers sampled, cigar lifestyle magazines appear to target middle-aged to older white men, featuring themes that emphasized high quality of the product; a luxurious lifestyle that involves premium cigars but also other products, such as vehicles, coffee, and travel, as well as masculinity and success; and cigar use as a fun social activity. New cigar trends and innovations were less frequently featured. Positions of power or high-level careers were often referenced by articles or covers featuring men in the field of sports, CEOs, or military figures. Despite few cigar ads coded as “sex appeal,” these ads pictured women in sexually suggestive poses holding a cigar while scantily dressed.
Content related to alcohol, such as whisky and wine, were identified in both paid ads and articles. The description of the taste of premium cigars very closely resembles that of wine. The large-scale events and festivals also featured both together, which may be because the same communications company owns Cigar Aficionado, Wine Spectator, and Whisky Advocate.
Summary and Conclusion
The committee observed in the Mintel dataset that one premium cigar brand (Drew Estate) had several e-mail advertisements that featured an “urban” lifestyle using graffiti and promotion of a music festival that featured musicians and premium cigar products. The committee's content analysis of cigar lifestyle magazines also included advertisements and articles promoting large-scale festivals, which featured premium cigars and alcohol. These findings led the committee to conclude that marketing strategies used by premium cigar companies include festivals, themes of an urban lifestyle, and hip-hop and rock music, which may appeal to young people. Based on its review of Mintel data and cigar lifestyle magazines, the committee concludes:
Conclusion 4-2: Based on the committee's primary data collection, there is conclusive evidence that premium cigar companies use lifestyle magazines and festivals to promote premium cigars. Some of these marketing strategies, such as sponsoring music festivals and promoting their products with an urban lifestyle and hip-hop and rock music, may appeal to young people.
Marketing on the Internet and Social Media
The Internet, which includes social media platforms, has become a popular venue for the tobacco industry to market products because it is lightly regulated and can reach a large number of people quickly at a low cost (Freeman, 2012).
Tobacco promotion and marketing on social media was uncommon when Monograph 19 was published in 2008 (NCI, 2008). Since 2008, evidence is growing that tobacco promotion is occurring on social media using strategies such as influencers and celebrities, paid online banner advertisements, and brand accounts without sufficient regulation (HHS, 2014, 2016). The committee found no published studies specifically examining premium cigar marketing on the Internet and social media. However, emerging data indicate that nonpremium cigar products (e.g., little cigars and cigarillos) are heavily marketed on social media platforms, such as Instagram (Allem et al., 2017; Richardson et al., 2014) and Twitter (Kostygina et al., 2016).
Navarro et al. (2020) examined whether cigar brands were using social media influencers to market cigar products on the brands' Instagram accounts from 2017 to 2018. The brands were identified from the top 20 leading cigar brands from Nielsen Scantrack data that tracks sales from total U.S. convenience stores and outlets (cigar brands from Nielsen data: n = 11) and Euromonitor's list of 2017 U.S. market leaders based on retail volume (additional cigar brands from the Euromonitor list: n = 13). They included all types of cigars, including premium. Seven of the 24 leading cigar brands had an official Instagram account, with at least one influencer in the 20 Instagram posts examined; two were premium9 cigar brands.
Another study examined whether leading tobacco brands (i.e., cigar, e-cigarette, cigarette, hookah, and smokeless tobacco) had a social media account in 2018 (O'Brien et al., 2020). The authors identified 112 leading brand names of all tobacco products using Nielsen Scantrack data, Euromonitor, and Population Assessment of Tobacco and Health (PATH) study data (only for hookah). For each brand, the authors searched whether an official account exists on Instagram, Facebook, Twitter, YouTube, Pinterest, and Tumblr. Eight were premium and 16 were nonpremium10 cigars. Specific conclusions regarding premium cigars cannot be drawn because the data analysts grouped all brands together. This study observed that leading cigar brands (as well as e-cigarette and hookah brands) had at least two social media platforms, with Facebook, Instagram, and Twitter being the most common.
As the Internet and technology rapidly evolve to engage and entertain their users, tobacco companies that market using these sources will also likely evolve, so studies will need to keep up with these changing trends. For example, mobile phone apps could be one way to market premium cigars. In 2012, one study examined the presence of pro-tobacco apps by searching the keywords “smoke,” “cigarette,” “cigar,” “smoking,” and “tobacco” on the Apple App Store and Android Market and found 107 apps. Apps relevant to cigars included one that showed where to buy tobacco products, including cigars (the authors did not differentiate cigar type); one for a premium cigar users advocacy group (Cigar Rights of America); and a “Cigar Smoker” app (the authors did not differentiate cigar type, but the example images included premium cigars), which provided information about cigar news, reviews, and deals, as well as options for users to share their own photos of their cigars on social media (BinDhim et al., 2014).
The committee's search of premium cigar brand11 apps on the Google Play Store (for Android phones) and the Apple App Store (for iPhones) indicated that only one brand had its own app. This finding is consistent with a study conducted in 2017 that examined tobacco brand apps in the Google Play Store and Apple iTunes; of 43 cigar brands (along with 20 cigarette, 20 smokeless tobacco, and 30 e-cigarette brands), the authors observed that no cigar (they did not specify type) apps were available on either, while cigarette and smokeless tobacco brand apps were available on Google Play (but not on Apple iTunes) (Navarro et al., 2019). Google and Apple prohibit apps that facilitate the sale of tobacco products. Furthermore, Apple prohibits apps that encourage consumption of tobacco products or encourage minors to consume tobacco products (Apple, 2021), and Google prohibits apps that “encourage the illegal or inappropriate use of alcohol or tobacco” (Google, n.d.).
Environmental Scan of Premium Cigar Companies' Online Presence
Given the dearth of published literature on premium cigar products, the committee conducted an environmental scan and content analysis of premium cigar companies' social media and webpages12 to document and describe the presence of their advertising of their products. The committee also assessed selling propositions within the content.
The committee assessed the social media and webpage presence of the 60 cigar brands initially classified as premium (4 more were added) (see Appendix E for a description of the methodology used to classify the brands as premium). The committee conducted a web search to document premium cigar brands' online presence, which included a website and/or a profile on social media platform(s), from June to July 2021. These platforms include Facebook, Twitter, Instagram, YouTube, and Snapchat, which are popular and used worldwide.
The committee assessed whether each brand had its own official website. The website's page, the presence of age verification or age gating, and online purchasing options were documented for each one. Regarding social media profiles for Facebook, Twitter, YouTube, and other media, the committee documented the handle for each brand's social media profile/site. The number of posts made on each platform during the data collection period was captured. Metadata for the social media sites were also captured, including the number of followers (or subscribers for YouTube), likes, comments, and/or views. In addition, the committee documented the presence of a smartphone app for each brand and the number of downloads. Finally, following the methodology used by Shen et al. (2017) and Escobedo et al. (2018), the committee documented the presence of selling propositions in the online content of each premium cigar brand:
- Sociability: content that promotes fun, hip, cool, contests, and adventures;
- Innovation: content that promotes simple to use, technology, convenience, and price;
- Party lifestyle: content that may include smoke/vapor, nightlife, celebrities, music, party, and holiday;
- Celebrity endorsement and the industry in which the celebrity is a part of (e.g., music, art, sports);
- Music content and the genre of music (e.g., pop, hip-hop or rap, dance or electronic, alternative, R&B rock, or other genres);
- Taste: content that implies smooth taste and/or satisfaction;
- Harm reduction: content that implies that premium cigars are safe or less harmful to use than others or are an alternative to quitting smoking;
- Quality: content that implies that the product is of high quality, historic, or longer lasting;
- Masculinity: content that feature themes, activities, and settings stereotypically considered masculine, such as the outdoors, and activities, such as manual labor or hunting;
- Femininity: content that includes encouraging female use of premium cigars, such as hashtags like #girlswhosmoke or #girlssmoketoo; and
- Sex appeal, including images or content that shows a “beautiful, glamorous, sophisticated, handsome, or cool-looking individual using tobacco.”
A descriptive analysis was conducted to assess the online presence of each premium cigar brand and capture the most common selling propositions.
Of the sample of 60 cigar brands initially identified as premium, 8 were sub-brands of 5 brands and 5 were not found in online searches, resulting in 47 brands searched (see Table 4-4). Thirty-six premium (77 percent) had an official website, and 31 (66 percent) had a Facebook page. Each brand had an average of 21,341 “likes” and an average of 22,225 followers on its Facebook page. Thirty-one premium (66 percent) had Instagram accounts, with an average of 842 posts and 34,210 followers. Nearly half (n = 28; 46.7 percent) had a Twitter account with an average of 12,727 account followers and 5,189 tweets. More than one-fifth (n = 11; 23 percent) had a YouTube page, with an average of 4,767 subscribers and 363,391 channel views. Eight (17 percent) of the 47 premium cigar brands used other online platforms: four (8 percent) had content on the Cigar World social media platform, three (6 percent) had LinkedIn accounts, and one (2 percent) had a Pinterest account.
Summary and Conclusion
The committee's analysis of the online presence of premium cigar brands identified that 77 percent of the brands examined had an official website, 66 percent had a Facebook account, 66 percent had an Instagram account, 57 percent had a Twitter account, and 23 percent had a YouTube account (see Table 4-4). The presence and use of social media to promote premium cigars is not currently captured by existing tracking methods of marketing expenditures. These findings led the committee to conclude that there is conclusive evidence that premium cigar companies have online and social media presences not captured by traditional methods of tracking marketing expenditures.
TABLE 4-4Online Presence of Premium Cigar Brands (n = 47)
| Online Presence | N (%) | Mean Engagement Per Account (Range) |
|---|---|---|
| Official premium cigar company website | 36 (77%) | — |
| 31 (66%) | 21,341 “likes” (6–152,259) 22,225 followers (6–150,737) | |
| 31 (66%) | 842 posts (1–3,282) 34,210 followers (4–146,000) | |
| 27 (57%) | 5,189 tweets (3–17,800) 12,727 followers (42–35,500) | |
| YouTube | 11 (23%) | 4,767 subscribers (70–25,000) 363,391 channel views (974–1,638,628) |
| Cigar World social media platform | 4 (8%) | — |
| LinkedIn account | 3 (6%) | — |
| Pinterest account | 1 (2%) | — |
SOURCE: Committee social media commissioned analysis (data available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu).
Conclusion 4-3: Based on the committee's primary data collection, there is conclusive evidence that premium cigar companies have online and social media presences not captured by traditional methods of tracking marketing expenditures.
Summary Finding
Based on the committee's (1) review of the literature on the presence of cigar and premium cigar advertising in print media and on the Internet and social media; (2) analysis of data on cigar advertising and marketing expenditures obtained from Mintel; (3) content analysis of cigar lifestyle magazines; and (4) environmental scan of premium cigar brands' web and social media presence, the committee finds:
Finding 4-1: Cigar Aficionado, the first magazine to specifically promote premium cigars as a lifestyle, was associated with the rapid increase in premium cigars in the early 1990s and, along with other cigar lifestyle magazines, continues to promote premium cigars. Since the publication of the NCI Monograph 9, Cigars: Health Effects and Trends, access to data on marketing expenditures has been limited, and there have been limited published data on marketing expenditures of premium cigars through traditional channels (direct mail, e-mail, etc.). Although the committee found it difficult to access marketing data (for both branded and nonbranded13 marketing) and few published studies on the marketing of premium cigars, this does not mean that marketing is not occurring. Based on the committee's primary data collection, it is evident that cigars are marketed in lifestyle and other magazines and on the Internet and social media platforms. There is evidence that premium cigars are marketed through direct mail advertisements, although the extent of this type of marketing is unknown because the tracking data are not readily accessible.
Advertising Promotions and Selling Propositions of Premium and Cigar Products
This section describes the advertising promotions and selling propositions used by cigar tobacco companies and other non-tobacco-industry sources (see Box 4-1 for the definitions used in this chapter of “advertising promotions” and “selling propositions”). The committee's definitions of both align with research that examined tobacco product advertising content (NCI, 2008; Shen et al., 2017). For this review, selling propositions are considered a component of cigar advertising promotions.
This section begins with a summary of articles that examined the general/overall advertising promotions. Next, it describes the unique selling propositions. Articles that examined premium cigar products are described first in each section. Given the absence of published literature focused exclusively on premium cigars, the literature search and subsequent article review were broadened to include those that described cigar products but did not specify type (such as premium, nonpremium, cigarillo, little filtered cigar). Next, the advertising promotions and selling propositions for non-large-cigar products, including cigarillos and little filtered cigars, are described. While the main goal is to describe findings for premium cigars, this section highlights the similarities in advertising promotions and selling propositions between premium cigars and nonlarge cigars.
Advertising Promotions for Premium Cigars and/or Brands
The committee found three articles that exclusively assessed the advertising promotions and selling propositions of premium cigars and/or premium brands: a Tobacco Industry Ad-Watch (Falit, 1997) and two scientific studies (DeSantis and Morgan, 2003; Wenger et al., 2001a). The articles were published between 1997 and 2003, during a greater than 50 percent increase in cigar sales and consumption (Department of Agriculture, 1997; Wenger et al., 2001a). The rise in cigar sales during the late 1990s was due, almost exclusively, to the sale of large cigars (Department of Agriculture, 1997; Wenger et al., 2001a). The stated goal of each article was to understand the role of advertising in increasing cigar sales and consumption. Additionally, the three articles analyzed content from prominent cigar magazines, such as Cigar Aficionado. In 1995, it was the most popular lifestyle magazine in the United States, with a readership of more than 400,000 per issue (DeSantis and Morgan, 2003; NCI, 1998). Falit (1997) cited studies that described the growing popularity of cigar products and increased advertising to 20-, 30-, and 40-year-olds as well as promotion to older adults. Despite this popularity among younger and middle-aged adults, Falit noted an initial delayed public health response to advertisements targeting 20–40-year-olds because they were not specifically targeting children.
Selling Propositions for Premium Cigars and/or Brands
“Luxury, success, and prestige”
Falit's (1997) Ad-Watch in the Tobacco Control journal describes the advertisements of cigars and their accompanying products (i.e., humidors, holders, lighters) in magazine publications, such as Cigar Aficionado and Smoke, and newspapers that were “geared towards older, more affluent adults” (p. 240). Older celebrities, including Hollywood movie stars, such as George Burns and those who have “achieved success and earned the right to smoke a cigar” (p. 240), were prominently featured in Cigar Aficionado and Smoke holding cigars or smoking them. The Ad-Watch also describes cigars as popular props in several major motion pictures during the late 1990s, notably an advertising campaign for the premium brand Macanudo. It featured “two men—one older and one younger—who shared cigars as a common interest and symbol of maturity and success” (p. 241).
Wenger et al. (2001a) conducted a content analysis of content in Cigar Aficionado (1992–1998) and another cigar lifestyle magazine, Smoke (1996–1998) to identify their role in the elevated premium cigar sales and consumption rates in the late 1990s. Overall, approximately 40 percent of the combined articles were focused on cigars. Of these articles, 92 percent portrayed premium cigars positively, highlighting them as “pleasurable, relaxing, and part of a successful lifestyle” (p. 282). Celebrities and influential public figures, including politicians, actors, musicians, and painters, were featured in 34 percent of the articles. Although Wenger et al. mentioned that sometimes the celebrities were “mentioned in passing” (p. 282), usually the articles featured a celebrity who described their favorable views on cigars or the role of cigars as a part of their lifestyle. Premium cigar events were featured in 12 percent of the articles and included social events, such as cigar smoking, eating gourmet meals and dinners (i.e., Cigar Aficionado's “Big Smoke” dinners), drinking “premium” alcohol, and the openings of cigar bars, lounges, and shops in the United States and other countries. The authors concluded that aligning cigar use with celebrities and influential public figures and promoting them at “exclusive” social events normalized and promoted cigar use as a part of a successful lifestyle.
Findings from Wenger et al. (2001a) indicate that approximately 40 percent of these articles advertised premium cigar smoking as a part of a successful, sophisticated lifestyle, which was promoted as a desirable “identity.” Additionally, 60 percent of the non-cigar-focused articles in Cigar Aficionado and 57 percent in Smoke “covered luxury topics such as art, sports, music, fashion, gambling, jewelry, collectibles, and leisure” (p. 280) that are consistent with a successful and desirable lifestyle. The inclusion of elegant content may indicate to the publications' readers that premium cigars are a part of a luxurious lifestyle.
“Cigar benefits outweigh health effects”
Cigars during the late 1990s were “not commonly believed to have the same health effects as cigarettes” and “the health effects of cigar smoking have not been researched nearly as much as those of cigarette smoking” (Falit, 1997, p. 241). Evidence presented in the Falit Ad-Watch indicates that premium cigar advertising promotions downplayed the health dangers of cigar smoking compared to cigarette use and supported the perception that cigars were a safe substitute. The Ad-Watch also notes that “with George Burns as the cigar's most popular ‘poster child,’ the health dangers of cigar smoking are subtly undercut” (p. 241).
DeSantis and Morgan (2003) conducted a content analysis of 41 Cigar Aficionado magazine issues published from 1992 to 2000 to analyze their “pro-smoking messages” (p. 460). DeSantis and Morgan noted that the magazine promoted “premium cigars (i.e., hand-rolled, expensive, and imported)” and included a quote from Cigar Aficionado that indicated that the sales and consumption of premium cigars were attributed to their publication (p. 458). From 1992 to 2000, 380 pro-premium cigar-smoking arguments were found, and 9.4 pro-premium-cigar arguments were present per issue (e.g., cigars are not cigarettes, life is dangerous, and health benefits arguments).
The “cigars are not cigarettes” argument was the most recurring theme and asserted that cigars were a safer alternative. This argument was based on the “significant differences in [cigar] product and process” and asserted that (1) cigarettes are addictive, whereas cigars are not because they are used infrequently; (2) cigarettes are inhaled, and cigars are not, thus they do not pose health risks to the lungs; (3) cigarettes are impure, but cigars are not because they contain “all-natural ingredients” (p. 466). Also, the cigar-making process purifies the products; and (4) cigarettes are consumed in mass quantities, whereas cigars are smoked “in moderation” (p. 467) and not as a daily habit. The “life is dangerous” argument asserted that cigar use is not as dangerous and/or risky as other behaviors, such as reckless driving, alcohol consumption, and breathing polluted air. The “health benefits” argument asserted that cigar smoking offers many health benefits, including stress reduction, decreasing the risk of several major health problems.
Advertising Promotions for Cigar Brands
In response to the lack of articles on advertising promotion and selling propositions for premium cigars, the committee broadened its search to include cigar products in general (i.e., not specifying premium, nonpremium, cigarillo, or little filtered cigar but instead using the broader term “cigar”).
Two articles described the advertising promotions for “cigar” products. Wenger et al. (2001a) conducted a content analysis of 790 cigar-focused newspaper and magazine articles published in the five largest U.S. newspapers by circulation between 1987 and 1997 but did not specify the cigar type. The authors coded for the primary focus (e.g., cigar business, events, trends) of the articles, image of cigars (positive: enjoyable, profitable, relaxing; negative: harmful, unpleasant), the tobacco industry portrayal (positive: profitable; negative: harmful; neutral: neither); and the presence of celebrities and public figures. Cigar businesses (39 percent of content) and events (19 percent) were the most prominent focus areas. The report did not describe the types of cigar business or events. The authors also noted that both cigars (62 percent) and the tobacco industry (78 percent) were portrayed positively in the majority of the articles. Celebrities and other public figures were quoted or described in 42 percent of the articles, with 87 percent having favorable attitudes toward cigars. The authors also coded for the presence of health effects, which is described in the relevant section.
Feit (2001) examined 70 cigar images in a sample of women's magazines published between 1992 and 1998 but did not specify the product type. The images were coded for image type (advertisements versus non-advertisements), the product advertised with or without an image, the presence of product with/without actors (e.g., individuals or cartoon characters), and sex of the smoker. The percentage of female compared to male cigar smokers steadily increased, with 25 percent of cigar images showing them in 1992 and 64 percent in 1998. These data indicated that the presence and portrayal of female cigar smokers increased significantly over the 7 years. The smokers included celebrities, such as actors and athletes.
Selling Propositions
“Cigar benefits outweigh health effects”
Three articles specifically examined and/or described the health effects noted or discussed in the cigar articles or advertising content. In a Tobacco Control Ad-Watch piece, Falit (1997) described the targeted marketing of cigars to adults aged 65+. Notably, older celebrities who appeared healthy, such as George Burns, were thought to “subtly undercut” any health dangers (Falit, 1997) (p. 241). Additionally, the awareness of health consequences of cigarette smoking, along with perceptions that cigars are less harmful (Falit, 1997) are speculated to have contributed to adult cigarette smokers' switch to cigars (Falit, 1997; Gerlach et al., 1997; NCI, 1998).
Wenger et al.'s (2001b) content analysis of Cigar Aficionado and Smoke examined the presence of environmental tobacco smoke (ETS) or scientific research and the health effects of premium cigars. Although health effects were not explicitly defined, the authors described and provided scientific citations that reported the increased risk of cancer, heart, and pulmonary disease among cigar smokers (p. 279). Only 1 percent (n = 4) of the 353 articles focused primarily on health effects. The central theme of these four articles, all published in Cigar Aficionado, was that the purported benefits (e.g., pleasure, relaxation) outweighed the potential adverse health effects. Scientific research on cigar use was mentioned in 2 percent of the articles, and the majority of the evidence was described as “weak” and “flawed.” ETS was mentioned in the context of smoking restrictions that denied “… smokers' rights” (p. 282), and the articles noted that scientific evidence on ETS health risks was considered “weak” or “contradictory” (p. 282). Finally, social events, including benefits to raise money for various health charities, were described. The authors purport that advertising these events markets the cigar industry as “socially responsible and supportive of good health while trivializing public health concerns about tobacco use” (p. 283).
Wenger et al. (2001a) coded for health risks (i.e., whether risks were mentioned, types of health effects mentioned, whether or how cigars were compared with cigarettes) in the advertisements. Of the 790 articles reviewed, health effects were the primary focus in 4 percent (35) but mentioned in 21 percent (169). Half (50 percent) of the articles portrayed cigars positively and minimized their health effects. Only 24 percent (41 of the 169) showed the health effects negatively. Fourteen percent of the articles compared the health effects to cigarette use, describing it as less harmful because cigars are consumed differently (i.e., without inhalation) and infrequently and contain fewer chemicals. These articles emphasized cigars being more socially acceptable than cigarettes, implying that they are part of a lifestyle.
“Cigars are a premium product”
Shen et al. (2017) examined the unique selling propositions in 171 print tobacco ads collected between August 2012 and August 2013 from the consumer, Sunday, local, and Hispanic-targeted magazines (p. 4). Of those, 22 ads were for “cigar” products. The type of product was not specified, and the term “cigar” was not defined. Overall, the authors found that cigars were being promoted in the advertisements as a “premium product.” The advertisements often promoted cigar use for special occasions and indicated that the products were often used by “sophisticated people” (pp. 7 and 17).
Advertising Promotions and Selling Propositions for Non-Large-Cigar Products
While the peer-reviewed article described next focuses on non-large-cigar products, such as cigarillos with brands like Black & Mild and Swisher Sweets, the advertising promotions and selling propositions for these products were similar to those reported in peer-reviewed articles examining premium cigar content. Rosario and Harris (2020) examined the messaging strategies of tobacco advertisements within an African American community, including for nonlarge cigars and their variation by tobacco product type. The advertisements were collected from 24 retail stores located in census tracts with greater than 70 percent African Americans in Greensboro, North Carolina. Of the 165 ads examined, 33 (20 percent) featured nonlarge cigars. Misdirection of attention messages, which consisted of images and text that redirected consumers' focus from health risks toward positive product attributes, commonly appeared in the nonlarge-cigar ads, with 67 percent of ad content using this messaging strategy. Phrases such as “limited release,” “enjoy,” and “hand-rolled” were found, with these phrases used to potentially redirect focus from health facts to positive attributes and feelings. The second most common message strategy was reassurance, which sought to convince consumers that tobacco product use is safe despite its health risks. Of the ads, 18.2 percent contained content that was classified as reassurance. Phrases such as “The natural choice…,” “Like sweets? Go natural,” and “Natural leaf cigarillo” were used to convince consumers that non-large-cigar use is safe.
Similar to what has been documented for nonlarge cigars, premium cigar advertising content has also sought to shift consumers' focus from health risks to positive product attributes, including using premium cigars as an essential component of a successful or luxurious lifestyle. The content in Cigar Aficionado and Smoke reduces consumers' ambivalence about the health risks by including older celebrities who appear healthy.
Summary and Conclusion
The committee's review of the literature found three studies published between 1997 and 2003 that specifically examined advertising content of premium cigar brands. Overall, these studies indicate that these were advertised and promoted as an integral component of a successful, luxurious lifestyle, used at “swanky” social events and by those influential celebrities and individuals. The articles noted that this “identity” was promoted in cigar lifestyle magazines, such as Cigar Aficionado and Smoke. Moreover, some content downplayed the health dangers of premium cigars compared to cigarettes and supported the perception of a safe substitution. Findings from the committee's systematic literature review and environmental scan of premium cigar content online suggest that the most pronounced selling propositions were that the benefits of cigar use outweighed their adverse health effects and that cigars are a premium or quality product.
Conclusion 4-4: Based on the 1998 NCI monograph on cigars, subsequent publications, the committee's primary data collection, and consistent with research on the “premiumization” of tobacco products that purport better quality and less harm, there is conclusive evidence that premium cigars are advertised and promoted as less harmful than other tobacco products and as having benefits that outweigh their adverse health effects. Premium cigars are also marketed as an integral component of a successful, luxurious lifestyle, used at upscale social events, and by influential celebrities and individuals.
SALES
Cigar sales data provide insight into where and how cigars are sold and in what quantities. Consistent with consumption data reported in Chapter 3, sales data from the Alcohol and Tobacco Tax and Trade Bureau (TTB) report that the total number of cigars (large and small) increased from 5.95 billion in 2002 to 10.14 billion in 2012, and per capita cigar sales also increased 6.4 percent annually (Agaku and Alpert, 2016). Notably, the market share for large cigars increased steeply between 2009 and 2012 to reach 93.1 percent during 2012 (Agaku and Alpert, 2016); these estimates include a range of large cigar products, including premium cigars. This increase did not match the prevalence of current cigar smoking by U.S. adults between 2002 and 2012, which remained constant (5.4 and 5.6 percent, respectively) (Agaku and Alpert, 2016).
Another source of sales data is point-of-sale retail tracking. Between 2012 and 2016, Nielsen data from convenience stores and all other outlets showed that cigar sales increased 29 percent in the United States overall (Gammon et al., 2019). During this time frame, this was largely driven by the 78 percent increase in cigarillo sales, from an average monthly sale of 0.432 to 0.768 per capita. In contrast, large cigars decreased by 42 percent (average monthly sale of 0.132 to 0.076 cigars per capita) and little cigars decreased by 20 percent (average monthly sale from 0.52 to 0.42 per capita) (Gammon et al., 2019).
Premium Cigar Sales
Data from TTB (see Chapter 3) suggest that the percentage of the cigar market that may be premium was 1.5–3.0 percent between 2010 and 2020, with the majority of the market composed of large cigars (which include filtered cigars, cigarillos, and larger traditional cigars).
Few studies have documented the venues through which premium cigars are sold and whether these venues are captured in existing retail surveillance. Studies on sales of large cigars, generally, have identified smoke shops/tobacco specialty or outlet stores (Corey et al., 2018), convenience stores (Corey et al., 2018), pharmacies (Seidenberg et al., 2013), and Internet vendors (Williams and Derrick, 2018). Only one study, conducted in 2013–2014, documented purchasing behaviors of adults who smoke traditional cigars (premium and nonpremium), providing greater insight into differences in their sales among cigar users (Corey et al., 2018). Premium cigar users were less likely to usually buy their cigars in person (77.6 percent premium versus 96.7 percent nonpremium) (Corey et al., 2018). Of those who usually did so, they identified smoke shop/tobacco specialty or outlet store (46.8 percent), cigar bars (29.9 percent), convenience store/gas station (18.2 percent), and somewhere else (5.1 percent) as the places where they purchase tobacco products most of the time (Corey et al., 2018). In comparison, nonpremium cigar users reported convenience store/gas station (78.5 percent) and smoke shop/tobacco specialty or outlet store (18.4 percent) (Corey et al., 2018). Premium cigar users were least likely among all cigar users to identify “they are affordable” as a reason for cigar smoking (22.7 percent premium versus 66.4 percent nonpremium) (Corey et al., 2018).
An analysis commissioned by the committee of data from the 2016–2017 PATH Wave 4 provides updated estimates on purchasing behavior for adults who smoke traditional cigars (premium and nonpremium), cigarillos, filtered cigars, and cigarettes (see Table 4-5) (Jeon and Mok, 2022). These updated estimates show that people who smoke premium and nonpremium cigars were equally likely to usually buy in person (76.4 percent versus 84.0 percent nonpremium). Of those, premium cigar users identified cigar bars (35.4 percent) as the most common place, followed by smoke shop/tobacco specialty or outlet store (44.3 percent). In comparison, nonpremium cigar users reported convenience store/gas station (64.5 percent). Approximately two-thirds (71.5 percent) of premium cigar users usually purchased a single cigar at a median price of $7.00 per stick. Similar to the Corey et al. (2018) findings from 2013 to 2014, data from 2016–2017 support that few people who use premium cigars identify affordability as a reason for use (30.2 percent).
Data submitted to the committee evaluated transaction-level data from five major online cigar retailers in 2017, identifying approximately 4 million online orders in 2017 by more than 1 million unique customers across 54,554 stock keeping units (SKUs).14 The average number of cigar SKUs per retailer was 10,911, highlighting the diversity of products offered. The majority of these orders (3.6 million) included premium cigars: 125,314,590 sold across 51,123 SKUs. The average number of cigars per order was 34.6, at an average price of $3.00 per; the average amount per order was $61.26.15 Premium cigar sales from these five online retailers in 2017 totaled $376.6 million. The majority of premium cigars sold in 2017 were not in sampler packs that include more than one type of cigar (87 percent). Data provided by some of the retailers for other years (2014–2018) also show that most premium cigar orders are for boxes of five or more cigars (95 percent) without single cigars or multipacks (2–4 cigars); greater than 60 percent of orders included only one or two brands.16 Online cigar sales also exhibit seasonality, with the lowest purchases in January and February and peak purchasing during the summer months.17 Using the TTB data for large cigars, Class H (see Table 3-1), as the denominator (380,000,000 sticks consumed in 2017), these data suggest that approximately 33 percent of premium cigars were purchased online in 2017. Survey data do not currently capture online purchasing behavior in premium cigar users. PATH only asks about where cigars are usually purchased for those who purchase in stores.
TABLE 4-5Tobacco Product Characteristics and Purchasing Behaviors Among Adult Current Established Traditional Cigar (Premium, Nonpremium), Cigarillo, Filtered Cigar, and Cigarette Smokers, PATH Study Wave 4, 2016–2017
| Premium Cigars (n = 336) | Nonpremium Cigars (n = 237) | Cigarillos (n = 918) | Filtered Cigars (n = 440) | Cigarettes (n = 8,590) | |
|---|---|---|---|---|---|
| % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | % (95% CI) | |
| Has a regular brand | 38.4 (31.8–45.4) | 73.8 (65.3–80.9) | 74.8 (70.2–78.8) | 68.0 (59.8–75.4) | 92.5 (92.0–93.1) |
| Top 5 brands smoked | Cohiba 20.3 | Black & Mild 23.6 | Black & Mild 51.0 | Black & Mild 20.7 | Marlboro 34.2 |
| (14.0–26.4) | (16.0–31.2) | (46.8–55.2) | (14.8–26.7) | (32.6–35.9) | |
| Arturo Fuente 17.9 | Acid 12.7 | Swisher Sweets 21.1 | Cheyenne 18.5 | Newport 15.9 | |
| (11.4–24.5) | (8.0–17.5) | (16.9–25.4) | (12.3–24.8) | (14.6–17.2) | |
| Romeo y Julieta 7.8 | Dutch Masters 11.8 | Backwoods 5.3 | Swisher Sweets 7.6 | Camel 10.8 | |
| (4.1–11.5) | (6.6–17.1) | (3.5–7.1) | (4.8–10.4) | (9.8–11.7) | |
| Montecristo 6.7 | Swisher Sweets 11.6 | White Owl 5.0 | 305's 7.3 | Pall Mall 7.0 | |
| (4.0–9.3) | (7.7–15.5) | (3.0–7.0) | (2.8–11.8) | (6.1–7.8) | |
| Macanudo 5.2 | White Owl 5.9 | Dutch Masters 2.4 | Djarum 6.5 | American Spirit 3.6 | |
| (2.8–7.6) | (3.1–8.7) | (1.0–4.0) | (4.8–8.2) | (3.2–4.0) | |
| Regular brand flavored or mentholated | 7.6 (5.5–10.5)^ | 50.3 (38.3–62.3) | 55.7 (50.4–60.9) | 48.4 (41.2–55.7) | 38.4 (36.8–40.0) |
| Usually buy in person | 76.4 (69.3–82.3) | 84.0 (74.9–90.3) | 92.5 (89.9–94.5) | 90.0 (85.5–93.1) | 94.9 (94.4–95.4) |
| Where buy tobacco product | |||||
| Cigar bar | 35.4 (28.4–43.1) | * | * | * | NA |
| Convenience store/gas station | * | 64.5 (57.4–71.0) | 85.2 (81.8–88.1) | 73.7 (68.6–78.3) | 88.1 (87.2–88.9) |
| Smoke shop/tobacco specialty or outlet store | 44.3 (35.2–53.8) | * | 11.3 (9.0–14.2) | 22.1 (18.4–26.2) | 10.0 (9.0–11.2) |
| Somewhere else | * | * | * | * | 1.9 (1.3–2.6) |
| Usual purchase size | |||||
| Single | 71.5 (66.7–75.9) | 41.9 (35.1–49.0) | 52.1 (48.4–55.8) | 79.4 (74.4–83.7) | 2.5 (2.1–2.9) |
| Box or pack | 28.5 (24.1–33.3) | 58.1 (51.0–64.9) | 47.9 (44.2–51.6) | 20.6 (16.4–25.6) | 83.3 (82.0–84.5) |
| Carton | NA | NA | NA | NA | 14.2 (13.1–15.4) |
| Price per stick (median, IQR) | $7.00 (4.00–10.00) | $1.07 (0.71–2.00) | $1.00 (0.66–1.08) | $0.11 (0.07–0.26) | $0.30 (0.25–0.35) |
- *
= The estimate has been suppressed because it is statistically unreliable. It is based on a (denominator) sample size of less than 50, or the relative standard error of the estimate (or its complement) is greater than 30 percent.
- ^
= PATH included 8.9 percent of premium cigar smokers who reported that their regular brand was flavored or mentholated. In the committee's working definition of premium cigars (see Chapter 1), they are not flavored. Thus, the definition used for PATH does not necessarily reflect that used by the committee.
NOTE: CI = confidence interval; NA = not applicable; PATH = Population Assessment of Tobacco and Health.
SOURCE: Jeon and Mok, 2022.
Data from these online retailers across 2014–2018 also allowed for exploration of demographics of premium cigar purchasers through age verification and geocoding of 80 percent of purchaser addresses to census tracts. Based on age verification for 83 percent of these orders, the mean age was 55.3; more than half (54 percent) of purchasers were over the age of 55, and approximately one-third (34 percent) were 35–54.18 The median household income in the census tracts of online premium cigar purchasers ($65,573) was higher than the U.S. median household income ($57,617); 15 percent of them live in a census tract with a median household income above $100,000, compared with 10 percent in the U.S. population overall.19 Greater than 20 percent of them live in census tracts where greater than 50 percent of the population aged 25 and older has a bachelor degree compared with 15 percent in the U.S. population.20 Limitations of this study include that it was limited to sales from large, online retailers; customer demographics are based on census tract data, not actual customer demographics; and no unique customer identification numbers were included, so individuals cannot be tracked across vendors to ensure unique customers across retailers (Voith, 2021).
Summary and Conclusion
Based on the committee's examination of cigar sales data from TTB and Nielsen, published and commissioned analyses from PATH (see Appendix D), and data submitted by the Cigar Association of America on major online cigar retailer transactions in 2017, the committee concludes:
Conclusion 4-5: There is strongly suggestive evidence from survey data that consumers of premium cigars who buy in person typically purchase their cigars from cigar bars or smoke/tobacco specialty shops or outlet stores, whereas nonpremium large traditional cigar users typically purchase their cigars at convenience stores/gas stations. A lower proportion of premium cigar users buy their cigars in person than nonpremium large traditional cigar users. Data from online cigar retailers show that a large proportion of premium cigar sales occur online, though this is not directly captured in current surveys of cigar users.
Premium Cigar Retailer Density
An exploratory analysis commissioned by the committee (Kong, 2022) mapped U.S. retailers registered with PCA to better understand the distribution of brick-and-mortar retail venues throughout the country. To be included in these analyses, retailers had to (1) be located in the United States, (2) have a valid address, and (3) currently be open upon review of the address.21 PCA provided the committee with a retailer-level dataset that included current members in 2019–2021, with all physical brick-and-mortar retailers with necessary state tobacco licensing and where the majority of sales were for premium cigars or pipe tobacco; retailer types, such as convenience stores, hookah/head shops, and vape stores, were excluded. The original dataset included 1,316 unique retailers. However, upon review of the address fields and states, 25 retailers were removed, leaving 1,291. All premium cigar retailers were spatially joined to their respective census tract and corresponding sociodemographic data to explore the density of premium cigar retailers and the characteristics of census tracts in which they were present. Figure 4-3 shows the distribution of premium cigar retailers across the United States.
FIGURE 4-3
Locations of 2019–2021 Premium Cigar Association retailers, United States (n = 1,291). NOTE: Supplemental materials available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas.edu. (more...)
Table 4-6 shows the total count and density of PCA retailer members by state. All states except two (North Dakota and Vermont) had premium cigar retailers, ranging from 1 in West Virginia to 220 in Florida. The density per 1,000 residents of outlets in states with at least 1 retailer ranged from 0.96 in Iowa to 25.1 in Delaware. Examination of data at the census tract level found that premium cigar retailers were present in a small proportion (1.7 percent) of tracts, with a median density of 0.0 retailers per 1,000 people and a maximum density of 8.2. Census tracts with a higher percentage of non-Hispanic white residents had greater odds of having at least one (versus no) retailer (odds ratio [OR]: 1.06; 95 percent confidence interval [CI]: 1.03–1.09). In contrast, tracts with a higher percent of Black (OR: 0.92; 95 percent CI: 0.88–0.96) and Hispanic/Latino/Latina (OR: 0.90; 95 percent CI: 0.84–0.96) residents had lower odds of having at least one retailer. Findings from these analyses support that while the majority of census tracts do not have a retailer, density varies widely at the state level.
TABLE 4-6Total Count and Retailer Density of 2019–2021 Premium Cigar Association Member Retailers by State, United States
| State | Count | Total Population | Density per 1,000,000 Residents |
|---|---|---|---|
| Alabama | 17 | 4,876,250 | 3.49 |
| Alaska | 3 | 737,068 | 4.07 |
| Arizona | 40 | 7,050,299 | 5.67 |
| Arkansas | 13 | 2,999,370 | 4.33 |
| California | 70 | 39,283,497 | 1.78 |
| Colorado | 15 | 5,610,349 | 2.67 |
| Connecticut | 11 | 3,575,074 | 3.08 |
| Delaware | 24 | 957,248 | 25.07 |
| District of Columbia | 4 | 692,683 | 5.77 |
| Florida | 220 | 20,901,636 | 10.53 |
| Georgia | 29 | 10,403,847 | 2.79 |
| Hawaii | 3 | 1,422,094 | 2.11 |
| Idaho | 6 | 1,717,750 | 3.49 |
| Illinois | 60 | 12,770,631 | 4.70 |
| Indiana | 35 | 6,665,703 | 5.25 |
| Iowa | 3 | 3,139,508 | 0.96 |
| Kansas | 12 | 2,910,652 | 4.12 |
| Kentucky | 23 | 4,449,052 | 5.17 |
| Louisiana | 11 | 4,664,362 | 2.36 |
| Maine | 2 | 1,335,492 | 1.50 |
| Maryland | 27 | 6,018,848 | 4.49 |
| Massachusetts | 17 | 6,850,553 | 2.48 |
| Michigan | 32 | 9,965,265 | 3.21 |
| Minnesota | 8 | 5,563,378 | 1.44 |
| Mississippi | 6 | 2,984,418 | 2.01 |
| Missouri | 19 | 6,104,910 | 3.11 |
| Montana | 3 | 1,050,649 | 2.86 |
| Nebraska | 13 | 1,914,571 | 6.79 |
| Nevada | 15 | 2,972,382 | 5.05 |
| New Hampshire | 14 | 1,348,124 | 10.38 |
| New Jersey | 31 | 8,878,503 | 3.49 |
| New Mexico | 6 | 2,092,454 | 2.87 |
| New York | 39 | 19,572,319 | 1.99 |
| North Carolina | 53 | 10,264,876 | 5.16 |
| North Dakota | 0 | 756,717 | - |
| Ohio | 34 | 11,655,397 | 2.92 |
| Oklahoma | 16 | 3,932,870 | 4.07 |
| Oregon | 13 | 4,129,803 | 3.15 |
| Pennsylvania | 84 | 12,791,530 | 6.57 |
| Rhode Island | 8 | 1,057,231 | 7.57 |
| South Carolina | 25 | 5,020,806 | 4.98 |
| South Dakota | 2 | 870,638 | 2.30 |
| Tennessee | 31 | 6,709,356 | 4.62 |
| Texas | 104 | 28,260,856 | 3.68 |
| Utah | 4 | 3,096,848 | 1.29 |
| Vermont | 0 | 624,313 | - |
| Virginia | 50 | 8,454,463 | 5.91 |
| Washington | 13 | 7,404,107 | 1.76 |
| West Virginia | 1 | 1,817,305 | 0.55 |
| Wisconsin | 20 | 5,790,716 | 3.45 |
| Wyoming | 4 | 581,024 | 6.88 |
NOTE: Supplemental materials available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu. SOURCE: Kong, 2022.
Summary Finding
Based on the committee's (1) review of the literature on cigar sales; (2) analysis of data on consumer purchasing behavior; and (3) analysis of data on premium cigar retailers, it finds:
Finding 4-2: Large cigar retail outlets include smoke shops/tobacco specialty or outlet stores, convenience stores (Corey et al., 2018), pharmacies, and Internet vendors. Premium cigar users report purchasing their cigars primarily in cigar bars and smoke shops/tobacco specialty or outlet stores. Data from online retailers suggest that a large proportion of premium cigar sales occur online, but this is not currently captured in national surveys of cigar users. Data provided to the committee show that all but two U.S. states have a physical premium cigar retailer and the density of premium cigar retailers varies by state, with some states having a significantly higher density of shops than others; there are no data on the location or sale of premium cigars in cigar bars. Based on an exploratory analysis, premium cigar retailers are more likely to be present in census tracts with a higher percentage of white residents; premium cigar purchasers are more likely to reside in census tracts with higher median income and education compared to the general population.
AWARENESS, KNOWLEDGE, AND BELIEFS
Consumers' uptake of the use of tobacco products occurs through a series of steps, from initial awareness, to knowledge of the product and its features, to formulating beliefs, such as perceived risks, to trial and sustained use (Rees et al., 2009). Consumers' awareness, knowledge, and beliefs can be influenced by factors characterized elsewhere in this chapter and this report, such as advertising and marketing, point-of-sale availability, and product characteristics (see Chapter 2) (Rees et al., 2009). Beliefs such as risk perceptions (i.e., people's thoughts and feelings about risks) are central to numerous health behavior theories and have been the focus of decades of tobacco research (Kaufman et al., 2020a,b; Slovic, 2001). Risk perceptions are also often the targets of interventions to prevent and reduce tobacco use (Kaufman et al., 2020b), such as required health warning labels on tobacco packaging/marketing and mass media campaigns designed to raise awareness about the risks. This section reviews the evidence on consumers' awareness of premium cigars, knowledge, risk perceptions, and other perceptions, such as perceived benefits and reasons for use, and on how beliefs such as risk perceptions relate to patterns of use of premium cigars and other forms of tobacco.
Awareness
Researchers have examined awareness of tobacco products, including various types of cigars, in U.S. adults and youth. These studies use data from population-based surveys, such as PATH, or other population-based data sources.
Adults
Weaver et al. (2016) assessed awareness by asking participants whether they had ever heard of various tobacco products, including “large, premium cigars,” before the survey. Overall, 90.5 percent of U.S. adults were aware of large premium cigars, and awareness did not differ significantly among never, current, and former cigarette smokers. For comparison, 87.3 percent of adults were aware of little cigars/cigarillos, 93.8 percent were aware of traditional smokeless tobacco (i.e., chew, snuff, dip), and 91.9 percent were aware of e-cigarettes.
Fong et al. (2019) report awareness of tobacco products among U.S. adults in 2013–2014, assessed using product images to clarify products of reference to participants. Overall, 66 percent of U.S. adults were aware of “traditional cigars” (see Table 4-7 for the percentages of U.S. adults who were aware of other types of tobacco products).
Nayak et al. (2017) report data on awareness of tobacco products (see also Weaver et al., 2016)) among lesbian, gay, and bisexual (LGB) adults compared to heterosexual adults. They did not report raw data for awareness, but the data indicate that awareness of traditional/large cigars was near or exceeded 90 percent and was comparable in heterosexual and LGB adults. This was similar for all tobacco products assessed.
Youth
Kasza et al. (2017) report data on tobacco product awareness among U.S. youth in 2013–2014; 40.1 percent reported awareness of traditional cigars (see Table 4-7 for the percentages of U.S. youth who were aware of other types of tobacco products). For all tobacco products assessed, including traditional cigars, only age groups were reported. Awareness was higher for all products among those aged 15–17 than 12–14 years.
TABLE 4-7Awareness of Tobacco Products Among U.S. Adults and Youth, 2013–2014 (%, 95% CI)
| Adults | Youth | |
|---|---|---|
| Traditional cigars | 66.0 (65.2–66.9) | 40.1 (39.0–41.3) |
| Cigarillos and filtered little cigars | 81.6 (80.6–82.5) | 46.2 (45.1–47.3) |
| Traditional smokeless tobacco | 81.6 (80.9–82.3) | 75.9 (75.0–76.9) |
| E-cigarettes | 85.7 (84.9–86.3) | 89.5 (88.8–90.3) |
NOTE: CI = confidence interval.
SOURCES: Fong et al., 2019; Kasza et al., 2017.
Summary on Awareness of Premium Cigars
Only one study provides data on U.S. adults' awareness of premium cigars, and research on youth awareness is less available. Some studies used measures that capture awareness of cigar products that likely include premium cigars, such as “large cigars” and “traditional cigars.” These studies have heterogeneity in measurement that likely contributes to variation in estimates of awareness. For example, estimates of awareness among U.S. adults from PATH that characterized “traditional cigars” and used product images to aid in measurement are lower than other population-based data collected around the same time using different measurement methods (e.g., Weaver et al., 2016). Noting these limitations, the available evidence suggests that awareness of cigar products that likely include premium cigars (e.g., large cigars, traditional cigars) is high among U.S. adults, that it is lower among youth than adults, and that youth awareness increases with age. Evidence is limited on whether awareness varies by sociodemographic and tobacco-related characteristics among adults or youth. Available data are limited to adults and suggest no substantial variability in awareness by cigarette smoking status (Weaver et al., 2016) and in LGB adults compared with heterosexual adults (Nayak et al., 2017).
From a research perspective, more specific measures are needed that distinguish premium cigars to capture awareness in the U.S. population. For example, PATH research using images to clearly depict different product types (e.g., premium cigars, nonpremium cigars, little filtered cigars, cigarillos) may help improve assessment of awareness.
Knowledge
No research directly examines consumers' knowledge of what are, or what defines, premium cigars and what makes them distinct from other types of cigars. Some small, observational studies with convenience samples provide suggestive evidence about consumers' knowledge of premium cigars.
Adults
In Casseus et al. (2016), participants (self-identified cigarette smokers) were shown photos of tobacco products without packaging and asked to identify whether it was a cigarette, little cigar, cigarillo, cigar, or roll-your-own cigarette. The products did not include premium cigars. Overall, variability was noted in the proportion of participants who identified cigar products as cigarettes and those who indicated that they were little cigars, cigarillos, or cigars, including by sex and age. The results suggest adult cigarette users are likely to misclassify cigar products.
Dickinson et al. (2016) report data from focus groups conducted in five U.S. cities in 2014. Adults who used cigars, cigarillos, and little cigars were included. Participants were shown pictures of cigar products and asked how they identify them. Overall, use of brand names was common. Participants were most likely to identify the picture of a large/traditional cigar as a “cigar”: however, they also used brand names (e.g., Cohiba), and some referred to large/traditional cigars as “blunts.” Little cigars, tipped cigarillos, and untipped cigarillos were predominantly identified by brand names and also as “blunts.” Little filtered cigars were most consistently misidentified as cigarettes, and many participants did not consider little filtered cigars, tipped cigarillos, and untipped cigarillos to be cigars. Finally, participants were asked whether they considered cigar users to be “smokers.” Most preferred the term “cigar smoker,” and others indicated that they would only use the label if they smoked several times a week or daily. Participants reported little cigars and cigarillos to be more common daily use products and large/traditional cigars as something for leisure time or special occasions. They were less likely to view large/traditional cigar users as “smokers.” Participants had mixed responses on whether inhaling the smoke means someone is a smoker and the connotations of the term (e.g., negative connotations associated with cigarette smoking).
Youth
Yerger et al. (2001) report data from focus groups conducted with Black/African American youth on understanding of cigar products and cigar use. The groups included cigar users and nonusers (the types of cigars used by participants were not specified), but results are reported for all participants combined. The findings indicate that youth had three distinct ways of referring to cigars, describing larger, premium-type cigars as “cigars”; however, participants rarely used these, viewing them as primarily used by older, wealthier people. Other types of cigars were predominantly referred to by brand, such as “Black & Milds.” “Blunt” was used solely for cigars used for smoking cannabis. The participants were a small, nongeneralizable sample, but the results suggest that the youth studied associate products that likely include premium cigars with older, adult smokers.
Summary on Knowledge of Premium Cigars
No research has directly examined consumers' knowledge of what premium cigars are, what distinguishes them from other types of cigars, or their health effects. Studies have used convenience samples and qualitative methods to examine views on cigar products and terminology used to describe them. None have specifically investigated whether and how consumers identify or distinguish “premium” cigars. This is a research gap that would need to be filled to better understand consumers' knowledge of premium cigars and how they view them relative to other cigar products.
Beliefs
Perceived Risks
Several studies have investigated perceived risks of cigars among U.S. adults and youth, including comparisons with other tobacco products and examining whether perceived risks vary by population groups. Most of these do not detail specific health risks caused by cigarette or other tobacco use but assess perceived health harm of the product alone (absolute harm) and in comparison to a standard reference product, typically cigarettes (relative harm). Many of these studies used population-based data representative of the United States, such as from PATH.
Adults
Fong et al. (2019) report perceived risks of noncigarette tobacco products relative to cigarettes among U.S. adults using data from PATH Wave 1 (2013–2014; n = 32,320). Perceived relative harm was measured as whether participants viewed traditional cigars, cigarillos, filtered cigars, traditional smokeless tobacco (chew, snuff, dip), and e-cigarettes as less harmful than, about the same as, or more harmful than cigarette smoking or whether they did not know. These data are shown in Table 4-8. For all products except e-cigarettes, the majority of adults viewed them to be about the same as or more harmful than cigarettes. The largest proportion of adults viewed e-cigarettes to be less harmful (40.7 percent), followed by traditional cigars22 (12.1 percent).
Multivariable analyses examined demographic and tobacco-related factors associated with the perception that traditional cigars are less harmful than cigarettes. The findings are shown in Table 4-9.
Corey et al. (2018) reported data from PATH Wave 1 on smoking patterns, purchasing behaviors, and reasons for use, including perceived risks by cigar type among U.S. adults. Information including brand and other characteristics (such as price) was used to categorize smokers' usual brand as filtered cigar, cigarillo, or traditional cigar, which was further categorized as premium or nonpremium. Overall, comparable proportions of premium cigar, nonpremium cigar, cigarillo, and filtered cigar smokers indicated that cigars may be less harmful than cigarettes (see Table 4-10).
TABLE 4-8Perceived Harm of Noncigarette Tobacco Products Relative to Cigarettes Among U.S. Adults, 2013–2014 (%, 95% CI)
| Less Harm | About the Same | More Harm | Don't Know | |
|---|---|---|---|---|
| Traditional cigars | 12.1 (11.5–12.8) | 61.7 (60.6–62.8) | 23.9 (22.8–24.9) | 2.3 (2.0–2.6) |
| Cigarillos | 7.1 (6.7–7.6) | 70.7 (70.0–71.5) | 19.8 (19.1–20.5) | 2.4 (2.1–2.7) |
| Filtered cigars | 7.6 (7.2–8.0) | 75.5 (74.8–76.3) | 14.5 (13.9–15.2) | 2.3 (2.0–2.7) |
| Traditional smokeless tobacco | 8.6 (8.1–9.1) | 60.9 (60.0–61.7) | 27.6 (26.8–28.4) | 3.0 (2.7–3.4) |
| E-cigarettes | 40.7 (39.8–41.5) | 47.3 (46.6–48.0) | 6.9 (6.4–7.3) | 5.1 (4.7–5.6) |
NOTE: CI = confidence interval.
SOURCE: Fong et al., 2019.
These estimates differed by cigarette smoking status. Across the four cigar products, the proportion of cigarette smokers indicating that cigars may be less harmful was the lowest for current and higher among former and never-cigarette smokers (see Table 4-11).
Analyses of Waves 2–5 of the PATH data commissioned for this report (see Appendix D) indicate some variability from year to year. For example, the proportion of premium cigar smokers indicating that cigars may be less harmful than cigarettes was 32.1 percent at Wave 2, 25.2 percent at Wave 3, 16.5 percent at Wave 4, and 36.9 percent at Wave 5 (Jeon and Mok, 2022). The variability may be attributable in part to methodological issues, such as attrition, in subsequent waves; it may also reflect the timing of survey completion, given potential seasonality in cigar use.
Wackowski and Delnevo (2016) assessed tobacco use behavior (cigarette smoking; menthol cigarette use; past 30-day use of cigars, smokeless tobacco, and waterpipe; and ever use of e-cigarettes) and perceived harm of cigars, e-cigarettes, waterpipe, snuff, dip, chew, snus, and menthol cigarettes relative to cigarettes in U.S. young adults. The measures excluded filtered little cigars but included large cigars and cigarillos. Young adults were more likely to indicate that e-cigarettes (57.8 percent) and waterpipe (24.5 percent) were less risky than they were to indicate that cigars (13.9 percent), menthol cigarettes (2.5 percent), and traditional smokeless tobacco (7.1 percent) were. They were also more likely to indicate that cigars are less risky than cigarettes compared to traditional smokeless tobacco, snus, and menthol cigarettes. In adjusted models, men were more likely than women, Black and Hispanic young adults were less likely than white young adults, and those with more than high school education were more likely to perceive cigars to be less risky than cigarettes.
TABLE 4-9Demographic and Tobacco-Related Factors Associated with the Perception That Traditional Cigars Are Less Harmful Than Cigarettes
| Comparison | Categories | Odds Ratio (95% CI) |
|---|---|---|
| Men vs. women | 2.17 (1.88–2.51) | |
| Higher education vs. < high school education | Associate's degree | 1.60 (1.05–2.44) |
| Bachelor's degree | 1.95 (1.21–3.07) | |
| Master's degree+ | 1.66 (1.12–2.47) | |
| Higher household income vs. < $10,000 household income | $75,000–$99,999 | 1.48 (1.13–1.95) |
| $100,000+ | 1.66 (1.28–2.16) | |
| Current or former tobacco user vs. never-tobacco user | Current | 2.36 (1.87–2.99) |
| Former | 1.88 (1.47–2.42) | |
| Less knowledge of the health risks of smoking overall | 1.13 (1.09–1.17) | |
| Current traditional cigar use | 3.25 (2.84–3.73) |
NOTE: CI = confidence interval.
SOURCE: Fong et al., 2019.
TABLE 4-10Cigar Smokers Indicating That Cigars May Be Less Harmful Than Cigarettes
| Cigar Smoker Type | (%, 95% CI) |
|---|---|
| Premium cigar smokers | 31.4 (26.0–36.7) |
| Nonpremium cigar smokers | 27.1 (22.7–31.5) |
| Cigarillo smokers | 24.5 (21.9–27.1) |
| Filtered cigar smokers | 27.7 (23.4–32.1) |
NOTE: CI = confidence interval.
SOURCE: Corey et al., 2018.
TABLE 4-11Perception That Cigars May Be Less Harmful Than Cigarettes by Cigarette Smoking Status (%, 95% CI)
| Premium Cigars | Nonpremium Cigars | Cigarillos | Filtered Cigars | |
|---|---|---|---|---|
| Current cigarette smokers | 14.1 (6.0–22.1) | 20.7 (15.9–25.9) | 17.8 (14.6–21.0) | 23.3 (18.0–28.6) |
| Former cigarette smokers | 37.9 (28.0–47.8) | 36.2 (23.2–49.2) | 31.0 (23.2–49.2) | 44.8 (31.5–58.1) |
| Never-cigarette smokers | 39.3 (31.5–47.0) | 36.7 (26.4–47.0) | 34.6 (29.6–39.7) | 32.6 (22.3–42.9) |
NOTE: CI = confidence interval.
SOURCE: Corey et al., 2018.
Smith et al. (2007) report data from a sample of college students assessing perceived risks relative to cigarettes (less harmful, as harmful/more harmful) for nicotine patch, nicotine gum, nicotine water, nicotine lollipop, nicotine inhaler, ultra-light cigarettes, waterpipe, light cigarettes, cigarillos, cigars, and smokeless tobacco along with demographic and tobacco-related predictors of perceived risks. Overall, 80.4 percent of participants perceived a nicotine patch to be less harmful, 75.9 percent for nicotine gum, and 47.1 percent for a nicotine inhaler. Overall, 40.4 percent of participants perceived ultra-light cigarettes were less harmful, 37.0 percent for a waterpipe, 35.2 percent for light cigarettes, 17.4 percent for cigarillos, and 16.9 percent for cigars. Although perceptions of some nicotine and tobacco products assessed varied by demographic and tobacco-related characteristics, there were no differences based on these variables for perceptions of cigars.
In a second paper, Smith-Simone et al. (2008) reported psychosocial profiles, including perceived risks, associated with cigarette smoking, waterpipe tobacco use, and cigar smoking. In multivariable models, lower perceived likelihood of sickness from cigar smoking was associated with ever and current (past 30 day) cigar smoking, and lower perceived likelihood of addiction was associated with current cigar smoking. Although different perception items were associated with use of cigarettes and waterpipe, the general patterns were consistent across these three products (i.e., lower perceived risks, higher likelihood of use).
Groups of adults
Campbell et al. (2019) surveyed adult patients enrolled in addiction treatment centers on demographics, tobacco use, and perceived risks; 77 percent were cigarette smokers, 8.3 percent were cigar smokers, 15.3 percent were little filtered cigar/cigarillo users, 11.4 percent were smokeless tobacco users, and 26.3 percent were e-cigarette users. Perceived risks were measured using a third-person scenario in which participants were asked to estimate the risks (0–100 percent chance) of lung cancer, having trouble breathing, and having a heart attack from cigarette smoking, and cigar, little filtered cigar/cigarillo, smokeless tobacco, and e-cigarette. Responses were averaged by product to create an overall score. Average perceived risks were 61.8 for cigarettes, 58.8 for cigars, 58.4 for little filtered cigars/cigarillos, 41.6 for smokeless tobacco, and 40.0 for e-cigarettes. Health risk perceptions were only associated with current e-cigarette use (higher perceived risk, lower odds of use) in analyses adjusting for demographics and treatment program type.
Youth
Strong et al. (2019b) measured risk perceptions as “How much do you think people harm themselves when they use [product]?” For some products, two other items measured “How long do you think someone has to use [product] before it harms their health?” and “Is using [product] less harmful, about the same, or more harmful than smoking cigarettes?” Another question assessed perceived addictiveness as “How likely is someone to become addicted to [product]?”
In this analysis, all cigar types were combined. Harm perceptions were combined into a composite index, with higher scores (range 1–3) reflecting greater perceived harm. Overall scores were highest for cigarettes (mean 2.79), followed by pipe tobacco (mean 2.50), smokeless tobacco (mean 2.49), cigars (mean 2.47), waterpipe (mean 2.22), and e-cigarettes (mean 1.95). Statistically, compared with smokeless tobacco, youth perceived cigars, waterpipe, and e-cigarettes as significantly less harmful. For cigars, perceived harm was associated with age and race and ethnicity: older youth (14–15, 16–17) perceived lower harm than younger (12–13) youth, and Black youth perceived lower harm than non-Hispanic white, Hispanic, and other non-Hispanic youth. For perceived addictiveness (score range 1–5; higher is more addictive), scores were highest for smokeless tobacco (mean 4.33), followed by cigarettes (mean 4.09), pipe tobacco (mean 4.07), cigars (mean 3.99), waterpipe (mean 3.99), and e-cigarettes (mean 3.60). Perceived addictiveness of cigars was lower among youth who were older (14–15 and 16–17 versus 12–13) and male and female respondents.
Strong et al. (2019b) also analyzed perceived harm and addictiveness relative to youth susceptibility to using each product and tobacco use behavior. For cigars, compared with never-users, those who were susceptible, those who had ever tried but had not used cigars in the past 30 days and those who had used cigars in the past 30 days endorsed significantly lower perceived harm and perceived addictiveness. Moreover, compared with never-users, those who had smoked cigarettes only, smoked cigarettes and used one or more other tobacco product, or used noncigarette combustible tobacco reported significantly lower perceived harm of cigars. Compared with never-tobacco users, all youth tobacco user groups reported significantly lower perceived addictiveness of cigars. Despite some variability, these associations were relatively consistent across perceived harm and addictiveness of tobacco products examined (i.e., susceptible youth and youth tobacco users tend to perceive tobacco products as less harmful and addictive).
Parker et al. (2018) analyzed risk perceptions among youth in an analysis similar to Strong et al. (2019b), but risk perception measures were not combined in an index. Absolute harm was measured as “How much do you think people harm themselves when they smoke/use [product]?” The findings are in Table 4-12. Overall, 30.6 percent of youth indicated that cigars were more harmful than cigarettes, and 11.5 percent indicated that they were less harmful. These proportions are similar to smokeless tobacco and pipes, but more youth reported that waterpipe and e-cigarettes are less harmful than smoking compared with cigars.
Summary of Cross-Sectional Studies of Perceived Risks
The evidence suggests that most U.S. youth and adults perceive cigar products that likely include premium cigars to be harmful and addictive. However, the same measurement limitations noted for awareness (particularly for PATH) apply to these findings. Studies measuring perceptions of cigars typically lump cigar products together or at best define “traditional cigars” or “large cigars,” which likely include but are not limited to premium cigars. Only one study differentiated risk perceptions by U.S. adults who smoke premium cigars, nonpremium cigars, cigarillos, and filtered cigars (Corey et al., 2018). Future research must improve the measurement of risk perceptions, including using more specific measures that follow expert recommendations for risk perception measurement (Kaufman et al., 2020a,b) and measures that distinguish perceptions of premium and other cigars.
Despite these limitations, the available evidence indicates that most U.S. adults perceive that cigars have associated risks of health harm and addiction similar to those of cigarette smoking. Among adults, men, those with higher education, current cigar users, and former tobacco users are more likely to perceive lower harms associated with cigar smoking. Among youth, generally perceived risks of cigars are comparable to other combustible tobacco products (e.g., cigarettes, waterpipe) and smokeless tobacco and higher than e-cigarettes. Some evidence indicates that risk perceptions of cigars vary by youth sociodemographic characteristics, including age (lower among older youth) and race and ethnicity (lower among racial and ethnic minority youth), but these data are limited. Among youth, current tobacco users tend to perceive lower risks of cigars than nonusers, a pattern consistent with most other tobacco products (i.e., lower perceived harm of tobacco products is associated with a higher likelihood of use). Overall, however, these findings should be interpreted with respect to measurement limitations of the evidence reviewed, as most of the available data are not specific to premium cigars.
TABLE 4-12Perceived Absolute Risk of Tobacco Products Among Youth Ages 12–17, 2013–2014
| Tobacco Product | % Indicating a Lot of Harm |
|---|---|
| Cigarettes | 84.8 |
| Smokeless tobacco | 61.4 |
| Cigars (traditional cigars, cigarillos, and filtered cigars) | 60.2 |
| Pipes | 58.2 |
| Waterpipe | 38.8 |
| E-cigarettes | 26.6 |
SOURCE: Parker et al., 2018.
Perceived Benefits and Reasons
No studies investigated perceived benefits of premium cigar smoking. Some studies have examined similar constructs, such as reasons for use, and are described below.
Adults
Corey et al. (2018) reported data from PATH Wave 1 on reasons for use by cigar type among U.S. adults; the findings are summarized in Table 4-13. Overall, premium cigar users were less likely than other cigar users to indicate that they choose premium cigars because they are affordable, come in flavors that they like, are promoted by people in the media or public figures, are an alternative to quitting tobacco altogether, feel like a regular cigarette, and are a way to cut down cigarette smoking. Premium cigar users were more likely to indicate that they smoke them when they socialize. For the data stratified by cigarette smoking status, many point estimates could not be provided for premium cigar users due to small sample sizes. Thus, these stratified analyses do not provide additional meaningful insights as to reasons for use of premium cigars by cigarette smoking groups beyond the overall numbers summarized.
Analyses of Waves 2–5 of the PATH study data commissioned for this report (see Appendix D) indicate that the reasons for smoking premium cigars were relatively stable over time. For example, at Wave 2, the most commonly reported reason was socializing (76.1 percent of premium cigar smokers), followed by flavors (38.9 percent), and affordability (26.6 percent). In analyses of data for Waves 3–5, however, not all data were collected/available for reasons for use (e.g., smoking while socializing was not available for analyses) (Jeon and Mok, 2022).
DeSantis (2002) conducted an ethnographic study of patrons of a cigar shop to understand their reasons for continued cigar smoking, despite known health risks, with more than 600 hours of fieldwork to collect information on behaviors and conversations from 1997 to 2000. From the description, this setting appears to be one where premium cigars are sold and consumed, but this is not explicit in the paper. The analysis included coding and synthesis of transcripts from individual interviews and group interactions and showed that cigar shop patrons supported six common pro-cigar arguments:
- 1.
Smoking cigars in moderation reduces health harms, and patrons adapted their definition of moderation to their own user patterns (i.e., cognitive dissonance);
- 2.
Cigar smoking has potential health benefits, such as stress reduction;
- 3.
Cigars are not cigarettes, cigarettes are full of chemicals, the quantity smoked is more, and smokers inhale them;
- 4.
Research on health effects of cigars is flawed and inconsistent over time;
- 5.
Other hazards are far more likely to cause harm than cigar smoking (e.g., pollution, car accidents); and
- 6.
Following the death of a fellow cigar shop patron, that other causes were the primary contributors to his heart attack.
TABLE 4-13Reasons for Using Types of Cigars Among U.S. Adults, 2013–2014 (%, 95% CI)
| Premium Cigars | Nonpremium | Cigarillos | Filtered Cigars | |
|---|---|---|---|---|
| They are affordable | 22.7 (18.5–26.9) | 66.4 (62.1–70.7) | 71.7 (68.8–74.5) | 80.2 (75.7–84.7) |
| The come in flavors I like | 48.6 (43.2–54.1) | 67.1 (61.7–72.5) | 71.9 (68.7–75.1) | 70.1 (66.3–73.9) |
| I like socializing when smoking them | 76.6 (71.8–81.4) | 63.4 (57.9–68.9) | 60.6 (57.1–64.1) | 49.9 (44.8–55.0) |
| People in the media or other public figures smoke them | 12.1 (8.8–15.4) | 21.0 (17.0–25.0) | 17.7 (15.5–19.9) | 17.5 (13.7–21.4) |
| The advertising appeals to me | 9.7 (6.3–13.0) | 15.1 (11.8–18.4) | 12.4 (10.1–14.7) | 13.7 (10.8–16.6) |
| I smoke them as an alternative to quitting tobacco altogether | 7.9 (5.2–10.5) | 17.8 (14.1–21.5) | 15.8 (13.2–18.3) | 18.6 (15.0–22.1) |
| I can smoke them at times when or in places where cigarette smoking is not allowed | 8.0 (5.3–10.7) | 12.4 (9.1–15.6) | 11.5 (9.5–13.5) | 12.9 (9.6–16.2) |
| Smoking them feels like a regular cigarette | 6.3 (3.6–9.1) | 26.8 (22.3–31.3) | 25.6 (22.8–28.4) | 52.4 (48.2–56.7) |
| Smoking them helps people to quit smoking cigarettes | 5.2 (3.0–7.4) | 17.7 (14.0–21.4) | 14.9 (12.6–17.3) | 19.1 (15.2–23.1) |
| I smoke them as a way to cut down cigarette smoking | 16.3 (9.7–22.9) | 28.5 (23.4–33.6) | 28.2 (24.4–31.9) | 29.8 (24.0–35.6) |
NOTE: CI = confidence interval.
SOURCE: Corey et al., 2018.
Groups of adults
Campbell et al. (2019) surveyed adult patients enrolled in a network of addiction treatment centers on demographics, tobacco use, and reasons for use; 77 percent were cigarette smokers, 8.3 percent were past 30-day cigar smokers, 15.3 percent were past 30-day little filtered cigar/cigarillo smokers, 11.4 percent were past 30-day smokeless tobacco users, and 26.3 percent were past 30-day e-cigarette users. Cigar (33.3 percent) and little filtered cigar/cigarillo users (25.1 percent) were more likely to indicate that they use these products because they enjoy the taste/flavor than smokeless tobacco (15.3 percent) and e-cigarette users (10.5 percent). Cigar users were less likely than users of all other products assessed to indicate they choose the product when they cannot smoke cigarettes (10.4 percent, versus 17.1 percent for little filtered cigars/cigarillos, 48.1 percent for smokeless, and 25.0 percent for e-cigarettes). In total, 7.3 percent of cigar users indicated that they smoked cigars to reduce health risks, compared with 5.1 percent for little filtered cigars/cigarillos, 6.9 percent for smokeless tobacco, and 11.2 percent for e-cigarettes. Cigar smokers were least likely to indicate that they smoke cigars to reduce/quit smoking cigarettes (8.3 percent, versus 9.1 percent for little filtered cigars/cigarillos, 11.5 percent for smokeless tobacco, and 29.3 percent for e-cigarettes). Greater than 40 percent of cigar and little filtered cigar/cigarillo users indicated “other” reasons (not specified) for using these products, higher proportions than smokeless tobacco (18.3 percent) and e-cigarette users (24.0 percent).
Smith-Simone et al. (2008) reported psychosocial profiles, including perceived social acceptability, associated with cigarette smoking, waterpipe tobacco use, and cigar smoking in a convenience sample of college students (n = 411). In multivariable models, only the perception that cigar smoking looks cool among peers was associated with current (past 30-day) cigar smoking. Despite different perceived benefits items associated with use of cigarettes and waterpipe, the general patterns were consistent across these three products (greater perceived social benefit is associated with product use). The authors also report on an overall perceived product attractiveness score, an index of perceived social benefits, and social acceptability: cigars and waterpipes were perceived to be more attractive socially than cigarette smoking.
Youth
Tucker et al. (2020) report data from a survey of youth experiencing homelessness in Los Angeles County, California. They assessed cigarette smoking and past 30-day use of other tobacco (natural cigarettes, e-cigarettes, little cigars/cigarillos, and cigars). Among tobacco users, the assessed reasons for use included that “you can use it in places where cigarette smoking is not allowed,” “I like socializing while using it,” “it tastes good,” “it smells good,” “you get more nicotine for the cost,” and “it gives you a good buzz.” These are reported descriptively for users of each product but not compared statistically. Notably, e-cigarette, little cigar/cigarillo, and cigar users were more likely to support these products because of the taste (74.2 percent e-cigarettes, 61.9 percent little cigars/cigarillos, 65.8 percent cigars) and smell (67.3 percent e-cigarettes, 57.2 percent little cigar/cigarillos, 56.8 percent cigars) than cigarette (50.3 percent taste, 36.6 percent smell) and natural cigarette (50.3 percent taste, 36.6 percent smell) users. E-cigarette users (72.3 percent) were more likely than little cigar/cigarillo (26.0 percent) and cigar users (24.0 percent) to indicate using e-cigarettes in places where cigarette smoking is not permitted.
Summary of Perceived Benefits and Other Perceptions of Premium Cigars
Research is limited on perceived benefits and reasons for using premium cigars. Only one study assessed reasons for use in a representative sample of U.S. adults using PATH data (Corey et al., 2018). The findings indicate adult premium cigar users are more likely than those who use other types of cigars to indicate socializing as a reason for use, and they are less likely to indicate smoking premium cigars for reasons related to cigarette smoking, such as smoking them in places where cigarette smoking is not allowed or to cut down cigarette smoking.
Other ethnographic (DeSantis, 2002) and observational research on groups of adults (Campbell et al., 2019; Smith-Simone et al., 2008) used convenience samples, so the generalizability of findings is more limited. The only study assessing perceived benefits or reasons for using cigars among youth was Tucker et al. (2020); although the measures used likely capture use behavior and reasons for using premium cigars, they were not specific to those, and it is unlikely that cigar use in this study reflected premium cigars.
Overall, the evidence is very limited on U.S. adults' and youths' perceived benefits and reasons for using premium cigars. Research is needed to better understand these populations' motives.
Associations Between Perceptions of Premium Cigars and Patterns of Use
Longitudinal studies have examined associations between perceptions of cigars and patterns of use among U.S. adults and youth. All of these studies have focused on risk perceptions (perceived harms, addictiveness) as predictors of use behavior.
Adults
Elton-Marshall et al. (2020) examined tobacco product risk perceptions, changes over time, and associations with use behavior among U.S. adults using PATH Waves 1 and 2. Risk perceptions of noncigarette tobacco products were measured relative to cigarettes. They examined change in perceived harm from Wave 1 to Wave 2 (decreased, no change, stayed the same) and how perceptions at Wave 1 relate to use behavior at Wave 2. Current users were defined as those who used the products every day or some days. Nonusers were those who never used or used previously but not currently.
Perceptions that traditional cigars are less harmful than cigarettes declined from Wave 1 (12.3 percent) to Wave 2 (8.6 percent). The proportion of adults who reported that traditional cigars are as harmful as cigarettes (“about the same”) increased from Wave 1 (61.4 percent) to Wave 2 (64.3 percent), with a slight increase for those who reported that traditional cigars are more harmful (24.3 to 24.8 percent). Relative to other products assessed, the proportion of respondents indicating e-cigarettes (41.2 to 29.0 percent) and waterpipe (17.8 to 13.6 percent) were less harmful than cigarettes declined, but there was little change in perceived harm of other noncigarette tobacco products.
In prospective analyses, for traditional cigars and all other noncigarette tobacco products, perceptions that the product is less harmful than cigarettes at Wave 1 were associated with increased odds of using the product at Wave 2 (Elton-Marshall et al., 2020). Traditional cigars, waterpipe, and smokeless tobacco had a significant interaction between product use at Wave 1 and perceptions of harm at Wave 1 on product use at Wave 2. The association between perceived lower harm at Wave 1 and product use at Wave 2 was stronger in Wave 1 traditional cigar users (OR: 2.28; 95 percent CI: 1.79–2.91) than Wave 1 nonusers (OR: 1.37; 95 percent CI: 0.96–1.94). The association between lower perceived harm of traditional cigars and subsequent use was also modified by sex, age, and race and ethnicity. Generally, the association was stronger among women, older adults (ages 55+), and those who identified as Hispanic/Latino. It was not modified by sexual orientation, income, or education.
For all products assessed except pipe tobacco, the prevalence of having decreased harm perceptions from Wave 1 to Wave 2 was highest among those who transitioned from nonuse to use (Elton-Marshall et al., 2020). For traditional cigars, among those transitioning from nonuse at Wave 1 to use at Wave 2, 20.2 percent had decreased harm perceptions. In comparison, 14.8 percent of those who were nonusers at both waves, 13.8 percent of those who transitioned from users at Wave 1 to nonusers at Wave 2, and 13.7 percent of those who were users at both waves decreased harm perceptions. These findings are consistent with the observed phenomenon of cognitive dissonance: some users tend to shift their risk perceptions to rationalize their own behavior.
Youth
Strong et al. (2019a) analyzed prospective data from U.S. youth aged 12–17 from PATH Wave 1 to Wave 2. The authors examined whether perceived harm and addictiveness of tobacco products changed over time, whether perceived harm and addictiveness at Wave 1 predicted initiation at Wave 2, and whether trying the product between Wave 1 and Wave 2 predicted decrease in perceived harm and addictiveness at Wave 2. They did not perform longitudinal analyses of change in perceptions for cigar products because the questions changed from Wave 1 to Wave 2. Questions captured absolute harm (how much does [product] harm your health?), how long someone needs to use [product] to harm their health, and perceived harm relative to cigarettes. Items were combined to reflect a score of 1–3, with higher values indicating greater perceived harm. Perceived addictiveness was measured with a single item and coded to a three-level variable for comparability.
The absolute percentages of youth indicating “high” perceived harm are shown in a figure, and point estimates are not provided. However, visual inspection indicates most youth report high perceived harm of cigars, a greater proportion than for waterpipe and e-cigarettes, and comparable proportions to cigarettes and smokeless tobacco. The proportion of youth reporting low perceived harm of cigars was greater among older youth (16–17) and non-Hispanic Black youth, although statistical differences were not reported. At Wave 1, the majority of youth reported high perceived addictiveness of cigars, and, similar to perceived harm, the proportion reporting low perceived addictiveness was higher among older youth (16–17) and non-Hispanic Black youth. The authors also report that perceived addictiveness of cigars increased from Wave 1 to Wave 2 in nearly all demographic groups, but they do not present associated data.
For nearly all tobacco products assessed, the probability of initiation from Wave 1 to Wave 2 was highest among those with low or medium perceived harm at Wave 1, followed by those who had high perceived harm, who were unsure, or who had not heard of the product. The median effect size across products for the association between low perceived harm and initiation was OR: 4.71. For perceived addictiveness, the probability of initiation from Wave 1 to Wave 2 was highest among those with low or medium perceived addictiveness at Wave 1, followed by those with high perceived addictiveness, those who were unsure, and those who had not heard of the product. The median effect size across products for the association between low perceived addictiveness and initiation was OR: 4.82. For traditional cigars, these results suggest that lower perceived harm and addictiveness among youth is associated with higher odds of subsequent initiation, a pattern that was consistent across the tobacco products examined.
Parker et al. (2018) analyzed the associations between perceived product-specific harms, perceived harm relative to cigarettes, and tobacco use initiation among youth from Wave 1 to Wave 2. This analysis is similar to Strong et al. (2019b), but risk perception measures were not combined in an index. Specific group analyses are not reported, but models are adjusted for age, sex, race, region, parental education, ever alcohol use, and ever-tobacco use at Wave 1.
For absolute harm perceptions of cigars, compared to those who reported a lot of harm, those who reported no or a little harm at Wave 1 were significantly more likely to initiate use at Wave 2 (OR: 2.6). Those who reported some harm had an increased odds of initiation as well, but the difference was not statistically significant (OR: 1.3). For e-cigarettes, pipes, waterpipe, and smokeless tobacco, youth who reported no or a little harm at Wave 1 had higher odds of initiation at Wave 2. Adjusted models examining the association between perceived harm relative to cigarettes at Wave 1 and initiation at Wave 2 showed similar patterns.
Youth who perceived cigars to be less harmful than cigarettes at Wave 1 were more likely to initiate cigar smoking at Wave 2 (OR: 1.5) compared with those who perceived cigars to be more harmful. This pattern was consistent for perceived relative harm of e-cigarettes, waterpipe, and smokeless tobacco but not for pipe tobacco. Overall, these data indicate that for most noncigarette tobacco products assessed, perceived lower absolute harm and perceived lower harm than cigarette smoking is associated with an increased likelihood of initiation among youth.
Summary on Perceptions and Use Behavior
Lower perceived harm and addictiveness of cigars is associated with cigar use in prospective studies, including current use among adults and initiation among youth. These patterns for cigars are consistent with those observed for almost all other noncigarette tobacco products, with few exceptions, in the literature (e.g., pipe tobacco). The same measurement issues noted for awareness and cross-sectional studies of risk perceptions (particularly for PATH study data) apply to these conclusions. Measurement of perceptions of cigars typically lumps the products together or, at best, defines “traditional cigars” or “large cigars,” which likely include but are not limited to premium cigars when assessing risk perceptions and associations with use behavior. The measurement of risk perceptions needs to be improved, including using more specific measures of perceived risks following expert recommendations (Kaufman et al., 2020a,b) and measures that distinguish between premium cigars and other cigar products. Despite these limitations, the available evidence indicates that lower perceived risks of cigars, which likely includes premium cigars, is associated with subsequent use.
Summary and Conclusions
National surveys, local surveys, focus groups, and ethnography studies have provided data to inform what is known about consumer awareness, knowledge, perceived risk, perceived benefits, and the relationship between perceptions and patterns of use of premium cigars. These studies include nationally representative and convenience samples that used different methods to assess various measures to inform the conclusions and research recommendations.
Awareness and Knowledge
In the committee's review, cross-sectional data from three large U.S.based national surveys assessed adult and youth awareness of cigars. Although different questions and methods were used in each survey, all surveys asked whether respondents had ever heard of a particular cigar type. These were large probability or population-based samples, but none of the surveys captured data on awareness or knowledge of the “health effects” of any specific cigar type, including premium cigars.
Conclusion 4-6: There is no research that examines whether consumers distinguish premium cigars from large cigars or other cigar types, consumers' knowledge of premium cigars, or what defines premium cigars.
Three studies among youth and adults, one quantitative and two qualitative, provide insight into consumer's knowledge of cigar types and their ability to distinguish cigarettes from cigars and cigar types. None of the studies captured data on consumer knowledge of the health effects of any specific type, including premium. Data that capture consumer knowledge of cigar products show that consumers misclassify them, even when shown images. There is a need to develop more specific measures that distinguish between premium cigars and other types to capture awareness of premium cigars in the U.S. population, and knowledge of the risks associated with them. For example, like the PATH study measures, using images to clearly depict different product types may help improve assessment of awareness and knowledge.
Perceived Risks and Benefits
The committee's review indicates perceived risks of cigars vary by tobacco user status, age, sex, race, ethnicity, and educational attainment. For example, tobacco users perceive risks of cigars of any kind but tend to have lower perceived risk of the health effects or harms than nonusers. This is based on data from cross-sectional studies that include multiple PATH waves, the National Young Adult Health Survey, and a large survey of adults enrolled in addiction treatment centers. Studies reported data on relative and absolute perceived risks of tobacco products compared to cigars of any type and focused on perceived harmfulness of cigars relative to other tobacco products, perceived health effects, and addictiveness of the tobacco products. Three studies, one among adults and two among youth, included data on absolute perceived risk of the health effects (i.e., heart attack, lung cancer) of any cigar type. Adult respondents in this survey (PATH) had lower perceived health risk of any cigar type compared to cigarettes.
The research reviewed did not distinguish between people's perceptions of premium cigars and other types directly; however, studies reviewed assessed perceptions of products that likely include premium cigars. Improved measurement of perceived risks of premium cigars is needed, including more specific measures that follow expert recommendations for risk perception measurement (Kaufman et al., 2020a,b) and measures that distinguish perceptions of premium and other cigar products.
Evidence is very limited on perceived benefits or reasons for using premium cigars in the U.S. population. Thus, little is known about how adult and youth perceive their benefits and whether these or reasons for use differ from other cigar types. The literature includes cross-sectional and qualitative data, but most studies do not specifically examine premium cigar use.
Conclusion 4-7: There is strongly suggestive evidence that the U.S. population perceives cigar products overall to be harmful and addictive. However, there is no research that examines the knowledge of the specific health effects of premium cigars.
Perceptions and Patterns of Use
In the committee's review, research analyzing prospective population-based data from PATH demonstrated that lower perceived risks (lower perceived health harm, addictiveness) of cigars is associated with subsequent use among U.S. adults and initiation of use among U.S. youth. These studies did not differentiate premium cigars from other cigar products.
Conclusion 4-8: There is strongly suggestive evidence from prospective studies that lower perceived harm and addictiveness of cigars in general is associated with cigar use behavior, including current use in adults and initiation in youth.
CONCLUDING OBSERVATIONS
Marketing and promotion are designed to increase the sales of tobacco products and increase consumer demand. Relative to other tobacco products, the committee found limited published data specific to the marketing and sales and consumers' awareness, knowledge, and perceptions of premium cigars. As a result, primary data collection was needed to understand their marketing and promotion practices. Thus, the committee conducted primary content analyses of magazines; examined direct print and e-mail marketing; conducted secondary analysis of existing surveys; conducted an environmental scan of marketing on social media; examined online marketing; collected data on retail marketing; and conducted literature reviews. Based on the available research and the committee's efforts, key insights can be drawn.
Consistent with research on the “premiumization” of other tobacco products, it is clear that premium cigars are marketed as a quality product with benefits that outweigh their potential risks. Marketing occurs through channels that are unique to premium cigars, such as lifestyle magazines and festivals, and through channels that are common to other tobacco products, such as DTC and online marketing. Premium cigar marketing uses strategies to increase product appeal by emphasizing premium cigars as part of a successful, luxurious lifestyle, use at upscale social events, and appealing to influential celebrities and individuals. Sales of premium cigars are also distinct from other forms of tobacco—consumers most often purchase them from cigar bars and tobacco specialty shops versus convenience stores and other retail locations. Online premium cigar sales are prevalent, though not captured in national surveys of cigar users. Finally, despite limited direct evidence on consumers' awareness, knowledge, and perceived benefits of using premium cigars, consistent with research on other tobacco products there is evidence that lower perceived risks of cigar products in general promote initiation and current use of cigars. See Box 4-2 for key research and measurement gaps.
BOX 4-2
Research Gaps.
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Footnotes
- 1
Note that when the terms “cigar(s)” or “cigars in general” are used in this report, they refer to all cigar types (filtered cigars, little cigars, cigarillos, and large/traditional cigars [which include premium cigars]). When discussing a specific cigar type, the type is noted in text.
- 2
Note that quotations are used at the first occurrence of the term “premium” in each chapter, as there is no formally agreed upon definition of what constitutes a premium cigar, and different entities might use this term differently. See Chapter 1 for more information.
- 3
Public Law 111–31.
- 4
“Modified risk tobacco products (MRTPs) are tobacco products that are sold or distributed for use to reduce harm or the risk of tobacco-related disease associated with commercially marketed tobacco products” (FDA, 2018).
- 5
Available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu. This is the committee's analysis of Mintel data; it does not represent the views or opinions of Mintel. - 6
Coupons were not identified in the Mintel data, but this does not imply that they do not exist for premium cigars.
- 7
See https://www
.thompsoncigar.com (accessed November 12, 2021). - 8
The codebook used (developed by the committee based on published analyses) and results from this review are available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu. - 9
As determined by the committee (see Chapter 1 and Appendix E).
- 10
As determined by the committee (see Chapter 1 and Appendix E).
- 11
The search included the premium brands identified in the committee-commissioned papers (see Appendix F).
- 12
The codebook used (developed by the committee based on published analyses) and results from this review are available in the project's public access file and upon request from the National Academies Public Access Records Office at PARO@nas
.edu. - 13
Nonbranded marketing refers to general promotion of premium cigars overall as a product type.
- 14
This paper was prepared for the Cigar Association of America, Inc., Cigar Rights of America, and the International Premium Cigar and Pipe Retailers Association by Richard P. Voith and Peter Angelides at Econsult Solutions, Inc. The full report is available in the project public access file and by request from the National Academies Public Access Records Office at PARO@nas
.edu. - 15
Ibid.
- 16
Ibid.
- 17
Ibid.
- 18
Ibid.
- 19
Ibid.
- 20
Ibid.
- 21
Not every address was reviewed.
- 22
Traditional cigars were defined as “contain[ing] tightly rolled tobacco that is wrapped in a tobacco leaf. Some common brands of cigars include Macanudo, Romeo y Julieta, and Arturo Fuente, but there are many others” (Fong et al., 2019).
Chapter 4 Annex. Evidence Tables
The following table provides descriptive and methodological information on the studies cited in Chapter 4; study findings and results are discussed in the chapter proper. See the Chapter 4 reference list for full citations.
TABLE 4A-1Descriptive and Methodological Information on Studies Cited in Chapter 4
| Reference | Data Source | Year(s) Data Collected | Study Design | Study Participants | Sample Size | Types of Cigars (Including Premium) and/or Tobacco Products Studied | Definitions of Types of Cigars (Including Premium) and/or Tobacco Products Studied |
|---|---|---|---|---|---|---|---|
| Campbell et al., 2019. PMID: 30206006 | Survey | 2016 | Cross-sectional survey | Adult patients enrolled in addiction treatment centers | 1,153 | Cigars, little filtered cigars/cigarillos, smokeless tobacco, and e-cigarettes | Not specified |
| Casseus et al., 2016. PMID: 26604260 | Online survey | Not specified | Cross-sectional survey | Convenience sample of adult cigarette smokers (smoked ≥1 cigarette per day) ages 18–64 | 344 | Products shown were machine-injected RYO cigarettes, Winchester little cigar, Santa Fe filtered cigarillo, Black & Mild filtered cigarillo, Nat Sherman cigarette, and Nat Sherman Black and Gold cigarette | Not specified |
| Corey et al., 2018. PMID: 29059423 | PATH Wave 1 | 2013–2014 | National longitudinal study | U.S. adults | 32,320 | Filtered cigars, cigarillos, or traditional cigars, which were further categorized as premium or nonpremium | “Traditional cigars contain tightly rolled tobacco that is wrapped in a tobacco leaf. Some common brands of cigars include Macanudo, Romeo y Julieta, and Arturo Fuente, but there are many others.” “Cigarillos and filtered cigars are smaller than traditional cigars. They are usually brown. Some are the same size as cigarettes, and some come with tips or filters. Some common brands are Black & Mild, Swisher Sweets, Dutch Masters, Phillies Blunts, Prime Time, and Winchester.” |
| Dickinson et al., 2016. PMID: 26826209 | Focus groups conducted in five U.S. cities | 2014 | Focus groups conducted in five U.S. cities | U.S. adults | 123 | Cigars, cigarillos, and little cigars | Not specified |
| Elton-Marshall et al., 2020. PMID: 32145496 | PATH Waves 1 and 2 | 2013–2014; 2014–2015 | National longitudinal study | U.S. adults | 32,320; 28,362 | Traditional cigars, filtered cigars, cigarillos, waterpipe, smokeless tobacco, pipe, and e-cigarettes | See Corey et al., 2018 |
| Fong et al., 2019. PMID: 30502927 | PATH Wave 1 | 2013–2014 | National longitudinal study | Population-based, representative sample of U.S. adults | 32,320 | Traditional cigars, cigarillos and filtered little cigars, traditional smokeless tobacco, and e-cigarettes | See Corey et al., 2018 |
| Kasza et al., 2017. PMID: 28121512 | PATH Wave 1 | 2013–2014 | National longitudinal study | Population-based, representative sample of U.S. youth | 13,651 | Traditional cigars, cigarillos and filtered little cigars, traditional smokeless tobacco, and e-cigarettes | See Corey et al., 2018 |
| Nayak et al., 2017. PMID: 28579496 | TPRPS | 2014, 2015 | Probability-based cross-sectional survey | Lesbian, gay, and bisexual adults (compared to heterosexual adults) | 11,768 | E-cigarettes, “large, premium cigars,” little cigars/cigarillos/filtered cigars, and waterpipe (hookah) | Not specified |
| Parker et al., 2018. PMID: 30397167 | PATH Waves 1 and 2 | 2013–2014; 2014–2015 | National longitudinal study | Youth ages 12–17 | 10,081 | Cigarettes, e-cigarettes, cigars (traditional cigars, cigarillos, and filtered cigars combined together), pipes, waterpipe, and smokeless tobacco | See Corey et al., 2018 |
| Smith et al., 2007. PMID: 17763115 | Cross-sectional Internet survey | 2004 | Cross-sectional Internet survey | Online convenience sample of college students | 411 | Nicotine patch, nicotine gum, nicotine water, nicotine lollipop, nicotine inhaler, ultralight cigarettes, waterpipe, light cigarettes, cigarillos, cigars, and smokeless tobacco (relative to cigarettes) | Not specified |
| Smith-Simone et al., 2008. PMID: 18783890 | Cross-sectional Internet survey | 2004 | Cross-sectional Internet survey | Online convenience sample of college students | 411 | Cigarette smoking, waterpipe tobacco use, and cigar smoking | Not specified |
| Strong et al., 2019. PMID: 30623806 | PATH Wave 1 | 2013–2014 | National longitudinal study | Population-based, representative sample of U.S. youth | 13,651 | All cigar types (little cigars/cigarillos, filtered cigars, and traditional cigars) were combined | See Corey et al., 2018 |
| Tucker et al., 2020. PMID: 31396821 | Sample from 25 street and service sites in Los Angeles County | 2017–2018 | Survey | Probability sample of youth experiencing homelessness in Los Angeles County, California | 426 | Past 30-day use of other tobacco (natural cigarettes, e-cigarettes, little cigars/cigarillos, and cigars) | Not specified |
| Wackowski and Delnevo, 2016. PMID: 26304709 | National Young Adult Health Survey | 2011 | Stratified random digit dial cell phone survey | Nationally representative sample of young adults ages 18–34 | 2,871 | Cigars, e-cigarettes, waterpipe, snuff, dip, chew, snus, and menthol cigarettes relative to cigarettes; excluded filtered little cigars but included large cigars and cigarillos | “Regular cigars can be large cigars or smaller in size such as cigarillos. They are not little cigars that have spongy filters like cigarettes. They are usually sold individually or in packs of 5 or 8. Some common brands are Black and Mild's, Swisher Sweets cigarillos, and Phillies Blunts, but there are others” (p. 329). |
| Weaver et al., 2016. PMID: 26560309 | TPRPS | 2014 | Probability-based cross-sectional survey | Representative noninstitutionalized U.S. adults | 5,717 | “Large, premium cigars” | “Large, premium cigars” |
| Yerger et al., 2001. PMID: 11211649 | Focus groups | 1998 | Focus groups | Black/African American youth ages 14–18 | 50 | Cigar (types not specified) | “The word ‘cigar’ encompasses several types and sizes of smokable noncigarette tobacco products, their common factor being a nonpaper, tobacco leaf or tobacco-containing outer wrapper” (p. 316). |
NOTE: PATH = Population Assessment of Tobacco and Health Study; RYO = roll-your-own; TPRPS = Tobacco Products and Risk Perceptions Survey.
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